GOING TO EXTREMES PHYSICIANS TRY TO ERASE MISCONCEPTIONS ABOUT BIPOLAR DISORDER AS A FOOTBALL PLAYER'S PLIGHT MAKES HEADLINES.Byline: Mariko Thompson Staff Writer
Barret Robbins Barret Robbins (born August 26, 1973 in Houston, Texas) is a former American Football center for the National Football League Oakland Raiders where he played for nine seasons between 1995 to 2004. isn't a flake. But to those unfamiliar with the extreme cycles of bipolar disorder bipolar disorder, formerly manic-depressive disorder or manic-depression, severe mental disorder involving manic episodes that are usually accompanied by episodes of depression. , the Oakland Raiders player's erratic behavior and suspension in the days leading up to this year's Super Bowl might have seemed indefensible.
What explanation could possibly exonerate an all-pro center who let down his team and disappointed an entire Raider Nation going into the NFL's greatest game?
In the days between the suspension and his statement confirming that he suffers from bipolar disorder, actor Maurice Benard suspected and sympathized. Benard, a star on ``General Hospital,'' knows what it's like to struggle against the tides of euphoria and utter despair. He has wrestled with bipolar disorder, also known as manic depression, for 17 years.
``Every time you go through a manic state, you're high and on top of the world,'' Benard said. ``Then you crash.''
Robbins' latest and highly publicized episode, during which he went missing the night before the Super Bowl, underlined several truths of bipolar disorder. First, the wild mood swings are accompanied by a neurochemical neu·ro·chem·is·try
The study of the chemical composition and processes of the nervous system and the effects of chemicals on it.
neu imbalance that cannot be overcome by sheer willpower. Second, in their stable periods, people who suffer from bipolar disorder can lead normal and productive lives. Third, when left untreated or unmedicated, the disease can have a debilitating de·bil·i·tat·ing
Causing a loss of strength or energy.
Weakening, or reducing the strength of.
Mentioned in: Stress Reduction effect on the individual and everyone around him.
Coincidentally, at the time of the Super Bowl, Benard was helping the National Mental Health Association launch an awareness campaign for bipolar disorder. The stark black-and-white public service announcements distill dis·till
1. To subject a substance to distillation.
2. To separate a distillate by distillation.
3. To increase the concentration of, separate, or purify a substance by distillation. the oppositions: It can make you feel on top of the world, then make you feel too weak to get out of bed. It makes you love everybody, then it makes you hate yourself. It can keep you up for three nights straight, then keep you down for three weeks straight.
An estimated 2.5 million Americans suffer from manic depression, a chronic and potentially fatal disorder. According to experts, up to one-third of those people remain undiagnosed. Without proper treatment, 15 percent will commit suicide and nearly half will attempt to take their lives. Forty percent will abuse alcohol or other drugs. Many have difficulty holding down steady jobs and the puzzling behavior often strains family relationships.
``It can be a very devastating dev·as·tate
tr.v. dev·as·tat·ed, dev·as·tat·ing, dev·as·tates
1. To lay waste; destroy.
2. To overwhelm; confound; stun: was devastated by the rude remark. illness for the individual and the family,'' said James Radack, vice president for public education at the National Mental Health Association. ``That's why we wanted to do the campaign. People with bipolar disorder can go a number of years before they get the correct diagnosis. With help, it is a manageable illness.''
In recent years, bipolar disorder has come out of the closet Verb 1. come out of the closet - to state openly and publicly one's homosexuality; "This actor outed last year"
out, come out
disclose, let on, divulge, expose, give away, let out, reveal, unwrap, discover, bring out, break - make known to the public . The television show ``ER'' highlighted the disease with a much-lauded, recurring story line featuring Sally Field. Celebrities such as Benard and Carrie Fisher have spoken candidly about the frightening highs and lows.
Benard, who plays Sonny Corinthos on ``General Hospital,'' initially feared the stigma of mental illness would harm his career. The decision to speak out was not easy.
``I was told directors wouldn't hire me,'' he said. ``They'd think I'd go crazy on the set. What's more important - directors or producers who might not cast me because they're ignorant, or helping people? So that's what I've been doing.''
Knowing the signs
Today, as a result of increased awareness, most people recognize the symptoms of depression, marked by a loss of interest in activities once enjoyed, extreme self-critical or suicidal thoughts, and a change in sleeping or eating patterns. Mania, a seductively euphoric state, can be harder to identify and harder to give up for those with the illness.
Mania has been romanticized as an artistic affliction, the burst of energy and creativity that fueled Virginia Woolf, Van Gogh and Beethoven. But the restlessness, irritability, rapid speech and self-aggrandizement that are symptoms of mania can lead to reckless behavior, including spending sprees and sexual indiscretions. In severe cases, people can experience delusions.
Stephen Hinshaw, professor of psychology at the University of California at Berkeley (body, education) University of California at Berkeley - (UCB)
See also Berzerkley, BSD.
Note to British and Commonwealth readers: that's /berk'lee/, not /bark'lee/ as in British Received Pronunciation. , chronicled the nature of the illness in his recent book, ``The Years of Silence Are Past: My Father's Life With Bipolar Disorder.'' As a child, Hinshaw was enveloped en·vel·op
tr.v. en·vel·oped, en·vel·op·ing, en·vel·ops
1. To enclose or encase completely with or as if with a covering: "Accompanying the darkness, a stillness envelops the city" in the silence and stigma of mental illness. His father, Virgil, a professor of philosophy, would disappear for long periods of time, which Hinshaw later learned were for hospitalizations. Virgil had his first delusional episode at age 16. He jumped off the roof of his home, thinking he could fly.
His father's lifelong battle led Hinshaw to study psychology. He studied mood disorders under Kay Redfield Jamison Kay Redfield Jamison (born June 22, 1946) is an American professor of psychiatry and writer who is one of the foremost experts on bipolar disorder, which she herself suffers from. , a former UCLA UCLA University of California at Los Angeles
UCLA University Center for Learning Assistance (Illinois State University)
UCLA University of Carrollton, TX and Lower Addison, TX professor who wrote a groundbreaking first-person account of the illness called ``An Unquiet Mind.''
``We're beginning to come out of the closet in terms of recognition and discussion, but we're not there yet,'' Hinshaw said. ``You can still, without any qualms, call someone crazy, psycho or retard. Even though they talk about cancer or AIDS, families are ashamed to admit a family member is crazy.''
Bipolar disorder has a genetic component and tends to run in families. But the predisposition doesn't mean children will develop the disease. If one parent has bipolar disorder, the risk to the child is about 5 percent. The risk increases to about 14 percent if other close relatives such as an aunt or uncle also are bipolar.
Sometimes a traumatic event, like a death in the family For the Batman graphic novel/storyline, see .
A Death in the Family is an autobiographical novel by author James Agee, set in LaFollette, Tennessee. He began writing it in 1948, but it was not quite complete when he died in 1955. or the ending of a romantic relationship, will trigger the illness.
``We tend to think things are all biological or all environmental,'' Hinshaw said. ``They're a combination.''
Psychiatrists used to believe that manic depression emerged in the late teenage years or in early adulthood. But researchers are finding onset can begin in childhood, though the illness presents itself in a different way. Children tend to cycle through the manic and depressive states at a faster pace, sometimes experiencing both in the course of one day, said Janice Papolos, editor of the ``The Bipolar Child Newsletter'' and co-author of ``The Bipolar Child: The Definitive and Reassuring Guide to Childhood's Most Misunderstood Disorder.''
In children, bipolar disorder often co-exists with attention deficit disorder attention deficit (hyperactivity) disorder (ADD or ADHD)
Behavioral syndrome in children, whose major symptoms are inattention and distractibility, restlessness, inability to sit still, and difficulty concentrating on one thing for any , obsessive compulsive disorder Obsessive compulsive disorder (OCD)
Disorder characterized by persistent, intrusive, and senseless thoughts (obsessions) or compulsions to perform repetitive behaviors that interfere with normal functioning.
Mentioned in: Tourette Syndrome and learning disabilities. The risk of partial diagnosis or misdiagnosis mis·di·ag·no·sis
n. pl. mis·di·ag·no·ses
An incorrect diagnosis.
mis·diag·nose is high. The stimulants and antidepressants Antidepressants
Medications prescribed to relieve major depression. Classes of antidepressants include selective serotonin reuptake inhibitors (fluoxetine/Prozac, sertraline/Zoloft), tricyclics (amitriptyline/ Elavil), MAOIs (phenelzine/Nardil), and heterocyclics used to treat the other conditions can actually worsen the aggressive and despondent de·spon·dent
Feeling or expressing despondency; dejected.
de·spondent·ly adv. behaviors, Papolos said. As with adults, proper treatment with mood stabilizers or anti-psychotic medications has proved effective, she said.
``I'm hearing wonderful stories,'' Papolos said. ``They're treated and stable and getting better in their teenage years. I like to hold out hope.''
One question that researchers have is whether the rapid cycles in children slow down with time and eventually match the more elongated e·lon·gate
tr. & intr.v. e·lon·gat·ed, e·lon·gat·ing, e·lon·gates
To make or grow longer.
adj. or elongated
1. Made longer; extended.
2. Having more length than width; slender. mood swings of the adult form.
``What we don't know Don't know (DK, DKed)
"Don't know the trade." A Street expression used whenever one party lacks knowledge of a trade or receives conflicting instructions from the other party. yet is if children who have bipolar disorder will look like the classic disorder we see (in adults) or if there's a new form that's arising,'' Hinshaw said.
The role of medication
Researchers also are seeking to get a better handle on the nature of depression in bipolar patients. More than 200 studies have been conducted on depression alone, but only 10 have looked at bipolar depression, said Dr. Lori Altshuler, director of the Mood Disorders Research Program at the UCLA Neuropsychiatric neu·ro·psy·chi·a·try
The medical study of disorders with both neurological and psychiatric features.
Once-standard approaches are changing as science discovers more about the effect of anti-depressant medications on bipolar depression. Doctors used to prescribe anti-depressants to bipolar patients temporarily for fear that long-term use would invoke a manic episode manic episode Psychiatry A period characterized by a persistently elevated, expansive, or irritable mood, with ↑ energy, ↓ sleep, distractibility, impaired judgement, grandiosity, flights of ideas, and so on, most often affecting Pts < age 25; MEs . But research shows that halting the anti-depressants is more likely to plunge them back into a severe depression, Altshuler said.
``If you follow them over time, what gets worse isn't the manias but the depressions,'' she said. ``As life unfolds, the depressions occur more frequently and are more disabling than the manias.''
The UCLA program has been part of a larger study comparing the effects of various anti-depressant medications on people with bipolar disorder. The study compared three drugs and looked at the patients' overall responses, how quickly they rebounded from depression and whether a particular drug was more likely to induce mania. Participants continued to take a mood stabilizer over the year-long course of the study.
Among the preliminary results, perhaps the most interesting finding is that nearly half of the patients enrolled in the study didn't respond to the anti-depressant medications at all, Altshuler said.
``There's an imperative to figure out what's the best treatment,'' she said.
Common mood stabilizers used to treat bipolar disorder are lithium and anticonvulsants Anticonvulsants
Drugs used to control seizures, such as in epilepsy.
Mentioned in: Antipsychotic Drugs, Osteoporosis such as Depakote. Though effective, lithium tends to cause weight gain, tremors, blurred vision and frequent urination urination
Process of excreting urine from the bladder (see urinary system). Nerve centres in the spinal cord, brain stem, and cerebral cortex control it through involuntary and voluntary muscles. The need to void is felt when the bladder holds 3. . Depakote, said to have fewer side effects Side effects
Effects of a proposed project on other parts of the firm. , still can result in weight gain, tremors, nausea and hair loss.
The side effects, along with the idea that mania will allow them to perform at a higher level, make taking the daily pills less appealing. Robbins, the Raiders center, apparently stopped taking his medication. Maybe he was in an expansive mood and didn't want to flatten out. Maybe he was too depressed to take the pills. The temptation to stop is always there.
``Family members are really essential,'' Hinshaw said. ``They need support and education. They need to help motivate the person to take the medication. Family members have been ignored too long as part of the assessment and treatment process.''
Mental health advocates say the mixed reaction to Robbins shows the need for public education on bipolar disorder. Yet they also see reason for optimism. To borrow a line from Hinshaw, Robbins could be the catalyst that makes the silence surrounding bipolar disorder a thing of the past.
For more information ...
For free educational materials and referrals to local services, contact the National Mental Health Association at (800) 969-6642 or visit www.nmha.org.
--To participate in a study, contact the Mood Disorders Research Program at the UCLA Neuropsychiatric Institute at (310) 794 9913 or visit www.npi.ucla.edu/uclamdrp.
--To learn more about early onset bipolar disorder in children
Children with bipolar disorder do not often meet the strict DSM-IV definition. , visit www.bipolarchild.com or www.bpchildresearch.org.
``The Years of Silence Are Past: My Father's Life With Bipolar Disorder'' by Stephen Hinshaw; Cambridge University Press Cambridge University Press (known colloquially as CUP) is a publisher given a Royal Charter by Henry VIII in 1534, and one of the two privileged presses (the other being Oxford University Press).
``An Unquiet Mind'' by Kay Redfield Jamison; Vintage Books
``The Bipolar Child: The Definitive and Reassuring Guide to Childhood's Most Misunderstood Disorder (Revised and Expanded Edition)'' by Dr. Demitri Papolos and Janice Papolos; Broadway Books
(1 -- cover) ABOUT FACE
Experts hope to raise awareness, understanding of bipolar disorder
(3) Maurice Bernard, ``General Hospital'' actor, on deciding to speak publicly about his bipolar disorder
(4) Sally Field portrays a woman with bipolar disorder in a recurring ``ER'' story line.
For more information (see text)