The Problem with how we treat Bipolar Disorder

From the New York Times Magazine by Linda Logan published April 26, 2013

Written by someone with bipolar disorder who had several hospitalizations she writes about what happens to the self in the treatment of bipolar disorder.

For the article click the link below:

The Problem with how we Treat Bipolar Disorder

ABOUT CALL ME CRAZY: A FIVE FILM

From a press release from Lifetime to be shown on April 20 at 8 pm.
Though I haven't seen it, the stories in one film would seem to be the first time one film covers a wide range of mental illness from a wide range of perspectives. So I thought it was worth the publicity and tentative endorsement.


ABOUT CALL ME CRAZY: A FIVE FILM
Lifetime 4/20 8pm

Written by Deirdre O'Connor (Five) and directed by Howard, Lucy follows the film's title character (Snow), a law student who finds herself amidst the horror of schizophrenia, landing her in an institution where, through the support of a new friend (Ritter), meds and her psychotherapist (Spencer), she begins her path to not only healing, but a promising future. Lucy also features Clint Howard (Fringe).

Grace, directed by Maguire and written by Howard J. Morris (Five), explores bipolar disorder through the experience of a teenage daughter (Hyland) whose mother (Leo) grapples with the condition. Also starring in Grace are Melissa Farman (Temple Grandin) and Aimee Teegarden (Friday Night Lights).

Allison weaves together comedy and family drama in a story about healing when its eldest daughter "Lucy" (Snow) returns home from inpatient treatment and spoils her sister "Allison's" (Vassilieva) unveiling of her new boyfriend to their parents (real-life wife and husband Smart and Richard Gilliland, Desperate Housewives). Allison, also featuring Ken Baumann (The Secret Life of an American Teenager), was written by Jan Oxenberg (Parenthood) and is directed by Dern.

Eddie, directed by Hunt and written by Stephan Godchaux (Five), delves into the world of depression as seen through the eyes of a comedian's wife (Thompson) as she grapples with understanding how her husband Eddie (Mitch Rouse, According to Jim), whom is so loved, can be so withdrawn and overcome with sadness. The short also stars Handler and features appearances by Dave Foley (The Kids in the Hall), Jay Chandrasekhar (Super Troopers), James Avery (The Closer) and Ross Mathews (Chelsea Lately).

In Maggie, penned by Erin Cressida Wilson (Secretary) and directed by Judd, a female veteran (Hudson) returns home from war to her son and father (Ernie Hudson), only to have her life shattered by the onset of posttraumatic stress disorder, through which her lawyer, "Lucy," helps her. Griffith also stars in Maggie.

Scientific Update: Exercise, Mood, and Bipolar Disorder

Exercise is well-known to influence both physical and mental health. The articles reviewed in this post are specific to the impact of exercise on mental health and the symptoms of bipolar disorder. These articles show that people living with bipolar disorder are more likely to be overweight and to have poor eating habits. The implications of these studies is that people living with bipolar disorder must develop good eating habits and a routing habit of physical activity.

Kilbourne, Amy M., Dana L. Rofey, John F. McCarthy, Edward P. Post, Deborah Welsh, and Frederic C. Blow. 2007. "Nutrition and exercise behavior among patients with bipolar disorder." Bipolar Disorders 9, no. 5: 443-452.

Objectives: There have been few comprehensive studies of nutrition and exercise behaviors among patients with bipolar disorder (BPD). Based on a national sample of patients receiving care in the Veterans Affairs (VA) health care system, we compared nutrition and exercise behaviors among individuals diagnosed with BPD, others diagnosed with schizophrenia, and others who did not receive diagnoses of serious mental illness (SMI). Methods: A cross-sectional study of patients who completed the VA's Large Health Survey of Veteran Enrollees section on health and nutrition in fiscal year (FY) 1999 and who either received a diagnosis of BPD (n = 2,032) or schizophrenia (n = 1,895), or were included in a random sample of non-SMI VA patients (n = 3,065). The groups were compared about nutrition and exercise behaviors Results: Patients with BPD were more likely to report poor exercise habits, including infrequent walking or strength exercises than those with no SMI. They were also more likely to self-report suboptimal eating behaviors, including having fewer than two daily meals. 

Piri, Mohsen, Shirin Zardoshtian, Shahrzad Khazaee, and Roghieh Piri. 2012. "The Effect of Eight Weeks of Aerobic Training on Reducing Mood Disorders, Depression And Mania in High School Students High School Boys." International Journal Of Academic Research In Business & Social Sciences 2, no. 1: 267-273.

Abstract: The aim of this study was to consider the effect of eight weeks of aerobic training on the reduction of mood disorders, depression and mania in boys' high school in Ilam-Iran. This was a quasi-experimental and field research taking the experimental and control groups into consideration. In this study, 60 students were randomly selected as the sample. In order to measure students' Depression and mania, multifaceted Minnesota questionnaire (MMPI-2) and depression and mania sub-scales were used. We applied both descriptive and inferential statistics using SPSS software for statistical analysis of data. The results showed that eight weeks of aerobic exercise had a significant effect on students` depressive disorders and mania. Eight weeks of aerobic exercise reduced depression and mania in experimental group of students. [Edited from the abstract written by the author]

Eriksson, Sebastian, and Gunvor Gard. 2011. "Physical exercise and depression." Physical Therapy Reviews 16, no. 4: 261-268.

Objectives: The objective was to review studies which used physical exercise as an intervention to treat major depression, focusing on methodology, mechanisms of action, types of physical exercise and treatment outcomes. Methods: A literature review from PsycInfo and PubMed databases from 2000-2010 using the key words 'major depression', 'exercise', 'outcome', 'physical activity' and 'aerobic training' as search terms. Results: Eight studies met the inclusion criteria. Seven of the eight studies showed significantly improved mood and reduced depression. Three studies measured an increase in aerobic capacity, two with correlated mood improvements. One showed a correlation between increased muscle strength and reduced feelings of depression. Conclusion: Physical exercise can be an effective treatment against depression. A mood enhancing effect of exercise was identified in the interventions regardless of the mechanism of action.  [Edited from the abstract from the author]

Bipolar Medications and Grapefruit & Citrus Juices

Although citrus juices including grapefruit juice are very good for you with their high levels of vitamin C and other nutrients, they have been known to have negative interactions with certain medications and some medications taken for bipolar disorder are included on that list. 

Certain nutrients within this family of fruits interact with medications that treat bipolar disorder (such as olanzapine) and this must be taken into consideration when deciding what fruit juice to drink. Olanzapine comes with a warning associated with the ingestion of grapefruits or grapefruit juice while on the medication because it impacts the way the body processes the active ingredient in the medication. Grapefruit juice has been known to impact the uptake (the rate of absorption) of certain substances and/or the bioavailability (how much is available to the body) of others.

Some researchers suggest that the pharmacokinetics (or intereactions) with medications is very complex and in one literature review almost 200 studies were found that studied grapefruit juice interaction and interactions were published for 40 drugs (Saito, Hirata-Koizumi, & Matsumoto et al, 2005). Another study found that due to the complexity involved in measuring intake and magnitude of interactions it was challenging to predict the extent of grapefruit product-drug interactions (Seden, Dickinson, Khoo, & Back, 2010). 

Some people with bipolar disorder  take hormone substitutes such as levothyroxine due to thyroid dysfunction, which can be a side-effect of lithium. It appears that although there is some effect of grapefruit juice on absorption of the hormone it does not impact the availability of the hormone to the endocrine system (Lilja, Laintinen & Neuvonen, 2005).

These articles and the warning labels on some medications would suggest that people taking medications for mental illness should avoid grapefruits until science can give firm recommendations. To be safe it is best to read the documentation that comes with your medication, especially the sections that describe possible interactions and side-effects. Discuss with your medical provider any risk of citrus/grapefruit interactions with any medications you are taking.

Lilja, J. L., Laintine, K., & Neuvonen, P. J. (2005). Effects of grapefruit juice on the absorption of levothyroxine. British Journal of Pharmacology, 60(3), 337-341

Saito, M., Hirata_Koizumi, M., Matsumoto, M, Urano, T., & Hasegawa, R. (2005). Undesirable effects of citrus juice on the pharmacokinetics of drugs: focus on recent studies. Drug safety: an international journal of medical toxicology and drug experience 28(8): 677-694.

Seden, K., Dickinson, L., Khoo, S., & Back, D. (2010). Grapefruit-drug interactions. Drugs, 70(18): 2373-2407.

Circadian Rhythms and Bipolar Disorder: Scientific Update

It has been some time since I wrote a post on scientific research, which was to be the focus of this blog but I expanded it into many things bipolar while staying on the science side. This post is one way to indulge my hypergraphia.

In selecting articles to review for this blogpost, I first find articles I understand as many neuroscience articles can be highly technical. Second, I find articles that have some practical utility to people living with bipolar disorder. So I tend to avoid articles that are related to mice or other animals. 

The first article is about the circadian rhythms. According to the National Institute of General Medical Sciences (NIGMS), which is a part of the National Institutes of Health (NIH), circadian rhythms are the physical, mental and behavioural patterns that closely follow a 24 hour cycle. These patterns are found in most living things including animals, plants and even microbes. Chronobiology is the study of circadian rhythms. Produced by natural factors in the body, circadian rhythms are also affected by factors in the environment with light being the most important as it controls the genetic switches that influence these patterns. Circadian rhythms influence many bodily functions such as body temperature, hormone releases and sleep/wake patterns. 


Circadian rhythm characteristics in mood disorders: Comparison among bipolar I disorder, bipolar II disorder and recurrent major depressive disorder. Chung, JK, Lee, KY, Kim, SH et al. (012) Clinical Psychopharmacology and Neuroscience, Vol 10(2), Aug, 2012. pp. 110-116.

Summary of Findings
This Korea-based study used factor analysis to study data on how people experience the rhythms of day and night and found that people with mood disorders were more likely to be evening types than people with no mood disorders. Those with bipolar disorder I were more likely to have evening tiredness than those with bipolar disorder II. Those with bipolar I scored higher for morning alertness than people with recurrent major depressive disorder (RMDD).



The second article is highly technical and the practical implications are not as explicit but the findings are worth a mention because they reinforce the link between abnormal circadian rhythm patterns and bipolar disorder.

A survey of genetic studies supports association of circadian clock genes with bipolar disorder spectrum illnesses and lithium response. McCarthy, MJ, Nievergelt, CM, Kelsoe, JR, & Welsh, DK. (2012), PLoS ONE, 7(2) 

Summary of Findings
This study acknowledges the relationship between abnormal circadian rhythms and bipolar spectrum disorders and that this has inspired the search for genetic sources for this abnormality. However, to date there have been no significant findings from this research that would link genes to these abnormalities. The researchers list 3 factors that could be a reason for this lack of significant findings: 1. complex traits usually involve more than one gene; 2. circadian rhythms may be more complicated than they first appeared; and, 3. genetic risk for bipolar disorder could be spread among many illnesses. Without going into technical detail, the major finding was that their analysis revealed previously unrecognized links between bipolar disorder and circadian rhythms.

Circadian rhythms and bipolar disorder. Murray, G. (2010). Bipolar Disorders, 12(5), 459-472

Summary of Findings
This accessible article is a review of existing literature on the relationship between abnormal circadian rhythms and bipolar disorder. It does not present anything particularly new but does reinforce what is already known.

Sleep and the Bipolar Mind

The list of symptoms for bipolar disorder as it appears in the DSM IV states that people with bipolar disorder are more likely to have problems sleeping and lack of sleep is both a cause and a symptom of bipolar disorder symptoms. Sleeplessness is a symptom of mania and although feeling tired is a symptom of depression, so are changes in sleep, which might result in sleeplessness or in sleeping too much. Not being able to sleep is also symptomatic of a mixed bipolar state.

Before or early in a bipolar episode you may experience a change in your sleep patterns, whether in quantity of hours, or the quality of your sleep – not feeling rested or frequent waking – that allow you to make the changes necessary to prevent an episode or mediate its length and severity through changes in behaviors that influence sleep. Being aware of these changes and recording them and the behaviors that accompany them will help you and your healthcare provider take the necessary steps to bypass an episode.

Once bipolar disorder has been treated people are less likely to have sleep problems. Having insufficient sleep can cause hypomania, depression and mania. Sleep loss is also a symptom of depression, mania and hypomania and thus is a significant issue for mental well-being that should be monitored by people living with bipolar disorder.  Even if you need medications to sleep you can have a better quality sleep by taking the following steps which may even help you reduce your reliance on sleep medications.

1. Develop a sleep routine to keep your circadian rhythms in order. This means going to bed and waking, and taking any medications at the same time every day, including weekends. This gets your body in a pattern of knowing when to feel sleepy and when to wake and allows you to get the amount of sleep your body needs for you to feel rested in the morning with the energy you need for your day.
2. Sleep in a cool, dark, quiet room on a comfortable bed. If there are lights or noises that annoy you then sleep with an eyeshade and/or earplugs. Or perhaps you want the soothing noise of a particular sound or music collection. Make sure your bed, pillow and linens are comfortable.
3. Exercise regularly to give your body a reason to be tired. Complete your exercise at least 2 hours before bedtime so that your body is not overheated or have an elevated heartrate near bedtime
4. Avoid caffeine, nicotine and alcohol. Caffeine and nicotine are stimulants and alcohol may help you fall asleep but interferes with sleep patterns to make your sleep less restful.
5. Relax before going to bed. Do relaxing activities before going to bed such as meditation or reading or knitting and avoid doing anything in bed but sleep and intimacy. 

Monitoring your sleep patterns may help you know what factors are helping you sleep and what factors are keeping you from a good night's rest. For a sleep log: §  http://www.helpguide.org/life/pdfs/sleep_diary.pdf

Other sleep resources: 

'Sleep Matters: The Impact of Sleep on Health and Well-Being' which is downloadable from http://www.mentalhealth.org.uk/publications/sleep-report/.

'Your Guide to Healthy Sleep' and it is available free at http://www.nhlbi.nih.gov/health/public/sleep/healthysleepfs.pdf. 

National Sleep Foundation (www.sleepfoundation.org)

American Academy of Sleep Medicine (http://www.sleepeducation.com/)

National Minority Mental Health Awareness Month

July is National Minority Mental Health Awareness Month.

So instead of creating original content for this entry, I will simply add links for sites where information and resources can be found about mental health issues among minority communities.


National Alliance on Mental Illness

American Psychiatric Association

National Network to Eliminate Disparities in Behavioral Health: Webinar

National Latino Behavioral Health Association

Black Mental Health.net

National Asian American and Pacific Islander Mental Health Association