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DR. JONES DR.

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BIPOLAR DISORDER Vol 6 2010 Wayne C. Jones, M.D. A board certified Psychiatrist with 30+ years of clinical, re- SPECTRUM OF BIPOLAR search, and teaching experience. thermostat. The thermostat gets Bipolar I: Severe , with He is among the first Psychia- stuck at one extreme (mania or de- trists to be certified as a Psycho- pression) and the temperature () • Distinct periods of elevated, pharmacologist. His specialties goes out of control. expansive or irritable mood include anxiety and mood disor- Mood swings can occur abruptly. • Inflated self esteem/ ders, stress management, ADHD, They may be induced by seasonal and innovative changes, hormonal changes, certain • Decreased need for medication management. medications (such as steroids, decon- • More talkative than usual gestants, antidepressants, stimulants, • /ideas recreational drugs), or too much or too The spectrum of bipolar disorders is • Distractibility by the irrelevant characterized by mood instability and little sleep. JONES’ DR. JONES’ DR. One of the biggest problems facing • Increased goal directed activ- . About 1% (2 million) of the . ity, psychomotor agitation population is bipolar I. Bipolar has mul- those with is what is ONES’ described as the “kindling effect”. This • Excessive/impulsive behavior tiple forms. It ranges in severity from in pleasurable activities mildly disruptive to life destroying. As means that every episode of abnormal mood (low or high), increases the sen- Bipolar II: Major depression, in other medical conditions such as (milder mania) diabetes and hypertension, the vulner- sitivity of the brain’s mood regulators. This makes it easier to have mood • Mood elevated or irritable ability to bipolar disorder is inherited. • More energy than usual Once you have it, you have it for life. swings in the future. • Talkative Fortunately, like hypertension, it can be Many of my patients are unques- • Decreased sleep medically controlled. tionably bipolar and many show no Mood swings usually start in the 20’s, signs of the disorder. But, patients that • Inflated self-esteem but can start in childhood or during the fall in a “gray” area with some symp- • teens. If depression is present in these toms present, make pinpointing the • Excessive involvement in early years, there is an increased risk diagnosis very difficult. These indi- pleasurable acitivities of bipolar. Sometimes, the first major viduals often appear to be primarily Major depression: mood swing doesn’t occur until the 30’s oppositional, substance abusers, or • No interest or pleasure or occasionally, later. have personality disorders. This group (Most common symptom) If mood is compared to room tem- is the greatest challenge to psychiatry • Depressed mood perature, (too cold equals depression and requires the closest scrutiny. Be- • Weight loss/gain and too hot equals mania), bipolar dis- cause of its complexity, bipolar disor- • / der usually needs to be treated by a order is like having a defective • Psychomotor retardation Psychiatrist. • Fatigue or loss of energy MEDICAL MANAGEMENT OF BIPOLAR DISORDER • Feelings of worthlessness/ guilt Mood stabilizing medications treat depression and mania: • Decreased concentration √Other Options: • Recurrent thoughts of death √Anticonvul- √Atypical * ** : sants Zyprexa* **** ***** • Thyroid For at least 2 years, periods of Depakote* • Risperdal* **** • Symbyax*** hypomania and depression • Lamictal** • Seroquel* ** *** **** symptoms that do not meet ma- • Tegretol* • Geodon* ** **** FDA approval for: *Mania jor depression criteria • Clozaril **Maintenance • Abilify* ** ***** (Stabilization) Bipolar NOS: ***Bipolar depression Official diagnosis for significant • Saphris* **** ****Mixed episodes *****Agitation bipolar symptoms, but not enough to qualify for BPI, II, CT

IS IT ADD/ADHD, BIPOLAR, OR BOTH? ABOUT OUR STAFF ADD/ADHD Bipolar (Mania) Paige Embrey, M.B.S., Only BOTH Only L.P.C.Clinical assistant to Dr. Jones, she is certified as a licensed profes- sional therapist. She is available for personal counseling, including chil- •Bedtime insomnia •Distractibility •Decreased dren, teens, social anxiety, and •Normal Mood •Racing (hyper- need for sleep ADHD coaching. •Decreased active) thoughts •Mood euphoric Self-esteem •Impulsivity or irritable •Behavior varies •Talkativeness •Inflated self-esteem Penny Chaney, B.B.A., -does writ- with situation •Restlessness •Behavior varies ing/editing, and research. She devel- “Prisoners of •Poor judgment greatly w/mood the present”* •Denial •Cyclic Symptoms ops patient education materials, man- •Continuous-usually •Excitement freq. depression agement of presentations, and web evident before 7 seeking •Average age site production. of onset 20

Melissa King, B.F.A. –Coordinator of our program for total fitness. She Many times ADD/ADHD and bipolar are hard to distinguish from each other. will serve as “coach” for patients that ADD behavior is consistent and is driven more by interest than by impor- wish to initiate positive lifestyle tance. Bipolar is cyclic and behavior is driven by mood. Many people have changes. both disorders. 60% of those with ADD will also be bipolar.

Davin Williams-A seasoned member of our administrative staff. She has SUBTYPES OF BIPOLAR DISORDER advanced training in stress disorders. DYSPHORIC MANIA AND RAPID CYCLING Persons Kelli Miles-Newest addition to our MIXED STATES It is possible with rapid cycling have at least administrative staff. She brings to have the symptoms of major 4 episodes per year of mania/ knowledge and experience to com- depression and mania at the hypomania, and/or major de- plete our team. same time. This is called a pression. It is estimated that mixed, or dysphoric state. It is 13-20% of bipolar patients are estimated that 31% of patients rapid cyclers. It is more com- presenting with mania have a mon in women, probably be- mixed state. It is characterized cause women have more hypo- DRUG ABUSE RATES HIGH by distinct periods of abnormally thyroidism. IN BIPOLAR and persistently elevated, ex- Rapid cycling is frequently caused by low thyroid. Some Alcohol Abuse/Dependence Lifetime: pansive, and/or irritable mood with depression (neither is due experts recommend keeping •13% in general population thyroid levels within the top 25% to just drug abuse.) •21% in depressed population of normal range of free T4. This •46% in bipolar population While the absolute changes in can be measured by a standard the brain chemistry are not fully blood test. Note: Many doctors Drug Abuse Lifetime: known, mixed mania may be only test the TSH for thyroid associated with brain transmit- disorders. Testing only TSH is • 6% in general population ters that are too high (dopamine not adequate for secondary thy- •18% in depressed population and ), and/or too roid disorders. low, (). Mixed states Rapid cycling is difficult to MULTIPLE MEDICATIONS OFTEN sometimes occur during transi- treat and may respond better to a than Lithium. NEEDED TO CONTROL SYMPTOMS tions from one phase of mood to the other. One study found patients to be on In mixed mood states it is es- the following to control symptoms: sential to treat the mania before “Mania is a sickness One medication 19% treating the depression. Starting for one’s friends, 2 medications 28% treatment with an antidepres- depression for one’s 3 medications 28% sant is like throwing kerosene self!” 4 or more 25% on a fire because it can trigger a -Robert Lowell manic state. HEALTHY LIFESTYLE AND BEHAVIORAL MANAGEMENT • Life charting-Construction of a graphic representation of major symptoms, major life Bipolar is a lifelong disorder. At this events and treatment over the person’s lifetime. This aids in establishing the course time, there is no known medication of the disorder and the life events that contributed to mood swings. that can cure or eliminate it. Medi- cation only manages and controls • Mood graph-This helps to optimize medication management. A daily chart monitor- the symptoms. Bipolar disorder ing sleep, symptoms, side effects, mood changes, medications, etc. provides a valu- must be constantly attended to just able tool for maintaining a good treatment plan. as the person with diabetes must do the things necessary to keep it un- • Good health habits-Developing and maintaining regular patterns of daily activities der control. helps reduce stressors that cause mood swings. It is especially important to develop Along with carefully managed regular patterns of sleep. Sleep deprivation triggers mania. However, too much medication, it is essential that a sleep causes decreased mental energy and motivation. healthy lifestyle be maintained. When both of these are achieved, • Involvement of a significant other-Spouses/friends can play an important role in mood can be stabilized and a nor- detecting a mood swing when the impaired person may not know they have a prob- mal, stable, high functioning life is lem (especially when manic). They can also provide encouragement for taking medi- possible. cation even when the bipolar person is feeling well and doesn’t think they need medi- cation.

DID YOU KNOW?…..

• 70% of persons with two bipolar parents • Bipolar disorder is not diagnosed on will be bipolar average for 9-10 years • Untreated bipolar disorder will worsen • 20% of those with bipolar disorder over time becoming more frequent and have panic disorder severe • 25% of those depressed are bipolar • Bipolar often begins with depression • 48% of those with bipolar disorder • Antidepressants can induce a manic consult 3 or more professionals be- response in a person that is bipolar fore receiving correct diagnosis • Bipolar is a serious disorder with a 15% • Bipolar disorder can be caused by rate of suicide head injury, substance abuse or ge- • 5-8% of the population have a bipolar netics spectrum disorder • Substance abuse or dependence is • The average age of onset is 15-19 more likely during mania treatment of bipolar • 70% of bipolars that stay up all night become manic the next day

IS IT DEPRESSION OR BIPOLAR DISORDER? Fred Goodwin, M.D., an expert on it is usually safer to treat with a mood RESOURCE CORNER bipolar disorder, cautions that antide- stabilizer first, not an antidepressant. pressants can trigger symptoms of Clues to look for in family history: √ The Unquiet Mind, by Kay Jamison, Ph.D bipolar disorder in a person that has √ Any extremes in mood/behavior √ Brilliant Madness, by Patti Duke never had symptoms in the past. √ Periods of high productivity What does this mean? When an √ Period of low or no productivity √ Manic Depression, by Fred Goodwin, M.D. individual goes to the doctor suffering from symptoms of depression the √ Episodic alcohol/substance abuse √ Sad to Glad, by Nathan Kline, M.D. genes could be present for bipolar √ Relatives that had “nervous break- downs” causing lost jobs, relation- depression, not just depression. If the √ Mood Swings, by Ron Fieve, M.D. bipolar genes are present, initial treat- ship problems, or hospitalization ment with antidepressants alone can √ Dramatic changes in sleep habits National Depressive & Manic-Dep. Assoc. cause symptoms of bipolar even if the (going without sleep for days or 730 North Franklin St., Suite .501 patient had no symptoms in the past. staying in bed for days at a time) Chicago, IL 60610 Phone: 1-800-826-3632 It is extremely important to give the √ Persons that seem normal most of physician a thorough family history the time, then suddenly become www.dbsalliance.org (depression & bipolar when seeking treatment of depression withdrawn, irritable, argumentative, support alliance) for the first time. If any known relative, or extremely talkative or aggres- (parent, sibling, child, Grandparent), sive has had any symptoms of bipolar, Mental Fitness Update 375 Municipal Suite 224 Richardson, TX 75080 972-234-0489 FAX 972-235-1558 www.AskDrJones.com [email protected]

Question: What was the ONLY mental disorder Nazi Other studies of bipolar and creativity found the following: Germany chose to spare in the so-called quest to • Four American poets have won the Pulitzer prize. “cleanse” the human race? All four have committed suicide. Answer: The bipolar population. While only 1% of the general population is bipolar I , Although Hitler’s decision was purely self-serving, he • 25% of award winning writers, artists, and musicians made a very astute observation. The manic people got in England were found to be bipolar I. things done. They were energetic, required little sleep, (so they worked harder and longer), and they were pas- sionate, creative people. Just a few of the notable people that have blessed Indeed, the world would probably be a gray, boring us with “mad genius” include: place without these people. In her book, , Kay Jamison explores the lives of many of the art- • Lord Byron • Edgar Allan Poe ists that have given us great works. They all share a • Emily Dickinson • Ralph Waldo Emerson common struggle with bipolar disorder. This does not • T.S. Eliot • Robert L. Stevenson mean that all creative people are bipolar. But a much • John Keats • Charles Dickens larger percentage of creative people have bipolar ten- dencies than the general population. Some studies sug- • Ernest Hemingway • Samuel Clemens gest bipolar is as high as 50% in creative people. • F. Scott Fitzgerald • Cole Porter Many poets, painters, composers, and writers were • Michelangelo • Irving Berlin inspired to create great works of genius when in the • Georgia O’Keefe • Peter Tchaikovsky exhilarating highs of mania. These same people often • Vincent van Gogh • George Handel wrote of the unbearable pain they experienced when the highs plunged into deep and often suicidal depres- This passage by the poet Lord Byron sion. Great poets and writers have penned beautiful, beautifully reflects the struggle of bipolar: moving narratives of the agony and ecstasy of being bipolar. William Wordsworth explains it this way: “Yet must I think less wildly-I have thought “By our own spirits are we deified. too long and darkly, til my brain became, We poets in our youth begin in gladness, In its own eddy boiling and o’erwrought, But thereof come in the end desponding and madness.” A whirling gulf of phantasy and flame: And thus, untaught in my youth my heart to tame, My springs of life were poison’d” -Lord Byron

Our main goal in writing this newsletter is to provide education that helps people have better quality lives and relationships! We would like to remind you however, our intention is not to personally advise anyone on treat- ment or medications. Please consult your physician before making any decisions concerning your own diag- nosis and treatment plan. We would be delighted to get comments/suggestions from you! Fax or E-Mail anyone on our staff at the numbers listed above. . . I HOPE SOMETHING IS OF VALUE TO YOU!