Wednesday, February 4, 2009

Does Bipolar Kill?

I recall attending my first-ever bipolar conference in Pittsburgh in June 2001. Robert Post MD of the NIMH informed us that those of us with bipolar can expect to die seven years earlier than the general population, independent of suicide.

A year or two later, I heard Ken Duckworth MD, then in the employ of the state of Massachusetts, relate an anecdote to a NAMI convention that ended in a colleague telling him, "You guys really know how to put on great memorial services."

This month's Psychiatric Services features a review of 17 studies involving 331,000 bipolar patients. The study found mortality from natural causes ranged from 35 percent to 200 percent higher than comparison groups. The rate is similar to that of smokers.

The study yielded no smoking gun, but its authors single out the usual suspects, including:

Stress - Stress is complicit in just about every mental and physical catastrophe, from flipping us out to stopping our hearts. Researchers have connected a range of dots - from genes that predispose our limbic systems to over-reacting to whatever life throws our way to cortisol released into our blood streams to over-excited neurons resulting in cellular breakdown. A very strong case can be made that all mental illness results from stress, as well as its corollary - the best way to manage mental illness is to manage our stress.

Risky lifestyles - Including smoking, drug and alcohol use, poor diet, and lack of exercise, not to mention lonely lives in toxic living conditions.

Our meds - Patients have been telling their psychiatrists since Day One that they don't enjoy being fat stupid zombie eunuchs. But only recently, on the heels of the NIMH-underwritten CATIE studies from a few years back, is psychiatry waking up to the fact that our meds may in fact kill us, particularly in regard to the metabolic effects of certain second-generation antipsychotics. Smart meds strategies may work wonders. Too many of us are exposed to dumb ones.

Bad health care - GPs and others tend not to take seriously patients they view as crazy, combined with the inability in some patients to effectively communicate with their doctors.

Bipolar kills. So do depression, anxiety, schizophrenia - you name it. Actually, death wins regardless of whether or not we have a diagnosis. No exceptions. But we don't have to sit around waiting for the inevitable. We can still make choices. Live long and prosper ...


Francesco Bellafante said...

Isn't another way of looking at it that our decisions kill us?

Society labels the chronically poor decision makers as mentally ill, no?

Isn't that what is going on?

What am I missing?

You say depression, schizophrenia, bipolar disorder... I say people routinely making 'creative' or out of the ordinary choices compared to the choices that other more 'normal' people make in similar situations, right?

John McManamy said...

Very interesting, Francesco.

"Society labels the chronically poor decision makers as mentally ill, no?"

Yes, definitely. If I keep choosing to drive my car into the same brick wall every day and make no attempt to correct my behavior, other people are entitled to ask questions.

This is not creative behavior to me, it's destructive.

I'm not totally in control of my brain, especially if I appear to lack the capacity to choose to avoid the brick wall. The logical course of action is to look for causes and solutions.

Psychiatry has many flaws - and we have a long way to go - but it represents a legitimate attempt to find causes and solutions.

I accept that all behavior has context. If I were to gamble on my income, I would have a gambling problem. Michael Jordan, on the other hand, may gamble a lot, but has no gambling problem.

Marilyn Monroe in top form is Marilyn. Someone else acting like Marilyn may be wrecking their life.

The beat goes on ...