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bizi · 02-10-2007, 03:34 AM

What triggers it?
Goodwin: Although genes are responsible for making a person vulnerable to developing it, the environment usually triggers it. The vulnerability is genetic, but the trigger is not. It may not be abnormal stress like a death in the family that triggers it. It might be normal stress.
Once a person has gone through several episodes, the disorder starts to take on a life of its own. The vulnerability for more episodes gets lower. Every time there is an episode, the brain changes chemically. It's sort of like allergies. You have tremendous exposure to a substance, and you become sensitive to it.
Often, people with undiagnosed mental disorders self-medicate. Are people with bipolar disorder likely to abuse alcohol and drugs?
Goodwin: About 30 to 50 percent of people with bipolar have a history of substance abuse. They may turn to alcohol and drugs to blunt the pain of depression.
Then, you have two problems you have to treat. You have the substance abuse and the bipolar disorder. That makes the treatment of bipolar harder.
Can people just get better on their own, without doctors?
Goodwin: If left untreated, bipolar tends to get worse. This is not something that they can get over on their own. It's inevitable that another episode is going to occur if they don't get treatment. That's one reason why we want to get the word out. Treatments have improved tremendously for this disorder. So, it's all the more unfortunate if people aren't seeking help. We think only half of people with the disorder are getting help.
Why aren't more people getting help?
Goodwin: Often, people are misdiagnosed. People tend to seek out help when they are depressed. When they are in their highs, they tend to have less insight into their behavior and think it's normal. However, families may be scared because they see patterns of behavior. Mania is often the beginning of a depressive phase.
What's the danger of misdiagnosis?
Goodwin: If the doctor assumes it's a unipolar depression, it would be treated with antidepressants, and by using antidepressants such as the selective serotonin reuptake inhibitors, you can make the mania worse. It can overshoot you into mania because there is no brake on it.
How are people treated?
Goodwin: The core of treatment is a mood stabilizer such as lithium. They can be very effective in manic episodes, but they have not been nearly as effective with depression. We had very little to treat the depression. Now, we have a very effective anticonvulsant drug called Lamictal® that was approved by the FDA recently for reducing the likelihood of future depressions in people with bipolar disorder. It is the first mood stabilizer to stabilize "from below" and therefore it gives more people reason to come out of the woodwork. People used to say, 'Why go to the doctor? All they can do for me is help with the high, which I like.' Now we have something for them.
What are the degrees of bipolar disorder?
Goodwin: There are so many variations of the disorder. Some people who have an episode in their teens may not have another for 10, 15 years. Other people may have episodes every year or every other year like clockwork. It's a spectrum disorder with many shades of gray.
Bipolar 1 is the most severe form. Almost every bipolar 1 patient goes into hypomania, which can develop into full mania. Someone with hypomania would tend to have very high energy, become more productive at work, have some trouble with overspending, but they would not reach the point of being hospitalized. How you might feel in a hypomanic phase is like hitting the lottery or winning a prize. But in hypomania, the euphoria tends to feel artificial to the patients.
Full mania is much worse and not pleasant at all - it's more than a cocaine high. When manic, people are often psychotic and are really disabled by the illness. They may need to be hospitalized against their will. They may have trouble with the police.Some people may have rapid cycling where they have four or more episodes in a given year or even within a 48-hour period. One out of every seven will be rapid cyclers.
What can families do to help?
Goodwin: Often it's up to the families to help because they have a better feel for what is going on. Insist on being involved in the treatment. A lot of misdiagnosis wouldn't happen if doctors involved families in the visits and management of the disorder.

Children, teens and adults being treated with antidepressants, particularly people being treated for depression, should be watched closely for worsening of depression and for increased suicidal thinking or behavior. Close watching may be especially important early in treatment or when the dose is changed - either increased or decreased. Bring up your concerns immediately with a doctor.