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Emotional extremes

Bipolar disorder, often misdiagnosed as simple depression, can worsen with antidepressants.

November 04, 2002|Benedict Carey | Times Staff Writer

The ideas come in a swarm, and they can be good ones: Move to Prague and teach English. Study jazz piano in the early-morning hours. Start a dot-com; hike the Appalachian Trail; write an opera.

"I wanted to save people," said Agnes Zsigovics, 28, a student in social work living near San Diego, who in her early 20s made plans to teach children living in the mountains of Venezuela -- only to ditch the idea at the last minute and fly to Montreal to teach Spanish. "I just had way, way too many projects in my head.... I can tell you this: People with bipolar disorder have the most interesting lives."

They can also have dangerous lives. Bipolar disorder is another name for manic depression, an incurable, lifelong mental condition in which people zigzag from these effusive emotional highs to paralyzing periods of despair, often accompanied by thoughts of suicide. Recent studies suggest that as many as 10 million Americans are afflicted with the condition to some degree -- far more than previously thought. The illness goes unnoticed or undiagnosed in many people because their manic episodes are neither dramatic nor especially destructive, psychiatrists report. The findings have prompted a wave of research into new drug and talk therapies and an increased willingness among psychiatrists to seek guidance from patients and their families.

For The Record
Los Angeles Times Tuesday November 05, 2002 Home Edition Main News Part A Page 2 National Desk 12 inches; 439 words Type of Material: Correction
Photo credit -- In Monday's Health section, the photo illustration for the story about bipolar disorder was incorrectly credited. It was taken by Times staff photographer Anne Cusack.
For The Record
Los Angeles Times Monday November 11, 2002 Home Edition Health Part F Page 8 Features Desk 1 inches; 63 words Type of Material: Correction
Photo credit -- Last week's photo illustration for the story about bipolar disorder was incorrectly credited. It was taken by Times staff photographer Anne Cusack.

"What we're learning is that patients do a lot better if they're collaborating on their own treatment," Dr. Gary Sachs, lead investigator of a large national study that is following about 2,500 patients with bipolar disorder and comparing treatment approaches.

Preliminary evidence from the trial, sponsored by the National Institute of Mental Health, suggests that patients are the best judge of what triggers their manias and that their family and friends are crucial allies in managing the disorder. "It's as if you're co-managing a baseball team, working together to decide which combination of drugs and therapy work best, and when," says Sachs, director of the bipolar treatment program at Massachusetts General Hospital.

For half a century doctors have treated bipolar disorder with regular doses of lithium carbonate, a naturally occurring mineral that acts in many patients like a steady hand on the emotional tiller. Though neurologists don't yet know how bipolar disorder develops, the mood swings have been linked to tidal shifts in the levels of chemical messengers in the brain, such as serotonin, glutamate and dopamine, which help people experience emotions. Lithium appears to calm these chemical waves, and in the process has spared uncounted millions from suicidal thoughts. Actress Patty Duke, in her autobiography "Call Me Anna," which describes her battle with bipolar disorder, calls lithium her savior, a drug that rescued her from probable suicide.

People with untreated bipolar disorder are about 30 times more likely to commit suicide than the overall population, in which 12 of 100,000 take their own lives. Even patients who receive treatment experience frequent relapses, and many will plunge into drug and alcohol abuse, or contemplate suicide, psychiatrists say. Often, the relapse can be due to the treatment itself. Researchers at the New York State Psychiatric Institute reported in June that about one of every three bipolar patients who visited psychiatrists during the 1990s received no mood-stabilizing medication. Many got only antidepressants. The problem is, while antidepressants may lift the mood of someone with bipolar disorder, they also often propel them into a manic episode and depressive rebound, accelerating their cycles and making the problem worse, researchers and patients say.

For all its power to dampen mood swings, lithium also fails to prevent relapse in at least half of people with bipolar disorder, according to Dr. Mark Rapaport, a psychiatric researcher at UC San Diego.

But in the last several years doctors have begun to experiment with a variety of anticonvulsant drugs, which appear to be effective at stabilizing mood swings, decreasing the frequency of both depression and mania, he said.

In the federal study led by Sachs, researchers have found that the suicide rate over two years is about half of what doctors would expect to see in a group of bipolar patients receiving treatment. Researchers attribute some of this improvement to the careful attention patients are getting, which likely has a soothing effect. Another possible factor is that about one in four patients is taking lamotrigine, a drug used primarily to control seizures in people with epilepsy. "This drug appears to be especially useful in preventing people from relapsing into the depressive phase," Rapaport said.

In other trials, drugs such as valproic acid (Depakote) and olanzapine have also proved useful in some patients as mood stabilizers.

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