Looking at the Bipolar Life-Cycle: A New Study Sheds Light
Most of us first experienced bipolar some time around our late teens-early adulthood. But if we cast our minds further back, in hindsight we can spot the early warning signs from years earlier. The pattern may go something like this:
Weird behavior when we were in grade school - moodiness, attention or anxiety issues, maybe stuff our teachers didn’t approve of. Even if we excelled or did well or had friends, we just knew we somehow didn’t fit in.
By the time we hit our teens, we had resigned ourselves to the fact that we were irredeemably different. The moodiness and all the rest ramped up. If we hadn’t experienced full-blown depression before, we were experiencing it now.
The only thing that was missing was that manic or hypomanic episode. But if we were dealing with raging hormones and whatever else passed for normal teen behavior, then everyone else missed it, too.
Maybe we somehow managed to scrape through high school with decent enough grades to get into college. Here, though, it all caught up with us. Combine a vulnerable brain with a drastic change in environment, and next thing, mid-semester, our parents are driving us home.
Or maybe it all blew up on us when we hit the work force. Life transitions are killers. That dream entry-level job, the one with zilch pay and high pressure and 100-hour weeks, how did that one turn out?
In a piece from earlier this year, we discussed brain development, what may be taking place under the hood as we transition from child to teen to adult. According to the theory, our brains may not have finished the task of laying down fully mature neural networks - the type we need to modulate our moods and impulses, not to mention sleep.
The people who study brain development don’t necessarily regard us as victims of biological fate. Rather, they ask us to view our worrying child and teen behaviors as part of the natural life-cycle of our illness.
The experts refer to this under-the-radar behavior as “prodromal.” Basically, they are validating our own recollections, all that weird stuff that went on with us before we became fully symptomatic.
But suppose we could identify our illness early in its life-cycle - in the prodromal phase - and intervene? This raises the scary scenario of giving drugs to apparently well kids. But the intervention could be a lot more benign - say by allowing at-risk teens the sleep they need for their brains to complete their long-term building projects.
If this means changing their school starting times to 11 AM, so be it.
An ongoing study (journal articles here and here) led by Anne Duffy of the University of Calgary lends strong support to “the developmental trajectory” of bipolar. Back in the early 2000s, Dr Duffy and her colleagues recruited 229 children who had one bipolar parent and tracked them for up to 16 years.
Although these children constituted a high-risk population, the vast majority did not develop bipolar. Of those who did, clear patterns emerged, in a series of stages:
During childhood, well states followed by non-mood disturbances, such as anxiety and sleep.
Into adolescence, we find minor mood disturbances and adjustment issues. Later, we see major depression breaking out. We also see evidence of substance use.
Mania was a rare event, typically appearing in late adolescence and early adulthood.
Eight in ten of those who developed bipolar began with a depressive episode. For these individuals, a bipolar diagnosis did not occur until age 21.
Interestingly, children of lithium non-responders were more likely to develop psychosis than the children of lithium responders.
The study authors strongly urge that clinicians ask their patients about “early natural history and evolution of psychopathology” and to take into consideration family history. The implication is that early intervention would lead to far better outcomes.
Let’s bring the discussion back to you. You are the ones with the lived experience. Looking back, knowing what you know now, how does this blog post resonate with you? If someone could have picked up an early-warning sign in you, say when you were age 11 or 12, and had there been an effective preventive intervention, would your life have turned out differently?
What about our current crop of kids? Do you think we can do anything for them? Should we be jumping up and down screaming from the rooftops right now? Or should we say nothing and wait?
No easy answers, here …
John is an author and advocate for Mental Health. He wrote for HealthCentral as a patient expert for Depression and Bipolar Disorder.