Bipolar Disorder

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Marcia Purse
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New Link Between Stress and Bipolar Disorder

Monday May 9, 2011

A newly published study says that having a bipolar parent increases the everyday level of a key stress hormone. This might seem like a no-brainer, but in fact the study results are more interesting than that. For one thing, they weren't looking at young children, but at offspring between the ages of 14 and 28, so many of the study participants were not actually living with the bipolar parent any more - yet the stress effect continued.

"Previous research has shown that children of parents with bipolar disorder are four times as likely to develop mood disorders as those from parents without the condition," said the senior author Dr. Mark Ellenbogen. "The goal of our study was to determine how this is happening."

They already knew that high levels of the stress hormone cortisol often occur in people who later develop bipolar disorder - and that high stress levels can contribute to developing BP. What they found out in this study is that people with a bipolar parent react to both low-level and high-level stress by producing more cortisol than those with the same stress level but no bipolar parent.

Here's an illustration: Megan, age 22, has a parent with bipolar disorder. Her best friend Laura, also 22, does not. One day the two of them have a terrible fight and their stress levels go sky-high. But Megan's body produces a lot more cortisol than Laura's does. And no matter how much stress there is on a given day, any stress will consistently produce more cortisol in Megan than in Laura. Because both high cortisol levels and high stress can contribute to the development of bipolar disorder, Megan's risk of becoming bipolar is higher than Laura's.

You might say hey, we already knew that, because we know children of parents with BP are much more likely to get BP themselves. But the point is, we now have a biological mechanism that could be part of the reason they're more likely to develop bipolar disorder. These results, said Dr. Ellenbogen, might lead to finding ways to prevent the increased sensitivity from developing.

His conclusion suggests that if Megan had learned better ways to cope with stress early in life, it could make it less likely that she'd go on to develop BP. Now wouldn't that be awesome!

Sources:
C. S. Ostiguy, Ellenbogen M. A., Walker C.-D., Walker E. F., Hodgins S. Sensitivity to stress among the offspring of parents with bipolar disorder: a study of daytime cortisol levels Psychological Medicine. Published online 2011.

Pederson, Traci. Children of Bipolar Parents Have Highly Reactive Stress Hormone. PsychCentral.com. May 6, 2011.

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Abilify Study Flawed, Say Researchers - Is Long-Term Use Appropriate?

Monday May 9, 2011

Abilify is an atypical antipsychotic that was originally approved (in 2002) to treat schizophrenia. In 2004 the drug was approved to treat acute manic and mixed episodes of bipolar disorder, and in 2005 the FDA approved Abilify for long-term maintenance therapy in bipolar disorder.

Now Harvard University researchers say that the 2005 approval was based on a single clinical study that had serious flaws. Psychiatrist Alexander C. Tsai, M.D., one of the lead authors of the current review, said the methodology was biased in favor of Abilify and the study was too short to give credible information about long-term use. In addition, that single study was funded by the companies that developed and market Abilify.

This does not mean you should stop taking Abilify immediately. Rapid withdrawal can cause serious side effects, for one thing. For another, says Dr. Tsai, "It may actually be working for some people. But it's certainly worth talking to your doctor about how it's working for you."

Dr. Tsai said his main concern "is that patients are getting diverted from more effective treatments." He also commented on the high cost of Abilify and said, "Frankly, I think it's an embarrassment to the profession that [Abilify] has been accepted so uncritically for this indication."

In their discussion of the study, the researchers wrote, "This lack of robust evidence of [Abilify's] benefit should be weighed against the potential for long-term harms that have been described with other antipsychotic medications and adverse events related to aripiprazole use, including tremor, akathisia, and significant weight gain." A spokesman for Bristol-Meyers Squibb said that there are other unpublished studies demonstrating the long-term benefits of Abilify that they will now make available. And a spokesman for the FDA said the agency will review the Harvard study.

Sources:
Tsai AC, Rosenlicht NZ, Jureidini JN, Parry PI, Spielmans GI, et al. 2011 Aripiprazole in the Maintenance Treatment of Bipolar Disorder: A Critical Review of the Evidence and Its Dissemination into the Scientific Literature. PLoS Med 8(5): e1000434. doi:10.1371/journal.pmed.1000434

Peeples, Lynn. Long-Term Use of Bipolar Drug Questioned. Health.com. May 3, 2011.

Disturbing Story from "Blessed With Bipolar" Author

Friday May 6, 2011

Richard Jarzynka, author of the book Blessed With Bipolar, tells a disturbing story of being held in psychiatric hospital and mistreated. He says he had gone to the hospital's Diagnostic and Evaluation Center - apparently an emergency room - for a problem unrelated to his bipolar disorder but was not allowed to leave. He was then manhandled by employees.

Jarzynka plays down the fact that he kicked the locked exit door a few times when told he couldn't leave, which probably led the security guards to believe there was a potential for him to become violent. What isn't clear is why he wasn't allowed to leave in the first place. Going to a diagnostic center to discuss restless leg syndrome, as he says, is not "voluntarily" going into an emergency room for symptoms of bipolar disorder.

Richard says he filed a grievance with the hospital, and since there was no resolution, has now filed a civil lawsuit against them.

Although nothing like this has ever happened to me, I have had physical symptoms blamed on bipolar disorder when there was no reason to do so. Has this happened to you? I invite you to share your stories:

Doctors Who Blame Bipolar Disorder for Physical Symptoms

Read Richard Jarzynka's blog on the incident: Psych Hospital Sued for False Imprisonment

Compare Prices: Blessed With Bipolar by Richard Jarzynka

Genetic Risk of Suicide in Bipolar Disorder

Monday May 2, 2011

Researchers at Johns Hopkins university say they've identified a gene variant that makes people with bipolar disorder more likely to attempt suicide.

The scientists looked at DNA from about 2,700 people with bipolar disorder where about half had attempted suicide and half had not. They found that the people whose DNA had a particular gene variant were from 1.4 to 3 times as likely to have attempted suicide, depending on how many copies of the variant were present. Studying additional DNA from over 3,000 more people with bipolar disorder confirmed these findings.

This particular gene "is thought to influence the same biological pathway as lithium, a medication known to reduce the rate of suicidal behavior."

Virginia L. Willour, PhD, the leader of the study, said, "What's promising are the implications of this work for learning more about the biology of suicide and the medications used to treat patients who may be at risk. Not everyone with bipolar disorder can take lithium because of its side effects. If we could give them another option, that would be fantastic."

Since the rate of suicide and attempted suicide is far higher among people with bipolar disorder than for the general public, research like this could be crucial for saving lives. Willour says more such studies, with larger samples, are needed, but that the results are very promising.

Source: Newswise