5 Treatments for Bipolar Depression You May Not Know—Yet

By Rhona Finkel

If you feel depression has come to predominate your bipolar existence, you're
in good company.

Research indicates that, at a minimum, three times as many days are spent in
depressive episodes than in manic or hypomanic ones for bipolar 1.

And Joseph R. Calabrese, MD, director of the Mood Disorders Program at
the Case Western Reserve University School of Medicine in Cleveland, Ohio,
estimates that for bipolar II the ratio is 40 to 1.

Now if only there was a good way out of those debilitating episodes.

But there just might be.

For just when you thought you'd tried it all--done the SSRI's, been talked into
paying more for Prozac and Zyprexa together in one pill form (Symbyax), tried
Seroquel and Abilify, been on Lamictal twice--and thought you'd continue
to have unremitting bipolar depression for as far as the future can see, well,
there's still hope.

It just comes from some unusual venues.

#1) Mirapex

Known as pramipexole in its generic form, Mirapex is used to treat the
symptoms of Parkinson's Disease, and, quirkily enough, Restless Leg
Syndrome, too.

That wouldn't necessarily make it an obvious choice for bipolar depression,
but it's what's called a dopamine agonist, acting in place of dopamine, which
is a substance in the brain that controls movement.

However, a paucity of dopamine has strongly been related to depression
(Wellbutrin, for example, is a well-known dopamine agonist), since dopamine
also controls emotional response, and the ability to experience pleasure and
pain.

It didn't take too long for researchers to put the two uses of dopamine
together, and in 2004 the first preliminary randomized, placebo-controlled
trial was published in the American Journal of Psychiatry by Joseph

Goldberg, MD, associate clinical professor of psychiatry at the Mount Sinai
School of Medicine in New York City and director of the Affective Disorders
Research Program at Silver Hill Hospital in New Canaan, Conn.

They studied a group of patients for whom mood stabilizers and standard
antidepressants had failed. And the results looked good. 67% of patients had a
reduction of 50% or more from their baseline depression scores, which is none
too shabby.

Mirapex is particularly helpful in re-invigorating motivation, all too often
sucked away by the depths of depression.

Still today, 8 years after the first study, Mirapex remains relatively unheard of
as a treatment for bipolar depression, but that's much the pity.

One well-known Atlanta psychiatrist, however, Dr. Darvin Hege, had such
good results from it that he incorporated his experiences into his blog, in the
post "Mirapex – A New Medicine for Depression", which is definitely worth a
look.

It is safe in conjunction with lithium and other mood stabilizers.

#2) Provigil

In one case with which I'm familiar, introducing Provigil to the medication
regime was like bringing back the dead.

Approved by the Food and Drug Administration for improving wakefulness
in patients with excessive sleepiness due to narcolepsy, sleep apnea, and shift-
work disorder, this young woman's depression was so severe that she spent 20
out of 24 hours sleeping. An introduction of Provigil, a tweaking of the dosage-
-she was out of bed and back with the living, although of course with a lot of
work to do.

Her situation is not unusual, since bipolar depression is often typified by
excessive fatigue.

So Dr. Mark Frye, head of the Mayo Mood Clinic which focuses exclusively on
treatment-resistant depression and bipolar disorders and a team of 11 other
researchers set out to study the efficacy of modafinil (Provigil) in bipolar
depression, again, like with Mirapex, as an adjunct to other treatments.

In their ground-breaking study on Provigil in the August 2007 issue of
the American Journal of Psychiatry, they found that, using three scales for
assessment, depression severity was "significantly reduced in the modafinil

group compared with the placebo group."

In another of Provigil's big sells, the drug didn't cause "switching," where
patients flip to a manic episode, which is a hazard with a number of standard
antidepressants.

Interestingly the study concludes that doses of 100-200 mg a day may
improve the symptomatology, while the woman I know didn't achieve full
relief until 400 mg.

We're once again reminded how psychiatry is a field with much art
commingled with its science.

#3) N-acetylcysteine

Just to clarify, I'm not one of those people who believes you can treat major
psychiatric disorders with vitamins and herbs.

It's be nice, I agree--but it's a bit of a fantasy.

So when I address this herbal supplement, know that I've got real, double-
blinded research behind me, not just a wing and a prayer.

N-acetylcysteine produces something called glutathione (and I promise to stop
using such technical terms for the rest of this discussion--really all we care
about is that it works, right?)

Anyway, this glutathione protects the outer layer of brain cells, as well the (ok-
-I'm hoping you know this word back from high school bio, so I won't have
lied) mitochondria of brain cells. Mitochondria, as I'm sure we all remember,
are the energy-producers of the cell. So this glutathione lets the brain cells
function better, and it particularly improves their functioning (warning: 2
big words coming but I feel confident they're familiar) when transmitting
messages through brain chemical messengers like dopamine and seratonin.
These messengers are big players in mood regulation, and improving
depression.

It's had a number of uses as a supplement, and then, as recently as the
September 2008 issue of Biological Psychiatry, there's has a study by Berk
et al that indicates it’s an effective add-on drug for bipolar depression. Their
conclusion was surprisingly definitive in the world of research studies, ending
with "NAC appears a safe and effective augmentation strategy for depressive
symptoms in bipolar disorder."

Big plusses? No known reports of adverse side effects (and when do you
hear that in discussions about bipolar medications?) and it’s a score
economically, with a 60-tablet bottle of 1000 mg pills sold online by Source
Naturals for $11.00.

#4) Synthroid (levothyroxine)

A 1999 paper in the American Journal of Psychiatry found that people with
lower thyroid levels were less likely to come out of their bipolar depression
when compared with those with higher thyroid levels.

It's well-known that if your thyroid levels are low, you can get depressed.

But here's where the surprise comes in: Thyroid hormones can act as a
treatment for bipolar depression, even if your thyroid levels seem normal.
They act like mood stabilizers by helping to stop mood cycling, and seem to do
this particularly well among rapid cyclers.

Levothyroxine, or T4, or Synthroid, is a synthetic form of the thyroid hormone.
And so far research is indicating that adding levothroxine to mood stabilizers
increases the stabilizers' efficacy.

As far back as 1990, two researchers studied 11 treatment-resistant bipolar
patients. Levothyroxine was added to their medication regimen, and, while the
patients took it, their scores on both depressive and manic symptom rating
scales decreased significantly.

A 2003 article reviewing the evidence thus far on synthroid and treatment-
resistant mood disorders found that "open-label studies have consistently
demonstrated that the behavioral expression of bipolar disorder can be
modified by a change in thyroid status. In many instances, the course
of illness is improved through use of supraphysiologic doses of L-T4
[levothyroxine]."

If you believe this treatment might be for you, print out the article above and
bring it to your doctor, so he's got a run-down of the facts.

And be aware, as with all hormone supplementation, that there might be
serious side effects, some long-term.

#5) Ketamine

This one got more press than the marriage of Kate and William, so you may
in fact be aware of it, but it comes under the heading of new and unusual
treatments for bipolar depression.

In what could turn out to be one of the biggest break-throughs in treatment
of bipolar depression, if scientists can figure out what's going on and make
the changes permanent, researchers found that a single inclusion with of the
anesthetic ketamine can improve the mood within minutes of a depressed
bipolar patient.

Dr. Carlos A. Zarate Jr. of the National Institutes of Health in Bethesda,
Maryland, and his colleagues gave a single dose of ketamine and a single dose
of placebo to a group of patients on two different days, and then assessed the
patients for depressive symptoms.

When the patients received the dose of ketamine, their depression improved
significantly within an astonishing 40 minutes--and remained better for 3
days.

79% of patients improved with the ketamine [a staggering number in
depression treatments], and 0% with the placebo.

While clearly a drug that allows you to relapse after 72 hours isn't going to be
a best-seller anytime soon, Zarate believes it can be useful in several ways. He
said it could be used to "jump-start" regular antidepressant treatment, or as
an anesthetic before ECT, thus contributing its antidepressant qualities just
when they're most needed.

Zarate and a co-author have filed a patent for use of ketamine in depression.
While he believes more research is needed to develop guidelines, he also
suspects doctors might already be using it in certain particularly refractory
patients.

I must say that the idea of a 40-minute wait for improvement, instead of the
4-6 weeks standard with antidepressants, has to be a big sell.

And on

And I haven't even addressed Rilutek, celexocib, or insulin sensitizers (for
real), which you can read about here.

Depression makes it seem that there is no hope, that you will continue to
flounder in your darkness forever. But sometimes it just takes a look outside
of the box--and a drug meant for Parkinson’s, or thyroid disorder, or to put
you under during surgery, is waiting there for you, to bring back the light and
joy in your life.

Who's Calling Me Crazy? A guest post by Dr Kimberley McMahon-Coleman.

 Madam Bipolar and I went to school together an undisclosed number of years ago, in a place called Lithgow. “Lithgow” can be used in a sentence in much the same way as Santana uses “Old Lima Heights” in Glee: “you can’t scare me, I’m from Lithgow” or “You’d better stop that, or I’ll go all Lithgow on you.” One thing you may not know about Lithgow, though, is that one you’re accepted there, you’re really accepted. In hindsight, there were 3 of us in our year 12 with pretty strong Asperger’s traits, but no one was reading much of Lorna Wing at the time and the intelligence and quirkiness were respected, rather than ridiculed, so it went largely unnoticed. 

My current job involves teaching Uni students the academic language and literacies they need to succeed. The students who are “triaged” to me are those registered with Disability Services, while my colleagues with ESL backgrounds take the international students, and so on. I see a pretty varied range of so-called “difference,” but most “disabilities” these days are invisible: specifically, mental health disorder and Asperger’s Syndrome. I’m often asked to what extent the diagnosis impacts on my teaching methods and the answer is, not much. Obviously if a student discloses that they have Asperger’s I’m going to reduce the metaphor to plain language quotient, or if s/he is dealing with anxiety I’m not going to add to the pressure by demanding prompt answers, deep self-analysis and extra homework. But you teach people, not symptoms. 

The research part of my job is closely related to popular culture, which is cool because I can go around quoting Glee on company time, but it also means I have to spend a lot of time explaining what on earth it has to do with my teaching. I’m looking at mental health, mental illness and mental disorders in popular culture, and the probable impact on the identity formation of adolescent viewers. It’s a link that’s not immediately obvious to everyone, but if you watch enough episodes of Buffy (and that was one of the ‘good’ shows which made an attempt to look at difference in a sensitive manner!), you realise how often words like “crazy,” “spaz” and “insane” are bandied about. It then becomes hard to argue that a teen watching it won’t internalise that message that the only way to be is 100% mentally healthy, all the time. 

I’m not sure who exactly is supposed to achieve this lofty standard (even Buffy didn’t manage it, and she was the Chosen One), but teens who believe the message that they are somehow deficient because there’s a bit of a misfire in one section of the brain sometimes grow up to be Uni students , and typically under-confident ones at that who (hopefully) eventually end up in my office.

So that’s the context. Now here’s what I don’t get: we know that nobody’s perfect. We know that 1 in 5 Australians will suffer from some form mental illness in their lifetimes, most likely anxiety and depression (I’m among that number, by the way. Does it make you judge me differently?). We know that 14% of children and adolescents will suffer from anxiety and/or depression (Mindframe National Media Initiative).  We know that people with “disabilities,” a word which is now used almost interchangeably with “diagnoses”—physical, mental, emotional—can be and are functioning members of society. My husband is one. Madam Bipolar is another. So surely there must come a time when the language we use reflects this, and is applied with equal thought across the spectrum of difference. I mean, you don’t hear people talking about “crips” anymore, but “retards” comes up in Facebook memes.

This post arose after I read an Amazon review, my head exploded, and I contacted Madam Bipolar to have a wee rant. Basically, I reviewed a book and then someone associated with said book decided to review my review, and me. At one point he addressed me as “Lady,” which perplexed me, because I couldn’t work out if he thought I was a cartoon dog or if he thought he was a ‘40s gangster in the Bronx. But the real kicker was his assertion that he thought it was time I changed my medication. 

I’m sure it was meant to be personally insulting. I was supposed to internalise the intended slur that I was crazy, and go off and cry about it. Boy, did he pick the wrong target. I work with the so-called “crazy” students every day, only I just call them students. I respect them for what they can do.  Some of them overcome some really big hurdles to complete their studies, and not of the “my printer wouldn’t work” or “I lost my USB” variety, either. I don’t see it as an insult to be like a group of people who are very determined to work through and past circumstances beyond their own control. You see, there are members of my family with heart disease, bipolar disorder, diabetes and asthma. Both of my parents-in-law are cancer survivors, and so am I.  That tends to give you some clarity about the things you can control and the things you can’t, and it’s made us all pretty pro-medication, what with it having kept us alive and functional and all. Medication is something you take under supervision because you’re being responsible and proactive; it’s not a sign of weakness. As for why chemical imbalances in the brain are somehow coded as being much less desirable and much more scary than chemical imbalances in ovaries or pancreases, or electrical irregularities in the heart or whatever, I just don’t get it. Sure, psychosis is scary to witness, but no more so than, say, being first responder to someone having a heart attack. 

So in the end I went a little bit Lithgow on the unconstructed reviewer. I politely contacted Amazon and they quickly removed his comments. But the incident did make me think. I’ve become more aware of how often I say that something is “driving me crazy,” for example. I think we all need to strip these words of their latent power by being more aware of when and how we use them, and the impact they have. Not because it is politically correct to do so, but because language is a really powerful tool, so we have a responsibility to be aware of how we’re wielding it.

What do you think? Is it “crazy” to think that we shouldn’t view words like “crazy” as benign?

Dr Kimberley McMahon-Coleman is a recovering high school educator who now teaches in Learning Development at the University of Wollongong. She has contributed to a number of books including Glee and Teen Culture (Forthcoming), Fanpires: Audience Consumption of the Modern Vampire (2011) and Open Graves, Open Minds: Vampires and the Undead in Modern Culture (Forthcoming). With Dr Roslyn Weaver from the University of Western  Sydney she has written Werewolves and Other Shapeshifters in Popular Culture: A Thematic Analysis of Recent Depictions (McFarland, 2012). The book focuses on the figure of the shapeshifter in literature and popular culture, and how it is used as a metaphor for difference. This marks a return to her early interest in vampires, werewolves and other things which Mulder might have investigated. She can be found in cyberspace at http://shapeshiftersinpopularculture.wordpress.com and on Twitter @KMcMahonColeman. 

10 Facts Everyone Should Know About Bipolar Disorder

10 Facts Everyone Should Know About Bipolar Disorder

"Knowledge is Power." ~ Sir Frances Bacon

 Seems that everybody nowadays knows someone (or certainly knows someone who knows someone) who has bipolar disorder (BD).

So you'd have thought that information about the illness would be clear, easily-accessible, and well-known.

Well, you'd have thought wrong.

Of course misconceptions still abound, but, beyond that, there are some important facts about BD that remain obscure to so many of those without the disorder--and, surprisingly, even to some of those with it.

Here are 10 facts everyone should know about BD:

1. BD is the sixth leading cause of disability in the world, according to the World Health Organization.

That puts it behind tuberculosis (can you imagine?) and road traffic accidents, but ahead of war. It is, additionally, the most expensive mental healthcare diagnosis in the United States, hands-down.

2. A shocking 1 in 4 bipolar sufferers receives an accurate diagnosis in less than 3 years.

Often mis-diagnosed as anxiety, depression, thyroid condition--you name it--it takes an unacceptably long time for doctors to finally pinpoint the real problem. During that time, more mood cycling occurs, which in turn leads to more mood cycling, which contributes to the severity of the condition.

3. Lifetimes suicide rates are higher for those with BD than for any other mental illness.

In fact, higher by far.

For major depressive disorder the suicide rate is 9%, which increases to 10% for schizophrenia. But the rate of suicide is double that in BD, with an estimated 20% of those with the illness taking their own lives.

4. Three times more days in a bipolar person's life are spent in a depressive state than in a manic or hypomanic state.

So many people are attached to their mania, and the energy and creativity it can bring. But as surely as devastating night follows day, depression rides on the heels of the manic pole. There is an inevitable plunge, and people will pay the price--in triplicate--for their elevated moods.

5. A full 50% of those with BD have co-occurring substance abuse issues.

Often in an attempt to self-medicate, people with BD will turn to drugs and alcohol. These in turn exacerbate the condition, and can wreak havoc on prescribed medication regimes.

6. When the first bipolar episode occurs, it is most likely to be a manic episode in males, while the first episode for females is more likely to be a depressive one.

7. Even after the first episode, BD can present quite differently for men and women.

Women more commonly experience rapid cycling, mixed states, and cyclothymia. Men, by contrast, more frequently experience early-onset bipolar disorder (which can lead to a more severe condition). Men also have higher rates of substance abuse [A.D.A.M., Inc., 2012].

8. The average age of onset for BD is 25.

The first occurrence is usually between the ages of 15-30. However, it can occur at any age, including in children (although that diagnosis has recently received much skepticism. See "Bipolar Disorder In Children--A Diagnosis in the Doghouse" for some of the latest research on the existence of the illness at young ages).

PsychCentral points out that an earlier age of onset doesn't bode well. Their article on age of onset notes:

"On average, the earlier the age at which symptoms appeared, the longer it took for the patients to be diagnosed.  In addition, the longer the delay in diagnosis, the more time patients spent depressed, the more episodes of depression they had, the worse the episodes were, and the more rapid the cycling of episodes."

9. Rates of bipolar differ among countries.

Although one would think the illness would occur at the same rate, whether in Dubai, Israel, Zimbabwe, Brazil--you name it, it turns out that a CNN study of 11 countries found wide variance.

The winner (if it counts as winning, I suppose), hands-down, was--who else?--the U.S., with the  highest lifetime rate of bipolar disorder at 4.4%, and overall wealthier countries had higher rates.

Just as a point of interest: Japan, which should have had higher statistics, had a lifetime prevalence of only 0.7%, while Columbia, a lower-income nation, turned out to have a relative high prevalence at 2.6%.

The loser (winner?)? India, the absolute lowest, with 0.1%.

10. The highest risk factor is something you can do nothing about. . . it's having a relative who has BD.

More than age, stress, and drug abuse (all potential risk factors for developing BD), genetics is the single biggest risk factor by far.

Those who have a parent or sibling with bipolar disorder are four to six times more likely to develop the illness, compared with controls. (see Nurnberger & Foroud, 2000).

Look, realizing that you've got the worst risk factor going, and that you're in a country where your diagnosis is most common can't really help you treat your illness. But just knowing the facts of your disorder give you some semblance of control over it.

Since knowledge is power, as per Frances Bacon, the more you know, the more power you have to manage your illness.

And making sure that you manage BD, instead of it managing you, well, that's the name of the game. So 10 points to you for reading this post; bipolar--none.

By: Rhona Finkel

The Bad News Plus The Good News - A Guest Editor

It's been a long time since I posted at Madam Bipolar but I am still determined to keep this as a place where people can go to for mental illness information.

That's why I am pleased to announce that Candida Abrahamson is going to guest edit this blog for a stint. I am sure many of you may know her work, which sets a standard on the internet for excellence in healthcare writing.

This period will also showcase the work of Rhona Finkle, who has written this week's piece on bipolar disorder and co-morbidity.

Here is the post and it is my pleasure to introduce them to you:

Medical Comorbidity in Bipolar Disorder: Just the (Unpleasant) Facts

By: RHONA FINKEL

"Bipolar Disorder ranks as the sixth leading cause of disability in the world, with an economic burden to . . .the US alone . . .[of] $7 billion in direct medical costs and $38 billion (1991 values) in indirect costs. . . .[P]atients with BD sustain health-care utilization costs that are as much as four times greater than costs for nonbipolar patients and a considerable part of these costs is driven by medical illness." ~ Soreca et al, 2009

Bipolar disorder (BD) is an illness with some scary statistics.

Its suicide rate is higher than that of any other mental illness, clocking in at 20%.

Over 50% of those with BD have substance abuse issues.

According to the National Institute of Mental Health, it results in a 9.2-year reduction in life span.

In short, it's a not an easy disorder with which to contend.

To make the situation vastly more challenging, it seems that people with BD have more medical comorbidities than those with other mental illnesses, complicating treatment, and contributing to shortening of lives.

Although the co-occurrence of physical illness in persons with schizophrenia has been addressed in multiple studies (see MC Ryan 2002, J Baldwin 1979, DR Folsom 2002, and Sernyak 2003--and get back to me if that doesn’t do it for you), before about 2005, medical co-morbidity in BD patients had received scant attention, even though the disorder itself is significantly more common than schizophrenia.

Finally a 2005 study, "Medical Comorbidity in a Bipolar Outpatient Clinical Population," looked at 1379 patients with bipolar disorder treated from 2001-2002 in outpatient clinics, perhaps assuming that an outpatient population might be a healthier one.

Nevertheless, it found systemic disease too common for comfort, with high percentages of endocrine and metabolic diseases, and diseases of the circulatory system, as well as of the nervous system and sense organs.

Cardiovascular diseases/hypertension, COPD/asthma, and diabetes were all common specific illnesses, and ones which correlate regularly across studies with BD.

In fact, cardiovascular and cerebrovascular diseases occur in BD at twice the rate of the general population (Soreca et a 2009).

Interestingly, the study left some illnesses un-addressed that are well-known to be associated with BD. For example, an estimated 25-27% of BD people suffer from migraines (e.g. T Mahmood et al 1999). Additionally, thyroid disease (see Cole et al 2002) is more frequently diagnosed in BD patients as doctors become increasingly knowledgeable about the inter-connections.

The 2005 paper was a toe in the water. Soon others jumped in head first.

Two 2006 papers only made the situation appear more drastic.

"Medical Comorbidity in Women and Men With Bipolar Disorders: A Population-Based Controlled Study" studied a sample of administrative claims from 1996 to 2001 from Wellmark Blue Cross Blue Shield, which covered 3557 bipolar I patients. The authors determined that people with BD had increased likelihoods of contracting conditions spanning every organ system.

And results from the 2006 "Medical Comorbidity in Bipolar Disorder: Implications for Functional Outcomes and Health Service Utilization" (McIntyre et al) further clarified the depth of the problem.

In the first "cross-national population-based investigation exploring the prevalence and functional implications of comorbid general medical disorders in bipolar disorder,” the authors found that

Rates of chronic fatigue syndrome, migraine, asthma, chronic bronchitis, multiple chemical sensitivities, hypertension, and gastric ulcer were significantly higher in the bipolar disorder group [in comparison to controls].

Adding to the tragedy of the situation, the bipolar illness itself became more recalcitrant and difficult to treat as the number and severity of medical illnesses increased:

Chronic medical disorders were associated with a more severe course of bipolar disorder, increased household and work maladjustment, receipt of disability payments, reduced employment, and more frequent medical service utilization.

Once the groundwork had been laid by these early studies, observers were quick to realize that physical illness all too often went hand in hand with BD, and study followed study confirming the correlation. The most surprising aspect is that it took so long for published work to validate what so many people with BD intuitively know.

In an unusual 2009 analysis David Kemp (Case Western Reserve University, Cleveland, Ohio) and colleagues looked at 98 adult outpatients with rapid-cycling bipolar I or II disorder and co-occurring substance abuse disorders. Because substance abuse is so common among this population, throwing it into the mix in assessing physical conditions made good sense.

The results were pretty shocking.

Every single patient enrolled in the study had at least one medical illness.

And, to strain credulity more, on average the subjects had 4.9 different medical conditions.

The disheartening stats just kept on coming:

·     52% had illnesses crossing four or more different organ systems,

·     24% had uncontrollable medical illnesses, and

·     the mean overall total Cumulative Illness Rating Scale score was 5.56 (4 is considered high).

·     38% were overweight and 29% obese.

AND--insult to injury--the number of medical illnesses increased with age, so an older person struggling with BD had both more mood stability behind her—and now increased physical challenges making the fight for stability all that much more difficult.

Number of Medical Comorbidities Stratified by Age Among Patients with Rapid-Cycling Bipolar I or II Disorder and Co-Occurring Substance Use Disorders (Kemp et al 2009)

Just to bring us to the present, the most recent relevant data comes again from David Kemp, who was back in action, this time studying 264 patients with bipolar I or II disorder in the Lithium Treatment Moderate Dose Use Study.

Presented at the 52nd Annual Meeting of the New Clinical Drug Evaluation Unit in Phoenix  this pasts May 29-June 1, 2012, these were inpatients, which might have added a level of complication--but this time rapid cycling and substance abuse were not requirements, so the degree of comorbid illness should be--and was, to some extent--lower.

But not low enough.

Guesses on the percentage of those patients who had significant medical comorbidity? Anybody?

A staggering 53%.

That's right. More than half of BD patients had a physical illness.

The most commonly affected systems for the inpatient population, slightly different from the outpatients, were the:

·     musculoskeletal/integumentary (33%),

·     the respiratory (27%), and

·     the endocrinologic/metabolic (25%) systems.

The most common individual conditions were:

·     migraine (25%) [no surprise, that statistic regularly recurs in research],

·     history of head trauma with loss of consciousness (19%), and

·     hypertension (16%).

And, once again, a greater medical illness profile correlated with a larger number of mood episodes.

Kemp et al note of their findings:

In this generalizable sample of patients with bipolar I and II disorder, the burden of comorbid medical illnesses is high and appears to influence course of illness and psychotropic medication patterns. (see MedWireNews)

It is a terrible irony. When all resources are needed, emotional, physical, mental, material, to fight against an illness, the illness is at the same time siphoning those resources off.

But if there is the will to fight, there is hope. Painter Edvard Munch, perhaps not a paragon of mental health, but certainly someone who would have been a seriously rich man had he only but lived long enough, said it best:

Without fear and illness, I could never have accomplished all I have.

So that is our mission: to fight on despite fear, despite mood dysregulation, despite multiple illnesses, to show how greatness can be achieved, just by overcoming.

REFERENCES

Beyer J et al. Medical comorbidity in a bipolar outpatient clinical population. Neuropsychopharmacology 2005; 30(2):401-4.

Carney CP, Jones LE. Medical Comorbidity in Women and Men With Bipolar Disorders: A Population-Based Controlled Study.Psychosomatic Medicine 2006; 68(5):684-691.

Cowen M. High medical illness rates in bipolar disorder. 28 June 2012.

Kemp DE, et al. Medical and Substance Use Comorbidity in Bipolar Disorder. Journal of Affective Disordors 2009; 116(1-2):64–69.

Kemp DE, et al. Medical comorbidity in bipolar disorder: relationship between illnesses of the endocrine/metabolic system and treatment outcome. Bipolar Disorder 2010; 12(4):404–413.

McIntyre RS, et al. Medical Comorbidity in Bipolar Disorder: Implications for Functional Outcomes and Health Service Utilization. Psychiatric Services 2006; 57(8).

Soreca I, Frank E, Kupfer DJ. The phenomenology of bipolar disorder: what drives the high rate of medical burden and determines long-term prognosis? Depression and Anxiety 2009; 26(1):73–82.

About Rhona and Candida:

Dr. Candida Abrahamson has been coaching and mediating since graduating with a Ph.D. from Northwestern University in 1984. She helps adults and adolescents through the particular struggles of our time: tension between couples, parenting frustration, blending new families, separation and divorce, (un)employment, cancer, and loss. With reason and moderation she assists people in shifting from fear and hopelessness to problem-solving and respect. When relationships come to an impasse, she uses mediation techniques to try to ensure that each party will have his/her needs heard and accounted for in a dignified way. In addition to talking, listening, and reframing, she utilizes the tools of metaphor, active teaching, role-playing, visualization, and occasionally hypnotherapy.

Her website is  http://candidaabrahamsonphd.com/,  and you can find more posts like this one on her blog at http://candidaabrahamson.wordpress.com.

Co-author Rhona Finkel is a Princeton University graduate who now researches and writes on science and mental health issues, covering topics as wide-ranging as retractions in scientific literature, mood disorders, technology and health, the plight of the mentally ill, psychiatric medications, and sociology research. Additionally she does PR for individuals and businesses, beefing up websites, establishing Internet presences, creating social platforms for owners, and then training them in how to use social media to their benefit. She is privileged to be an author on Candida Abrahamson’s Blog.