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| Welcome to Bipolar Support. Org
The purpose of this web site is to provide information about bipolar disorder and to offer support, not only to those afflicted, but their family, loved ones and friends. This web site is operated by just these kinds of people. We are not licensed psychiatrists, psychologists or mental health counselors, but a community of people who want to share experiences and hope. All posts and comments in this website are personal opinions and should not be substituted for therapy or other professional mental health counseling. Browse through our Directory to the left to find more details about us, bipolar disorder and resources we offer, such as recommended books, links to find help near you, as well as supportive forums and chat rooms. There's even a place to keep a private journal and a free mood chart in our downloads section. We welcome you to join our community and hope you find it informative and comforting. | | | | |
|  Posted by Mocha on Monday, August 04 @ 01:40:36 CDT
One of the things that's visible here is the way people support one another. It drew me here and made me want to participate, and I did. But after a few weeks, I got scared. I had been participating, but now I couldn't figure out what to say. I don't know how many posts I started and never sent. I wanted to respond, but couldn't; wanted to write about my own feelings and couldn't put the words together, except maybe very briefly and noncommitally.
Part of it, I think was that I came to realize the depth of suffering and the very hard lives of many people here. Especially the age 15-21 thread: I wanted to say these were OK years for me, but I was ashamed because they were so difficult for many others. And the thread was scary to me too, too. I don't know if you scared me (how?) or if I was scared of something in myself (what?). Maybe it was some kind of trigger. It just made me very uneasy. I felt out of place and I backed off. Didn’t read the whole thread.
But I kept on reading, every day. I felt detached but compelled. I think I knew I would come back but didn’t know how. Then I saw stricco’s funny e-mail responses and I knew I could come back through humor. And maybe I could write this, and send it.
A problem of mine is not trusting and I never talk about how much I need to be able to do so. It’s not trust in general, like, “Will he keep his word?” That can be an issue, but it’s not a problem unless it doesn’t happen. It’s this: trusting that someone cares for me, and keeps caring. I can hardly believe that it’s really possible. I don't think I understand or can feel caring, my own or that of others, very well. So through my life I’ve always tried to impress people with what I do, what I accomplish, thinking then they won’t notice what I really am. And I’ve been mostly successful at work and elsewhere. But it was never enough; I always needed more affirmation; I couldn’t look back; I couldn’t trust that it was real, that there was really a caring or loving connection between me and those others. It all mostly seemed, and probably was, superficial.
I’ve told you about my mania a few months ago, which rather suddenly turned into depression in early April. The pdoc and I are having a lot more trouble finding the right med cocktail than ever before. A difference in my life now is that I’m retired and don’t have as much opportunity to do that described in the previous paragraph.
So I’ve been mostly depressed with some better days, including a few days this week. But today the bottom dropped out again, and I was more miserable than ever, all the more so because I had been feeling better. So I cried and cried and cried.
My wife S and I have been married 36 years. She’s been through all this bp crap with me. She’s not the most patient person in the world, and she can be very critical, but she’s never criticized me for my bp symptoms, even though they have been extremely difficult for her to cope with at times, as you all know. Especially the manic symptoms, which I usually didn’t recognize because they rarely got in the way of the (outside) achievements and accomplishments I was aiming for. Oh, I don’t like thinking of the way I behaved!!! because I was so blind to it then. I would run to the pdoc when I felt depressed. The rest of the time I would say I felt fine. If I looked manic, he didn’t say. But what can you see in 10 minutes every month or three? I liked him… I was getting what I wanted… what’s not to like? Oh BTW I didn’t have any tdoc. Just the meds. And my wife. And, the past few years, a spiritual director.
During this time of depression I’ve thought a lot about all that S has put up with, and all she’s done for me apart from the chaos of my bp, how I’ve been self-absorbed and career-oriented, how I haven’t helped out that much, how much, for example, she’s made our home what it is and I’ve been lazy even on the traditional male fix-up projects so that she’s often done them. What a drag I must be. I do so little. I certainly do need her, but what does she need me for?
So I was saying something like that today through my tears, and I said I loved her, and she said me too, like she always does, and I said how can you love me when you do so much and I do so little, and she said she loves me not for what I do or don’t do but for who I am, and I think maybe for the first time, because she’s said it before, I believed it. I trusted her. I can do it, at least once. She cares for who I am, an “I” that I swear to God I want to find and enjoy being. My true self….
My true self, the one God created, not the false self I run around showing to everybody, including myself. The one that always just is. Be here now. A phrase I’ve been contemplating for many years. Hard to do (duh!). Doesn’t answer to the how-to question like most everything else in the world, the world in which I succeeded but which didn’t care for me. Or maybe, more likely, I didn’t care for it, I was just in the game for the recognition…. God, I hate to face up to this self. It seems fundamentally dishonest. But it’s how I got along. And it certainly wasn’t dishonorable, as the world goes. Maybe even it’s the rule.
My dad was messed up and he couldn’t give me the attention and love I needed from him as a child. When I was 16, we moved to another state and I had to remake my life. A big part of it was rejection of my father (I was ashamed of him) and subsituting the elders in a male-dominated, authoritarian church whom I could easily please by making myself into the model boy/young man. The big deal was to go on a church mission where I promptly showed bp behavior, though nobody, least of all me, recognized it as such. Hey, this was 1961-63! Midway some probably obnoxious manic behavior was interpreted by the mission president and others as a challenge to the line of authority and I got called on it. I was devastated: the way I had bought into the system, this was the absolute last thing I wanted to do. Everything depended on knowing my place, but also (privately) on working my way up, excelling and gaining recognition, and that was what I had known about consciously (if secretly). After I was confronted, I went into a depression but recovered soon enough and finished my mission. But then I knew I had a problem with authority and was able, in my mid-20s, to finally work it out in my mind and break with that particular church.
Writing this has brought me a thought. Maybe this is what scared me about your age 15-21 lives, messed up as many of them were. I was horrified, but I don’t think I’m a selfless person whose concern was mainly for you. My life was messed up too, but I covered it up with this conventionally “good” behavior. It got me a long ways, well into my 20s, anyhow. I was lost for awhile, but had some support, and always did well in school. I thought I would fit in on the opposite side of the desk at a university, but when I got there it was m/d x 5 years over the stress of classroom teaching. I had thought it would be the profession made for me. Graduate school had been so lovely. I resigned from the university. One reason I could is because I had S to carry me through. No more serious depressions for a while, but mania or at least hypomania, looking back. I don’t know how she did it. Loyalty runs in her family.
So I can see somewhat of a connection there to my being scared here a couple of weeks ago. Now I have been able to write this. I feel better, and better being here. Maybe this isn’t even the first time you’ve heard this sort of story. I’m writing it for my own sake, but posting it because I want to trust… to actually experience your caring and return it to you.
One of the things that's visible here is the way people support one another. It drew me here and made me want to participate, and I did. But after a few weeks, I got scared. I had been participating, but now I couldn't figure out what to say. I don't know how many posts I started and never sent. I wanted to respond, but couldn't; wanted to write about my own feelings and couldn't put the words together, except maybe very briefly and noncommitally.
Part of it, I think was that I came to realize the depth of suffering and the very hard lives of many people here. Especially the age 15-21 thread: I wanted to say these were OK years for me, but I was ashamed because they were so difficult for many others. And the thread was scary to me too, too. I don't know if you scared me (how?) or if I was scared of something in myself (what?). Maybe it was some kind of trigger. It just made me very uneasy. I felt out of place and I backed off. Didn’t read the whole thread.
But I kept on reading, every day. I felt detached but compelled. I think I knew I would come back but didn’t know how. Then I saw stricco’s funny e-mail responses and I knew I could come back through humor. And maybe I could write this, and send it.
A problem of mine is not trusting and I never talk about how much I need to be able to do so. It’s not trust in general, like, “Will he keep his word?” That can be an issue, but it’s not a problem unless it doesn’t happen. It’s this: trusting that someone cares for me, and keeps caring. I can hardly believe that it’s really possible. I don't think I understand or can feel caring, my own or that of others, very well. So through my life I’ve always tried to impress people with what I do, what I accomplish, thinking then they won’t notice what I really am. And I’ve been mostly successful at work and elsewhere. But it was never enough; I always needed more affirmation; I couldn’t look back; I couldn’t trust that it was real, that there was really a caring or loving connection between me and those others. It all mostly seemed, and probably was, superficial.
I’ve told you about my mania a few months ago, which rather suddenly turned into depression in early April. The pdoc and I are having a lot more trouble finding the right med cocktail than ever before. A difference in my life now is that I’m retired and don’t have as much opportunity to do that described in the previous paragraph.
So I’ve been mostly depressed with some better days, including a few days this week. But today the bottom dropped out again, and I was more miserable than ever, all the more so because I had been feeling better. So I cried and cried and cried.
My wife S and I have been married 36 years. She’s been through all this bp crap with me. She’s not the most patient person in the world, and she can be very critical, but she’s never criticized me for my bp symptoms, even though they have been extremely difficult for her to cope with at times, as you all know. Especially the manic symptoms, which I usually didn’t recognize because they rarely got in the way of the (outside) achievements and accomplishments I was aiming for. Oh, I don’t like thinking of the way I behaved!!! because I was so blind to it then. I would run to the pdoc when I felt depressed. The rest of the time I would say I felt fine. If I looked manic, he didn’t say. But what can you see in 10 minutes every month or three? I liked him… I was getting what I wanted… what’s not to like? Oh BTW I didn’t have any tdoc. Just the meds. And my wife. And, the past few years, a spiritual director.
During this time of depression I’ve thought a lot about all that S has put up with, and all she’s done for me apart from the chaos of my bp, how I’ve been self-absorbed and career-oriented, how I haven’t helped out that much, how much, for example, she’s made our home what it is and I’ve been lazy even on the traditional male fix-up projects so that she’s often done them. What a drag I must be. I do so little. I certainly do need her, but what does she need me for?
So I was saying something like that today through my tears, and I said I loved her, and she said me too, like she always does, and I said how can you love me when you do so much and I do so little, and she said she loves me not for what I do or don’t do but for who I am, and I think maybe for the first time, because she’s said it before, I believed it. I trusted her. I can do it, at least once. She cares for who I am, an “I” that I swear to God I want to find and enjoy being. My true self….
My true self, the one God created, not the false self I run around showing to everybody, including myself. The one that always just is. Be here now. A phrase I’ve been contemplating for many years. Hard to do (duh!). Doesn’t answer to the how-to question like most everything else in the world, the world in which I succeeded but which didn’t care for me. Or maybe, more likely, I didn’t care for it, I was just in the game for the recognition…. God, I hate to face up to this self. It seems fundamentally dishonest. But it’s how I got along. And it certainly wasn’t dishonorable, as the world goes. Maybe even it’s the rule.
My dad was messed up and he couldn’t give me the attention and love I needed from him as a child. When I was 16, we moved to another state and I had to remake my life. A big part of it was rejection of my father (I was ashamed of him) and subsituting the elders in a male-dominated, authoritarian church whom I could easily please by making myself into the model boy/young man. The big deal was to go on a church mission where I promptly showed bp behavior, though nobody, least of all me, recognized it as such. Hey, this was 1961-63! Midway some probably obnoxious manic behavior was interpreted by the mission president and others as a challenge to the line of authority and I got called on it. I was devastated: the way I had bought into the system, this was the absolute last thing I wanted to do. Everything depended on knowing my place, but also (privately) on working my way up, excelling and gaining recognition, and that was what I had known about consciously (if secretly). After I was confronted, I went into a depression but recovered soon enough and finished my mission. But then I knew I had a problem with authority and was able, in my mid-20s, to finally work it out in my mind and break with that particular church.
Writing this has brought me a thought. Maybe this is what scared me about your age 15-21 lives, messed up as many of them were. I was horrified, but I don’t think I’m a selfless person whose concern was mainly for you. My life was messed up too, but I covered it up with this conventionally “good” behavior. It got me a long ways, well into my 20s, anyhow. I was lost for awhile, but had some support, and always did well in school. I thought I would fit in on the opposite side of the desk at a university, but when I got there it was m/d x 5 years over the stress of classroom teaching. I had thought it would be the profession made for me. Graduate school had been so lovely. I resigned from the university. One reason I could is because I had S to carry me through. No more serious depressions for a while, but mania or at least hypomania, looking back. I don’t know how she did it. Loyalty runs in her family.
So I can see somewhat of a connection there to my being scared here a couple of weeks ago. Now I have been able to write this. I feel better, and better being here. Maybe this isn’t even the first time you’ve heard this sort of story. I’m writing it for my own sake, but posting it because I want to trust… to actually experience your caring and return it to you.
Written Jul 08, 2006
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|  Posted by gruvhip on Thursday, July 17 @ 18:06:48 CDT
It was a dark and stormy night ..... Before me, an amazonian blonde with cropped hair gesticulated wildly. Shrewish screaming pierced my ears. Thrown cutlery pierced the plaster walls. Yanno .. there comes a time in every man's life when he doesn't know whether to smack a dame in the mouth, or put her over his knee. I'm passive aggressive. I stayed quiet, figuring she'd work out which she preferred and do it herself.
The storm howled outside, mirroring the chaos inside. A powerful gust jolted the lock, slamming the front door open. I could see my belongings strewn across the lawn. Clothing blown into the shrubbery. My favourite white cotton shirt, stirring restlessly in a pool of mud, as the wind slurred across surface. Was I really going out in this weather? I walked to the bathroom to grab "old faithful".... a box of anti-depressants. The shrew screamed again ... and again ..each time tearing into my soul ... like an alchemist witch with a dagger at the final newt. It seemed I didn't have much choice.
Was I REALLY going out in this weather? A gym pumped iron grip grabbed hold of my arm while her other fist slammed into my body. Repeatedly. Screaming .. Screaming ... Shoved to the door .... slung unceremoniously through like a cook heaves the morning's garbage. The door slammed. The lock clicked. Sheltering below an eave, I was alone. Forlorn. Abandoned, misunderstood ... mistreated.
Like a miracle, the storm abated instantly. The rain stopped, wind died. Like a sign from God. "You're better off out here". Shrubs stopped their maddened shaking. Puddles settled into calm ponds. Water poured down the gutters, sluicing away the detrius of man: cans, wrappers, pastic bottles .. leaving the street clean and new. I was feeling better already. I walked. Just walked and walked. Anything to get away from that place... away from her. Clouds scurried, and tentatively the stars came to life. I could see the warm glow from windows, where families ate together. The flickering of television crept out .. and music sometimes danced through the breeze.
The park .. I was close to the park. I knew this place from when I was a boy. Familiarity felt safe. The manicured lawns glistened with moisture, asphalt shone under lights. Flower gardens burst with blooms and the allure of fragrance tantalised my nostrils. This must be spring. In this place of nurtured abundance, the world seemed full and rich. Yet I felt so lost. Brushing the droplets from a painted seat, I leaned back and rested. Rested my heart ... soul .... mind.
Stress. I have to be careful. I knew how stress sends my system spiralling. Taking the pills from my pocket, I popped out two and swallowed them dry. Erch. There was a drinking fountain near here .. I'm sure. Quickly found, I washed the chemical taste from the back of my throat. Back to the seat. I sat quietly. The time stretched. How could I go back ... to THAT .... I couldn't. But something was stopping me from walking away.. to build something better. I was stuck.
Slowly, calmly, I took the pills from my pocket and stared at the blister pack. A fresh box... full. The foil twisted and creaked as I popped each tablet out. My hand filled. I dropped them in my shirt pocket, and continued. Job done.
I filled my mouth with half the pills and took a gulp of cold fresh water. A few stuck, so I gulped again. Foul taste. Filled my mouth again and took a larger gulp. Repeat and stir. Wash and spit to lose that foul aftertaste. Then quietly .. calmly .. walked back to the seat and sit. And wait. Disconnected. One hour. Two. Tongue thickened... muscles slackened... pulse dropped.
The fighter woke. "I am NOT going to die like this..NO WAY...I'll get to the hospital if it kills me". Not sure where the wry wit came from. I had to hurry. My stomach held enough junk to kill me. I knew it. I tried to move fast. I couldn't. The pills were beating me. Every block was getting harder .. Keep going, just keep going. I was slowing. Not even smart enough to knock on a door. How many blocks? Why did I walk so damn far? I'm fading .. I can feel it. Somehow .. I don't know how .. I made it. I kicked on the door until the bitch let me in. Terror showed in her eyes. She could see how close I was. "Don't you f-ing die on me!!"... she screamed repeatedly as she raced to the hospital. It wasn't out of care. Pure guilt. Pure self serving fear. My head was rolling. I couldn't feel much.
But feck her .. and feck this disorder. I lived
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|  Posted by Mocha on Thursday, April 24 @ 00:00:00 CDT
My earliest memory is of my mother reading to me by the light of a ceramic cowboy lamp that she made me. She read me "Clifford the Big Red Dog", I believe. I knew she loved me then, despite all the abuse. Fear and love existed together and I had no difficulty with that- contradictory emotions were, and are, commonplace with me. I am at ease with my emotions... They come unbidden and, therefore, I do not blame myself for them. I think that this is a lesson my mother taught me, inadvertently or not.
I just don't know for sure. Perhaps it is mostly in my own imagination.
My childhood wasn't what you'd call successful. I was bright enough but a wise-ass and a late bloomer to boot. All the tough kids would try to start trouble with me in school where, with my quicker wit, I would invariably make them look foolish. After school, however, my wit was no match for their fists.
This went on for years. I said I was bright- not wise.
And I was angry. I stayed angry until not that long ago.
I would like to say that I did well in school because it was the one place I could be successful- where I received positive feedback. This is the tale that I, as a teacher, tell my students. In truth, I succeeded at school because I had no choice. Failure was not an option. Hell, "B" stood for "beating" in my mother's home. I have since seemed to have lost those brain skills- due to age and medication (prescribed and recreational). Several times I've written something only to reread it and get that "WTF was I thinking?" feeling. Happens more and more... I'm sure you'll get the same feeling reading this.
In short, I am no longer 'bright.' But I am still a wise-ass; your garden variety nut-job.
Anyway, my success in school is proof that the fear of my mother outstripped the biology of my yet undiagnosed bipolar. Somehow I stayed focussed on the light, no matter how dark the days became.
I wasn't diagnosed until later in life- 36 or 38 years of age (I remember it began with a 3 and ended with a loop or two...memory fails me after that). My then fiance, M, insisted I see a doctor about my temper. Me, being the accomodating fellow I am, agreed. Several docs later I had the classification we've all come to know and mostly accept.
I'm happy about it. I don't hate the fact that I have brown eyes or a full head of thick brown hair so I refuse to hate the fact that I have bipolar. Hell- sometimes it really comes in handy- like when I have to paint an entire room in one afternoon and I just happen to be manic. I don't particularly care if anyone does have a problem with my diagnosis. In fact, eff anyone who can't take a joke. It's been my experience that normal people have just as much baggage as anyone with an official classification.
So I made it through high school and lettered in football (American football- the one with all the needless commercial breaks and actual scoring). I bring up the latter because the two may have gone hand-in-hand. Football gave me a safe place to be aggressive and it continued the lessons of discipline that began at home. Football made it possible to manage my bipolar without my knowing I had it. Of course, it may have delayed my diagnosis. But still- I was lucky.
Football also gave me a way to pay for college. But it couldn't do my schoolin' for me.
In fact, it was tricky to get through college undiagnosed, unmedicated and unscathed- and thats why I didn't... Scathed I was- in spades. It took me four years, three summer schools, one arrest, a couple of suspensions, and a few too many habits in vice to somehow achieve my diploma. Not a diploma in any practical fields mind you- majors in theater and english and minors in religion and education. Bipolar indeed.
With that background I naturally gravitated to special education. Which is, in my humble opinion, the finest profession for someone with MI. Eighteen years later, I am still here. That's not to say it was easy ... How I managed to hang on to my job is more a credit to the nature of that job than to my effort, I think. Somewhere along the way I learned to sprint- to go short distances while holding on to any shred of sanity. I can accomplish this in a profession with as few hours required at a time as mine. So I held onto that shred but I didn't manage to hold on to much else.
Well my computer...
When I joined BPS M had gone her own way and I had found another sucker I was very interested in. I have no desire to share the horror story that my life was ( any more than I already have)- I just knew I needed help- particularly if I wanted to keep this woman.
BPS was just what I needed. I knew I needed help but I really wasn't ready to do everything I had to. I wasn't that lightbulb quite yet- I could almost change myself. If it wasn't for the no nonsense advice of the members, mods and admins I know I wouldn't have made it.
I have since married that sucker, known here as messydesk. She is diagnosed as bipolar as well.
Yes, our life is bliss.
That is a load of shit and you all know it. Our fights are legendary- epic in proportion. They move with earthquake type intensity and yet blow over like a summer rain. Yet we know that bad weather looks worse through a window. Easy to anger at times, we are also easy to forgive and forget. After all, we must give what we hope to receive from one another. It does work for us so far, a mere six months in.
I'll update as needed.
I am grateful for this site and all its members. I am glad to be more than just an on a bit, off a bit member. I am grateful for the lessons I learned here- the most memorable being that of boundaries, staying compliant with doctors and meds, and that I am unique- just like everyone else.
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|  Posted by gruvhip on Tuesday, September 04 @ 18:10:13 CDT
Scientists Test New Bipolar Remedies
Associated Press - September 03, 2007
NEW YORK - Scientists are casting a wide net to find better treatments for the crushing depression and uncontrolled manias of bipolar disorder, and some approaches they're testing seem pretty surprising.
Like skin patches that prevent seasickness. Or a drug that fights Lou Gehrig's disease. And then there's a newly invented device that resembles a hair dryer in a beauty salon.
Some of the strategies were identified by logic, and others by pure chance. Scientists already have evidence that they may someday prove useful against bipolar disorder, also called manic-depression.
Doctors yearn for better therapies to treat the condition, which can rip careers and marriages apart and drive people to suicide. It is so complex and mysterious that researchers haven't developed a medication specifically for it since lithium, more than half a century ago.
Bipolar disorder appears in various forms and degrees of severity in about one in every 25 American adults at some point in their lives, according to a major study published in May.
The disorder is characterized in part by episodes of mania, which are periods of boosted energy and restlessness that can run for a week or more.
"You have so much energy, you have so many great ideas" said Tamara, 26, a Pittsburgh resident who was diagnosed several years ago. She asked that her last name not be used.
"You feel like you're thinking so clear, you've got the answer for everybody. You need to tell them, you need to phone all your friends... It's so hard to sleep. You keep thinking of all sorts of things."
But mania can also bring extreme irritability. Tamara's energy and charisma made her the life of the party, but "if somebody spilled a drink on me, I would just explode," she recalled. "It's like all your emotions are just completely intensified."
She got into fights and experienced road rage. She made bad decisions, plagiarizing a college paper and behaving promiscuously.
"A lot of things sound like a good idea when you're manic," she said, "and they're really not."
During manic episodes many people even get hallucinations or delusions, and Tamara experienced those too. "I was convinced I could hear other people's thoughts, or at least know what they were," she recalled. "I thought everybody was saying bad things about me."
The disorder also brings episodes of depression that last a week or more.
"Nothing is interesting," Tamara said. "You're bored with everything... Nothing sounds fun anymore. All you want to do is sleep. I slept days and days away."
In her senior year of college, thoughts of suicide frightened her into seeking help.
Doctors currently treat bipolar with a variety of drugs including lithium, anticonvulsant medications that can stabilize mood, and antipsychotics. Psychological therapy and patient education greatly boost the effectiveness of the drugs.
Tamara takes lithium and another drug, and says, "I'm doing fine right now."
She's lucky. Bipolar disorder is hard to treat chiefly because the depressive episodes are more severe and more resistant to therapy than ordinary "unipolar" depression, notes Dr. Andrea Fagiolini, an associate professor of psychiatry at the University of Pittsburgh.
Overall, current medications for bipolar "certainly reduce symptoms but don't do a good enough job," said Dr. Husseini Manji of the National Institute of Mental Health. "Many patients are helped, but they're not well."
What's more, many patients can't tolerate current bipolar medications because of side effects like weight gain, sleepiness, tremor, and the sense of feeling "drugged," Fagiolini said. (Some patients also stop taking their medicine because they miss the "highs" of the disease, he noted).
A study of treated patients published last year found that about 60 percent got well for at least eight weeks, but only half of that group remained well when followed for up to two years. That was with very good therapy, noted Dr. Andrew Nierenberg, professor of psychiatry at Harvard Medical School.
"That means there's a lot of room for improvement," Nierenberg said. "That's why we need new treatments."
Just as heart attacks come from chronic heart disease, the manic and depressive episodes come from an underlying chronic brain disease. And "we just don't really understand what's behind the illness," said Dr. Gary Sachs, who directs bipolar research at Harvard's Massachusetts General Hospital.
The mystery and complexity of the disorder have discouraged scientists from trying to develop drugs for it, Manji said. Not since lithium have they developed a drug specifically for bipolar, Manji said.
Like lithium, some of the latest crop of early candidate drugs revealed their potential simply by chance.
Take the experience of NIMH researchers Maura Furey and Dr. Wayne Drevets with the drug scopolamine, which is normally used to keep people from getting seasick or carsick. Several years ago, they were studying whether scopolamine could improve memory and attention in depressed people. So they gave the drug intravenously to depressed patients, trying to find the right dose for a brain-imaging study.
They noticed that patients started feeling less depressed the night after the injections. Most antidepressants take weeks to kick in.
"Some patients would say it was the best night of sleep they'd had in many years, and the next morning they woke up feeling a substantial lifting of their depression," Drevets said. "In many cases that improvement persisted for weeks or even months."
Drevets and Furey quickly changed their research focus to test the drug's effect on depression itself. And in October 2006 they published an encouraging, though preliminary, result with a small group of depressed patients, some of whom were bipolar.
Now Furey is leading a study using scopolamine skin patches - like travelers wear to prevent motion sickness - to treat depression in bipolar disorder as well as ordinary depression. For now, people shouldn't try patch treatment for depression on their own, she said.
A similar bit of serendipity showed up at McLean Hospital in Belmont, Mass., in 2001. Depressed bipolar patients who were getting their brains scanned for a study of brain chemistry suddenly felt a lot better. Alerted by a research assistant, scientists started taking a closer look. And in 2004, they published their conclusion that the electric fields produced by the brain scans might lift depression. It's still not clear how.
Follow-up studies have had inconsistent results. But researchers have now built a device that resembles a hair-salon dryer to produce electric fields. They plan to start testing it this fall.
Researchers have also used the few insights they have into the disease to develop potential treatments.
That's the story with riluzole, now used to treat the paralyzing disorder Lou Gehrig's disease, also known as ALS or amyotrophic lateral sclerosis. Scientists found that a drug that's effective against depression in bipolar disorder boosts the abundance of a certain protein in rat brain cells, and that riluzole does too. So the researchers tried riluzole in a small number of depressed bipolar patients, and in some patients the symptoms virtually disappeared, Manji said.
So riluzole, which is distributed by Sanofi-Aventis, might become a treatment for bipolar disorder, he said.
Similar research used an off-the-shelf drug to get a lead for developing a new medication. Studies in rats showed that lithium and another anti-mania drug hamper the effect of a particular enzyme in the brain. That suggested other drugs that hamper the enzyme might work against mania too, Manji said.
The best available candidate: tamoxifen, used to fight breast cancer. Manji's recent study in a small group of bipolar patients found that tamoxifen quickly quelled mania. Other studies have found similar results, he said.
That shows the value of blocking the enzyme, and now Manji is trying to develop other drugs that will do that, perhaps for use in emergency rooms. He wants to avoid tamoxifen itself because of concern about long-term side effects, since his work requires a higher dose than women use to stave off breast cancer for years.
Scientists say the real key to unlocking the mysteries of bipolar disorder - and thereby exposing targets for drugs - lies in a new generation of research into DNA.
In recent months, scientific journals have begun to publish the early results of a revolution in DNA analysis: the ability to scan entire genomes in detail to find genetic variants that predispose people to particular diseases. Some of the new work is implicating dozens of variants in bipolar disorder.
Such work can expose the hidden biological underpinnings of disease, and tip off researchers to unsuspected targets for intervening.
"We've been stumbling in the dark for most of our history" of bipolar research, said gene expert Dr. Francis McMahon of NIMH. But "these kinds of studies ... will really give us the chance to reason from biological insights back to the patient."
Sachs, of Harvard, agreed: "I think these whole-genome scans will in fact be the important bridge to better treatments."
And not just in some far-distant future. The new gene studies, Sachs said, help give "a great potential to advance the field in our lifetimes and treat people who are living now."
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|  Posted by gruvhip on Wednesday, February 21 @ 07:33:46 CST
Gruvhip writes: Am J Psychiatry 163:1135-1136, July 2006
doi: 10.1176/appi.ajp.163.7.1135
© 2006 American Psychiatric Association
Editorial
Mary L. Phillips, M.D. and Ellen Frank, Ph.D.
We now recognize that bipolar disorder is often accompanied by anxiety, eating, and substance use disorders (1) and high rates of medical illness, especially cardiovascular, cerebrovascular, and metabolic diseases (2). Individuals with bipolar disorder also suffer from a marked disruption in sleep rhythms and social relations. Rather than defining bipolar disorder solely as one of episodic mood disturbances, we should consider defining it as a multisystem disorder involving disturbances in all of the above-mentioned domains. By employing a symptom-based rather than an etiologically based approach, DSM-IV fails to reflect the multisystem presentation of bipolar disorder.
Increasingly sophisticated neuroimaging and genetic research have deepened our understanding of the neurobiology of bipolar disorder as one involving complex disturbances in relationships, linking environment, genes, neural systems, and behavior. This approach supports the research agenda for DSM-V, emphasizing the need to translate basic and clinical neuroscience research findings into a new classification system for psychiatric disorders (3). Although the understanding of the pathophysiology of bipolar disorder remains limited, preliminary findings from recent neuroimaging studies have indicated persistent dysfunc
tions specific to bipolar disorder within neural systems underlying mood and cognition (4, 5) that are also found in healthy first-degree relatives as endophenotypes of the disorder (6). Specific genetic variables contributing to normal functional variation may further affect dysfunctions within these systems (7).
How can DSM-V reflect the clinical complexity and pathophysiology of bipolar disorder? An immediate first step is initiating large-scale studies to identify the specific clinical spectrum, neurocognitive, and neuroimaging measures that best distinguish individuals with bipolar disorder from those with other mood and psychotic disorders and incorporating these as supplementary diagnostic criteria into DSM-V. The future challenge will be to test the construct validity of these new measures versus conventional criteria in longitudinal studies examining clinical outcome and treatment response, leading ultimately to an etiologically and pathophysiologically based classification system for bipolar disorder.
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