Sanjay Gupta, MD, Everyday Health: What is bipolar illness, how do you define it?
Katherine Burdick, PhD, Associate Professor, Psychiatry, The Icahn School of Medicine at Mount Sinai: Bipolar disorder is largely distinguished from major depression because it has what they refer to as both poles, both the depression as well as the acute mania. You see fluctuations between patients experiencing euphoria or heightened irritability and very increased levels of energy, lack of need for sleeping, the side of what we think about is mania, in contrast to the exact opposite pole, which is the depression. It’s an episodic illness, so what we see are patients who have acute periods followed by what tends to be at least some periods of recovery.
Dr. Gupta: Is there some sort of existing pattern of cycling?
Dr. Burdick: We tend to see, if untreated, episodes of depression that last I think on average about nine months. With adequate treatment, it can be much shorter than that. Manias in contrast tend to last slightly shorter, but they also tend to be more disruptive in patients’ lives. We do know that if mania is your first episode that the course of your illness tends to be predominated by mania. You’ll have more manic episodes than you’ll have depressed episodes, and the opposite is true.
Dr. Gupta: Who is the typical patient, and when do they first start to have symptoms?
Dr. Burdick: The short answer is there is no typical patient. What we tend to see is an onset somewhere around the mid-20s. Many patients do very, very well in school all the way through high school. Problems start to occur sometime either in late college or even in the beginnings of the first job that they may have after college
Dr. Gupta: Bipolar 1 and bipolar 2. What are the differences?
Dr. Burdick: So the differences tend to be the severity of the mania, whether or not a patient ever experiences what we think of as full-blown mania. Patients with bipolar 2 never develop that full mania.
Dr. Gupta: Someone’s diagnosed and it’s a clear diagnosis. Do they have to be on medications?
Dr. Burdick: Most doctors would argue that a patient once diagnosed with bipolar will start medication and will take medication for the rest of their lives. There are patients who do well off of medications. They’re not your typical patient with bipolar disorder.
Dr. Gupta: If someone’s very diligent about their taking their medications, what can you tell them in terms of, you know, the life they’re going to have?
Dr. Gupta: When patients respond early to medications, and many patients do, that is a good predictor of good outcome.