Ask The Clinic: Answers
Here are some answers to your recent questions about...
Do all people with bipolar disorder need to take medication for the rest of their lives?
90% have recurrent episodes, so preventive treatment is recommended.
For someone with Bipolar, are their mood swings or irrational behavior worse when they are not feeling well? (if they have a cold or stomach illness)
Physical illness can make mood symptoms worse or some (e.g. thyropid disease) can even mimic a mood disorder.
Nutrition
Can bipolar disorder be effectively treated with natural dietary supplements? It has been suggested that particular supplements might help, but the research so far has yielded no clear answers. The omega-3 (“essential”) fatty acids, found in flaxseed oil and fish oil, affect cellular systems related to those affected by lithium and valproate (Depakote). Studies, however, have had variable results and are inconclusive about whether they effectively treat bipolar disorder. There may also be danger involved with overconsumption, particularly with fish oil, and moderation is advised.
Inositol also occurs naturally and affects cellular systems similar to those affected by lithium. Once again, the research is inconclusive for inositol as a potential treatment for bipolar disorders. Researchers have also looked at the vitamin folate, which the body uses to form the nutrient SAMe. Scientists observed low levels of red blood folate in patients with unipolar depression. Studies of folate as an anti-depressant in unipolar depression have been inconclusive, however, and there have been no studies of the vitamin specific to bipolar depression. As for SAMe, which is available over-the-counter as a dietary supplement, doctors in Europe have been prescribing it as an antidepressant for over 30 years. Some data suggests, however, that SAMe can cause mood elevation. St. John’s Wort, perhaps the best-known nutritional supplement potentially related to mood disorders, may present similar problems for bipolar patients, and studies of the substance in bipolar treatment are lacking. Studies of St. John’s Wort for unipolar depression have been inconclusive.
Diagnosis
How is bipolar disorder diagnosed? Well, that is the million dollar question! We are looking for genetic tests and brain scan tests, but really the brain is too complex to have a single, simple, easy to interpret test to make the diagnosis. That's the goal, but we're not there yet. Right now, the diagnosis is still clinical, meaning a trained healthcare professional needs to understand what clinical symptoms are present and make a diagnosis from there, after considering other alternative explanations too.
However, several self-rating forms can increase your suspicion. The Mood Disorders Questionnaire (MDQ) is a good initial screening tool. The main point to keep in mind is that the MDQ is not definitive for a diagnosis, but can lead one to seek the right type of healthcare professional for evaluation. Hopefully, in the future we will have tests that say "if you are positive in this test, then you have an increased risk of having bipolar."
Genetics
How genetic is bipolar disorder is well known. Which genes are involved and how do they cause bipolar is not known at the current time. Out of all psychiatric illnesses and most other medical illnesses, bipolar disorder is highly genetically based. In identical twins (same genes, same fetal environment, similar general childhood environment), the chance of both twins having bipolar disorder is up to 70%. In comparison, in fraternal twins (half of the genes are the same, but everything else is pretty much the same - same fetal environment and similar general childhood environment), the chance of both siblings having bipolar is down to 20%. That means that genetics plays a huge influence on bipolar disorder, maybe more than environment. As we get farther away, genetically speaking, the number of shared genes decreases and so does the risk. Therefore, parents or siblings having bipolar disorder puts the risk at up to 20% for children and siblings. For uncles, aunts, or grandparents, the risk goes down further to a maximum of 10% or so. One last point to keep in mind is that even though genetics are so important, except for identical twins, there is still a majority chance of NOT getting bipolar disorder; and treatments and therapy now are much better than in the past.
Unipolar vs. Bipolar Depression
Is there a difference between unipolar and bipolar depression? Yes! Not only are there brain and chemical differences that are being found in research, but the treatments may be quite different. In the past, and maybe even in some clinical practices now, antidepressants are used for any type of depression. However, whereas antidepressants are known to be useful for unipolar depression, the jury is still out on how good antidepressants are for bipolar depression. Some people even think that antidepressants may make bipolar disorders worse. That's why it's so important to have a good relationship with your healthcare professional.
Internal Staff Login