Asked Us Anything About... Bipolar Disorder. I'm Scott Gilbert.
Life is a series of ups and downs. Happiness followed by Sadness.
That's normal. But how do we know when either of those moods may last for a week or more?
How do we know if it may indicate something more severe? Perhaps, we're
having trouble staying focused or even having trouble sleeping? That may
indicate bipolar disorder. Also referred to as, manic depression. Here to talk with
us about that today is, Dr. Erica Saunders. She's Chair of Psychiatry here
at Penn State Health Milton Hershey Medical Center. Dr. Saunders, appreciate
your time today. Let's start by talking about the fact that we all feel happy
sometimes and sad sometimes. That's a that's a matter of life so how do I know
if it's possibly a more serious series of ups and downs I'm experiencing?
Thank you for having me today, Scott. That's a very good question because of course, we
all have ups and downs in our moods and we actually need that to think well
to make good decisions about our life we need to have that emotional reaction and
that's perfectly normal. The problem that that is experienced in bipolar disorder
and in depression is that the moods get stuck outside of that normal range.
So usually you wake up in the morning if you happen to wake up on the wrong side
of the bed and have a have a low mood, you might do something even without even
realizing it to make yourself feel better. I like to have a hot cup of
something in the morning, you might talk to somebody that you love that sort of
thing and it might make you feel better. But when the biological processes start
in the brain that lead to bipolar disorder, the moods get stuck outside of
that normal range and the usual things that you want to do to help yourself
feel better, to make yourself feel less anxious, concentrate better
just don't work and we know from research that actually the parts of the
brain that control thinking and cognition and the parts of the brain
that control emotion, aren't as well connected when there's an active
depression or mania going on. So as a clinician how do you diagnose something
like bipolar disorder what are some of the things you look for? So the first
thing that we ask about is mood. A low mood, feeling sad, feeling down, depressed
or being on a to enjoy things which we call anhedonia.
Those are problematic moods that if they last long enough or caused significant
enough problems in somebody's life we are concerned about. The other type of
mood that we ask about and is important in bipolar disorder, is a mood that's too
high, too elevated, where people feel perhaps so much energy so, so revved up
that they can't think and make good decisions for themselves and for those
around them and in that case that's called hypomania or mania. So we asked
about moods specifically but the other things that are affected include sleep,
appetite, energy, concentration, memory, so it's really a constellation of
problems that of course affect people's functioning. We're talking about periods
of mania and periods of depression. Well I'm less likely to seek clinical help of
course if I'm feeling fantastic even if I'm feeling way up perhaps. So I would
think that the fact that people may seek more treatment more often when they feel
depressed could that possibly lead to a Misdiagnosis of depression if the
clinicians not careful? Absolutely. Absolutely and so bipolar disorder can
present for the first time as depression and so a good assessment and evaluation
will ask about all types of moods that a person is experienced in their life if
they become problematic. Sometimes, when somebody's experienced an elevated mood
that's abnormal they may not realize it and loved ones in their life may help
them to understand that there's something that could be problematic.
Sometimes, even in an elevated mood can be uncomfortable and a person might
might actually realize it themselves. It could be either one. You're watching
Ask Us Anything About Bipolar Disorder from Penn State Health Milton Hershey Medical
Center. I'm Scott Gilbert. This is Dr. Erica Saunders, she's Chair of Psychiatry
here. She welcomes your questions, you can add them as a comment below this Facebook
Facebook post, whether you're watching this live here on Friday or if you're watching
after the fact we can still track down an answer to your question. So, feel free
to ask away in the comments below this post and of course if you find this
information useful we hope that you'll share it on
your Facebook page. Dr. Saunders, at what ages does bipolar disorder typically get
diagnosed? When does it become most noticeable? Most people who experience
bipolar disorder begin to have problems during the teen years with mood and
often with anxiety as well. So low mood, high mood, as we talked about before but
generally the age between 15 and 25 is the most common age that that this
becomes problematic for for an individual. And we talked about some of
the things that clinicians look for but what are some things that family members,
friends can look for some warning signs that you may know somebody for a while,
you may know them as someone who's happy sometimes sad sometimes what's that sign
that maybe you're a loved one might need some help? The problems with
relationships and problems with social functioning in general that might relate
to feeling down or feeling too high and excited that people aren't able to
really interact. So those are warning signs in depression unfortunately
people can feel so hopeless and sad that they may not think that things will ever
get better and that can lead to thoughts of suicide and that of course is a very
attended to very quickly. As with many medical conditions there are different
types of bipolar disorder it's not a across-the-board diagnosis necessarily.
Can you walk us through briefly a couple of different types? Certainly there are
two types that we really talk about bipolar one disorder and bipolar two
disorder. And the difference comes in that bipolar one disorder has periods of
what we call mania which is severe elevated mood and when I say elevated
it's not just happy but it's, it can be happy it can also be uncomfortable but
elevated energy, inability to sleep, inability to make good decisions,
impulsivity, often leads to people doing things that they would never otherwise
do that can get them into legal trouble and be very dangerous.
So that's mania and that is the hallmark symptom or hallmark episode of bipolar
one disorder. In bipolar two disorder, individuals experience what we call
hypomania which is elevated mood but not to the severe extent that you can have
in bipolar one disorder and frequently long and severe depression. We're
learning about bipolar disorder today from Dr. Erica Saunders she's Chair of
Psychiatry here at Penn State Health Milton Hershey Medical Center. We welcome
your questions just add them to the comment field below this Facebook post
and we'll pose them to Dr. Saunders. Either live or after the fact we'll get
you some answers as well. Now Dr. Saunders is not just a clinician but
also a researcher and you had a recent study that found that well bipolar
disorder occurs a similar frequency in men and women there are some differences
in how each gender experiences episodes of mania or depression. Can you tell us a
bit about that and why that's a significant finding? So that's something
that we're very interested in, so bipolar disorder is prevalent at about one to
two percent in the population equally as you said equally prevalent in men and
women. However, the experiences are different and so what we found in a
series of studies is that women tend to have more anxiety with bipolar disorder
some studies have found that women have more depressive episodes and we found
that difficulty sleeping even when people with bipolar disorder are feeling
well or not in a depression or mania can tend to be more problematic for women
than for men. We're interested in this because there's different underlying
biology that might be important for men and women and we hope to really learn
more about that so that we can better predict which treatments will match best
for each individual patient. We really want to get to the point. We have a nice,
way we have a number of different treatments for bipolar disorder both
medications and psychotherapy and we would really want to be able to predict
early on in the course of illness which treatment is going to help which patient.
There's a different biological causes depending on gender possibly? Possibly.
So we're looking at different inflammatory factors that might be involved the
inflammatory system it has now been linked to a number of different
conditions include getting obesity, mood disorders,
depression, bipolar disorder, perhaps others as well and so we're looking at
whether specific inflammatory changes in the body may be important or predictive
of symptoms in men and women and that may tell us something in the future
about what treatment is is best. Now what do we know in general about the causes
and risk factors for bipolar disorder? So we know in general that one of the the
biggest risk factors for bipolar disorder is that it runs in families so
it's what we call hereditary. There's a genetic component to bipolar disorder
but it is not so it may pass from generation to generation but it's not
something that's a certainty in a family. So, if one of my parents has it, maybe
I won't get it. You're not definitely going to have it but you
have a higher risk than the general population of having bipolar disorder. So
family history is a component of it. There are environmental factors that
might lead someone to have be more likely to have bipolar disorder.
Environmental triggers of mood and then we know that there are a number of
different biological systems that are involved and there's a lot of really
exciting research going on right now to try to understand what biological
factors are important. We have a question online from, Andrea and this is something
I think a lot of parents and grandparents can relate to she says my
grandson is three and there are times he goes on a rage and then when you tell
him no then he goes in cries. Can you tell what could be wrong? So I mean, is
this possibly normal behavior for a three-year-old? So that's a very good
question and so one of the things that we do when we evaluate people for
bipolar disorder is to understand at whatever age they are, what is the usual
behavior that's expected for that period of development and what might be
abnormal behavior. So there are a lot of different
factors that can play a role in anger and in rage and in different moods at
every stage of development and so it's a little hard to say
whether that's bipolar disorder specifically. Also, just taking that
question a bit more general when we look in when we have children who are
experiencing difficulties with mood sometimes it can present a bit
differently than than an adult and so we have to understand what those factors
are for that individual child and that's that's part of an evaluation. And that's
kind of related to a question we just got from Tara, who's asking ,what the
signs are of bipolar disorder specifically in children? So in children,
due to emotional development children don't always present with the same the
same words to describe emotional feelings may be very difficult for
children to describe their emotions and an emotional development happens in you
know in a progression throughout childhood. So we look for disturbance in
in school, difficulty with grades, difficulty with social functioning and
then try to understand whatever moods that child is experiencing what are they,
what are they like? But you may not see what we call the classic
euphoric or happy elevated mania that we see sometimes in adults. For children, it
might be more irritability, more anger, and more being just unable to control
emotions. You're watching Ask As Anything About... Bipolar Disorder from Penn State
Health Milton Hershey Medical Center. This is Dr. Erica Saunders, she's
answering questions here today and some great questions so far so thank you very
much and please keep the questions and comments coming. I'd like to ask about
what some of the consequences of bipolar disorder? That is, to what extent
can this disrupt somebody's life. So the consequences can unfortunately be at
times very, very severe. So as I said before, bipolar disorder can lead people
to feel hopeless and feel like taking their own life
that's a horrible tragedy that can be the outcome of this of the severe
illness. Additionally, people can have such difficulty at work or school that
they're unable to continue with the job that they want or continue schooling and
difficulty and this can be a problem in disrupting relationships. So we work very
carefully with the patients and families that we see to understand what the
impact has been of mood problems on the life of that individual so far
and do whatever we can to prevent having those types of problems in the future.
We work to educate people about what is bipolar disorder, what steps can
you take to improve the mood functioning and sometimes that's
of course you know, focus of our treatment but there are also a lot of
other ways that we help individuals with with regulating mood.
I was going to ask about treatments a bit because it seems like as with many
psychiatric conditions, there is medication as an option, there's therapy
as an option and what kind of determines the path of treatment for a given
patient. So we have medications for bipolar disorder which we call mood
stabilizing medications which both treat manias and depressions and prevent
future episodes. So this is an episodic illness where people tend to be affected
for a while and then maybe not affected for a while. When you say awhile, that's like
a week or two sometimes? It can be a week or it can be up to months. And the natural
course of the illness is to go into what we call remission which is not to
have any mood symptoms at that time. But then to come back and recur and so we
treatment with medication can help prevent future episodes which is really
important for overall health and for overall brain health. So there are a
number of medications that can be helpful. We also use different types of
psychotherapy, cognitive behavioral therapy or interpersonal therapy,
dialectical behavioral therapy. There are a number of different types.
to match a situation. And that helps patients and Families really build up the resilience needed to
deal with these devastating illnesses in their life and to regulate emotion.
They're very well tested, evidence-based techniques to help someone regulate
emotion that we teach. Is there a temptation among people who have bipolar
disorder to maybe self-medicate with drugs, alcohol, even caffeine and that
extra cup of coffee? Absolutely. You know when any of us feel down, low, bad,
angry, we try to do something to change that feeling. That's completely natural
and so many people turn to substances for that same reason
because substances do change how we feel. Unfortunately, that often becomes a
vicious cycle and substances that are commonly abused, alcohol, drugs of abuse,
even caffeine at times can set someone up for maybe feeling better in the
moment but long term it usually leads to much worse problems with mood, sleep,
anger, irritability and sometimes can even trigger addiction and a physical
addiction dependent dependence process that is a separate illness but also very sever.
This is Ask Us Anything About... Bipolar Disorder from Penn State Health
I'm Scott Gilbert, alongside Dr. Erica Saunders, she's Chair of Psychiatry here
at Penn State Health Milton Hershey Medical Center
She's been answering my questions and yours and we welcome any additional
questions you may have here as we bring things to a close. And of course, an
important question is, if people want more information, I understand they can
go online to PennStateHealth.org/psychiatry. Is that the best place to go?
Yes, that's correct. We provide services here through Penn State Health we also have an affiliation with
Pennsylvania Psychiatric institute in Harrisburg that has services available there as well.
Very robust psychiatry department so people can take advantage of those
services. Even if it's just a call and maybe I'll learn a little bit more.
What should that first call be if somebody feels that maybe they personally might
be experiencing this? Should they talk to their primary care physician
or go beyond that? So primary care physicians often are a very good place
to start so I would say primary care physicians, psychiatric specialty
services, psychologists, psychiatrists, therapists. Therapists can
be nurses or social workers. We all work together as a team to provide treatment
for patients and for individuals if somebody's experiencing a crisis there
is a crisis help in counties in Pennsylvania. It's available through the
county, the local emergency room for emergencies and there are numerous help
lines for suicide if someone's experiencing thoughts of suicide which
is also a place to turn. A lot of places to turn for good information. Thank you
Thank you for the good information today Dr. Saunders. Dr. Erica Saunders, she's
Chair of Psychiatry here at Penn State Health Milton S Hershey Medical Center.
She was our guest. Thank you for being the viewers here for Ask Us Anything
About... Bipolar Disorder from Penn State Health.