Written by Nadia Norcia Radovini, communications advisor at Sunnybrook Health Sciences Centre.
March 30 is World Bipolar Day and we've set out to address some myths about the condition.
In the first days of spring, we are eager to store away our shovels and look forward to warmer weather.
"Most people will notice a slightly improved mood when the days get longer in the spring, and, unfortunately a slight dip in happiness when cold weather hits in late fall," says Dr. Mark Sinyor, a psychiatrist at Sunnybrook. "But for people with mood disorders, particularly bipolar disorder, these weather changes can sometimes have a much bigger impact."
We called upon Dr. Sinyor and his colleagues, who specialize in treating bipolar disorder at Sunnybrook, to further describe this seasonal effect, and also to help more generally demystify this psychiatric condition for us.
"Sunlight works as an antidepressant and, when light levels rapidly drop in the autumn months, people with bipolar disorder can become depressed," explains Dr. Ayal Schaffer, head of the Mood & Anxiety Disorders Program and Deputy Psychiatrist-in-Chief at Sunnybrook. "On the other hand, when 'spring forward' happens and the amount of sunlight increases, people with bipolar disorder can have the opposite reaction and experience mania, which is a state of abnormally elevated or irritable mood, arousal and/or energy levels that can have an effect on their functioning and relationships with others."
These seasonal fluctuations are more common the farther away you are from the equator, adds Sinyor, probably because weather patterns change the most at the poles and are much more consistent year-round at the equator.
Over the last 20 years, substantial progress has been made in understanding this psychiatric condition but there remains some confusion and mystery around it; the doctors help us address some of the more common myths:
Myth: Symptoms of bipolar disorder in youth are caused by hormone changes, conflict with parents, and/or peer problems
Hormonal changes, conflict with parents, and peer problems are almost universal among teens. And yet, at least 95 per cent of teens do not experience symptoms of bipolar disorder.
"Although such factors as hormones and stress can influence the timing of the onset of bipolar disorder, they do not in and of themselves cause it," says Dr. Ben Goldstein, director of the Centre for Youth Bipolar Disorder at Sunnybrook.
Bipolar disorder is among the most heritable medical disorders, meaning it tends to run in families. "Minimizing stress and optimizing family and social relationships can, however, help to keep mood stable among teens who have bipolar disorder," adds Goldstein.
Myth: Bipolar disorder is a harmful label to give a teenager
"Medical diagnoses such as bipolar disorder should be made only after a comprehensive assessment," says Goldstein. "When warranted, a diagnosis of bipolar disorder helps identify appropriate treatment. In contrast, not making the diagnosis of bipolar disorder when it is warranted can potentially lead to treatments that are unhelpful or even harmful for teens with bipolar disorder."
Most teens with bipolar disorder have struggled with mood problems for years before they are diagnosed. Teens are often relieved to "finally have an answer" about the reason for their symptoms, and having an appropriate treatment plan instills hope that there can be smoother roads ahead.
Myth: Little can be done to prevent suicide in people with bipolar disorder
Unfortunately, it's true that people with bipolar disorder have one of the highest lifetime risks of suicide among those with mental illness. "Much of that is probably because depression and feelings of hopelessness are often a part of bipolar disorder and these things also put people at risk for suicide," says Sinyor.
"However, there is no reason that anyone with bipolar disorder has to die from suicide. There are many effective treatments for bipolar disorder and bipolar depression. Our understanding of the illness and how to treat it is improving every year and we know from experience that someone can be very suicidal at one moment, but with proper treatment that can change, in some cases rapidly. Depression and mania are reversible conditions and suicidal thoughts and behaviours should be a signal that someone needs treatment, not that they need to die."
Myth: Lithium is a dangerous drug that should not be used in older adults with bipolar disorder
Evidence-based medicine shows that lithium is one of the most effective mood stabilizers and is universally recommended as a first line treatment for bipolar disorder. "Unfortunately, excessive concerns about kidney damage and toxicity have resulted in a significant decline in its use and hence many bipolar patients are being denied a potentially useful treatment," says Dr. Ken Shulman, psychiatrist and Chief of the Brain Sciences Program at Sunnybrook.
"While there are legitimate concerns about lithium in older adults, careful monitoring and use of lower dosages and blood levels can minimize potential complications and provide mood stability for many older bipolar patients." Recent evidence suggests that lithium may even have neuroprotective properties and may reduce the risk of dementia in mood disorder patients who are at increased risk for developing dementia.
Myth: Bipolar disorder is a condition you're constantly stuck with; there's nothing you can do about it
"The vast majority of people with bipolar disorder will experience recoveries (several consecutive months without symptoms)," says Goldstein. "However, most will also have recurrences of bipolar disorder (new episodes after a period of recovery). Adhering to treatment with medications and therapy, avoiding or minimizing substance use, and leading a balanced lifestyle with healthy sleep, exercise, and nutritional habits can help minimize the impact bipolar disorder has on the lives of individuals with bipolar disorder."
- Bipolar disorder and treatment options - Sunnybrook Says post
- 3 ways to boost your mood in winter - Blog & video
- Bipolar disorder and heart disease: what's the link? Blog & video
- Anxiety and its Treatment Across the Lifespan - Sunnybrook Speaker Series Event
- A Patient Writes: "I am Dead Inside." When a Mental Health Issue Requires a Second Opinion
- Department of Psychiatry at Sunnybrook
Find more mental health information and resources from Sunnybrook experts at health.sunnybrook.ca
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If a friend is blowing her paycheck on shopping sprees she can't afford, watch out. A person in a manic phase of bipolar disorder is more likely to take big risks, including spending splurges that can lead to mountains of unmanageable debt.
A sudden revving up of a person's sex drive, obsessively thinking or talking about sex, or engaging in sexual encounters he otherwise wouldn't (like a one-night stand or sex with someone he doesn't know well) are all symptoms of hypersexuality, another less-obvious mania clue.
These often go hand-in-hand with manic episodes: As many as 60 percent of people with bipolar disorder have abused alcohol or drugs at some point in their lives. Depressants such as alcohol or pain pills can send a person with mania straight into depression, while stimulants like cocaine can have the opposite effect.
Little need for sleep is another red flag that a person may be having a manic episode.
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