No pole too far if mood takes
Bipolar disorder is devastating but there is hope ahead, writes Leigh Dayton
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.’’
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