Bipolar disorder is characterized by episodes of acute illness followed by periods of complete, or nearly complete remission. An episode of mania tends to last for a shorter period than an episode of depression. Without treatment, mania lasts for around four to six months, whereas an episode of bipolar depression lasts around six to nine months. That said, the duration of both types of episode are known to last up to two years or more, although this is much more typical of a depressive episode. With medical intervention the clinical course looks different. So, an episode of mania is generally responsive to treatment within two to four weeks, but this relies on prompt recognition and action.
The duration of a bipolar depressive episode can be reduced by many weeks if treated with antidepressants. The big dilemma is the known clinical effect of hastening the onset of hypomania or mania. This on-off pattern of medication is implicated in rapid cycling episodes. Rapid cycling is more common in women.
Gary Sachs, MD is director of the bipolar research program at Massachusetts General Hospital and Assistant Professor of Psychiatry at Harvard Medical School. He points out that, across a lifetime, a person with bipolar will experience an average of 8 to10 episodes, with between four to six years typically separating the first and second episodes. As the person ages, the ‘interepisode interval' gets shorter between the second and fifth episodes. After this point the interepisode interval can be as short as 18 months. However, to focus only on average figures does tend to ignore what can be some pretty meaningful differences. Sachs states that 10 to 15 illness-free years are about as common as annual episodes from the outset.
It is estimated that as much as 60 percent of people with bipolar also have an alcohol or substance abuse problem. These appear to be as much a risk factor as they are a consequence of bipolar. The fact that they coexist has the effect of lengthening the duration of episodes.
In terms of health and life expectancy. it's a sad but undeniable fact that bipolar disorder is strongly associated with premature death. Sachs suggests a lifetime risk of suicide as high as 20 percent. Other health issues are implicated with drug and alcohol use, but also the fact that medication is implicated in weight gain and lithium in particular can have adverse effects on kidney function.
My closing notes relate to family history and modern lifestyles. It is well documented that bipolar disorder runs in families. The genetic mechanisms have still to be understood although pieces of the puzzle are gradually being revealed. In terms of personality, nothing has yet been revealed to suggest that any specific type or trait is more or less predisposed to bipolar. One factor known to be influential in triggering bipolar events is stress. Stressful life events coupled with poor social support is a recipe for relapse. Alifestyle that can promote healthy living, regular sleep and reduce triggering the stress response system, is far more preferable.
Published On: August 18, 2010
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