Is it true that bipolar disorder may cause individuals to age earlier and, if so, is there anything we can do about it?
Yes, people with bipolar are more likely to suffer from many age-related conditions and have an earlier age at death due not only to unnatural, but also natural, causes. This suggests that bipolar should be considered not just as a brain disorder but as a condition that affects many systems in the body. To prevent or minimize premature or accelerated aging, treatments should focus both on dampening mood swings and increasing overall health and wellness. Providers, family members, and patients can work together to incorporate positive lifestyle changes like healthy diet, exercise, sleep hygiene, and stress reduction, all of which may lead to a better outcomes for those living with bipolar disorder.
What is stigma, and what effect does it have on people with bipolar disorder and their families?
Stigma is the psychological shunning and even shaming of members of “outgroups” not favored by mainstream society. Despite great progress in understanding and treating many forms of mental illness, stigma remains strong in this area, at the levels of policy (e.g., lack of parity for mental health coverage), media coverage (which still features images of violence and incompetence), and low levels of social contact (driven by fear and stereotypes). The potential unpredictability of manic and depressive cycles may fuel stigma against bipolar disorder per se. Of particular concern is the tendency for members of stigmatized groups to internalize society’s messages and biases, fueling self-stigma–a key predictor, in mental health, of failing to engage in needed treatments. Even more, family members must often battle associated stigma (formerly called “courtesy stigma”) in their efforts to support their affected relatives.
Signs of progress are apparent: Think of self-help and advocacy groups, more accurate and humanized media coverage, and spreading knowledge of the real benefits of evidence-based treatments for improving the lives of countless individuals experiencing bipolar disorder. In the end, it will take far better access to proven treatments, along with greater empathy and support on the part of the general public, to turn the tide.
How do I know if my child's thoughts, feelings or behavior are "normal" or signs of concern?
If your child experiences any signs of concern, ask yourself the following questions:
Intensity: How intense are your child’s behaviors, thoughts or emotions
Frequency: How often does your child feel or behave this way?
Duration: How long do these individual episodes or periods last?
Functionality: Above all else, consider how your child is functioning and whether or not your child is impaired in any way at home, at school or with friends.
If your child’s emotions or behaviors are more intense, frequent or longer in duration than most other children his or her age and those emotions or behaviors are causing impairment, it may be a sign of concern and you should contact a mental health professional for a consultation.
What is the relationship between the thyroid system and mood?
Circulating thyroid hormones, produced by the thyroid gland, play a critical role in the metabolic activity of the adult brain, and neuropsychiatric manifestations, e.g. depression, of thyroid disease have long been recognized. Without optimal thyroid function, mood disturbance, cognitive impairment and other psychiatric symptoms can emerge. Several lines of evidence suggest that there may be abnormalities in thyroid hormone metabolism in patients with mood disorders. Supporting this hypothesis, are observations that suboptimal availability of circulating thyroid hormones may contribute to the high rate of treatment failures in bipolar disorder. Because of this relationship, adjunctive treatment with thyroid hormone is one approach for people with bipolar disorders. Such use of levothyroxine (L-T4) at supraphysiologic doses has offered promise in research studies, including rapid cycling bipolar disorder and refractory depression. The hypothesis driving these studies was that increasing the availability of thyroid hormones to the brain does change the phenotypic expression of the disorder and is associated with improvement of mood and cognition.
How is bipolar disorder diagnosed?
Bipolar disorder is diagnosed using clinical criteria, based on a number of symptoms and their severity and duration. This means that there is no unequivocal objective way to confirm the diagnosis yet. However, if someone fulfills the criteria that are described in either the DSM-5 or the ICD-10 (the two systems that are used for that), the diagnosis is undoubtful and the potential benefit of treatment is very high.
The problem is that quite many people have some of the symptoms but not all, and therefore do not qualify for the diagnosis despite having many of its features and consequences. The use of clinical criteria is still the best system until the ongoing research can provide ways of confirming the diagnosis which are not exclusively based on symptoms, as in other areas of medicine. If anyone has reasonable doubts on his/her diagnosis, it may be good to get a second opinion from another specialist.
What is epigenetics and how does it help us find new treatments for bipolar disorder?
DNA delivers the information of the structure of proteins, i.e., amino acid sequences. This is usually thought as “genetic information”. In addition to this information, how DNA is read is determined by DNA-protein interactions. DNA undergoes chemical modifications such as methylation, and this affects DNA-protein interaction and gene expression. This phenomenon is called “epigenetics”. Whereas DNA sequences are transmitted from parents, DNA modification can be affected by environmental factors including early environment. Effect of early environment is known to be a risk factor of bipolar disorder, but its mechanism is not known. Epignetics might shed light on the mechanism of how early environment confer a risk of bipolar disorder, and if it is clarified, it might be a clue to develop new treatments to counteract early adversity.
What new treatments are available or being developed for bipolar disorder?
New treatments can be divided into lifestyle, psychological and biological. The first studies aiming to modify lifestyle variables such as diet and smoking cessation are being done and they hopefully will contribute to wellness.
In terms of psychological therapies, much attention is being directed to adaptation of psychological modalities to the Internet. These include mobile apps, electronic self-monitoring and psychosocial interventions for individuals such as Moodswings.net.au and for caregivers such as bipolarcaregivers.org. Many studies are being done adapting the third-wave CBT modalities such as Mindfulness and Acceptance and Commitment Therapy to people with bipolar disorder.
On the medication front, newer versions of existing therapies, such as anti-convulsants and new anti-psychotics are being developed. Studies are being done to clarify the role of antidepressants in the disorder. Interestingly, a number of recent studies have been published suggesting Lithium remains the most effective agent for the disorder.
A number of more experimental novel strategies are being studied, which vary from aspirin, ketamine, N-Acetylcysteine, minocycline and mitochrondrial augmentation therapies. While these are promising, it is too early for these to be first-line options.
Can genetics help us find which medication will work best?
To choose among the multiple treatment options for bipolar disorder, physicians often rely on a trial-and-error approach: different medications are used one after another until an effective one is found. Any such individual trial can take several months or even longer. As a result many patients stabilize after a considerable delay. Ongoing research promises to find effective treatments based on combinations of molecular genetic markers. While “we are not there yet”, we already know that the presence of specific psychiatric disorders in families and how affected family members responded to their treatments can guide us in selecting among treatments such as lithium, lamotrigine or atypical antipsychotics. Thus carefully documented family history alone can be useful for individualizing the treatment of bipolar disorder.
When it comes to nutrition, what is the best diet for people with bipolar disorder? Are there any foods that should be avoided?
Increasing evidence suggests that people with bipolar disorder may benefit from healthy diets consistent with a Mediterranean diet – that is with plant-based foods, such as fruits and vegetables, whole grains, legumes and nuts along with olive oil. Minimizing salt and red meat and avoiding processed foods including juices can also help. The main idea is to eat foods that decrease inflammation and avoid foods that increase inflammation. Also, foods with high fiber content can help good bacteria grow in our gut (the microbiome). Some also recommend natural probiotics (such as fermented foods, kefir, and yogurt).
How mood stabilizing drugs can alter the changes in brain structure and function in patients with bipolar disorder?
There are many different treatments for bipolar disorder but no one has figured out what is common between them to account for their mood stabilizing effects. A number of labs including ours have focused on targets inside the cell to explain how the drug works. Among these targets, factors involved in cell growth and protection and the brain’s antioxidant system stand out as the most important. These experiments point to the ability of treatment to prevent potential cell loss and damage that occurs particularly after multiple mood episodes. This suggests that early intervention and prevention against more mood symptoms is a good choice for most people with bipolar disorder.