Depression may be bipolar II

Moods: Doctors are recognizing that many patients previously thought to have depression may instead have a subtler form of bipolar disorder.

Medicine & Science

March 10, 2003|By Jonathan Bor | Jonathan Bor,SUN STAFF

Everything about Elizabeth Burkett suggested a young woman deep in the quagmire of depression. Months went by when she didn't want to do anything but sleep or stare at her computer screen, and she couldn't bear the thought of talking to anyone. Antidepressants made her worse.

Last year, though, she mentioned to a doctor that she occasionally flew into fits of rage in which she'd chase her husband around the house, shouting that she hated him. "I'd literally go from ice cold water to boiling, no middle points," said the 26-year-old rock musician from Tennessee.

Instead of depression, Burkett was then diagnosed with a subtle form of bipolar disorder - called bipolar II - and treated with different medication, which moderated her moods. Increasingly, doctors are recognizing that many bipolar patients, while not exhibiting the elation of classic manic depression, experience milder highs or energetic bursts of anger.

"The diagnostic umbrella of bipolar disorder is enlarging as we do more research," said Dr. Francis Mark Mondimore, a Johns Hopkins psychiatrist. "There are a number of people who share some of the features of full-blown manic-depressive illness, though they don't have all the features of that disorder. These folks clearly benefit from a number of treatments for bipolar that had been reserved for manic depressives."

Though the concepts of depression and mania were recognized by the ancient Greeks and Persians, it wasn't until the early part of the 20th century that the idea of an illness marked by both states entered the mainstream. It came to be known as manic depression and, later, bipolar disorder.

People with classic bipolar disorder fluctuate between extremes of depression and euphoria. They might spend days or weeks feeling immobilized with sadness, then suddenly feel consumed with energy and power. They appear to be constantly in motion; they might spend wildly, abuse drugs and act promiscuously.

The definition began to broaden in the early 1970s, when doctors recognized a group of patients who were mainly depressed but also experienced mild highs called hypomanias or angry periods called mixed states. The term bipolar II was coined to describe these patients, and it was codified into the standard manual of psychiatry.

Dr. James Potash, a Hopkins psychiatrist, said patients experiencing hypomania might talk fast or feel the impulse to stay up half the night doing chores. Because patients might not see these moods as anything more than welcome respites, they might not think to report them in therapy.

"Sometimes people describe feeling more special, more important or powerful, or more attractive," said Potash. "Creative people will feel that they have written something that will be a best seller."

Though their manic states are relatively mild, their depressions are often longer and more disabling than those that afflict patients with classic bipolar disorder. Both groups of patients are treated with lithium and other drugs that were originally prescribed to combat seizures, but later became mainstays in the treatment of bipolar illness.

Evelyn McCann, an administrator with the Johns Hopkins biomedical engineering program, repeatedly sank into long, dark periods when she'd feel utterly worthless: a bad wife and mother, a fraud at work, a person who was merely taking up space.

When she sought help in the early 1980s, her psychiatrist noticed that sometimes - and for only brief periods - she felt unusually clearheaded, almost elated. On such occasions, she might wake with a bound and launch into flurries of housework or gardening.

"One morning, I woke up and decided I needed to wallpaper my bedroom," said McCann, 56. "For whatever reason, it had to be done by 4 o'clock. I bought the brushes and pans. It was great." Later, "I realized what a mess I had made."

But these were times to savor, she said, chiefly because they relieved her from the despair that frequently had her contemplating suicide. "If I could spend my whole life in hypomania, it would be wonderful," said McCann. "I'd like to bottle it up and put it on the shelf."

McCann's diagnosis did not bring a lasting fix. Initial combinations of anti-depressants and anti-seizure drugs worked for a while but ultimately lost their effect. Recently, she has enjoyed 11 months of steady relief on her current regimen of anti-depressants. "It may be the medication, or it may be good luck," she said. "But I don't feel that I have this Sword of Damocles hanging over me."

Official estimates are that 1 percent of the population suffers from bipolar disorder. Half as many, according to studies, qualify as bipolar II, though Potash said he believe its true prevalence runs as high as 2 percent.

The tendency to place more and more patients beneath a bipolar tent has its detractors. Dr. E. Fuller Torrey, an expert in schizophrenia and bipolar disorder, says some psychiatrists are "medicalizing" normal human behavior.

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