The Young, The Restless

BY KINGSON MAN
Daily Staff Reporter
Published November 17, 2004

For a disorder that is often first diagnosed from 18 to 24 years of age, it strikes many as surprising that college students aren’t more aware of bipolar disorder. Lost in the shuffle of breakups and hookups, good grades and bad, a pattern of mood swings is easily written off as part of the college experience.

“Going crazy at 17 was the most traumatic experience I ever had,”

writes Lizzie Simon in her book “Detour: My Bipolar Roadtrip in 4-D.” The Columbia University student was first diagnosed with bipolar disorder at the age of 17. And her life was about to get a lot crazier when she’d have to deal with her problem at college.

At Columbia, Simon managed her disorder privately, for the most part. “In 1998, nobody talked about mental health, depression, bipolar disorder. I felt very much alone,” Simon said. So she coped in a personal, individual way. “I was an overachiever. I had straight A’s, productions going on, was a workaholic.”

In her spare time, Simon went to the library to research her condition. She also went to support groups secretly and didn’t tell any of her friends.

She emphasized the role of personal responsibility in the management of her health and as part of this responsibility, understood the importance of a proactive relationship with her psychiatrist.

“You shouldn’t just go into the office and listen and do whatever they tell you. Come with questions.” For her, visits with psychiatrists weren’t lectures, but discussion sections.

Bipolar disorder is defined as “a brain disorder that causes shifts in mood,

energy and ability to function” by the National Institutes of Health. The process of diagnosing people, however, is more difficult.

For 2 to 4 percent of the population, bouts of mania and depression are indicative of a serious psychological disorder, according to the Henry Ford Health Center in Detroit.

There is no blood test or clear physiological indicator for bipolar disorder like there is for chicken pox or the flu. Rather, diagnosis is based on a list of symptoms as defined by the Diagnostic and Statistical Manual, also known as DSM-IV, said Vicki Hays, associate director of the University’s Counseling and Psychological Services.

“People don’t ‘look’ bipolar,” said Melvin McInnis, Professor of bipolar disorder and psychiatry in the University of Michigan Health System. “Most students who end up seeing a psychiatrist have gone through many levels of health providers. It takes a good hour to get to know the person and develop rapport and a trusting relationship, but for a good clinician it’s not as difficult as it sounds.”

Differentiating between bipolar disorder and schizophrenia or depression, however, is more difficult. During treatment, students may be in either their depressive or manic states and be falsely diagnosed. An antidepressant may push someone with bipolar disorder into a manic episode.

Emerging directions in the science of bipolar disorder aim to improve the methods of diagnosis. Studies of twins and adopted children show a genetic link for the disorder between first-degree relatives. Neuroimaging studies that use MRI and PET scans are also attempting to identify specific patterns of electrical charges or abnormalities in the brain.

Current research has not identified the manner in which bipolar disorder changes the brain’s chemical composition or neural wiring.

“Is there a specific pathophysiological change in the brain? The answer, for now, is no,” said Cathy Frank, director of outpatient services at the Henry Ford system.

“If you’ve ever seen one you’ll remember it for the rest of your life.”

That’s how McInnis described witnessing a severe manic episode.

Clear-cut cases range from individuals who feel elated and enlightened to extreme degrees, such as one student who went to the Caribbean islands and spent $10,000 throwing parties for strangers or an architect who went through two-day periods in which he could “see how things were supposed to be done, thought more clearly, could easily draw 3-D renditions, all with little or no sleep,” McInnis said.

But bipolars aren’t always feeling like they’re “dancing on the table, driving at 100 miles per hour,” he said.

“Most commonly, an individual has a low-grade chronic depressed mood for 60 to 70 percent (of the time). “The real problem,” McInnis said, is the patients who are “not totally sick, who — even untreated — are getting to jobs and classes.”

The enduring phenomenon of chronic low-grade depression causes symptoms most college students are familiar with: feeling tired all the time, having a hard time concentrating and not being able to achieve at one’s potential.

Distinguishing between individual differences of personality and the more harmful effects of a disorder is subtle, and “isn’t going to be found in one gene,” McInnis said.

“The measure of temperament — whether a person is intro- or extroverted, how one reacts to positive or negative news, how one deals with stress — are all helped by current psychological surveys, “and these tools are continuing to be useful,” McInnis said.

However, survey evaluations aren’t enough to shed light on the underlying causes of temperament and more severe mood disorders.

Upcoming research will focus on biochemical pathways and how genetic dysfunctions or environmental stresses may have a cascade of psychological consequences. “It’s a wonderful time to be in the field,” McInnis said.

“Knowledge that it’s a treatable disorder is particularly important,” Frank said, emphasizing the importance of a healthy relationship between patient and psychiatrist.

Current treatment entails a combination of medication and psychotherapy. Also used to treat schizophrenia, “Lithium remains one of the best medications around to treat bipolar disorder,” McInnis said.

Also under investigation are drugs used to treat epileptics, but McInnis said, at this early stage, “We don’t understand how the dickens it works.”

Another treatment method being researched is the use of trans-cranial magnetic stimulation, or using specifically tuned magnetic fields to relieve some symptoms of depression. Work is underway to miniaturize the technology to create a handheld device for treatment.

This past summer, the University held a conference on depression and college students — the only one dedicated to the topic in the United States, McInnis said. But he added that “colleges have been by and large under resourced.”

In an effort to raise awareness nationwide, Simon has been traveling around the country with the Detour to Wellness series of events, which aims to create communities of support and to raise the profiles of younger people suffering from bipolar disorder. There will be a Detour to Wellness event in Dearborn tomorrow and details can be found at www.detourtowellness.com.

On campus, the University’s Counseling and Psychological Services in the Michigan Union and Pierpont Commons offers free counseling to enrolled students for bipolar disorder, depression and other concerns. Also available is the Institute for Human Adjustment in East Hall and the University Hospital’s outpatient psychiatric services, Hays said.

In addition to traditional forms of treatment, however, Simon encouraged students to come to a personal understanding and approach to their wellness. “I wasn’t a full-time patient during those productive college years … you are so much more than your disorder.”