A Science Update published by the National Institute of Mental Health (NIMH) entitled “Imaging Studies Help Pinpoint Child Bipolar Circuitry” reports the results of recent brain imaging studies that reveal that “…the brain works differently in youth with bipolar disorder (BD) than in chronically irritable children who are often diagnosed with pediatric BD.”

According to Ellen Leibenluft, M.D., chief of NIMH’s Section on Bipolar Spectrum Disorders, which is conducting the studies, “This suggests that chronically irritable children may suffer from a syndrome distinct from BD and may require different treatments.”

This particular article draws some very useful distinctions among the following three diagnoses:

Last week I did a post entitled “Supportive Catch Phrases That Make My Blood Boil.” It generated some great discussion, and I thank all of you who posted such insightful comments. Venting like this helps me keep a sense of humor when I’m feeling the sting, and many of your comments made me smile, some made me laugh, and a few made me think that maybe my feelings were misdirected.

A couple people were obviously upset. I noticed on our Facebook page that we lost a few people who previously “liked” the page. I’m sorry to see that, but I can understand why some people may have been turned off. It just goes to show that I’m not always the most sensitive person on the planet either.

Researchers at Johns Hopkins University School of Medicine have published a study entitled “Chronic Corticosterone Exposure Increases Expression and Decreases Deoxyribonucleic Acid Methylation of Fkbp5 in Mice,” Endocrinology, September 2010, in which they claim to have identified a possible epigenetic cause of depression and other mood disorders, including bipolar disorder. For a more layman’s account of the study and its conclusions, I recommend the Johns Hopkins press release entitled “Chronic Stress May Cause Long-Lasting Epigenetic Changes.”

The prefix epi- means outside, above, over, or on top of. The term epigenetic refers to factors outside the fundamental gene structure that affect a gene’s expression. In this study, researchers examined the effects of a common stress hormone on a gene that has been linked to mood disorders and found that “… long-term exposure to a common stress hormone may leave a lasting mark on the genome and influence how genes that control mood and behavior are expressed.”

Over the course of my family’s experience with bipolar, I have been on the receiving end of plenty of excellent information and advice. I’ve also heard several phrases intended to help us deal with painful, overwhelming situations that I have come to despise. Here are a few:

“Hang in there.”

“God never gives you more than you can handle.”

“Don’t take it personally.”

Current Psychiatry Online (August 2010) has an excellent article by Bryan K. Tolliver, MD, PhD entitled “Bipolar disorder and substance abuse: Overcome the challenges of ‘dual diagnosis’ patients.” If you are interested in exploring the connection between bipolar disorder and substance abuse, I encourage you to read the article.

Tolliver includes a table in his article (Table 1) designed to assess the strengths and weaknesses of some of the most common theories of why substance abuse so often accompanies bipolar disorder. One of the most common theories he examines is that substance abuse arises from attempts to self-medicate – to treat the symptoms the individual is experiencing. Tolliver points out three facts that challenge this belief:

Lately, we’ve noticed many articles floating around the Web about the fact that bipolar disorder is not associated with increased incidents of violent crime. Most, if not all, of these articles are in response to a study published in the Archives of General Psychiatry (September, 2010) entitled “Bipolar Disorder and Violent Crime.” In this study, researchers arrived at the following conclusion:

Although current guidelines for the management of individuals with bipolar disorder do not recommend routine risk assessment for violence, this assertion may need review in patients with comorbid substance abuse.

In other words, if any connection is to be made between bipolar disorder and violent crime, it’s not the bipolar disorder causing the problem. An increased risk of violence is constrained almost entirely to instances in which alcohol or substance abuse is also at work.

Genetic Engineering & Biotechnology News recently ran a brief article entitled “EU Sanctions Merck & Co.’s Sublingual Bipolar Disorder Drug Sycrest.” Sycrest was first approved in the U.S. in 2009 where Merck markets it as Saphris. Sycrest/Saphris is a “sublingual asenapine drug for treating moderate to severe manic episodes in adult patients with bipolar I disorder” and for treating schizophrenia. When used in treating bipolar disorder mania, it is most effective when used with other anti-manic medications, including lithium and Depakote.

Saphris/asenapine is the newest member of the class of drugs called atypical antipsychotics. It works in the same general manner – affecting primarily dopamine receptors. It also carries the same potential risks that we describe in our initial post on atypical antipsychotics. It is approved for use in schizophrenia and Bipolar I disorder for acute mania. It comes in a sublingual form (under the tongue), which some patients prefer, but which many people don’t like.

PMK asks…

My daughter Baker Acted eight days ago. She is 25 with no indication of a problem until a few weeks ago. She has ADD and was taking Adderall. She started taking Phentermine to lose weight and was taking energy drinks – Rock Star etc. She’s had a very demanding sales job in which she needed to go to networking events at night in addition to her job. She lost it this weekend while involved in a very stressful job-related event. It appears she lost her sense of reality – made many charges for clothes, stayed up almost with no sleep three or four days, said and did things out of character, until someone called 911.

Is it possible this was caused by all of these stimulants?

In Part I of this two-part series, I discuss the differences between bipolar and borderline personality disorder in terms of diagnosis. In this part, I focus on differences in treatments for the two conditions.

Treating Bipolar Disorder

Bipolar disorder has been considered a biological illness for many years, and the research has focused largely on medications. A standard repertoire of medications is used to treat bipolar: