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A quick and easy reference to help understand Bipolar Disorder James Witschner and Marcia Rose
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CELEXA
(citalopram) Celexa is a new addition to the selective serotonin
reuptake inhibitors (SSRIs). Although it is new here in the
United States, it has been in use in Europe since 1989. It
is hoped to have the same effect as other antidepressants
but with fewer less adverse reactions. Some of the side effects
are nausea, dry mouth, sweating, slight weight loss, and some
sexual problems in males. You should not be taking this medication
if you are on other antidepressants in a group called MAO
inhibitors. There should be a two-week change over time between
taking SSRIs and MAO inhibitors.
CHILDREN
WITH BIPOLAR DISORDER Bipolar disorder in children
is the same illness that adults have. In adults the moods
have a marked difference between the highs and the lows, whereas,
in children the moods are more continuous, producing chronic
irritability and few noticeable periods of being well. Symptoms
can show in early infancy with erratic sleep patterns, excessive
need for closeness of the parents and seizure-like tantrums.
Children can have many of the adult symptoms but some are
more unique to children such as: Destructive rages Rapidly
changing moods Separation anxiety Defiance of authority Hyperactivity
Distractibility Bed wetting Nightmares It has only been in
recent years that doctors have begun to regularly diagnose
children with this illness. It is suspected that a significant
number of children diagnosed with attention deficit disorder
or depression really have early-onset bipolar. It is known
that genetics and family history can be a decisive part in
diagnosing this illness. This illness can be directly linked
to a parent or it can skip a generation. A general guideline
to understand the genetic link could be as follows: 1. One
percent, more or less, would be the guideline for the general
population who will have bipolar affective disorder. 2. Having
one parent with the illness could bring the risk of any individual
to 15-30 percent. 3. Having both parents with the illness
could bring the risk of any individual to 50-75 percent. 4.
Having a sibling or a fraternal twin puts the risk at about
15-25 percent. 5. Having an identical twin would be closer
to 70 percent. The families who are involved with children
who have bipolar affective disorder are usually very traumatized
by the early onset of this illness. With adolescents, it is
sometimes a traumatic event that triggers the first episode.
Future episodes can occur when there is no obvious stress
factor involved. Puberty in itself is a high stress time for
children and can often bring about the first obvious symptoms.
Once this illness becomes apparent, other episodes will continue
and worsen without treatment. Even when it is obvious that
a child’s behavior is not normal, it can be a very difficult
and time-consuming to get a correct diagnoses. There are many
situations and/or illnesses that can mask a proper diagnosis.
If a child is not responding to a particular treatment that
has been going on for some time, it is up to the parents to
seek another solution. There can be tragic circumstances for
the child that is not properly diagnosed. The child’s ability
to function at home, school and in the community at large
can be greatly impaired. Children can be removed from school
and be placed in treatment centers when not necessary. They
can become hospitalized or become part of the legal system.
The suicide rate for untreated bipolar illness can be as high
as 20 percent. Even if there is no cure for this illness,
there is plenty of hope. When diagnosed correctly, in most
cases treatment can stabilize your child’s moods and allow
him or her to lead a happy and productive life.
COCKTAILS
It is often very frustrating to treat manic depression. What
works for one person may not work for another. Sometimes a
combination of medications are needed to be effective. Patients
as “med cocktails” or “meds” often refer these varying mixtures
to. Because many people need a combination of two or three
drugs to get stable, it can take quite some time to find the
right medications (and the right dosages of each). This is
usually on the order of magnitude of weeks or months... but
it's been known to take years to find the exact combination
and dosages that work. If the first medication you get does
not help, it does not mean you are untreatable! Work with
your doctor and make sure that he or she is listening to you.
Don’t give up! Some drugs can potentially cause relatively
severe side effects. Don't hesitate to complain to your doctor
and insist on lowering dosages or trying a new drug if the
side effects are intolerable. In particular, mood stabilizers
and antipsychotic in high doses can make you very tired and
slowed down and "zombie-like”. Don't accept this as a necessary
condition of getting well! Sometimes, as with any drug, you
will have to choose between total elimination of symptoms
and a tolerable level of side-effects; the key thing is to
communicate with your doctor about what you're experiencing
and make sure that you know all your options. Lithium is the
oldest and most common mood stabilizer and is often the first
drug you will get when diagnosed with bipolar disorder. It
tends to be fairly easy to tolerate for most people and stabilizes
50-60% of patients all by itself. Common side effects are:
lethargy, diarrhea, nausea, frequent urination, tremor, and
weight gain. The other mood stabilizers are anticonvulsants,
used primarily to treat epilepsy but are also effective in
the treatment of Bipolar Disorder. Depakote and Tegratol are
very common in the treatment of bipolar illness. Depakote
side effects are similar to Lithium but long-term toxicity
may be less severe. Some people find that Depakote gives them
depression, or intensifies existent depression. It can also
cause sexual dysfunctions in both men and women. Side effects
of Tegretol are generally more severe than for Lithium or
Depakote, but some patients who cannot tolerate Lithium do
fine on Tegretol. Tegretol is also especially effective for
rapid cycles. Antidepressants are part of most people's treatment
if their disease includes severe depression. However, those
who have bipolar disorder must use them cautiously. Although
they normally do not cause folks to get high, even when taken
in larger doses than needed, for a significant number of individuals
with bipolar disorder they can cause mania or hypomania and/or
may trigger rapid cycling. Antidepressants can take a really
long time to work--six weeks or more--and then it may take
a while to find the one which works for you, so the hardest
part about antidepressants is often the waiting! Antipsychotic
drugs also called neuroleptics or major tranquilizers, have
several uses in bipolar patients. One main use is to calm
people down in acute mania while waiting for a mood stabilizer
to work. These drugs are also used in low doses as sleeping
pills or to combat anxiety, and in higher doses for psychotic
symptoms such as hallucinations, delusions, etc. They are
also used in combination with a mood stabilizer as part of
the maintenance medications used to prevent further episodes.
The major risk with these drugs is a condition called tardive
dyskinesia--where the twitching or stiffness remains after
the drug is discontinued. This is quite rare at low doses
and when the drugs are not used for very long.
CREATIVITY
AND BIPOLAR ILLNESS There is no argument that there
can be great creativity with some that have the bipolar illness.
There have been many famous and infamous people who have suffered
and touched people through this illness. Naturally it is in
the hypo manic state that the creative individual with bipolar
disorder does their best work. Manic individuals have been
known to stop treatment because they fear that they could
lose their creativity. This is far from the truth. Treatment
can be a very constructive channel to their best work. Scientists
have gone over the work of many renowned writers, artists
and composers, finding not only the creative side of mania
but also the deadly side of suicide. Biographical studies
of the early generations have shown up to an 18 percent higher
rate of mood disorders and suicides in artist and writers.
Both manic depressive and creative persons seem to share certain
abilities. They can function on a few hours of sleep and are
still able to focus intensely on their work. They have bold,
inventive and intuitive ideas. They react with deep emotional
intensity. They have a wide perception on many ideas. Unfortunately,
if the creative individual with bipolar goes untreated severe
depression can set in. This can lead to a total loss of all
the earlier benefits of the mania and bring about all the
destruction of a depressive state. The idea that a person
can control the hypomania as needed is false. Proper treatment
is needed to allow the full benefits of the creative side
while keeping at bay the destructive side of this illness.
CYCLOTHYMIC
DISORDER This variant on Bipolar Disorder is characterized
by many episodes of Hypomania and only occasional episodes
of mild depression. The mood swings are not as severe. This
is classified as Bipolar III and can have the same destructive
problems as any mood disorder. Thirty percent of people diagnosed
with Cyclothmia disorder will eventually develop Bipolar I
or II.
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