Bipolar disorder: causes, symptoms, and treatment approaches

Bipolar Disorder: Genetics, Environment and Remedies

According to the American Family Physician journal, "Bipolar Disorder is an illness that causes extreme mood swings. This condition is also called manic-depressive illness" (AFP, 2000). People with Bipolar disorder often express 'extremes' in emotions where they go from the ultimate happiness and 'high' to the ultimate depression and sadness.

These are often referred to as Manic and Depression episodes where "Manic episodes usually begin abruptly and last for between 2 weeks and 4-5 months (median duration about 4 months). Depressions tend to last longer (median length about 6 months), though rarely for more than a year" (WHO, 1992). These types of episodes can be induced by stress or traumas and occur at any age.

The disorder is often hereditary and affects both men and women equally. The chances of having the disorder greatly increase if there is one parent that has the disorder although it is hard to predict which generation is susceptible to being diagnosed with it. Diagnosing Bipolar disorder isn't so simple either, with an estimated "70% of people with bipolar disorder receive an initial misdiagnosis, often seeing 3 or 4 physicians before the correct disorder is identified"(Singer & Levine, 2003). This situation is dangerous to untreated cases of Bipolar disorder as "25% to 50% of affected patients attempt suicide at least once" (Singer & Levine, 2003).

Physicians have a questionnaire they follow when diagnosing Bipolar Disorder because it is often misdiagnosed, and it is believed that "as many as three times more Americans may have bipolar disorder than previously believed. Over 85,000 participants completed the Mood Disorder Questionnaire (MDQ) and 3.7% were screened positive. A positive screen was defined as at least seven of 13 bipolar symptoms with co-occurrence of at least two symptoms and a patient-rated assessment of moderate or serious impairment due to these symptoms" (Psychopharmocology, 2003). These staggering results imply that public awareness of the disorder needs to improve as does the abilities of physicians to properly diagnose the disorder either through additional means (for example, hereditary information) and through proper mental health awareness.

Genetic studies involving 40 families over six decades have shown that "consistently [show that] the risk to relatives of those with the disorder is greater than the risk to relatives of normal controls" (NIMH, 2003). This implies that the disorder is predominantly hereditary although it is hard to pin-point particular genes involved and "likely involves multiple interacting genes" (NIMH, 2003).

Recent studies have also shown that there is a correlation between Bipolar disorder and the frontal lobes of the brain, where serotonin is believed to be linked to the cognitive processes that occur during episodes. Serotonin contributes to different activities within the brain including memory, learning and attentiveness. Through controlled conditions using tryptophan, it was learned that those patients with Bipolar Disorder I and II were more vulnerable than the control patients, therefore illuminating to the possibility that Bipolar Disorder patients already suffer from cognitive deficits in the frontal lobe region.

Other research has shown that environment does play a factor in episodes and the frequency of mania and depression in people who have Bipolar disorder. "The frequency of all manic episodes combined peaked in early spring, with a nadir in late fall. Pure manic admissions showed a similar pattern. Mixed manic admissions had a significantly different pattern, with a peak in late summer and a nadir in November" (Cassidy, 2003). Like most people suffer from 'Winter Blues' or seasonal depression, so too do Bipolar Disorder patients go through lows and highs in their mood episodes.

The treatment of Bipolar Disorder has been predominantly through the use of anti-depressives and lithium. Lithium has gone through scrutiny recently since many physicians feel that it is an overvalued drug despite showing decreased rates of morbidity (suicide) in patients since the 1970s.

People with the disorder have to re-evaluate all aspects of their lives and usually change certain aspects, including diet and sleep habits. A good sleep schedule is imperative because lack of sleep or a poor sleep routine can trigger mania attacks. This kind of scheduling is also important in eating habits where "eating one meal later on in the day has been said to make [your] BP harder to treat" (Phiel, 2003).

Certain foods and additives can trigger mania and depression and things like caffeine, antihistamines, smoking and alcohol can all add to the external factors of stress and poor sleeping and eating habits that in turn can affect the episodes in Bipolar patients. Foods like lean chicken, complex carbohydrates are highly recommended while "sugar and saturated fat, dairy products, carbonated beverages, food colorings, flavorings, preservatives and other additives" (Phiel, 2003) should be avoided.

Exercise is also vital as this reduces the stress factor and can aid in proper eating habits as well as "reducing depression, especially aerobics, and also helps to rid yourself of manic extra energy" (Phiel, 2003). The basis of diet, proper sleeping habits and exercise seem to be common sense for anyone, regardless of if they have Bipolar Disorder or not, and following such a system greatly affects mood swings and overall mental health in everyone.

Besides using prescribed medications, many people choose to complement their medication with herbal remedies and vitamins and minerals. Among these is Omega-3 (fish oil) which has been shown in studies to aid in making a difference in the frequency of episodes in Bipolar disorder. Other minerals include multivitamins (without iron), taurine, zinc, vitamin C, vitamin B6, B-Complex and 5-HTP which is more for people who have trouble sleeping.

Herbal remedies include the use of St. John's Wort in some cases, and alternative therapies like Bright Light Therapy which has been well received for the treatment of SAD (Seasonal Affective Disorder). It is a relatively inexpensive treatment that involves special 'grow lights' that have become more available on the market. Acupuncture has also been viewed as helping with mental health issues, including Bipolar Disorder.

Nevertheless, a recent case in the U.S. described a female patient as suffering from "hypomania after adding St. John's Wort and Ginkgo Biloba to her regimen of fluoxetine and buspirone, which remitted after discontinuation of the herbal medicines" (Eaton, 2002). Studies with the use of combining herbal remedies with prescription medicines is something that goes across the board in medicine, but the affects can be devastating in mental health patients that do not realize the harm they could cause themselves by not consulting a physician, or not researching the use of herbal and alternative treatments before introducing them into their regime.