No pole too far if mood takes

Bipo­lar dis­or­der is dev­as­tat­ing but there is hope ahead, writes Leigh Day­ton

The Weekend Australian - Travel - - Resources -

TIM Silk doesn’t have bipo­lar dis­or­der. Un­til re­cently, he didn’t even know any­one with the de­bil­i­tat­ing men­tal ill­ness char­ac­terised by in­tense mood swings from manic highs to de­pres­sive lows. But the young neu­ro­sci­en­tist be­came in­ter­ested a few years ago when he no­ticed sim­i­lar­i­ties be­tween bipo­lar’’, as he calls it, and de­vel­op­men­tal brain disor­ders such as autism, which he was study­ing.

It be­came ap­par­ent to me how much bipo­lar gets mis­di­ag­nosed,’’ he says from his of­fice at the Queens­land Brain In­sti­tute at Bris­bane’s Univer­sity of Queens­land.

There’s a big gap in terms of aware­ness of the dis­or­der — peo­ple ac­knowl­edg­ing it and seek­ing help — and in terms of the need for re­search into get­ting a quicker di­ag­no­sis.’’

One thing led to an­other, and ear­lier this month Silk an­nounced that 16 peo­ple con­nected to bipo­lar, in­clud­ing suf­fer­ers and psy­chi­a­trists, had signed on to the BiPo­lar Ex­pe­di­tion — a jour­ney to, where else, the North and South Poles.

Silk con­ceived the project and got it go­ing to raise two things: re­search funds and pub­lic un­der­stand­ing.

The con­cept of pole to pole’ nicely cap­tures the bipo­lar con­di­tion,’’ says psy­chi­a­trist Gor­don Parker, ex­ec­u­tive di­rec­tor of the Univer­sity of New South Wales’s Black Dog In­sti­tute, a part­ner in the ex­pe­di­tion along with the Aus­tralian Ro­tary Health Re­search Fund. Peo­ple are on snakes-and-lad­ders tra­jec­to­ries.’’ He adds that Silk’s project is timely. As the BiPo­lar ex­pe­di­tion­ers gath­ered at the Syd­ney Har­bour Bridge to phys­i­cally il­lus­trate the need to bridge’’ the knowl­edge gap, Parker was fi­nal­is­ing ar­range­ments for an up­com­ing book, Mas­ter­ing Bipo­lar Dis­or­der , in which peo­ple with bipo­lar de­scribe how they man­age the con­di­tion.

One thing that’s con­sis­tent through­out peo­ple’s sto­ries is that they say, once we got the di­ag­no­sis and med­i­ca­tion right, the (lifestyle) things I learned to do my­self were the most im­por­tant things I could do to con­trol the dis­or­der’,’’ he says.

Bipo­lar BiPo­lar ex­pe­di­tioner Craig Wil­son agrees that it’s pos­si­ble to have the dis­or­der and lead a pro­duc­tive life: It’s not a death sen­tence’’.

But com­ing to grips with bipo­lar dis­or­der can be a long slog. Two sep­a­rate Aus­tralian stud­ies found that it takes be­tween 12 and 20 years just to get an ac­cu­rate di­ag­no­sis — if at all. Many of the roughly one-in-200 peo­ple with bipo­lar re­main un­di­ag­nosed.

Wil­son suf­fered for 19 years be­fore his con­di­tion was picked up and he re­ceived med­i­ca­tion that helps sta­bilise his mood, es­pe­cially the lows.

And as Parker says, the lows are low, re­ally low: They can be very phys­i­cal. Peo­ple can’t con­cen­trate, it’s hard to get out of bed, the body is slowed down. Peo­ple can’t be cheered up, there’s no plea­sure in life’’. In con­trast, the highs can be ex­tra­or­di­nary, fan­tas­tic. No one (seeks help) dur­ing a high,’’ he notes.

And that’s ex­actly why many peo­ple fail to get an ac­cu­rate di­ag­no­sis, says Michael Berk, a Univer­sity of Melbourne psy­chi­a­trist with joint ap­point­ments to Bar­won Health, The Gee­long Clinic and the Ory­gen Re­search Cen­tre: In or­der to di­ag­nose a de­pres­sion as bipo­lar or just plain de­pres­sion, the pres­ence of el­e­vated mood, ma­nia or hy­per­ma­nia, is es­sen­tial. The fact that they had ma­nia a few years ago is ir­rel­e­vant or de­sir­able to peo­ple.’’

Com­pli­cat­ing di­ag­no­sis is the bipo­lar isn’t all the same.

Some peo­ple suf­fer in­tense mood swings, oth­ers less in­tense but more fre­quent bouts, and some may even ex­pe­ri­ence two moods in one: hy­per and ag­i­tated, de­pressed and dis­tressed.



Lit­tle won­der that 25-50 per cent of bipoplar suf­fer­ers at­tempt sui­cide. Fif­teen per cent suc­ceed. I was on the cusp of sui­cide,’’ con­fesses Wil­son, now a suc­cess­ful busi­ness­man.

But as if an­tic­i­pat­ing Silk’s call for faster, bet­ter di­ag­nos­tic tools, re­searchers in the US re­ported ear­lier this year that they were close to a blood test for mood disor­ders. ( Molec­u­lar Psy­chi­a­try , 26 Fe­bru­ary 2008). They had, they claimed, iden­ti­fied so-called biomark­ers’’ in blood that re­flect molec­u­lar changes in the brain as it os­cil­lates from mood to mood.

Al­though psy­chi­a­trists have been aware that bipo­lar ill­ness and other psy­chi­atric con­di­tions pro­duced molec­u­lar change in the brain, there was no way to mea­sure those changes while the pa­tient was liv­ing,’’ says the team leader Alexan­der Niculescu of the In­di­ana Univer­sity School of medicine.

Now, he claims, blood tests could al­low psy­chi­a­trists to quickly as­sess the ef­fec­tive­ness of a med­i­ca­tion with­out the typ­i­cal lengthy wait­ing pe­riod.

And ac­cord­ing to Berk, get­ting the med­i­ca­tion bal­ance right is step two in help­ing peo­ple such as Wil­son get their lives back on track. The trick, he says, is sta­bil­is­ing mood’’ and not treat­ing the highs and lows as sep­a­rate disor­ders. That’s the rub,’’ he notes.

What’s good for one is prob­a­bly not a good idea for the other.’’

This process is not a one-way street. Both Berk and Parker say peo­ple with bipo­lar must work with doc­tors to build a lifestyle that makes cop­ing eas­ier, not harder. For in­stance, while al­co­hol and recre­ational’’ drugs make peo­ple feel bet­ter in the short-term, longert­erm use al­ters bio­chem­i­cal path­ways in the brain and, as Berk says, mood de­te­ri­o­rates’’.

Add cig­a­rettes to the no-go list. Along with US and Aus­tralian col­leagues, Berk found that smok­ing to­bacco is toxic’’ to mood. ( Jour­nal ofAf­fec­tiveDisor­ders, 14 Fe­bru­ary 2008) Not only does it in­crease the risk of mood disor­ders, smok­ing makes them hard to treat.

Clearly, elim­i­nat­ing neg­a­tive be­hav­iours is crit­i­cal, but so too is adding pos­i­tive ones:

mood di­aries’’, reg­u­lar rou­tines and ac­tiv­ity (es­pe­cially sleep), stay­ing in touch with friends and fam­ily and ex­er­cise all help.

There’s also some ev­i­dence that low-sugar, low-fat di­ets pro­tect against mood swings. Berk says there’re hints that some in­di­vid­ual nu­tri­ents’’ are help­ful: Omega 3 fatty acids, folic acid, vi­ta­min D and pos­si­bly even mag­ne­sium.

To­gether, an ac­cu­rate di­ag­no­sis, the right med­i­ca­tions and a lifestyle that recog­nises the na­ture of bipo­lar can mean the dif­fer­ence be­tween de­spair and hope.

I treat doc­tors, lawyers, peo­ple who can func­tion and en­joy life in all mean­ing­ful ways,’’ notes Berk. Some even travel the globe pole-to-pole. I’m up to the chal­lenge,’’ says Wil­son. I know my lim­its now.’’

Pic­ture: Vanessa Hunter

Po­lar trek: BiPo­lar Ex­pe­di­tion­ers climb Syd­ney’s Har­bour Bridge. Be­low, Tim Silk, far left sec­ond row, saw the dif­fi­cul­ties suf­fer­ers have in be­ing cor­rectly di­ag­nosed

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