Of all mental illnesses, bipolar disorder is, perhaps, the most mysterious. Often referred to as the dark side of creativity, it disproportionately affects people otherwise known as uncommonly gifted or even geniuses. The list of celebrities known to have bipolar disorder is long and glorious: writers Edgar Allan Poe, Ernest Hemingway, and Jack London; artists Vincent Van Gogh, Edward Munch, and possibly Picasso; movie stars Robin Williams, Catherine Zeta Jones, and Ben Stiller. Winston Churchill was remembered by his friends as either “at the top of the wheel of confidence or at the bottom of an intense depression”. Florence Nightingale, a social reformer renown as the founder of modern nursing, shifted between “period of extreme productivity, creativity and insights that go beyond what would normally be possible and bouts of severe depression” for most of her life. And even the genius of geniuses, Albert Einstein, was known to experience periods of extreme productivity and deep despair, which nowadays would most likely be diagnosed as bipolar.
But the cost of being a genius is high. Make no mistake — bipolar disorder is a dangerous illness. It causes serious shifts in mood, energy, thinking, and behavior—from the highs of mania on one extreme, to the lows of depression on the other. More than just a fleeting good or bad mood, the cycles of bipolar disorder last for days, weeks, or months. And unlike ordinary mood swings, the mood changes of bipolar disorder are so intense that they interfere with the person’s ability to function.
During a manic episode, a person might impulsively quit a job, charge up huge amounts on credit cards, or feel rested after sleeping two hours. He/she may engage in reckless sex or carelessly abuse drugs and alcohol. During a depressive episode, the same person might be too tired to get out of bed, and full of self-loathing and hopelessness over being unemployed and in debt. At the extreme, a person with untreated bipolar disorder is substantially more likely to commit suicide.
Bipolar disorder is hardly a rare disease. According to National Institute of Mental Health, bipolar disorder affects approximately 5.7 million adult Americans, or about 2.6% of the U.S. population. Although bipolar disorder is equally common in women and men, research indicates that approximately three times as many women as men experience rapid cycling. Women may also have more depressive episodes and more mixed episodes than do men with the illness (Journal of Clinical Psychiatry, 58, 1995).
But what causes the disease? What triggers it? And how can it be treated?
Unfortunately, the mechanism of bipolar disorder remains mysterious. We know that genetic factors play a significant role. About half of the people with bipolar have a close blood relative with a mood disorder. A person who has a parent with bipolar disorder has a 15 to 25 percent chance of having the condition, which is much more than population average of 2-3%. And yet although a person with a bipolar identical twin (same genetic material) is much more likely to have the same condition, it is certainly not always the case.
We know that several complex chemicals, so called neurotransmitters or chemical messengers in the brain, such as norepinephrine, serotonin (and probably many others), are involved. Yet how exactly they interact and what triggers their malfunction that manifests in abnormal mood swings is still not fully clear.
It is also remarkable that bipolar disorder is appearing at increasingly early ages. It is possible that this apparent increase in earlier occurrences is due to advanced diagnostic capabilities that were not available in the past. But it could also be possible that this change in the age of onset may be a result of social and environmental factors. We simply don’t know.
Does it mean that there is no hope for the people who suffer from bipolar? Not at all! Several treatments are already available that can be used to control the mood swings. Some patients respond to older medications, such as lithium, which are reliable and well-tolerated by most. There are newer, more expensive medications that may provide greater symptom relief, but also have greater side effects. In some cases, combinations of different drugs are prescribed.
No doubt, eventually the puzzle of bipolar will be solved and the genius who will find the solution will be named a Nobel Prize winner. For now, however, finding the right treatment remains a matter of identifying medication that will work for a given patient. What works for one may not work for the others. To be successful, doctors need to have a broad spectrum of treatments. This is why pharmaceutical industry is actively developing new medications, promising even more effectiveness with, hopefully, fewer side effects. Several of these are in clinical trials now.
Dr. Stolyar is Associate Director of Psychiatry at Boston Clinical Trials. He has conducted over thirty clinical research studies in the areas of mental health and behavioral disorders