The other day, (well now it has been a couple of months! I am so not keeping up with this blog!) some friends and I went to see the movie “Silver-Lining Playbook.” It was a good movie. The acting was excellent. I assume that if Bradley Cooper had not been up against Abraham Lincoln, he would have won an Oscar for his portrayal of an individual with bi-polar disorder.
However, the story line itself was total fantasy and, as the movie proceeded, it became more and more a fantasy. Maybe the author of the book/movie entitled the story, “Silver-Lining Playbook” precisely to let the movie viewer know that we would be shown a fantasy. But any of us who have seen/lived with someone diagnosed with bi-polar disorder knows that this dis-ease (at least up until now) does not have a silver lining attached to it. I found the fantasy that the movie portrayed a bit over the top. Now I know that American movie goers tend to love the happy ending story and this was as fairy tale-ish “…and they lived happily ever after” as it gets. But I found it a little disturbing to approach the topic of an illness wherein there has been no cure found [as of yet] in such a fantasy like way.
Bipolar disorder has no single cause. It appears that certain people are genetically predisposed to bipolar disorder. Yet not everyone with an inherited vulnerability develops the illness, indicating that genes are not the only cause. Some brain imaging studies show physical changes in the brains of people with bipolar disorder. Other research points to neurotransmitter imbalances, abnormal thyroid function, circadian rhythm disturbances, and high levels of the stress hormone cortisol. These imbalances purportedly can be modified with pharmaceuticals. But pharmaceuticals have their side-effects, some of which can be pretty nasty.
External environmental and psychological factors can be involved in the development of bipolar disorder. These external factors are called triggers. Triggers can set off new episodes of mania or depression or make existing symptoms worse. However, many bipolar disorder episodes occur without an obvious trigger.
- Stress – Stressful life events can trigger bipolar disorder in someone with a genetic vulnerability. These events tend to involve drastic or sudden changes–either good or bad–such as getting married, going away to college, losing a loved one, getting fired, or moving.
- Substance Abuse – While substance abuse doesn’t cause bipolar disorder, it can bring on an episode and worsen the course of the disease. Drugs such as cocaine, ecstasy, and amphetamines can trigger mania, while alcohol and tranquilizers can trigger depression.
- Medication – Certain medications, most notably antidepressant drugs, can trigger mania. Other drugs that can cause mania include over-the-counter cold medicine, appetite suppressants, caffeine, corticosteroids, and thyroid medication.
- Seasonal Changes – Episodes of mania and depression often follow a seasonal pattern. Manic episodes are more common during the summer, and depressive episodes more common during the fall, winter, and spring.
- Sleep Deprivation – Loss of sleep—even as little as skipping a few hours of rest—can trigger an episode of mania.
Lithium is the oldest and most commonly used mood stabilizer. It is “highly effective” for treating mania. Lithium can also help bipolar depression. However, it is not as effective for mixed episodes or rapid cycling forms of bipolar disorder. Lithium takes from one to two weeks to reach its full effect. But some of the side effects of lithium include:
weight gain, drowsiness, tremors, weakness and fatigue, memory and concentration problems, stomach pain, thyroid problems, nausea, vertigo.
Of course every doctor will tell you that not everyone develops these side effects, but if you happen to be one of the ones who does, would you willingly subject yourself to them?
In extreme cases, antipsychotics may be prescribed for bipolar disorder.
Antipsychotic medications used for bipolar disorder include:
- Olanzapine (Zyprexa)
- Quetiapine (Seroquel)
- Risperidone (Risperdal)
- Ariprazole (Abilify)
- Ziprasidone (Geodon)
- Clozapine (Clozaril)
The common side effects of antipsychotic drugs are similar to those of the mood stabilizers: Drowsiness, Weight gain, Sexual dysfunction; Dry mouth; Constipation; Blurred vision.
Often, antipsychotic medications are combined with a mood stabilizer such as lithium or valproic acid. So you can imagine what someone on both antipsychotic drugs and mood stabilizers might look like. This is why I put the words “highly effective” in quotes. By whose definition?
My apologies to the readers: I seem to have lost the sources by which I got my details on symptoms and remedies. However, a google search for bipolar disorder will bring up pages with which you can further educate yourself. But please, please, do not think that the two individuals portrayed in “Silver-Lining Playbook” are representative.
© Yvonne Behrens, M.Ed 2013