Bipolar4LifeSupport

When a single drug does not work, experts recommend trying other mood stabilizers. If several medications are tried with no improvement, trying a combination of mood stabilizers is the next step. This approach is called combination therapy. Two mood stabilizers together may be more effective in relieving symptoms than one alone.

Sometimes, a mood stabilizer is used in combination with medication to relieve behavioral symptoms (hyperactivity or physical expression of distress, such as restlessness, pacing and hypersensitivity to surroundings), psychosis, anxiety or insomnia. These drugs are called adjunctive medications.

Adjunctive medications include benzodiazepines, a type of sedative that is prescribed for behavioral agitation or verbal excitement. For instance, lorazepam (Ativan®) can calm a hostile or aggressive manic patient. Antidepressants may be prescribed for depressed bipolar patients to improve their mood, but careful monitoring is necessary to avoid pushing the mood into mania or hypomania (which is less severe than full-blown mania). The choice of antidepressant is influenced by patient tolerance, potential drug interactions and side effects. For example, a patient who gained weight on lithium would be prescribed an antidepressant associated with less weight gain such as bupropion (Wellbutrin®).

Sometimes, patients with extreme manic episodes can develop psychotic symptoms, such as paranoia, hallucinations and delusions. When psychotic symptoms occur during mania, supplementing the mood stabilizer with an antipsychotic drug can be helpful. Antipsychotic medications are administered during acute treatment and usually can be tapered before continuation treatment begins. However, some patients experience the best results by staying on an antipsychotic drug. A newer class of antipsychotic medications used in the management of manic patients is risperidone (Risperdal®), haloperidol (Haldol®), quetiapine (Seroquel®) and olanzapine (Zyprexa®).

If you have bipolar disorder, one of the best things you can do to help manage your illness is learn all you can about the disorder. You can do this by reading books, going to lectures and talking to your doctor. Learn how to understand the symptoms and recognize when you need to seek help.

You may also want to find support from others who have the illness. Support groups are available in most areas and are an important part of treatment. Support groups provide emotional support, education, understanding, accountability and self-awareness. Participants develop a bond with others because they share common gound.

Talking to other people who have learned successful coping strategies with the illness is extremely helpful in dealing with bipolar disorder. The Depressive and Manic-Depressive Association is a good place to look for a support group in your area.

Other helpful hints for managing bipolar disorder include:

• Communicate openly with your doctor. You may want to keep a diary of you daily moods or checklist of symptoms to share with your doctor.
• Remain open to feedback from loved ones who may recognize early symptoms of an episode before you do.
• Try to keep stress in your life manageable when possible.
• Sleep well. Establish stable patterns by going to bed around the same time each night and get up about the same time in the morning. Poor sleep can trigger mood symptoms. If you have trouble sleeping or are sleeping too much, be sure to tell your doctor.
• Maintain a regular pattern of activity. Don’t push yourself to hard or try to do too many things at once. Try to work a predictable schedule with hours that allow you to get uninterrupted sleep. If symptoms interfere with your work, ask your doctor or therapist for help. Sometimes it is important to discuss these problems openly with employers. Your company may have a confidential Employee Assistance Program to assist you in dealing with your illness at work. If so, make an appointment.
• Avoid alcohol or mood-altering drugs. They can interfere with your medications and bring on symptoms. If you have a problem with drugs and alcohol, ask for help and consider joining a self-help program such as Alcoholics Anonymous.
• Remember that even small amounts of alcohol, caffeine and some over-the-counter medications for colds, allergies or pain can interfere with your sleep, medicine and mood.

As public health experts debate the best ways to reduce suicides––a top-five leading cause of death among Americans aged 10 to 54 in 2013––new research calls attention to the importance of early intervention based on long-term risk factors.

In a study published in the February 2015 issue of JAMA Psychiatry, a team led by NARSAD Scientific Council member and 2008 Distinguished Investigator grantee J. John Mann, M.D., probed the extent to which suicidal behavior in a parent gets passed on to children. The investigators tracked 701 children of 334 people diagnosed with mood disorders for an average of six years to identify factors that predicted suicide attempts among the children.

The research team also included 2001 NARSAD Distinguished Investigator grantee David A. Brent, M.D., 2013 Young Investigator grantee Nadine M. Melhem, Ph.D., and 1996 and 1998 Young Investigator granteeJohn G. Keilp, Ph.D.

The investigators found that having a parent who had attempted suicide made it nearly five times more likely that one of their children would make an attempt. It has been known that both genetic and non-genetic factors related to the predisposition for suicidal behavior or to psychiatric illnesses that trigger suicidal behavior, are transmitted in families. This study sought to identify the factors responsible for such familial transmission.

Suicide attempts were more likely among those children who, like their parents, were diagnosed with a mood disorder such asmajor depression or bipolar disorder. Such diagnoses appear to be needed for the manifestation of suicidal behavior, about a year before the first attempt. Most people diagnosed with depression do not attempt suicide because they do not have a predisposition to suicidal behavior.

Independent of family history of depression, impulsive and aggressive behavioral traits among the children also made it more likely that they will attempt suicide. This indicates a greater propensity to act on emotions. Those with pronounced aggressive and impulsive traits are also more likely to be diagnosed with a mood disorder; the combination puts them at greater risk for a suicide attempt.

These findings highlight the importance of three long-term risk factors in predicting suicide attempts: a family history of suicide attempts, a family history of mood disorders, and a personal history of impulsive aggression. It’s important that such families focus on early detection and treatment of mood disorders and aggressive-impulsive traits, the researchers say.

In recent months, public officials have taken steps to make it more difficult for people to attempt suicide. There are plans to build suicide-prevention structures around San Francisco’s Golden Gate Bridge and New Jersey’s George Washington Bridge.

Efforts on all fronts may be needed to address troubling recent developments in suicide research, including the increase found in suicide rates among African American children between 1993 and 2012, as reported in JAMA Pediatrics on May 18th. This was a period in which suicide rates went down among white children.

Measuring the activity of a panel of genes may provide enough information to diagnose bipolar disorder from a blood sample, according to a study published August 4th in the journalTranslational Psychiatry. Currently, bipolar disorder is diagnosed by experienced clincians based on a subjective evaluation of a patient’s symptoms; there is no blood test or brain scan that can diagnose the disorder.

In the study, which included 37 patients with rapid-cycling bipolar disorder and 40 healthy controls, researchers found that a composite measure of activity within a set of 19 genes offered diagnostic sensitivity and specificity corresponding to a “moderately accurate” test. Their analysis also identified specific genes whose activity is lower in people with bipolar disorder than in healthy individuals, as well as an additional gene whose activity spikes when patients with bipolar disorder are in a depressed state. Those findings call attention to biological pathways likely to be involved in the disorder.

To carry out the study, a team of scientists including first author Klaus Munkholm, M.D., at the University of Copenhagen, identified 19 genes that previous studies had indicated might behave differently in people with bipolar disorder, and for which relevant variations were likely to be detectable in blood cells. They took blood samples from the patients over a period of six to 12 months, keeping track of whether patients were in manic, depressed, or euthymic (neither manic nor depressed) states at the time each sample was collected.

The team, which included Lars Vedel Kessing, M.D., a 2012 NARSAD Distinguished Investigator and 2010 Foundation Colvin Prizewinner, then measured the activity of the 19 genes they had selected. Each sample received a gene expression score that considered the activity of all 19 genes together. These scores were sufficiently different between healthy participants and those with bipolar disorder to distinguish between the two, most of the time. For a portion of their blood samples, the scientists used the gene expression score to correctly identify 78 percent of samples from patients with bipolar disorder. Sixty percent of the samples from healthy individuals were correctly identified.

Further studies will be necessary to evaluate the gene panel as a potential biomarker of bipolar disorder. Including additional information in the score, such as levels of specific proteins, might improve its diagnostic sensitivity and specificity, the scientists say.

The study also generated some insight into the biology of bipolar disorder.  Two of the genes that were tracked in the study—POLG and OGG1—were significantly less active in people with bipolar disorder than they were in healthy controls. Another, NDUFV2, showed increased activity during depressed states among people with bipolar disorder, when gene activity was compared during individual patients’ different mood states. Together, these findings point toward problems with mitochondrial function and DNA damage repair, the team says.