Samantha Wargo

Bipolar Disorder

Bipolar disorder is a mental health disorder that affects many people every year,

anywhere between 0.5-1% of the population. Scientists believe it a disease complexly

rooted in genetics, although the exact how and why are not currently known. The

symptoms of this disease can range from one extreme of feelings to the complete

opposite. Scientists and doctors are not in complete agreement on how to treat this

disease. Some believe antidepressants alone are enough, while some believe more

therapy and/or medications in combination are needed. The use of antidepressants as a

common therapy to treat bipolar disorder is controversial due to the lack of evidence

regarding the effectiveness in treating the disease.

 A) Bipolar disorder is characterized by severe changes to the mood levels, energy

levels, or every-day activity levels of a person. The person experiences manic episodes

(extremely happy), depressive episodes (extremely sad), or mixed episodes (extremely

sad but also extremely energized) (National Institute of Mental Health, n.d.).

B) Some common illnesses seen in patients with bipolar disorder are

hypertension, diabetes, thyroid disease, and migraines. These illnesses can be related

most likely because of smoking, obesity, and anxiety disorders that are prevalent in those

with bipolar disorder (Saunders & Goodwin, 2010).

C) Scientists believe that bipolar disorder is a multifactorial disease but the cause

is strongly rooted in genetics. The heritability in relation to the concordance rate

approaches 1, which means that it is a trait largely determined by genes (Jorde et al.,

2016).

D) Several genes on multiple chromosomes are thought to be involved with

bipolar disorder. Voltage-gated calcium channel genes appear to be the best choice for

research (Jorde et al., 2016).

E) The prevalence of this disorder is approximately 1/100 to 1/200 people in the

population (Jorde et al., 2016).

F) To determine if one has bipolar disorder, a doctor will conduct a physical

examination, an interview, lab tests- to rule out other things that may cause problems

with ones mood- and a mental health evaluation (National Institute of Mental Health,

n.d.).

G) Treatment could involve one or all of the following: mood stabilizers,

antidepressants, atypical antipsychotic medications, psychotherapy, and

electroconvulsive therapy, but only in the case that other treatments do not work or

cannot be used (National Institute of Mental Health, n.d.).

H) This mental illness tends to be lifelong, with over 50% of patients having

recurring incidents while 16% recover, meaning not having an episode for 5 years.

Mortality associated with bipolar disorder comes from the patient committing suicide,

with 35% of patients attempting suicide and 8% succeeding (Saunders & Goodwin,

2010).

I) There is not just one type of bipolar disorder, there are many subcategories.

These are: bipolar I disorder, bipolar II disorder, bipolar disorder not otherwise specified,

cyclothymic disorder, and rapid-cycling bipolar disorder (National Institute of Mental

Health, n.d.).
 It seems as though a lot of research has been done with bipolar disorder in its

relation to the use of antidepressants, but not a lot of concrete evidence has come from

that. Most studies done on antidepressant treatment have concluded that there is not

enough evidence to say one way or the other what should be done. The use of

antidepressants as a common therapy to treat bipolar disorder is controversial due to the

lack of evidence regarding the effectiveness in treating the disease.

When treating bipolar disorder, doctors use medications and/or therapy.

Medications typically used are mood stabilizers, antidepressants, and atypical

antipsychotics (National Institute of Mental Health, n.d.). Monotherapy, the treatment

with one drug, is seen in 5-10% of patients. Almost 50% of patients are treated with 3 or

more drugs and/or therapies (Saunders & Goodwin, 2010). When using antidepressants

alone, it is thought that it can have the effects of switching from depression to mania or

create the rapid-cycling disorder. Rapid-cycling disorder is a subcategory of bipolar

disorder that is categorized by four or more episodes of mania, depression, or mixed

states in one year (National Institute of Mental Health, n.d.). In 10-30% of patients, the

use of antidepressants did cause mania (University of Maryland Medical Center, n.d.). A

manic episode is the extremely happy mood, the opposite of a depressive state (National

Institute of Mental Health, n.d.).

With this statement, it can be controversial itself. A person with bipolar disorder

is predisposed to going from one extreme to the other, so how can one determine if this is

really the result of the medication or the disease itself? If a patient has had both

depressive and manic episodes then how is one to know the difference from them

experiencing a bipolar episode or an antidepressant-induced episode. That being said, if

there is evidence that antidepressants are the cause of mania then it could be that the

medicine is not working, working the wrong way, or not working well enough. Most

studies report that there is not enough solid evidence to say whether antidepressants work

or do not work.

One study done, compared the use of mood stabilizers and antidepressants to just

mood stabilizers. The scientists determined that in both cases, the patients recovered

approximately the same. It is mentioned that more long term studies were needed. So in

this case, results were inconclusive because the amount of patients recovered was almost

the same whether antidepressants were used or not (Sachs et al., 2007). In another study,

The International Society for Bipolar Disorder made claims that due to limited data they

could not endorse antidepressant use but it did appear that patients could benefit from

those in combination with mood stabilizers (Pacchiarotti et al., 2013). A mood stabilizer

is a drug that is commonly used in mental illnesses because it decreases abnormal brain

activity (National Institute of Mental Health, n.d.). The International Society for Bipolar

Disorder is a group that was created to promote awareness and education about bipolar

disorder to professionals in the health field. This group has representatives in almost 20

countries and is a major contributor to research and data (The International Society for

Bipolar Disorders, n.d.).

 All in all, using antidepressants as a common therapy to treat bipolar disorder is

controversial because evidence is lacking regarding the effectiveness in treating the

disease. With a disease as complicated as this, although extensive research has been done,

much is still unknown. Scientists have failed to agree whether antidepressants are a

beneficial treatment due to their possibility of causing manic episodes as well as their

actual effectiveness of treating bipolar disorder.

 References

The International Society for Bipolar Disorders. (n.d.). About ISBD. Retrieved from

http://www.isbd.org/about

Jorde, L. B.., Carey, J. C., & Bamshad M. J. (2016). Medical Genetics (5th ed.). Philadelphia,

PA: Elsevier.

National Institute of Mental Health (n.d.). Bipolar Disorder. Retrieved from

https://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml

Pacchiarotti, I., Bond, D.J., Baldessarini, R. J., Nolen, W. A., Grunze, H., Licht, R. W., .... &

Vieta, E. (2013) The International Society for Bipolar Disorders (ISBD) task force report

on antidepressant use in bipolar disorders. Am J Psychiatry, 170(11), 1249-1262. Doi:

10.1176/appi.ajp.2013.13020185.

Sachs, G.S., Nierenberg, A. A., Calabrese, J.R., Marangell, L.B.,Wisniewski, S. R., Gyulai, L.,

. & Thase, M. E. (2007). Effectiveness of Adjunctive Antidepressant Treatment for

Bipolar Depression. The New England Journal of Medicine, 365, 1711-1722. Doi:

10.1056/NEJMoa064135

Saunders, K. E. A., & Goodwin G. M. (2010). The Course of Bipolar Disorder. Advances in

Psychiatric Treatment, 16(5), 318-328. Doi: 10.1192/apt.bp.107.004903

University of Maryland Medical Center (n.d.). Bipolar Disorder. Retrieved from

http://umm.edu/health/medical/reports/articles/bipolar-disorder