Bipolar and Shorter Life Expectancy - Rounding Up the Usual Suspects

Patient Expert

Last week, we looked at three studies that indicated that people with serious mental illness can expect to lose anywhere from nine to 25 years of life. The one study that looked at those with bipolar in particular suggested 10-11 lost years.

The studies were based on data from patients in the mental health system in various jurisdictions. The deaths by and large were from medical conditions such as respiratory and cardiovascular diseases. In one of the studies, the authors observed that the impact of serious mental illness on life expectancy is higher than for smoking, diabetes, and obesity.

Of course, these studies do not take into account patients who do well and leave the mental health system. In all probability, these would be the very people whose lifestyles and circumstances are conducive to longer lives.

Yet, clearly we are at risk. The studies did not identify any specific causes and effects, but it's fairly easy to round up the usual suspects. Let's begin:


Stress has to be public enemy number one. Stress releases glucocorticoids and adrenalin into the bloodstream, which prime the body for handling emergencies. In Why Zebras Don't Get Ulcers, Robert Sapolsky of Stanford University points out that in dealing with the crisis at hand, the body in essence ceases work on its long-term building projects (such as making bone marrow) in favor of stoking the heart and lungs, waking up the brain, and delivering instant energy to the muscles.

This is a small price to pay for not getting eaten by a bear. Soon enough the system resets to normal. But constant exposure leads to chronic stress, which impacts every organ system in the body. Soon, we are living our lives as if there is a bear around every corner.

On a more micro level, glucorticoids have a way of overwhelming individual cells. Constant bombardment undermines the maintenance systems of these cells, which makes them vulnerable to the next round of stress. Over time, entire cell networks (including neural pathways) are compromised.

Perhaps we should view mental illness as "vulnerability to stress disease." Our population tends to be the first to panic and last to settle down. The pressure builds. Something has to give: The heart, the immune system, the brain ...

You've heard it once, you've heard it a thousand times: Learn how to manage stress. Seek out friendlier environments. Take breaks. Find out which particular stress-busters (mediation, yoga, hobbies, music, supplements, as-needed meds) work best for you. You know the drill.

Bad lifestyle choices and risky behavior

This is a simple counting exercise. People with bipolar and depression smoke more than the general population, drink more, and use more street drugs. In addition, we are less inclined to do what our doctors tell us (such as eat right and exercise) and far more likely to tempt fate (such as engaging in casual sex).

If only we could just stop. The catch is most of us lack incentive. We simply don't care if we live to age 85. We are just trying to get through the day, any way we can. (See Dean Ornish's take on this here.)

Socio-economic fall-out from mental illness

Perhaps the main side effect of mental illness is poverty. Bye bye middle class life. Hello poverty-related diseases and conditions - asthma, obesity, malnutrition, on and on and on.

Medications side effects

A good many psychiatric meds are weight-gainers. The newer antipsychotics, in particular, are notorious for risk of obesity, metabolic syndrome, and diabetes. Lithium poses a danger to the thyroid and kidneys. Some meds may interfere with sleep. Others may turn us into zombies. Others carry warnings about the small possibility of strange stuff happening. Often strange stuff happens with no warnings.

Sometimes, we have no choice but to accept certain trade-offs. Too often, though, we are subjected to doctors who refuse to listen. It works the other way, too. Too often, patients don't speak up.

Social isolation

We were built to be around people, built to love, built to be loved. People in committed relationships live longer. Alas, we tend to find ourselves marginalized, living on the fringes, sleeping alone.

Pessimism and despair

Here's the money quote from a 2004 article on WebMD:

Researchers found that compared with people who reported a high level of pessimism, those who were very optimistic had a 55% lower risk of death from all causes and a 23% lower risk of heart-related death.

See how that works when you're depressed. See how that works when the cumulative effects of your condition - day in, day out - sap the last of your vital reserves and rob you of the will to live.

But here's the funny thing ...

If you're like me, you're probably wondering why you're not dead yet. When all is said and done, all things considered, it's amazing how resilient we are, amazing what strengths we have. Somehow, we have a way of falling down seven times and getting up eight. If people only knew. No, they'd never believe us.