Bipolar Disorder, Living With (cont.)

One of the reasons, for example: what we know about the postpartum period is there are so many hormonal changes that if a woman has an underlying predisposition or biological genetic predisposition to a mood disorder, that's the most likely time it's going to be triggered. So some combination of an underlying predisposition or vulnerability combined with strong hormonal changes can make a real difference.

However, what we also know about mood disorders is that their age of onset is quite young for both depression and particularly for bipolar illness. The average age of onset for bipolar illness is about 18. So, most people who have their first occurrence of mania or bipolar depression are going to have it when they are relatively young.

MEMBER QUESTION:
Since I have been on my medications I've felt flat. I have very little emotion and I'm not interested in any of my usual activities. Could one of the medications cause this?

JAMISON:
Yes and these are things that you always want to sort out if people are feeling flat, unenergetic and emotionally distant or unengaged:

  • Is it depression? Depression can certainly look that way.
  • Is it a thyroid problem? That can be treated pretty straightforwardly.
  • Is it a medication? If it's a medication, is it inevitably going to cause that reaction in that person or is it related to the dose?

These are the sorts of issues that should be brought up with the person's doctor. I'm a great believer that people should go into their doctors' offices with note pads full of questions.

MEMBER QUESTION:
Do you have any suggestions for dealing with economic stressors during periods of low functioning?

JAMISON:
Wow, not really. I think that there are some things that you can do when you're well to protect yourself.

A lot of people who have bipolar illness, for example, when they get manic, spend money in an irrational way. They can make contracts with their family members for the family to manage the majority of the money so that they don't get themselves into terrible financial problems. In terms of acute financial problems when depressed -- not really.

It's one of the most barbaric aspects of our health system; that psychiatric care is expensive and unaffordable for so many people. This is ultimately a political issue and one that the advocacy groups and support groups that I know are very actively involved in trying to do something about -- so that psychiatric illnesses are given parity with medical illnesses so people don't have that kind of financial strain. A lot of people in this country are put in the position, when they are depressed, of having to choose between not taking medication or not being able to pay their rent and that's inexcusable.

MODERATOR:
Yes, it is. Members, you may want to search on WebMD and look in our WebMD Live archives. We have done a couple of interviews with Roslyn Carter, former first lady, who is very active in this area, on mental health parity and erasing the stigma of mental health in our society.

JAMISON:
She has been terrific and also very active on the other side of the aisle is Senator Pete Domenici, whose daughter has schizophrenia; he's been a very active participant. And of course the late Paul Wellstone -- more than anyone in the United States Senate -- he and Senator Domenici worked together very closely to try to do something about parity. The problem is it actually tends to pass the Senate, and then gets bottled up in a very small subcommittee of the House of Representatives. That has to do with insurance companies.

MODERATOR:
Yes, that's exactly what Mrs. Carter said.

JAMISON:
She has been great, of course. She and her husband both -- she has been just fabulous.

"My experience with support groups is that they have more ideas than anybody, both more practical and more invested in trying to help other people with similar problems."

MODERATOR:
She spent over 30 years trying to get people to understand that mental illness is an illness -- just as diabetes or kidney disease and that people need to be allowed to have their dignity and receive treatment.

JAMISON:
Yes, she has been terrific.

MEMBER QUESTION:
I'm 58, recently divorced, on a medical assistance program and just diagnosed as suffering from bipolar disorder. I can't find a psychiatrist who will accept medical assistance. I really need to speak to someone soon.

MODERATOR:
Unfortunately her situation is not terribly unusual.

JAMISON:
No, it's not. Again, I think going to one of the support groups or the advocacy groups like the Depression and Bipolar Support Alliance or the National Alliance for the Mentally Ill and asking some other members of groups what their suggestions are in the local community might help.