Talk:Bipolar disorder

bi-polar illness

Since my entry thus designated was speedily deleted because it "provides no meaningful content or history, and the text is unsalvageably incoherent", a friend who had happened upon it before it got gonged and found it useful asked me to re-instate it, so I append my point in this article. However, many of us m.d.s prefer "manic depressive" as being more accurately descriptive of the condition. "What's the 'F.N.' stand for?" I'm frequently asked. "Frequently Normal," I tell 'em. --F.N. Wombat 15:17, 16 August 2007 (UTC)

Don't feel like signing in after saying this. I'm probably Low grade bi-polar and have known since I was about 15 or so. I'd sleep alot sometimes and not sleep for days, depersonalization real bad, depression then happy. All that stuff rolled into one. Everyone has some flaw though so i'm not whining about that. What I will say is this. I have been given celexa and one other antidepressant. Neither one did anything at all for me. I go to college and same old same old. No one really knows cause who gives a shit really. For the first time at age 19 I smoke a joint. Guess what? Ever since I started all I have to once a day I light up. I work at 60 thousand dollar year high tech job with danger every where making food for literally hundreds of thousands of people and I am a POTHEAD according to some people. 60 thousand net, not gross, net. It's like you try to better yourself, to make yourself healthy, to balance out, and all the sudden your a fucking drug addict for not using the right drugs. Under that same hypocritical logic anyone who drinks 1 beer a week to me is raging alchoholic who we should lock up in jail for years. All I have is he who without sin cast the first stone, otherwise shut the fuck up.

um....number one, if you are bipolar giving you antidepressants is just going to screw things up more, so whoever prescribed them to you.....yeah. and, so what if people think youre a pothead. just do your own thing and if it works it works. people just have fun chastizing people all over the place, it has nothing to do with you personally. i dont think this really belongs here but, whatever.

Typo

"However, the relationship between the disorder and creativity is still very unclear."

Can someone delete the extra 'the' here?

sure. and i case you said 'thank you', you're welcome.

basic description/summary

This article is missing a basic description/summary of the condition, and seems to just straight into more detailed discussion which assumes prior knowledge -- Lee Carré 23:27, 14 September 2006 (UTC)

I've now rolled the article back to an earlier, and in my opinion better structured, version, as it was as of as of 19:13, 13 September 2006 [1]. Also, I see that the version I rolled back seems to contain substantial amounts of text from other websites, such as [2], against the Wikipedia copyright policy. -- The Anome 23:34, 14 September 2006 (UTC)

I'm proud of the changes that have been made to this article - some of which I've done and are still retained. I'm also glad that the article is locked now. Too many changes were being made by individuals who weren't qualified to be writing about the disorder. Great job Wikipedia! Shows that open source info can be as good or better than closed source.

there is a new type of bi-polarness, there is now gender bi-polarness is when people can go from liking women, to men, in an instance.

Nonesense. Empacher 14:50, 15 April 2007 (UTC)

This 'aspect' of bipolar is not recognized by the psychiatric community. What are your sources for this comment? What is the basis for validity? samba6566 23:20, 17 April 2007 (UTC)

As I noted in another comment to you, 3 Masters degrees, 2 Phds, about 30 years of experience in the field, and subscriptions to about a dozen academic journals. Yes, my retort is snarky, but this Wikipedia is meant to be a serious scholarly endeavor, not a blog based on personal perview.

Bipolar Spectrum Disorder discussion needed

There seems to be extensive revisions to the DSM IV definitions underway due to the fact that so many do not meet the strict criteria but don't fall under other diagnostic categories. We should have a discussion of Bipolar Spectrum disorder. I put in a paragraph but it is really a stub. Ksvaughan2 22:06, 9 May 2007 (UTC)

Technically, there is no such thing as Bipolar Specturm Disorder. There is, however, the concept of spectrum disorders, a subset of which would be bi-polar. I suspect that a general discussion of the spectrum model, and how it applies to each of the personality disorders should be included on every page addressing Axis II diagnoses.

As it stands, as the DSM-V is not yet published, we would do well to stay within the bounds of the current diagnostic criteria, and address the disorder as a discreet categorization, while including a section on the specturm model, as it applies. Cheers! DashaKat 12:25, 10 May 2007 (UTC)

...whether or not they receive adequate treatment?

I have some concerns about this statement: "People suffering from the disorder may be periodically disabled, but many live full and productive lives whether or not they receive adequate treatment." This statement has been chopped around recently till it has reached this state. I'm not so sure that people can live full and productive lives whether or not they receive adequate treatment. It just doesn't make sense to me. --WikiCats 22:28, 8 October 2006 (UTC)

I read this article out of curiousity because I have BPII and this statement struck me as contradicting most of the rest of the article. Besides, how can you say that untreated bipolar sufferers may lead full productive lives (whatever you define that as) when someone who has been diagnosed will, in all likelihood, receive some kind of treatment? If someone has a reference for this, fine, but this contradicts both my personal experience as someone suffering since childhood but not diagnosed until my mid-30's, and everything else I've read about bipolar disorder.Grrrlgeek 21:49, 16 October 2006 (UTC)

I believe that the "whether or not they receive adequate treatment" is meant to suggest that bipolars can "live full and productive lives" without resorting to psychiatric treatment (ie. lusion to the belief that psychiatric treatment fails to satisfy many bipolars). Anarchist42 22:24, 16 October 2006 (UTC)

But does " lusion to a belief" belong here? And when I read "treatment" I didn't necessarily think psychiatric; even self-treatment is treatment.Grrrlgeek 03:29, 17 October 2006 (UTC)

Good question. I believe that, in general, psychiatrists do not regard self-treatment as appropriate and claim that they are very successfull in treating bipolar disorder using pharmaceuticals (a claim that is disputed by many patients). The statement in question evolved as the two sides tried to emphasize their opposing beliefs, until a balance was achieved. Anarchist42 19:53, 17 October 2006 (UTC)

If it refers only to psychiatric treatment it should say so. What I really think is that the sentence is opinion only and has no place in an encyclopedia article, but that is opinion only as well ;}. The article is marked for cleanup anyway so hopefully someone with more experience in these apparently delicate matters will have a chance to work on it.--Grrrlgeek 19:11, 19 October 2006 (UTC)

I think that statement is far too vauge for this article as well. What defines a "full and productive" life? I ask this as one who has been diagnosed with some form(see below) of the disorder, though I am not sure I would say that I am "suffering." If full and productive means meeting or exceeding the living standard of one's parents (one definition I have heard) then no, I would say I could not do that, nor would I really care to. I am confident, however, that I could live independantly, defining productivity only as I view it, and without mental health care so long as I am not expected to live to someone elses high standard. Thus the statement is far too vauge, but I personally believe that it holds some accuracy.

+(I am still under 18 and they won't tell me which form of the disorder; I only found out because one of my school's case managers let it slip right after I got taken to a psychiatrist)--Agent of the Reds 13:59, 30 March 2007 (UTC)

I agree that "full and productive" life seems like a throw away statement since it is not defined. In addition, the idea of treating without medication is a dangerous proposition. Here is what NAMI has to say on the point:

"Without treatment, however, the natural course of bipolar disorder tends to worsen. Over time a person may suffer more frequent (more rapid-cycling) and more severe manic and depressive episodes than those experienced when the illness first appeared.4 But in most cases, proper treatment can help reduce the frequency and severity of episodes and can help people with bipolar disorder maintain good quality of life." http://www.nimh.nih.gov/publicat/bipolar.cfm —The preceding unsigned comment was added by Azureone (talk • contribs) 00:21, August 20, 2007 (UTC).

Personal Descriptions section

"The following is a quote from a successfully treated individual with bipolar disorder (from the U.S. National Institute of Mental Health):"

I think this quote should be replaced because:

1) It starts off as if describing bipolar depression in general and in sensationalist terms too ('manic-depression...incites dreadful behaviours', 'destroys...') and also makes strong scientific claims (says e.g. "it is an illness which is biological") - rather than elucidating a sufferer's personal experience.

2) The quote was selected in some way by the NIMH, which as noted above (by me in a previous incarnation) is a strongly 'biomedical' organisation (even though they removed that term from their website banner shortly after it was highlighted) and it seems likely that they chose a quote that fit with their outlook and aims

3) The link is to a page that appears to be a sort of position statement on bipolar by NIMH and doesn't actually seem to have the quote on it - and no information on who this person was, how NIMH got the quote from them, what 'successful' treatment they were receiving, or anythign to enable validation of any of it

EverSince 16:29, 12 November 2006 (UTC)

It's a quote from Kay Redfield Jamison's An Unquiet Mind: see [3] for a cite. Jamison is a well known researcher in the field, and is bipolar herself; in this quote, she's referring to her own experience of, and treatment for, bipolar disorder. I can't see anything particularly contentious about her statement about the nature of the disease: the statement that bipolar disorder has biological origins is consistent with all recent research. -- The Anome 12:00, 13 November 2006 (UTC)

Thanks for clarifying this here and on the page, this was not indicated or linked to previously, and explains the sensationalist (published book) language. It remains the case that the quote was orginally transferred to here because NIMH had included it in their work.

To start again - Kay Redfield Jamison is of course very well-known and respected in this area, but the purpose of this section seems unclear when there are two quotes from one person giving generalised clinical opinions as much as describing a personal experience. I am assuming a section like this, if it is allowed on Wikipedia, should be confined to the latter, and should give a representative range of quotes as far as possible? What about finding a more personal quote from Kay (her medical work could be addressed elsewhere in the article of course)? Some other quotes could be obtained from user-led organisations - I see Bipolar World has a list of personal stories [4] EverSince 17:32, 13 November 2006 (UTC)

I asked about this on the policy page, and I guess user-led org materials wouldn't really be reliable/verifiable enough. When I get time I will try to find reliable published works with quotes from someone diagnosed with bipolar - I hope anyone else can too of course. I do think the first Jamison quote can be replaced by something more balanced, or at the very least, in the interests of NPOV, counterbalanced by an additional view of its nature/etiology etc. EverSince 21:00, 5 December 2006 (UTC)

Personally, I don't think that this section adds anything to the article, which is very long and needs a lot of cleaning up. I don't think this is in the style of Wikipedia, I haven't seen "Personal accounts of ..." in other articles, about medical conditions or otherwise; please correct me if I am wrong. I also agree with EverSince, if this section has a place in this article, it should consist of some actual "personal experience" type quotes. It all just seems very out of place, and I'm going to be bold and remove it now. /skagedal^... 21:29, 5 December 2006 (UTC)

Is this a joke?

"Leading bipolar specialist, Gillian Townley, has researched the effect of the Ferret Rabbit process."

I can't find anything on the web about that, and "ferret rabbit" sounds suspiciously like something someone would consider a joke in an article about bipolar. Anyone got a cite or just confirmation that it's not a lie?--Nyxxxx 03:26, 30 November 2006 (UTC)

I am 99% sure it is not true. There is no web reference for "Gillian Townley" apart from the other pages which have copied wikipedia. Cas Liber 20:04, 4 December 2006 (UTC)

Looks like someone removed it. I didn't want to unless I could be sure it wasn't true. --Nyxxxx 23:48, 5 December 2006 (UTC)

Length of article -removing bipolar in children bit

Bipolar is considered to be pretty rare before late teens. As the article is very long it may be better to move this section. As well there is some pretty controversial (well, more controversial) material in this section. cheers Cas Liber 20:14, 4 December 2006 (UTC)

I agree. More of a summary of the key issues/controversy would seem to suffice in this article EverSince 21:05, 5 December 2006 (UTC)

Actually, Casliber, there's been a wave of diagnosis in the USA of young children, toddlers and even infants being diagnosed with bipolar now. Joe Biederman (sp?) specializes in the arena of psychiatrically labelling children, a very disturbing trend. 208.181.100.40 13:55, 27 July 2007 (UTC)

It's possible that many children are misdiagnosed as ADHD. Also, children do not know how to report symptoms. What is probably depression, is sometimes reported as boredom for example. I have the disease, and my son had serious problems. I was under the impression that it was an adult onset disease also. However, when we began treating him as if he were bipolar, he improved. Also, as I think back to my childhood I recognize signs of mania very early. I have also noticed in myself that a structured environment dramatically reduces my mood swings. It may be then that when teenagers are given more freedom that the lack of structure brings on or allows the symptoms to become more severe and recognizable.

In any case, having a section on childhood bipolar is important for those parents who might have bipolar children but not be sure. A very good book on the topic is The Bipolar Child.

Organization

Does this article seem to change around quite a lot and be relatively disorganized? Currently a lot of points are duplicated in different personal-seeming wording, and the various headings seem quite disparate with an unclear flow. Would it help to establish some kind of agreed basic organization on this talk page? I'm wary of spending time trying to organize the article otherwise, in case it's wasted. The structure of other psych pages would seem to suggest something like:

• simple intro/overview
• diagnosis (incl. subtypes and comorbidity)
• symptoms/features
• history
• epidemiology (e.g. prevalence)
• etiology (causes/influences/models)
• treatments and services
• self-management/society/recovery
• controversies?

Any other suggestions? Just noticed there's been a similar discussion to this already, middle of last year, but seems that it would still be useful to get a basic heading structure clearly listed EverSince 04:44, 24 January 2007 (UTC)

Excellent idea and I'd like to help if I can. Thanks, EverSince. 24.68.236.106 00:36, 25 January 2007 (UTC)

I'd like to archive some of this talk page, as quite dense and takes a while to load on a slower connection. Not sure where up to exactly (or perhaps whether to extract just the oldest/least relevant conversations) but I'll have a go soon unless any other suggestions EverSince 11:43, 23 February 2007 (UTC)

Yes, please! I think usually the archiving is done chronologically. It would be best to have some description of the major topics discussed at the link to the archive even though not all talk-page archives have that.--Grace E. Dougle 11:54, 23 February 2007 (UTC)

Hypomania

"Some do not experience full-blown mania, and will display milder symptoms, known as hypomania." Seeing as hypomania has alreaddy been mentioned twice in the first section, isn't this a bit redundant? --Scorpios 13:37, 24 January 2007 (UTC)

Well this is example of issue raised above EverSince 14:02, 24 January 2007 (UTC)

added under "medical imaging"

• • • Please don't delete again without discussing here first***

Added paragraph:

It's important to note, however, that currently bipolar diagnosis is made solely on the basis of a psychiatrist's judgement. No medical imaging or any other modern technology is able to objectively diagnose any mental illness.

I suggest changing this to the following:

The diagnosis of Bipolar Disorder is made based on the assessment and evaluation of a mental health professional. The assessment may include clinical judgement, various psychological tests, a review of history, and a comparison of presenting symptoms with the DSM criteria. There are no biological tests for this disorder

The words "solely" and "modern" present a slant that isn't particularily neutral. Furthermore, a variety of mental health professionals can diagnosis and the basis for a diagnosis is ususally multi-modal. DPeterson^talk 13:20, 25 January 2007 (UTC)

I agree with the suggested rewording. A minor point, we recently seemed to come to a consensus on the schizophrenia talk page that the term "laboratory test" might be best, or personally I think "medical test" is more clear/standard than "biological test." EverSince 18:53, 25 January 2007 (UTC)

Either word is fine with me. I used the word "biological" and not "medical" since a psychiatrist is a medical professional and a psychiatrist might (I'm guessing here since I am not a psychiatrist) say that the procedures used are "medical." DPeterson^talk 22:06, 25 January 2007 (UTC)

Your wording is good, DPeterson. "Biological" or "laboratory" are the most accurate descriptions here, I think, because filling out items on a DSM checklist is lame and arbitrary, but still "medical." 208.181.100.40 13:51, 27 July 2007 (UTC)

added under "aspects of bipolar disorder"

Iatrogenic (illness caused by medical treatment) bipolar disorder is a relatively common response to standard treatment (SSRI antidepressants and/or electroshock treatment) for unipolar depression. Some feel this danger warrants the addition of mood stabilizers into the drug regime. 24.68.236.106 00:45, 25 January 2007 (UTC)

You will need to have a verifiable citation to support this statement. DPeterson^talk 13:29, 25 January 2007 (UTC)

Evidently, this is called Bipolar III: http://www.bipolarworld.net/Phelps/ph_2001/ph190.htm but is not yet officially recognized by the Holy DSM. If someone's bipolar already, then mania caused by treatment is called "manic switching." But my area of interest is in people who aren't bipolar but become that way through treatment. 208.181.100.40 13:48, 27 July 2007 (UTC)

added under "heritability"

Added paragraph: Currently, there is no evidence of any kind of pathology (e.g. chemical brain imbalance or structural dysfunction in the brain) underlying this (or indeed, any) psychiatric diagnosis. 24.68.236.106 00:43, 25 January 2007 (UTC)

I can see the sorts of points you're trying to include but these come across to me as POV and unsourced, rather than something balanced and sourced on the the findings re neurotransmitters/neurocognitive funcioning etc, and diagnostic practices.... EverSince 10:36, 25 January 2007 (UTC)

Re the utter lack of verifiable chemical imbalance or other physical characteristic for bipolar disorder or any other psychiatric condition, you don't have to take my word for it. The American Psychiatric Association is very honest on this point. There is NO objective test for any mental illness. 70.66.128.222 19:36, 30 April 2007 (UTC)

Deleted sections

I have deleted several lines and sections that have had a or tag for quite some time. Unless someone can provide a reliable citation to support the statements, please leave them deleted as they are just opinions without appropriate references to support those statements. There are other lines that should also be deleted unless references can be provided to support the contentions. I will remove those at a later date. MarkWood 23:20, 27 January 2007 (UTC)

Sections marked citation needed should be deleted after awhile if no one can find appropriate sources. DPeterson^talk 17:18, 5 February 2007 (UTC)

On the ignorant section about "Bi-Polar Disorder and Creativity."

"A number of recent studies have observed a correlation between creativity and bipolar disorder,[2][3][4] although it is unclear in which direction the cause lies, or whether both conditions are caused by some third, unknown, factor." Very funny indeed as it to me (a certified bipolar AND artist) seems to label creativity as an illness. I know that my bipolarity and my creative urge go hand in hand to a certain degree. Many bipolar people are completely uncreative, but a vast majority of the creative people that I know are bipolar, ranging from lightly manic (productive) to full blown manic depressives (unproductive). I´m not keen on people labeling bipolarity an illness either. Its an exaggerated state of mind for sure, and can lead to disabling psychosis if spun out of control, but please note that many bipolar people would not give it up for anything. —Preceding unsigned comment added by Wondering Spirit (talk • contribs) 13:10, August 30, 2007 (UTC)

Contrary to popular belief, disabilities -- of any kind -- do not make people more "creative." Stevie Wonder is not more "sensitive" to sound because he's blind -- he just has on of the finest ears for rhythm and melody in recorded history. Likewise with bi-polar disorder -- even though we have these myths about the "sensitive," "melancholy" artist, bi-polar disorder does NOT make one "more creativity." It is a crippling illness which leads to feelings of worthlessness, apathy, and eventually suicide. bi-polar disorder is not just a few "sad feelings" in someone's "head" -- it is an illness as real and verifiable as cancer -- therefore to attach some kind of 'mystique' to it is completely inexcusable. So, for the self-appointed expert who placed the silly "Depression and creativity" section in the article on bi-polar disorder, I have just this to say: Van Gogh's bi-polar disorder did not cause him to paint the "Starry Night" -- but it did cause him to shoot himself. Think before you post such ignorant garbage on Wikipedia.

Surely the correct way to proceed is not to simply nuke the section. It's a fairly common belief that bipolar disorder is somehow connected to creativity. Now it may very well be hogwash but there have been studies on the subject and there's more than enough reason to keep this section and address the issue. Pending discussion here, I will revert your deletion which, incidentally also added a sentence to the effect that bipolar disorder was the explanation for a majority of suicides, divorces, and employment terminations. That last statement is dubious at best. Pascal.Tesson 19:43, 15 February 2007 (UTC)

The section has had for quite sometime and no one has provided any reliable citations that meet the wikipedia standard of being verifiable. I suggest the section be removed unless citations can be provided to support the statements. DPeterson^talk 21:26, 15 February 2007 (UTC)

I'm all for removing anything that's uncited but removing the section won't solve anything. The article should address the issue: if there's no conclusive evidence then that's what the article will say but there's clearly a wide belief that creativity has some relation to bipolar disorder. This is often said and has been the subject of various studies (random example: [5]) so it should not be simply zapped. Pascal.Tesson 22:15, 15 February 2007 (UTC)

The section does need to be cleaned up, properly cited and tightend but it should not be deleted. This is just a summary of a more detailed main article on the subject: Creativity and bipolar disorder.--Grace E. Dougle 22:55, 15 February 2007 (UTC)

Well, until someone who is interested adds citations and cleans it up, it should be removed. I will delete it and put it in the sub-section below so that if there is an editor who is interested that person can make the edits as suggested above. DPeterson^talk 23:08, 15 February 2007 (UTC)

I'm not currently interested in cleaning up that section, I don't really have the qualifications to do so and I will certainly not get into an edit war over this. But for the record, I think that deleting the section is a bad, lazy choice. Why not simply write a few lines simply saying that a connection is often claimed and that current studies are inconclusive in that respect? Pascal.Tesson 23:33, 15 February 2007 (UTC)

Sure, if you or someone who has an interest in adding, deleting, or editing the section to fix it does so that would be great. In the mean time, the section is not encyclopedic in nature as it does not have citations that meet the wikipedia standard of being verifiable. DPeterson^talk 00:32, 16 February 2007 (UTC)

The issue discussed in this section is encyclopedic. We will edit it in the main article text as is usually done on Wikipedia. Also, not all of it is unreferenced. Additional sources have been given in this thread a few posts further up by Pascal.Tesson. We should only remove text when it is likely that there are no references ever to be found. The connection between creativity and mania has been discussed for quite some time.--Grace E. Dougle 09:59, 16 February 2007 (UTC)

I guess the issue with both the BPD and bipolar articles is that both have swollen to huge sizes with numerous sections over the past year or so and rather then bloating again people are trying to be judicious about what goes in. I feel this bit really isn't part of teh core issue about the illness and the bet thing would be a link (plus a very brief summation) to an article on a separate page. cheers Cas Liber 10:39, 16 February 2007 (UTC)

There is a strong link between bipolar disorder and creativity; see Jamison's research, and her popularization Touched by Fire, and also Nancy Andreasen's work in the 1970s. However, just because a significantly high proportion of creative people have bipolar disorder, doesn't necessarily mean that the correlation works the other way; no-one is pretending that bipolar disorder is anything other then destructive, even in the lives of those few people who are fortunate enough to also gain a benefit from it. -- The Anome 11:03, 16 February 2007 (UTC)

The "reference" "Kay Redfield Jamison. Touched with Fire: Manic-Depressive Illness and the Artistic Temperament. ISBN 978-0684831831" is of dubious value. First, it is old, 1970's, second, it is not an empirical study. Unless some empirical evidence in a professional peer-reviewed publication can be cited, then this section should be removed. DPeterson^talk 21:39, 16 February 2007 (UTC)

The current content (of the section) is not a summary of what is on the main articel about creativity and bipolar and should be moved there with a 1-2 sentence intro. Cas Liber 23:03, 16 February 2007 (UTC)

I have copied the text from here to the subarticle Creativity and bipolar disorder. The section here should be shortened to about half its length, imho.--Grace E. Dougle 16:56, 17 February 2007 (UTC)

From creativity,

“ Creativity and mental health

A study by psychologist J. Philippe Rushton found creativity to correlate with intelligence and psychoticism.[28] Another study found creativity to be greater in schizotypal than in either normal or schizophrenic individuals. While divergent thinking was associated with bilateral activation of the prefrontal cortex, schizotypal individuals were found to have much greater activation of their right prefrontal cortex.[29] This study hypothesizes that such individuals are better at accessing both hemispheres, allowing them to make novel associations at a faster rate. In agreement with this hypothesis, ambidexterity is also associated with schizotypal and schizophrenic individuals.

Particularly strong links have been identified between creativity and mood disorders, particularly manic-depressive disorder (aka bipolar disorder) and depressive disorder (aka unipolar disorder). In Touched with Fire: Manic-Depressive Illness and the Artistic Temperament, Kay Redfield Jamison summarizes studies of mood-disorder rates in writers, poets and artists. She also explores research that identifies mood disorders in such famous writers and artists as Ernest Hemingway (who shot himself after electroconvulsive treatment), Virginia Woolf (who drowned herself when she felt a depressive episode coming on), composer Robert Schumann (who died in a mental institution), and even the famed visual artist, Michelangelo.

”

-- Creativity, Wikipedia

It makes more sense to me, therefore, that bipolar is an effect rather than a cause of creativity, or rather that both are an effect of changes to the prefrontal cortex. In future can we try not to be so blunt and offensive when referring to bipolar sufferers, regardless of how angry we are as to a particular inclusion of something etc. I have a good friend who suffers from bipolar, and making it sound as if bipolar sufferers are simply no-hopers who are all going to shoot themselves doesn't inspire much confidence in me as to your opinion. senex 04:48, 10 March 2007 (UTC)

Poll

To get a sense of what editors think about this section, a poll might be in order. Please put your vote and reason below regarding deleting the section for now.DPeterson^talk 13:22, 17 February 2007 (UTC)

'Delete section on creativity and bipolar'

1. 'YES'Leave deleted because there are not any empirical evidence in a professional peer-reviewed publication cited nor material that meets the wikipedia standard of being verifiable and reliable.DPeterson^talk 13:22, 17 February 2007 (UTC)
2. _'YES' Per nom, and I am not convinced that the emphasis of the assertations in this section match their source, which is a print publication, they certainly don't match the description here Kay Redfield Jamison where it is asserted that she showed cases where manic depression and creativity co-existed, not that she claimed any unusual prevalence. We can't have articles full of personal opinions backed by cited sources that have been bent and trimmed to half fit them. Until that discrepancy can be cleared up (one way or another) I am deleting myself. Feel free to re-write and replace it more in accord with its sources. --Zeraeph 17:25, 17 February 2007 (UTC)
3. Changed my vote to not have this section. It is obviously extremely controversial since it has been removed again and again. Whether creativity is associated or not really does not matter. It is more important to have a stable article, and that won't be possible with the section in it. So: YES, leave out section on creativity.--Grace E. Dougle 17:40, 17 February 2007 (UTC)
4. Yes, with at most 1-2 sentences and link to another page which already exists. The material can be cut and pasted and moved to the talk page of that article (Bipolar and creativity) so that some interested party can edit it into the article there. Cas Liber 19:16, 17 February 2007 (UTC)
5. No, never, never! It is a researched subject, if not exactly proven, and whether we agree with the content or not is not a reason to remove it. What happened to objectivity? Deleting the article when there is numerous works that can be used as citation seems to me nothing but laziness. There's an entire book on it! (Touched with Fire) It's 1996, but the material itself is not exactly the type that outdates considering that it is based mainly on historical accounts. JaneDOA 06:02, 18 February 2007 (UTC)

'leave section on creativity and bipolar'

1. _-- Grace E. Dougle 16:56, 17 February 2007 (UTC)There is research from institutions like Princeton. The usual Wikipedia pattern should be followed: we have a detailed article on the matter, and we should have a section with a few lines in this articles.
2. Yes Leave out this section...it just doesn't belong in this article. MarkWood 22:57, 18 February 2007 (UTC)

'Leave the Section in on Creativity and Bipolar'

Regarding the comment on no substantive investigation on the issue of creativity and bipolar; hogwash. Kay Redfield Jamison has conducted extensive research and studies on this issue. It was published under the title "Touched with Fire: Manic-Depressive Illness and the Artistic Temperament". Ms. Jamison suffers from Bipolar herself, and is one of the foremost experts on bipolar disorder (quote taken from wikipedia article on Ms. Jamison). In her book, Ms. Jamison presents persuasive arguments and data (supported by studies and research) demonstrating that creativity is exceptionally more common among those of us who are bipolar, than the unaffected majority. If you have credentials that exceed hers, or have conducted research of your own that proves hers is incorrect, then I will side with you. Until then, I very strongly oppose your comments and your attempts to remove valuable, correct information based on your own misplaced feelings. samba6566 23:30, 17 April2007 (UTC)

The book is interesting, but it is not an empirical study of the subject. It is more of a "think-piece." She presents interesting material, but not empirical evidence. DPeterson^talk 00:21, 18 April 2007 (UTC)

samba6566 - 3 Masters degrees and 2 PhDs (all in the social sciences) puts me a bit ahead of Ms. Jameson. She is what is referred to as an expert patient...not a crediable source until she's got a genuine study upon which to base her postulates and premises. Game to DPeterson. Empacher 01:31, 18 April 2007 (UTC)

That's Professor Jamison, to you. If you're really that experienced, I'm surprised you haven't heard of her. Professor of Psychiatry at Johns Hopkins, MacArthur Fellowship recipient, NIMH Styron Award recipient, co-author of the standard medical text on bipolar, author of over a hundred papers on bipolar. I could go on. --ascorbic 18:06, 29 May 2007 (UTC)

Who said I hadn't? Given your list of contributions, it appears as if you've dropped in here only to snark. I am more than certain the good Professor/Doctor/Ms. Jameson does not need you to defend her. And, pedigree or not, she's still an expert patient. I, personally, have a problem with that.--Empacher 18:35, 29 May 2007 (UTC)

Let's not have a vote, please

Polling is not a substitute for discussion. The content of articles should be determined by consensus driven by evidence from reliable sources, not by counting supporters of any particular view. Please see WP:VOTE for more details.

As far as I can see, we seem to have achieved a consensus on the following:

• the current article has an excessive emphasis on the suggestions of a link between creativity and bipolar disorder, and that this discussion needs to be cut down
• any such assertion should be backed with cites -- we have cites, but they date back to the 1970s, and some contributors suggest (without providing any cites) that these results are now outdated.

Why not proceed on that basis for now?

First, let's find some cites that meet the normal standards for evidence-based medical research that either support or oppose the hypothesis that bipolar disorder is correlated with creativity. Then, let's work out what to do after that.

A Medline search for "bipolar creativity" brings up 83 hits.

I suggest starting with

Santosa et al. Enhanced creativity in bipolar disorder patients: A controlled study. J Affect Disord. 2006 Nov 23; PMID 17126406.

Rihmer et al. Creativity and mental illness. Psychiatr Hung. 2006;21(4):288-94. PMID 17170470.

Nowakowska et al. Temperamental commonalities and differences in euthymic mood disorder patients, creative controls, and healthy controls. J Affect Disord. 2005 Mar;85(1-2):207-15. PMID 15780691.

I particularly like the abstract of the last-cited paper, which reads in part:

“ OBJECTIVE: Understanding of mood disorders can be enhanced through assessment of temperamental traits. We explored temperamental commonalities and differences among euthymic bipolar (BP) and unipolar (MDD) mood disorder patients, creative discipline graduate student controls (CC), and healthy controls (HC).

...

CONCLUSIONS: Euthymic BP, MDD, and CC compared to HC, had prominent temperamental commonalities. However, BP and CC had the additional commonality of increased openness compared to HC. BP had particularly high Cyclothymia scores that were significantly higher then those of MDD. The prominent BP-CC overlap suggests underlying neurobiological commonalities between people with mood disorders and individuals involved in creative disciplines, consistent with the notion of a temperamental contribution to enhanced creativity in individuals with bipolar disorders.

”

-- The Anome 19:03, 17 February 2007 (UTC)

Good detective work, but Ref 1 and ref 3 are the same authors reporting different questionnaires on the same bunch of 49 people, while ref 2 discounts the link. I actually don't object to the discussion of the subject matter per se, but it is not a core part of an encyclopedic entry on bipolar either. Instead, a well-written page on bipolar and creativity (the beginnings of one which already exists) is the place this material should be taken. I am not saying it should be deleted outright. cheers Cas Liber 19:28, 17 February 2007 (UTC)

Well, I can't take much credit for it: it didn't take much effort to type "bipolar creative" into PubMed, and these are just a few of the top results from that search.

I must say that I don't see ref 2 as discounting the link. Its abstract reads, in full:

“ It has been known for a long time that people with salient social and artistic creativity suffer more frequently from psychiatric illnesses than the average population. In their review paper, the authors assess the Hungarian and international scientific literature regarding the association of creativity and psychopathology. They conclude that contrary to the concept prevailing in the first part of the 20th century about the strong association between schizophrenia and creativity, the results of empirical research now unambiguously suggest that prominent social and artistic creativity is associated primarily with affective, and more specifically with bipolar affective illnesses. In addition, we already know that as regards the development of creativity, it is not the given affective (depressive, manic, hypomanic) episode which is important, but the hyperthymic or cyclothymic temperament structure which also predisposes for affective illness. ”

(My italics).

What is interesting, though, is that it does discount the mood-phase-related theory in favour of a temperament-based theory, and suggests that this may be the cause of both the illness and the beneficial creativity.

I particularly like the fact that it's a review paper: unfortunately, Unfortunately, I don't have access to Hungarian medical journals at my fingertips, so I can't follow up its cites.

I do agree with you, though, that this article should not give undue emphasis to the BP <--> creativity link, and should certainly not use the link to romanticize BP in any way, but it seems to be a sufficiently widely held, and now reasonably uncontroversial (at least, apparently, in the medical literature, if not in this talk page) view that it deserves some prominence in the article.-- The Anome 19:35, 17 February 2007 (UTC)

Discussion here would be a good thing. The results of the poll do suggest strongly that most editors prefer leaving out the offensive section. DPeterson^talk 17:23, 18 February 2007 (UTC)

Offensive?--Grace E. Dougle 17:42, 18 February 2007 (UTC)

Desperately seeking cleanup

Creativity and bipolar disorder desperately needs attention. It's an appalling mess. -- The Anome 20:30, 17 February 2007 (UTC)

tagged Cas Liber 00:45, 18 February 2007 (UTC)

--Aervanath 08:34, 18 February 2007 (UTC)==Merge from Creativity and bipolar disorder==

I'm not even sure it should be an article. I am never happy with articles that essentially artificially combine two topics that are covered elsewhere in their own right. I would rather see it cleaned up, merged here and re-directed? --Zeraeph 20:46, 17 February 2007 (UTC)

Well, if it does belong as a subsection in another article, I guess this article is the one it should belong to. However, doing this would be in direct opposition to the current attempts to move any detailed discussion out of this article. Still, its current content is so poor, I'd support just redirecting it here, without any attempt at merging, until a better article can be written. -- The Anome 21:03, 17 February 2007 (UTC)

The topic itself is perfectly legitimate, and encyclopedic, the references are not outdated, wrong, old, or anything. Any association between creativity and bipolar needs to be banned from this article on the grounds of maintainability only. I am against deleting and redirecting creativity and bipolar disorder. Tag to be cleaned up if it isn't already. And you obviously won't be able to merge it because a section on creativity in this article is about to be banned per poll above.--Grace E. Dougle 21:17, 17 February 2007 (UTC)

I am not saying it is a bad article, it actually has promise, just that it is a "non-topic" like "cashmere and chanel" or "cheese and wedgewood", they have been known to be together, associations have been made, but the combination of the two is not an encyclopaedic topic at all --Zeraeph 21:26, 17 February 2007 (UTC)

You have just added a merge-template to creativity and bipolar disorder, but you don't want a section on it in here (see poll). That's contradictory. What are you arguing for?--Grace E. Dougle 21:39, 17 February 2007 (UTC)

I think you are misunderstanding my earlier comment. I did not want the section here as it existed, because it was not supported in that form by the only source cited. I actually said that I had no objection to a re-write that did relate fully to real sources. Equally i see no reason why any valid, cited information in the current Creativity and bipolar disorder article should not be merged here as a subsection (and, whatever is not valid and cited, of course, just deleted). --Zeraeph 21:53, 17 February 2007 (UTC)

ok. However, the valid, cited information in this other article is the same info that was here this afternoon. I just copied it there a few hours ago. The problem I see with keeping it here as a subsection is that it is something that will lead to edit wars. The same info has been added and deleted many times during the past 48 hours. The aim of this game is to create a stable article which can be awarded GA status.--Grace E. Dougle 22:05, 17 February 2007 (UTC)

Well obviously, as the text was not a good match the citations, that particular text should not have been put here, perhaps NONE of the existing Creativity and bipolar disorder should make the transition, but rather a subsection on that topic that accurately represents valid sources? In other words, as far as I am concerned the topic is not appropriate as an article, it is appropriate as a subsection, but there does not seem to be any valid, cited text to use for that yet. Apart from the first paragraph of the existing article, which has already made the transition here into the intro today. --Zeraeph 22:45, 17 February 2007 (UTC)

OK - I feel the best is for a a 1-2 snetence redirect, so I Oppose merge FWIW. Cas Liber 00:43, 18 February 2007 (UTC)

These should not be merged. DPeterson^talk 01:45, 18 February 2007 (UTC)

• I would say that the bipolar disorder article is already really long, we shouldn't be trying to add more material if we don't have to. Creativity and bipolar disorder does need to be cleaned up and sourced, though. Maybe also add a tagline to top, saying that Creativity and bipolar disorder is an expansion of that section in the bipolar article, like at Mixed state (psychiatry).

In my view, the post which triggered this discussion, which was unsigned, was highly POV and misleading. A medical and a social model of disability are both generally accepted and synthesized, including by the World Health Organization's ICF, but that post expounded only a medical model, calling anything else "ignorant garbage".

In regard to bipolar disorder, I don't believe these issues should be singled out for exclusion or minimization, whether on the basis of the length of the article or possible edit conflicts. And I would argue that actually the focus should not be solely on "creativity". Studies and models of hypomania/mania have made links to goal-pursuit and achievement more generally, e.g. [6]. Incidentally, purely for incidental interest as pop psych, couple of books arguing America may be founded on this kind of link![7]

I'm not sure if a separate article on this is needed or not but I think we should try to summarize the issues within this article if possible EverSince 17:02, 18 February 2007 (UTC)

Bipolar disorders research

Sometime between the split of Bipolar disorders research from this article, the link to it was removed. Can anyone look into the article and see if they can link back to it from this article? Squids_and_Chips 00:41, 28 February 2007 (UTC)

Done. DPeterson^talk 13:06, 3 March 2007 (UTC)

External Links

The section was a mess, and filled with non-notable link-spam. Rather than playing favorites, I removed them all, and replaced with the dmoz template. I am suggesting that the addition of any additional links should be discussed here. Leuko 03:20, 5 March 2007 (UTC)

Bipolar blog

There has been talk of adding this blog of a personal/educational account of bipolar disorder:

http://thesecretlifeofamanicdepressive.wordpress.com

What do you think? I think under "Further Reading" it's acceptable. It's written in a literary fashion and is being published as a book.

Razamatazz 03:10, 5 March 2007 (UTC)

IMHO, we should not link to this blog since it is not a WP:RS, and per WP:EL links to blogs and personal websites should be avoided. Leuko 03:18, 5 March 2007 (UTC)

Bipolar II, Mood Swings without Mania

I would like to add a link to http://psycheducation.org/index.html . It is a comprehensive, well-referenced site from a psychiatrist and his studies specifically about Bipolar II. This type of mood disorder is being diagnosed more and more (POV AFAIK). In my case, they treated me for depression and anxiety for years with no success. However, ceasing antidepressants and going on Lamictal has helped immensely.

Back on topic, I submitted the link to http://www.dmoz.org and think it would be a valuable link on this site. Thoughts? DeeKenn 18:05, 18 May 2007 (UTC)

"Leading cause of disability"

Bipolar disorder is a severely disabling medical condition. In fact, it is a leading cause of disability in the world, according to the World Health Organization.[citation needed]

This is not true. Bipolar disorder is the sixth, not first, leading cause of disability in the Western World. I can't find an exact citation but here is some info:

http://www.nimh.nih.gov/publicat/burden.cfm

Razamatazz 03:20, 5 March 2007 (UTC)

Yes, I removed the stmt since no citation has been provided. DPeterson^talk 13:04, 5 March 2007 (UTC)

Request for Semi-Page protection

I put in a request for semi-page protection, given the frequent vandalism by IP addresses. See [8] DPeterson^talk 23:09, 19 March 2007 (UTC)

It is done now...I hope this helps. DPeterson^talk 13:04, 20 March 2007 (UTC)

Sounds good. EverSince 15:42, 20 March 2007 (UTC)

Worldwide view / Northern Hemisphere?

I've perused this page and the talk page archives, and I can't for the life of me find why this page is tagged as biased towards world-northern views. Does the psychiatric community outside of the Northern Hemisphere subscribe to some different form of science? This tag should be justified or removed. Ohm 813 18:26, 24 March 2007 (UTC)

My thoughts for a while...I have removed it now. DPeterson^talk 21:51, 24 March 2007 (UTC)

Flux link invalid

The 'Flux' link under

Diagnosis

  Diagnostic criteria

as you can see, points to Flow_%28psychology%29.

'Flux' implies a cycle of mania/depression, while flow is a state of concentration which might be experienced while manic.

RaLuc 21:24, 1 April 2007 (UTC)

Request for comment

Letting everyone here know that I have filed, Wikipedia:Requests_for_comment/DPeterson --Mihai cartoaje 00:22, 11 April 2007 (UTC)

Writing a Comment

I'm doing a report on bipolar disorder and just wanted to write a comment.

Do you need any help? DPeterson^talk 22:58, 11 April 2007 (UTC)

Divorce comment should be reconsidered

The section on bipolar disorder and divorce rate is superfluous and should be deleted or added to another section; or perhaps a note can be added to a wikipedia page about divorce. Here the section is short and insignificant. The illness causes substantial additional burdens on every aspect of life, not just marriage, so making a special comment about divorce is pointless.

But the statistic is valid...maybe just moving the material to another section? DPeterson^talk 22:31, 14 April 2007 (UTC)

The higher divorce rate, if true, could be due to the psychiatric label rather than any actual disorder. Psychiatry is very good at ruining family dynamics, e.g. patient on one side, other family members and doctors on the other. Francesca Allan 00:15, 4 September 2007 (UTC)

A bipolar page for people with bipolar

I have bipolar. Does noone else see how assinine it is for someone like me who cannot read information about how bipolar causes problems concentrating to read and pay attention cos the information is long and wordy?

Can someone please make a page about bipolar for people with bipolar? Something short, sweet, and with simple english?

Regrettably, the symptoms you describe are not associated with Bi-polar. They are a comsequence of your medication, active depression, and/or co-morbid ADD/ADHD.

That said, your comment would demand that this become a forum/bulletin board, not an encyclopedia. And, by virtue of independent evaluation, Wikipedia is written at about a 5th grade reading level...same as the NY Times...acceptable by any standard, no? Empacher 01:28, 19 April 2007 (UTC)

Yes, true. This is an encyclopedia. there are a number of very good bulletin boards and talk forums for people with Bipolar Disorder...I think evern listed in the links section of this article. JonesRD_talk 12:36, 22 April 2007 (UTC)

To Empacher, I'm not sure what you're saying. You told the gent why he's feeling the way he is and that it's not related to bipolar. However, active depression is part of bipolar. Hypomania can cause anxiety sufficient enough for cognitive confusion. Also, unless you are an MD or other qualified health care professional who specializes in these things I would not try to diagnose the cause of someone's symptoms over the internet. DeeKenn 23:17, 18 May 2007 (UTC)

To reinforce that last point, even if you ARE an MD or other qualified health care professional who specializes in these things, I would not try to diagnose the cause of someone's symptoms over the Internet!!! DagnyB 23:24, 18 May 2007 (UTC)

Heartily agreed! DeeKenn 23:30, 18 May 2007 (UTC)

It is, in fact, quite clear that you do not understand what I am attempting to get across. Actually, I did not tell this individual why he was feeling the way he was feeling, nor did I say that his expression were not a charactersistic of a bi-polar condition. What I did say was that he was describing a symptom profile that was either co-occurring with bi-polar, or a consequence of a medication regimen.

Further, to both DeeKenn and DagnyB, diagnosis is an art, not an exact science. As a respected clinical diagnostician, I can assure you that there was no diagnosis proferred in my statements. Rather, these were observations and opinions based on evidence presented. That said, 2 Masters degrees, a PhD, an MD, and more years in the field than is likely you've been on the planet do, in point of fact, give me the latitude to express opinions that may be, shall we say, amore substantial than is typical of other contributers.

Yes, I am being both haughty and arrogant in my response, but, where I come from, uninformed attacks are not well received. Enjoy your weekend. Empacher 02:13, 19 May 2007 (UTC)

I'm sorry, Empacher, but this is the internet and, therefore, your appeal to authority really is futile. Furthermore, it is quite clear what you wrote. Any more comments to me may be directed to my talk page. DeeKenn 02:29, 19 May 2007 (UTC)

The beauty of this medium is that your statements -- all of them, in fact -- speak quite vividly for themselves. I wish you a very pleasant weekend, as well. DagnyB 02:18, 19 May 2007 (UTC)

Wikipedia isn't a place for personal stories...so your story and material, while very valuable and important isn't really for an encyclopedia. The suggestion regarding bulletin boards is a good one. SamDavidson 16:31, 19 May 2007 (UTC)

Thanks for the validation, SamDavidson. Much appreciated. Empacher 13:45, 20 May 2007 (UTC)

Wait. I thought your qualifications were Three Masters degrees and 2PhDs (all in the Social Sciences). Which is it? And if they are in the social sciences, which? And how does that qualify you medically? And surely, if you are who you say you are, you are aware that while bipolarity can be comorbid with AD/HD, it has quite a clear cognitive defect profile, possibly made worse by a depressive cycle -- not some sort of oddball comorbidity with MDD -- and possibly by the fact that manias have been shown to be neurotoxic. [9] Or dare I question?--Mrdarcey 13:53, 7 June 2007 (UTC)

Bipolar disorder and paranoia?

In the second paragraph of the intro, it says "Bipolar disorder is also associated with a variety of cognitive deficits, in particular, difficulty in organizing and planning. The disorder may also skew the ability to judge others' emotion, and alter sense of awareness" and cites an article from ask.com. This article says nothing about cognitive deficits related to bipolar disorder, it only explains that paranoia "can be a symptom of bipolar disorder". I dont know where the link is between paranoia possibly being associated with bipolar 1 and bipolar disorder being "associated with a variety of cognitive deficits". The latter is possible, but the citation is empty. i would change it, but i want to make sure i'm not missing something.

Change it. There is no relationship between Bi-polar and "cognoitive deficits. Diagnostically, depression presents with difficulty in concentrating, forgetfulness, etc., but these are attendant symptoms...not cognitive deficits associated with the disorder. Cognitive deficit implies a permanent condition.

As for the paranoia, nope. Empacher 10:49, 19 April 2007 (UTC)

I agree. SamDavidson 14:21, 19 April 2007 (UTC)

Horse*&!%. Psychosis, including paranoia, is a very real symptom of bipolarity. See the NIMH page [here]. Am looking for cites about cognitive profiling of bipolarity and will post when I recover them.--Mrdarcey 15:38, 7 June 2007 (UTC)

A quick Google search for "bipolar cognitive function" turned up any number of hits, including:

[Cognitive Funcition in BD] a listing of three abstracted articles; from Bipolar Disorders, Volume 8 Issue s1 Page 2Issue s1 - 3 - August 2006

[Impaired cognitive function hints at bipolar I disorder vulnerability] follow the link at the bottom for the abstract, which lists imparied psycho-motor speed, executive function and visual memory in euthymic patients.

[Cognitive Function Across Manic or Hypomanic, Depressed, and Euthymic States in Bipolar Disorder] American Journal of Psychiatry, February 2004

[Cognitive function in euthymic Bipolar I Disorder] Psychiatry Research, Volume 102, Issue 1, Pages 9-20 (10 May 2001)

[Cognitive function in euthymic bipolar patients, stabilized schizophrenic patients, and healthy controls.] Journal of Psychiatric Research 2000 Jul-Oct;34(4-5):333-9

And those were just the first five hits. I'll assume good faith, but on this you're just plain wrong. Will add some cites to statement in article.--Mrdarcey 16:02, 7 June 2007 (UTC)

Yes, that is true. Psychosis can be characterized by episodes of paranoia, and bipolar disorder can involve mania with psychosis. However, my concern was that that that particular section of the article was qualifying bipolar disorder as being "associated with a variety of cognitive deficits" and citing an article connecting bipolar disorder with paranoia, although paranoia is not a so-called cognitive deficit. I did not intend to convey that bipolar disorder, bipolar I in particular, is not associated with psychosis and therefore paranoia. And, for that matter, is one is to present impared cognitive function with bipolar disorder, it needs to be presented in a thorough way, not as a single unelaborated sentence. All of the aforementioned studies associate impaired cognitive function with bipolar I and suggest it is an endophenotype and not a symptom persay of the disease itself. I do not agree with "bipolar disorder is associated with a variety of cognitive deficits" being tossed into the intro.

I do not know how i can be "plain wrong" about something i did not claim, and i suppose i should thank you both for your gracious assumption of good faith and for including a "cognition" section. April.s 06:00, 12 July 2007 (UTC)

Jumping in here. Clinically speaking, "cognitive deficits" do not refer to the potentially co-occurring para-psychoses associates with bi-polar depression. CD refers to a failure of functioning. Psychotic depression and psychotic mania associated with BiPD, as well episodic paranoia or other markers and, and do, occur. These, however, are NOT cognitive deficits, they are cognitive decompensations that are markers for mental illness. Apples and oranges in terms of terminology. --DashaKat 13:18, 12 July 2007 (UTC)

Classification Bipolar disorder is commonly categorized as either Bipolar Type I, where an individual experiences full-blown mania, or Bipolar Type II, in which the hypomanic "highs" do not go to the extremes of mania. The latter is much more difficult to diagnose, since the hypomanic episodes may simply appear as a period of successful high productivity and is reported less frequently than a distressing depression. Psychosis can occur, particularly in manic periods. There are also 'rapid cycling' subtypes. Because there is so much variation in the severity and nature of mood-related problems, the concept of a bipolar spectrum is often employed, which includes cyclothymia. There is no consensus as to how many 'types' of bipolar disorder exist.[10] Many people with bipolar disorder experience severe anxiety and are very irritable (to the point of rage) when in a manic state, while others are euphoric and grandiose.

I disagree with the statement that "hypomanic episodes may simply appear as a period of successful high productivity." It is well know in the literature that these episodes can also manifest as extreme anxiety and irritability. It should also be noted that may who are diagnosed at Bipolar II often still suffer a 'full-blown' bipolar incident. Or as the NIMH puts it:

"A mild to moderate level of mania is called hypomania. Hypomania may feel good to the person who experiences it and may even be associated with good functioning and enhanced productivity. Thus even when family and friends learn to recognize the mood swings as possible bipolar disorder, the person may deny that anything is wrong. Without proper treatment, however, hypomania can become severe mania in some people or can switch into depression."

Temporary Bipolar Disorder Following MDMA Usage Or Following Psychiatric Treatment For Depression

I have read in a few places now, that after usage of MDMA, the "Black Tuesday"/"Mid-week blues" is a temporary Bipolar disorder. It slightly makes sense, but I am not familiar enough with the science behind brain chemistry to feel comfortable doing the research and concluding that this is true. Anyone who feels like checking this out, that would be cool. --Somewilliepete 21:43, 26 April 2007 (UTC)

What you are describing is a drug-induced reaction, but not Bipolar Disorder, per DSM-IV-R-TR criteria. DPeterson^talk 21:51, 26 April 2007 (UTC)

What you are describing is called dopamine downregulation. It is a severe withdrawal symptom caused by using excessive amounts of speed. In minor forms, it happens with people who use psychostimulants for attention deficits, and is called "rebound." It is entirely different from the manias triggered by SSRIs.--Mrdarcey 16:21, 8 June 2007 (UTC)

Actually, bipolar disorder very often IS merely a "drug-induced reaction." Jane Pauley's mania and hospitalization after steroid use springs to mind. The psychiatric line is that drug-induced mania is merely an "uncovering of latent bipolar disorder." Common sense would suggest otherwise. I'd be very interested to see research on how many bipolar diagnoses immediately follow antidepressant or electroshock treatment. Certainly, mine did. 70.66.128.222 19:40, 30 April 2007 (UTC)

That's a gross generalization that is pretty insubstantialable. Read this: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10721497&dopt=Citation. DashaKat 21:48, 30 April 2007 (UTC)

On the contrary, even mainstream outfits like NAMI promote the use of mood stabilizers in addition to antidepressants for exactly this reason -- that treatment for depression can cause (although they call it "uncover") mania. Iatrogenic bipolar disorder is a very real risk. 207.194.14.57 22:00, 6 May 2007 (UTC)

I have no idea why you posted that link -- that article refers to substance abuse in combination with bipolar disorder. We're talking about drug treatment (not substance abuse) triggering bipolar disorder. 207.194.14.57 22:03, 6 May 2007 (UTC)

No. The guy asked a question about drug abuse causing bipolarity (despite the distinction that he is complaining about a depressive, not manic, outcome). And the article has point c, if you missed it.--Mrdarcey 16:21, 8 June 2007 (UTC)

Shouldn't "mania triggered by SSRIs" (noted above) as well as post-electroshock be included in the article? People with a mild depressive disorder can be catapulted into a devastating disability. Effectively, unipolar depression is converted into bipolar disorder. Good for the drug companies, I guess, but not so great for the patients. Iatrogenic bipolar disorder is a substantial risk.

I brought this subject up, then DashaKat posted an unrelated article on drug abuse. 208.181.100.25 00:23, 9 June 2007 (UTC)

Did you read the article or just the abstract? If only the abstract, you've no idea if the article said anything about antidepressants or not (and why would it say anything about ECT?). Replace the words "substance abuse" with "drugs". You have an article saying drugs cannot be primarily blamed for bipolar disorder. Make sense?

Furthermore, you're assuming that antidepressant use preceeds a diagnosis of bipolarity, as it apparantly did for both you and me. In other words, if SSRIs cause bipolarity, you would have to take them independently for a previous diagnosis of MDD before the switch happens. But that doesn't explain why the exact same cycling into (hypo)mania happens in people who already have a bipolar diagnosis, even when previously stabilised on anti-convulsants:

[Risk of switch in mood polarity to hypomania or mania in patients with bipolar depression during acute and continuation trials of venlafaxine, sertraline, and bupropion as adjuncts to mood stabilizers.]

[switch in bipolar depression: comparison of adjunctive venlafaxine, bupropion and sertraline.]

A better explaination is that anti-depressants cause symptomatic upward cycling in a fair number of bipolars, no matter what stage of the disorder, but is not causative of the disorder itself. I don't disagree with you that environmental factors, like drug use, can aid in sending someone towards bipolarity; I'm a big believer in neural plasticity. But the genetic predisposition existed before anti-depressant use, and, if anything, that was just the last piece of kindling on the fire.

Finally, if "big pharma" is so evil here, and is in cohoots with the FDA as is often claimed, why is it that US doctors are required to stabilise bipolar patients with the two oldest and cheapest medications, lithium or a valproate, before secondarily trying a new school anti-convulsants (where there is comparatively little research money) and, usually, only then an atypical anti-psychotic (where there is a great deal)? In other words, the most expensive medications, pushed most by "big pharma", are only ever used as a last resort. And in the end, you can always tell your doctor no.--Mrdarcey 20:20, 9 June 2007 (UTC)

The most current research from a multi-site large-scale clincial study found no relationship between SSRI use and the onset of mood disorder or manic episodes among pts with bipolar D/o. DPeterson^talk 20:34, 9 June 2007 (UTC) A very recent study (See Sachs, G., et. al. New England Journal of Medicine, April 26, 2007) found that, "Antidepressants are safe to use with mood stabilizers but ease bipolar depression no better than placebo pills do." The study invovled 366 volunteers diagnosed with bipolar disorder at 22 centers in the US. "The federally funded investigation indicates that antidepressant use doesn't hasten the emergence of maic symptoms." (Science News, p. 196, March 31, 2007, vol 171, #13.).DPeterson^talk

From above:

"A better explaination is that anti-depressants cause symptomatic upward cycling in a fair number of bipolars, no matter what stage of the disorder, but is not causative of the disorder itself. I don't disagree with you that environmental factors, like drug use, can aid in sending someone towards bipolarity; I'm a big believer in neural plasticity. But the genetic predisposition existed before anti-depressant use, and, if anything, that was just the last piece of kindling on the fire."

In the absence of proof one way or the other, isn't it more scientific to assume the simplest explanation? It's the principle of parsimony. Try this hypothetical: depressed patient, treated with antidepressants and/or electroshock, goes manic. Psychiatrist somersaults his logic to claim that patient is now exhibiting their previously "latent" bipolar disorder. In any other field of science, this kind of reasoning would be laughable. (Imagine an asthma drug that stops the heart. Would his doctor claim that the unfortunate patient suffered from "latent" heart disease all along? And, if they did, would that guy be allowed to practice medicine for long?) Why isn't the simpler explanation considered? Treatment for depression caused mania. Depressed person is now bipolar. Worse for the patient, better for everybody else -- the psychiatist, the bureaucrats, and especially Big Pharma. The worst aspect of all this is that statistics can never be gathered on iatrogenic bipolar because psychiatrists refuse to accept the mess they have made. 208.181.100.3 16:53, 24 July 2007 (UTC)

MrDarcey said above: "And in the end, you can always tell your doctor no." Wrong, wrong, wrong! Involuntary patients aren't allowed to say no. 208.181.100.3 16:58, 24 July 2007 (UTC)

Uh, - "Wrong, wrong, wrong!" - it's called AMA (Against Medical Advice), and there is no hospital on the planet that enforces unwanted treatment, or unwanted treatment by proxy. --DashaKat 17:18, 24 July 2007 (UTC)

Don't know where in the world you are, DashaKat, but in North America involuntary psychiatric treatment is frighteningly common. Please at least do some minimal research before making such a preposterous claim. You could start with the Wikipedia article on involuntary treatment. 208.181.100.64 15:16, 25 July 2007 (UTC)

Bipolar Disorder & Genetics

There's a big difference between running in families and being genetic. Eye colour is genetic. Speaking English runs in families. As bipolar is only a subjective judgement, it would be impossible to demonstrate a genetic basis for it. In other words, if you're willing to take on a psychiatric label such as bipolar, then chances are you would pass on your critical thinking style to your children and thus such children would be more willing to accept a psychiatric label than otherwise. Until there is an objective diagnostic test for any mental illness, such statements about genetics are pure folly. 207.194.14.57 22:11, 6 May 2007 (UTC)

Twin studies suggest a strong correlation from genetic influences: see, for example, [10] In addition, a recent NIMH study [11] has shown strong correlations with individual genes. -- The Anome 08:55, 13 May 2007 (UTC)

I see. And is there a vast pool of research candidates available? How many families with a history of bipolar disorder (which is a very subjective judgement, by the way) produce twins and adopt one of them out and keep the other? JuneTune 00:30, 14 May 2007 (UTC)

I think we'd need to read the citations/sources to evaluate that. If the sources are verifiable, then they are valid. DPeterson^talk 00:34, 14 May 2007 (UTC)

Yes, vast pools of research candidates exist, and are being studied: numerous large-scale studies have been, and still are, underway for decades. -- The Anome 07:59, 14 May 2007 (UTC)

The study that The Anome linked to above referred to 11,288 same-sex twins born in Denmark between 1870 and 1920. That seems a surprisingly high number. Anyway, even if a valid study compared fraternal and identical twins, the problem still remains -- psychiatric status is a judgement call and thus counting becomes tricky. JuneTune 00:41, 14 May 2007 (UTC)

The hypothesis that bipolar disorder is at least partly caused by genetic inheritance is looking better and better as evidence accumulates from multiple independent studies with a variety of methodologies.

Yes, diagnosis is a human judgment call. One of the things which is so interesting about the genetic research is that it shows that this human judgment has a significant correlation with physical observables which were not available to the diagnostician at the time of diagnosis. There are also studies showing correlations between brain scan measurements and diagnosis status. Since diagnosis of bipolar disorder does not involve brain scans, this information would also almost always have been unavailable at the time of diagnosis.

If you look at this from a Popperian viewpoint, research has so far failed to falsify the genetic hypothesis, and is doing a pretty good job of falsifying the null hypothesis that there is no relationship between genes and bipolar diagnosis, which would imply that there would be no more correlation than that expected by chance.

All of these results strongly suggest that bipolar disorder has physical correlates. Cause-and-effect is harder to discern, but in at least the case of genetic correlation, the genetic makeup of the individual cannot be the result of bipolar disorder, and is therefore a plausible cause. Furthermore, some of the biochemical pathways affected by the genes in question appear to be the same as those previously hypothesized to be implicated in the biochemistry of bipolar disorder.

We live in exciting times. -- The Anome 07:44, 14 May 2007 (UTC)

No, The Anome, we live in nightmarish times, times where pseudoscience masquerades as medicine, where a psychiatric label will get you involuntary hospitalization and treatment. The human judgement a.k.a. psychiatric label has not been shown to significantly correspond with any physical observable. As an aside, the term "physical observable" is a bit of a misnomer as the scans that purport to show electrical activity actually only measure blood flow, which may or may not correlate to electrical activity. That huge leap of faith is called "neurovascular coupling" and it's a pretty shaky theory. I'm not very up on philosophy so I can't comment on your Popper comment. Despite it, we only have evidence of bipolar diagnosis running in families -- that's not the same as being genetic. And since you bring up the perennial problem of cause and effect, let's be clear that even if there were to be a physical observable linked to bipolar disorder, we would have no way of knowing if we were looking at the cause or the correlate. There is no specific biochemistry of bipolar disorder. Jane Pauley went manic after being on steroids. I, and thousands of other psychiatric assault survivors, became manic after being treated with SSRIs. We don't have a clue how our thoughts, emotions, moods and experiences work and it would cause a lot less heartache if we could just admit that. JuneTune 03:42, 15 May 2007 (UTC)

Also, The Anome, the American Psychiatric Association confirms that there is NO physical observable (your words) that can be used to diagnose ANY mental illness. So if what you claim above is true, you best let them know. JuneTune 04:00, 15 May 2007 (UTC)

As bipolar is only a subjective judgement, it would be impossible to demonstrate a genetic basis for it.

Or, it isn't a subjective judgment at all; or it is a subjective judgment based on observable criterion. Either way you're incorrect:

The underlying neurobiology of bipolar disorder

The Neurobiology of Bipolar Disorder

Oh yeah, genetic links have been demonstrated quite successfully too...

From arthritis to diabetes: scientists unlock genetic secrets of diseases afflicting millions, The Guardian June 7, 2007

Genetic Roots of Bipolar Disorder Revealed by First Genome-Wide Study of Illness

This new research should be incorporated into the article. Cheers.--Mrdarcey 14:20, 7 June 2007 (UTC)

The American Psychiatric Association says there is no biological marker for bipolar or any other mental illness. I guess you should update them, Mrdarcey. 208.181.100.25 00:27, 9 June 2007 (UTC)

It's mystifying that one can successfully treat a chronic, genetic neurological disorder without changing someone's neurology. For those of us who are Big Pharma skeptics, could you hazard a guess how this "disease" can disappear without neurological intervention (i.e. drug treatment)? Previously bipolar people presumably have the same neurobiology. So, evidently, that "faulty" neurobiology doesn't have to correlate to this "disease." 208.181.100.25 00:47, 9 June 2007 (UTC)

Furthermore, now that the good news is out (bipolar disorder is a proven brain disease), I guess that means treatment will now fall under the rubric of neurology, not psychiatry. That is indeed good news -- treatment by REAL doctors. 208.181.100.25 00:49, 9 June 2007 (UTC)

I'm not sure I follow you, snark or no. First, the research is weeks old. I'm quite sure APA members are aware of it. I'm not sure what you want them to do since the DSM V isn't due for 4 more years. They have, though, supported a putative link between observations drawn from neural imaging in adults, particularly in the prefrontal cortex, and bipolarity:

[Brain Imaging and Child and Adolescent Psychiatry With Special Emphasis on SPECT] (see pages 5-6)

Second, is that a criticism, a comment, a proof, what? Bipolarity isn't a disease. Nor is it something that can "disappear" given the current state of knowledge: Treatment is symptomatic only; there are no "previously bipolars". And why are you assuming bipolars have the same neurobiology? As whom? Other bipolars or those with healthy brains? In anycase, there is ample evidence that manias are neurotoxic, and thus dangerously change the brain's structure, and that lithium and anti-convulsants work not only as neuroprotectives, but also restore previously lost neurons. Though this is discussed in the Manji article above, you can find a shorter, lay explaination here:

[Interview with Husseini, Manji M.D.]

So yeah, medications do change neurobiology. Why is that necessarily a bad thing given the alternative?

Third, the differences between psychiatry and neurology are, yes, shrinking to the point where they are becoming more or less arbitrary. So go see your neurologist if you like. Good luck with symptomatic relief, though.

Finally, how is any of this at all constructive to the article?--Mrdarcey 21:18, 9 June 2007 (UTC)

Mrdarcey, bipolar disorder is claimed to be a "biologically based brain disease," by E. Fuller Torrey and many other researchers. Despite your assertion, it certainly can (and does!) in many cases disappear without changing neurology (i.e. taking psych drugs). This kind of throws into doubt the "biologically based brain disease" theory.

Yes, there are "previously bipolars." I'm one of them. Speaking of neurotoxic, let's be honest and admit that psychoactive drugs are also neurotoxic. Yes, it's bad for a brain to be "mentally ill" but it's also bad for a brain to be chemically "improved." I would never argue that medications don't change neurobiology -- of course they do! That's how they have their effect. That's not always a bad thing, of course, if the balance of risks/benefits favours treatment. However, that's often not the case and for many patients, they're never given an opportunity to assess the risks/benefits for themselves.

No, psychiatry and neurology are not merging together. If you consult a neurologist about an alleged brain disorder such as bipolar, you'll be referred to a pscyhiatrist. Psychiatrists specialize in the study of psych drugs on symptoms. When it comes to psychiatry, cause and effect are often confused. Psychiatrists also often fail to recognize that a lot of psych symptoms are actually caused *by* treatment, not an underlying disorder.

I think it's important for the public to be aware that psychiatry is only a pseudo-science and the evidence is against the biological model of mental disease. That's why these subversive contributions are constructive to the article. 208.181.100.3 16:40, 24 July 2007 (UTC)

Minor point of grammar, but misleading and unresolvable

There is an unclear pronoun reference in the second paragraph of this article that has a major impact on meaning; I can't simply fix the error because I do not know the intended meaning. Here's the paragraph:

"There are many variations of this disorder. Moods can change quickly (4 or more times in one year) or more slowly. In psychiatric terms, this is called rapid cycling or slow cycling, respectively. Ultrarapid cycling, where moods change several times per week, is very rare. These mood patterns are associated with distress and disruption, and a relatively high risk of suicide."

In the last sentence, the phrase "These mood patterns" might refer just to the ultrarapid cycling mentioned in the paragaph before, or it might refer to all the mood patterns described in the paragraph. The reason this matters is that one meaning indicates that people with ultrarapid cycling have a relatively high risk of suicide, whereas the other meaning indicates that everyone with bipolar disorder has a relatively high risk of suicide (which would be pretty depressing to a reader coming here for general info on his or her recently diagnosed bipolar disorder!)

My inclination is to link the suicide rate to the ultrarapid cycling -- correct? Grammargal 04:34, 14 May 2007 (UTC)

Mood swings associated with distress, disruption and increased risk of suicide are common to all types of bipolar disorder. JuneTune 04:56, 14 May 2007 (UTC)

Yes, JuneTune, that is also my understanding. DPeterson^talk 17:53, 18 May 2007 (UTC)

Each type of cycle is usually referred to as a single pattern. Since JuneTune is correct in her statement, I have added a study that examines the incidence of suicide in all forms of Bipolar Disorder, and specifically shows the high risk of suicide. Absentis 13:54, 3 June 2007 (UTC)

In 25 years as a professional, as researcher, and a university professor, I have never heard of a cycle being referred to as a "single pattern". Please provide a reference. --DashaKat 17:18, 3 June 2007 (UTC)

25 years in the business, and you dispute the fact of involuntary treatment? 208.181.100.64 15:30, 25 July 2007 (UTC)

Keep the conversation in the appropriate thread and, yes, no self-respecting institution enforces treatment without consent or consent by proxy.

There's a difference between treatment being unwanted, and treatment being enforced against one's wishes. --DashaKat 20:03, 25 July 2007 (UTC)

Then I guess the Vancouver General Hospital, Royal Jubilee Hospital (Victoria), Royal Columbian Hospital (New Westminster), Riverview Hospital (Coquitlam) and Penticton Regional General Hospital are all non-self-respecting institutions. Weird. That's most of the major psychiatric hospitals in southern British Columbia. Mental health legislation allowing involuntary treatment is on the books in every province and every state in the USA. You're just wrong, DashaKat, and I'm shocked that someone who claims to be a professional isn't aware of involuntary treatment. Pray tell, what is the difference between unwanted treatment and forced treatment? Probably a semantic absurdity. 208.181.100.40 13:41, 27 July 2007 (UTC)

Antidepressants may not provoke manic episodes

A very recent study (See Sachs, G., et. al. New England Journal of Medicine, April 26, 2007) found that, "Antidepressants are safe to use with mood stabilizers but ease bipolar depression no better than placebo pills do." The study invovled 366 volunteers diagnosed with bipolar disorder at 22 centers in the US. "The federally funded investigation indicates that antidepressant use doesn't hasten the emergence of maic symptoms." (Science News, p. 196, March 31, 2007, vol 171, #13.). DPeterson^talk 14:37, 20 May 2007 (UTC)

This is my first ever post on Wikipedia, so please excuse me if I do or say something wrong here. I'm not a doctor, but as just an individual, I think it might be appropriate to mention on the main page (or at least make it clearer) that using standard anti-depressants, without the use of atypical antipsychotics or mood stablizers, can often have little or no efficacy for bipolar depression. For an individual struggling with the condition, that could be very valuable information of the type they'd hope to find when looking at the main entry for the condition; it's easy enough to cite to, and I just think it might be beneficial to readers to clearly spell this out in the text body. ElHalo 07:24, 22 May 2007 (UTC)

Well, this seems to fly in the face of my anecdotal experience. Emsam, a transdermal MAOI patch, certainly did send me into a hypomanic phase. I was a miserable SOB. What kind of antidepressants did the study use? Do you have a link to at least an abstract? DeeKenn 17:22, 29 May 2007 (UTC)

Statistical studies do not mean that the results found will be evident in 100% of the cases. Anecdotal experiences that are inconsistent with the statistical results are certainly possible. The studies do seem to suggest that the "lore" regarding SSRI's and Bipolar disorder causing manic episodes is not present. In other words, the manic episodes experienced by some with Bipolar who are taking SSRI's may not have anything to do with the SSRI. RalphLender^talk 15:23, 30 May 2007 (UTC)

Woah. The study was about antidepressant use with anti-convulsants, yeah? That's quite different than antidepressant use without! I don't have access to pubmed, and there is no link, so unless someone can provide more than two out of context sentences, I think the statement should be stricken or clarified.

I'm willing to spot you that the lack of antidepressant efficacy could be real. Research has suggested the neurodisturbance in bipolarity resides in the neuroreceptor itself, and possibly not in faulty neurotransmitter production. That being said, I know a lot of bipolars for whom antidepressants, particularly non-serotenergic ones, do something. Even if it is only relieving anxiety. That doesn't disprove the quite common observation -- or, yes, my personal experience -- that antidepressants, most often SSRIs, can trigger bipolar manias.--Mrdarcey 14:33, 7 June 2007 (UTC)

I have located the abstract of that article, and I believe you have misread it. It states that, "Our study was designed to determine whether adjunctive antidepressant therapy reduces symptoms of bipolar depression without increasing the risk of mania." It says nothing at all about bipolars receiving antidepressant monotherapy and the related risk for a manic/mixed episode. Furthermore, they don't appear to draw quite the conclusion you state. According to the authors, "The use of adjunctive, standard antidepressant medication, as compared with the use of mood stabilizers, was not associated with increased efficacy or with increased risk of treatment-emergent affective switch. Longer-term outcome studies are needed to fully assess the benefits and risks of antidepressant therapy for bipolar disorder."[12] I have reverted, but left the reference, and added a link to the abstract.--Mrdarcey 15:08, 7 June 2007 (UTC)

Treatment-induced mania in a previously nonbipolar patient will still be considered an "uncovering" of "latent" bipolar illness. Iatrogenic (caused by treatment) bipolar will continue to be routinely ignored by Big Pharma and its adherents. 208.181.100.25 00:39, 9 June 2007 (UTC)

The study is pretty clear that they found no relationship between med use and the triggering of manic episodes. This is the most current material and from a large study. It runs counter to the pervailing mythology, and is a good study methodologcially DPeterson^talk 20:37, 9 June 2007 (UTC)

I'm not critiquing it methodologically or in conclusion. I'm saying that the entirity of the study's sample were patients already stable on anti-convulsants. If I've misread something, let me know, but that is a far cry from anti-depressant monotherapy. I've provided links above to studies addressing just that and saying opposite things, though possibly in smaller numbers than previously thought. Anecdotally, I'm dubious, as SSRI induced hypomania has happened to me at least twice before mood stabilisers and not since. I will try to find studies, since it seems to be an accepted fact everywhere I look, however the drug companies try to disguise it on PI sheets.

I would whole-heartedly support putting a sentence in the treatment section regarding the apparant lack of efficacy of anti-depressants on the bipolar and using that study as a cite.--Mrdarcey 21:34, 9 June 2007 (UTC)

Risk of Switch in Mood Polarity to Hypomania or Mania in Patients With Bipolar Depression During Acute and Continuation Trials of Venlafaxine, Sertraline, and Bupropion as Adjuncts to Mood Stabilizers

Antidepressant treatment-associated behavioural expression of hypomania: a case series.

Validating antidepressant-associated hypomania (bipolar III): a systematic comparison with spontaneous hypomania (bipolar II).

Clinical variables related to antidepressant-induced mania in bipolar disorder.

Clinical features of antidepressant associated manic and hypomanic switches in bipolar disorder.

Serotonin transporter linked promoter (polymorphism) in the serotonin transporter gene may be associated with antidepressant-induced mania in bipolar disorder.

Bipolar disorder, antidepressants and induction of hypomania or mania. A systematic review. More or less on your side.

Antidepressant-induced mania: an overview of current controversies.

The association between substance abuse and antidepressant-induced mania in bipolar disorder: a preliminary study.

Antidepressants in bipolar disorder: the case for caution.

The treatment of bipolar depression.

Ad naseum. In addition to the newer research suggesting genetic factors related to antidepressant caused manic switching, there is also a raft of literature on the effects of specific antidepressants on manic switching, concluding that fluoxitine might well be useful as poly or monotherapy in certain cases of BP2/NOS. It is also repeatedly suggested that Lithium/antidepressant polytherapy is more efficacious than not.--Mrdarcey 23:25, 9 June 2007 (UTC)

The newest study suggests that SSRI's do not cause a switch to manic episodes. The studies you cite are all older than this most current one. DPeterson^talk 00:31, 10 June 2007 (UTC)

Take a look at [[13]], specifically,

One of the interesting things you find when you review the literature is the remarkable dearth of studies that carefully and rigorously look at whether antidepressants per se are effective in bipolar depression. Very few studies have ever been done, and many are either small, or short, or they include patients who aren't really representative of the types of patients who would usually be seen in clinical care. So the need was to try to establish: (1) whether antidepressants are helpful if they are added to ongoing treatment with mood stabilizers, and (2) to assess the safety of antidepressants. There is the idea, not supported by a lot of data, that the modern antidepressant might actually exacerbate the course of bipolar disorder, that they could cause either rapid cycling or a switch from depression into mania, hypomania, or a mixed state.

DPeterson^talk 00:44, 10 June 2007 (UTC)

I'm sorry. What have I not made clear in the difference between using an antidepressant by itself, and in using an antidepressant adjunctively to a mood stabiliser? Or that the article's own conclusion states that more research is needed because of the limited scope of the study?

It should be noted what the drugs used in the study were. Three antidepressants were used: buproprion (Wellbutrin/Zyban), paroxitine (Paxil) and tranylcypromine (Parnate). Only one of those is an SSRI (Paxil), while buproprion is specifically known to be less activating to bipolars (see the first article above). No tricyclics were used in the study. I'm quite unclear how you're deriving that all SSRIs are represented here. Neither does one limited scope study disprove everything that came before it.

Again, I'm willing to give you that there might be a limited use of antidepressants in the bipolar pharmacoepia. I'll also give you that certain antidepressants are less activating than others, particularly to those in the BP2 part of the scale. But to claim that antidepressants do not cause manic reactions in bipolars is to ignore overwhelming research, observational and anecdotal evidence.--Mrdarcey 01:06, 10 June 2007 (UTC)

To quote the abstract from the first source cited:

ABSTRACT "Background Episodes of depression are the most frequent cause of disability among patients with bipolar disorder. The effectiveness and safety of standard antidepressant agents for depressive episodes associated with bipolar disorder (bipolar depression) have not been well studied. Our study was designed to determine whether adjunctive antidepressant therapy reduces symptoms of bipolar depression without increasing the risk of mania.

Methods In this double-blind, placebo-controlled study, we randomly assigned subjects with bipolar depression to receive up to 26 weeks of treatment with a mood stabilizer plus adjunctive antidepressant therapy or a mood stabilizer plus a matching placebo, under conditions generalizable to routine clinical care. A standardized clinical monitoring form adapted from the mood-disorder modules of the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, was used at all follow-up visits. The primary outcome was the percentage of subjects in each treatment group meeting the criterion for a durable recovery (8 consecutive weeks of euthymia). Secondary effectiveness outcomes and rates of treatment-emergent affective switch (a switch to mania or hypomania early in the course of treatment) were also examined.

Results Forty-two of the 179 subjects (23.5%) receiving a mood stabilizer plus adjunctive antidepressant therapy had a durable recovery, as did 51 of the 187 subjects (27.3%) receiving a mood stabilizer plus a matching placebo (P=0.40). Modest nonsignificant trends favoring the group receiving a mood stabilizer plus placebo were observed across the secondary outcomes. Rates of treatment-emergent affective switch were similar in the two groups.

Conclusions The use of adjunctive, standard antidepressant medication, as compared with the use of mood stabilizers, was not associated with increased efficacy or with increased risk of treatment-emergent affective switch. Longer-term outcome studies are needed to fully assess the benefits and risks of antidepressant therapy for bipolar disorder. (ClinicalTrials.gov number, NCT00012558 [ClinicalTrials.gov] .)"

It's very clearly stated that stabilizers were used by all participants in the study. The finding is that ADs given to those on stabilizers might not have much efficacy on bipolar depression. The secondary finding is that for bipolars on stabilizers, there might not be as much switching to mania or mixed states when ADs are used as adjunct therapy. There is a growing body of research concluding that stabilizers plus antidepressants might not have the efficacy on bipolar depression as once thought. This shouldn't be confused with a finding that ADs sans stabilizers cause less manic/mixed switches for bipolars than previously thought.

As Mrdarcy pointed out (and posted a number of studies, more of which can be found on PubMed), it is well established that antidepressant use by bipolars correlates with switches to mania or hypomania or mixed states when taken without stabilizers. Yes, there are differences in triggering for different types of ADs but all are linked to this type of mood phase change. Query on PubMed did come up with one study suggesting as you've proposed, http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=17391421&ordinalpos=2&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum "Effect of second-generation antidepressants on mania- and depression-related visits in adults with bipolar disorder: a retrospective study," but it is based on a retrospective study of a national managed-care claims database. This presumes proper diagnosis in the first place with no confirmation by the researchers. In other words, it's not sufficient to negate the body of research that's come before and after it.

Unlike Mrdarcy, I'm reluctant to cede that without stabilizers ADs can successfully be used without switching and/or kindling in bipolars. I'd suspect the proper diagnosis when no switching occurs is MDD, MDD with anxiety, refractory depression, or Cyclothymia. I am very interested in seeing your sources. Please post links available to the general public. #16 is not viewable.Staciabb 17:57, 17 June 2007 (UTC)

Relapse

I'd like to suggest that in this section it be made clear that often there is no discernible trigger for relapse. As it reads now, it sounds almost as if there is always or usually an identifiable behavioral or situational trigger. This is incorrect. 71.234.195.253 08:05, 4 June 2007 (UTC)

What specifically would you suggest? JonesRD_talk 18:27, 4 June 2007 (UTC)

71.234.195.253, you are correct in your perception. Bi-polar does not lend itself to relapse, it recurs. The terminology used here is incorrect, and has been addressed. --DashaKat 19:34, 4 June 2007 (UTC)

"Recurrence" is probably a better word than "relapse," though I've certainly seen it referred to as "relapse" in medical literature. Specifically, however, I think there should be, at the very least, a phrase in this section, perhaps before the sentence "The following behaviors can lead to depressive or manic recurrence:," such as "Though bipolar disorder often recurs with no observable trigger, [the following behaviors can lead to depressive or manic recurrence.]"

Also, in the last paragraph of this section, I think it should again be made clear that the only time a friend or relative has a possibility of helping to manage recurrence, is if there is, in fact, an observable external trigger. 71.234.195.253 18:22, 8 June 2007 (UTC)

Oh, sorry -- I forgot to sign in for my last two comments (User:71.234.195.253). This is me: NSpector 18:24, 8 June 2007 (UTC)

Personality disorders

Why is this page in the personality disorders category? I thought that in the DSM-4 at least, it was not a personality disorder. I couldn't find an explanation in the article. 72.83.127.85 22:35, 6 June 2007 (UTC)

Well spotted. will fix cheers, Cas Liber | talk | contribs 23:18, 6 June 2007 (UTC)

Clinical Depression?

I've something of a problem with this phrase in the first sentence and this disam page. Particularly since the first sentence in the Clinical Depression article clearly states that the phrase refers to MDD or unipolar depression, but NOT bipolarity.

Would suggest a change to something like "depressive phase". Am always hesitant to edit articles like this though, where there I haven't stepped in before.--Mrdarcey 14:41, 7 June 2007 (UTC)

Extra "the"

Please erase the extra "the" at the end of the introduction (However, the relationship between THE THE disorder and creativity is still very unclear.[2][3][4] One study indicated increased striving for, and sometimes obtaining, goals and achievements)

Euthymia between episodes isn't always the case

The article claims that "These clinical states [depression, mania etc] typically alternate with a normal range of mood, which is termed euthymia."

This is usually the case, but around 25 % of bipolar people experience lesser cycles in mood (kind of cyclothymic) between the episodes. I think the article should mention that.

I don't think it's as high as 25%. This is where diagnosis and assessment of mood WRT environment gets really tricky; it is a devastating disorder and many people are siginificantly impacted upon - hence it can be tricky to distinguish a depressive episode vs unhappiness at current circumstances. cheers, Casliber (talk · contribs) 20:51, 24 June 2007 (UTC)

I'm not talking about episodes, but fluctuations that still aren't normal. Here's one source: http://index.glaxowellcome.se/gws/bipolar_sjukdom/del1_%20Biopol%E4r_sjukdom_ny.pdf (page 33) - unfortunatly in swedish, but translated into english it goes something like: "Between the episodes the majority gets back into a fully normal ability to function. But around one in four have even between the episodes a mood that changes more than normally, and a significantly reduced ability to work." I'll try to find some other sources in english for you.

Making this into a Featured Article

Dear all, Schizophrenia has just passed a Featured Article review and gives a great template and way forward to get this to FA. I can see some remodelling on this one along the lines of that one (headings etc.) would go along way to getting it there. Do others think this is a good idea? (i.e. reorganizing the headings as a first-up) cheers, Casliber (talk · contribs) 14:38, 24 June 2007 (UTC)

Yes, reorganizing this article along the lines of the Schizpophrenia article would be an improvement. DPeterson^talk 15:51, 24 June 2007 (UTC)

OK - reorganized so that themes flow better and a couple of more generic headings are more clearly specified. Except the Aspects section - not sure how that should go -I'm flicking back and forth and musing on this one.cheers, Casliber (talk · contribs) 21:11, 24 June 2007 (UTC)

• Not sure about the Angst and Marneros ref - need to see this at work. My greek lexicon has μανια as madness esp. WRT Bacchic frenzy....cheers, Casliber (talk · contribs) 21:51, 24 June 2007 (UTC)

I'd love to see this article be featured - and want to help. I just did some small edits on the 'mania' section - but it can still use a lot of help, expanding, references, etc. There seem to be many folks on this talk page throwing out references - wish those would go into the article! caveat: I'm a fairly new wiki editor and just getting more involved.--Murmur74 02:05, 1 July 2007 (UTC)

Great - when you get a subject this size, the trick is figuring out what should go on the main page and what should go on secondary article pages. The article should not be bigger than schizophrenia which is about the upper size limit. Which refs were you concenred about disappearing? They may be on one of the seconday pages. Also it is a moot point whether there are refs in the lead or not (as they will be reffed subsequently in the article). We can start a to-do list here:

oh, by 'thrown out' I meant put out into discussion but not included into the body of the article. I like your to-do list, am going to add some comments below.--Murmur74 19:38, 1 July 2007 (UTC)

Great. As with just about any controversial article, I think it needs to get all the way to FA to get some stability as there'll be a (sort of) sanctioned version to refer to then. cheers, Casliber (talk · contribs) 23:11, 1 July 2007 (UTC)

To-do list

• Aspects/Signs and Symptoms section needs a cleanup. Most other psych articles have DSM IV TR criteria here. Question is, would it make the article too big?? cheers, Casliber (talk · contribs) 02:32, 1 July 2007 (UTC)

I think we should list DSM criteria, would be better to have it more accurate but longer. --Murmur74 19:38, 1 July 2007 (UTC)

Here's the problem with that. The APA strictly forbids the reproduction of the DSM criteria by non-sanctioned organizations. About 2 years ago there was a huge ta-do around Wikipedia's inclusion of DSM criteria on its pages. The request to cease and desist was appealed by several editors, and all were vociferiously denied. The reason that this page does not include the DSM criteria is because it is a hold over from the time when all of the criteria were removed from all of the psych pages. --DashaKat 23:04, 1 July 2007 (UTC)

Gawd, there are an awful lot of pages now with them on....we'll have to look up the archives...cheers, Casliber (talk · contribs) 23:09, 1 July 2007 (UTC)

• Under Further reading, the contemporary 1st hand accounts should be made iinto a paragraph discussing as at the bottom of schizophrenia.

• If schizophrenia is anything to go by, the article will be underreferenced with anything under 110 or so refs. Much info is currently unreffed

• many refs are listed in parentheses. I'm not sure who listed them (well I suppose I could trawl through and find out) but they all need to be found, completed and inlined.

• Sticking to mainstream is important. Ultrarapid cycling is not classified under DSM IV and highly controversial.

• The bipolar in kids bit too, this was always thought of as really rare. We need to be careful how we go here.

• Needs to explain and give timeline for evolution of terms from Manic-Depresion to Bipolar Affective Disorder to Bipolar Disorder and why in History Section.

• Current refs would be better cited in cite format.

• I've placed some fact tags but more are needed. A whole bunch come straight out of DSM IV which I haven't bothered tagging.

• Etiology section is a bunch of statements which need to be converted into cohesive paragraphs of info.

Mania and over the counter prescription drugs.

Mania and over the counter prescription drugs

There should be a section added to this site to document that in some cases, (many perhaps not reported) over the counter medications have triggered such episodes.

I recall doing some research and noting that many schizophrenic episodes followed flu like symptoms. It becomes apparent now that 'some' of these individuals were reacting the medication they took for their flu.

Phenylpropanolamine (PPA) is a sympathomimetic drug similar in structure to amphetamine which was formerly present in over 130 medications, primarily decongestants, cough/cold remedies, and anorectic agents. - - A report on PPA, from the Dept. of Psychiatry, F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland. Pharmacopsychiatry 1988 stated: - - :We have reviewed 37 cases (published in North America and Europe since 1960) that received diagnoses of acute mania, paranoid schizophrenia, and organic psychosis and that were attributed to PPA product ingestion. Of the 27 North American case reports, more reactions followed the ingestion of combination products than preparations containing PPA alone; more occurred after ingestion of over-the-counter products than those obtained by prescription or on-the-street; and more of the cases followed ingestion of recommended doses rather than overdoses. - - :Failure to recognize PPA as an etiological agent in the onset of symptoms usually led to a diagnosis of schizophrenia or mania, lengthy hospitalization, and treatment with substantial doses of neuroleptics or lithium. - - PPA is no longer available in any medication in the United States since 2000.

--Caesar J. B. Squitti  : Son of Maryann Rosso and Arthur Natale Squitti 20:36, 16 July 2007 (UTC)

A review of your Talk page, prior to my requesting a speedy deletion of your Fugue (mental state of mind) page (it's redundant, shows a consistent disregard for Wikipedia policy, specificially with regard to repeated attempts to publish original research, grandstanding on issues of personal importance (of which, IMHO, this is one), and general POV writing.

As I noted previously, 37 cases in 47 years flies right in the face of substantial statisical analysis of any sort. That you are continuing to push this matter is surprising, coming from someone who is also interested in establishing a mathematical proof for the existence of God -- did you get to look over the Intelligent math article yet?

Either way, kindly take a step back and make an effort to recognize the purpose and intention of Wikipedia, as well as the work that is done here. I am certain that you have a great deal to contribute, if you would simply make more of an effort to find a way of presenting your contributions within the parameters of the forum. Cheers. --DashaKat 00:26, 17 July 2007 (UTC)

Sorry Caesarjbsquitti, I agree with Dashakat - due to the depth of topic and limitations of the article length, it has to be a summary of the most salient points. cheers, Casliber (talk · contribs) 01:18, 17 July 2007 (UTC)

Rapid Cycling

I edited the subcategories from Bipolar I, Bipolar II Rapid Cycling and cyclothymnia. Both Bipolar I and Bipolar II can encompass rapid cycling and rapid cycling is not a subcategory, it is an acceleration.

good call - sorry I missed it. cheers, Casliber (talk · contribs) 02:55, 26 July 2007 (UTC)

antidepressants can cause manic switching

This is a pretty critical issue. Treatment for depression can cause mania (and thus a new diagnosis of bipolar disorder). Please see http://www.blackdoginstitute.org.au/bipolar/treatments/bipolar.cfm Could we add this to the etiology section, please? 208.181.100.64 15:27, 25 July 2007 (UTC)

The diagnosis is Bipolar III- bipolar caused by antidepressants. Razamatazz 12:48, 27 July 2007 (UTC)

Great! Thanks, Razamatazz. Could we add this to the article, then? 208.181.100.40 13:29, 27 July 2007 (UTC)

Oh, but it seems not to be in the Holy DSM. See http://www.bipolarworld.net/Phelps/ph_2001/ph190.htm 208.181.100.40 13:33, 27 July 2007 (UTC)

The DSM-IV is quite out of touch on this one. It's on the bipolar spectrum:

http://www.psycom.net/depression.central.lieber.html

The DSM-IV doesn't even recognise ultra rapid cycling! (Razamatazz)

Guess we'll just have to wait for the New & Improved Holy DSM! Coming Soon! From a Drug Rep Near You! 208.181.100.55 15:19, 31 July 2007 (UTC)

From the link that Razamatazz kindly posted:

Bipolar III: hypomania due to antidepressant drugs

Bipolar III ½: hypomania and/or depression associated with substance use

208.181.100.55 15:22, 31 July 2007 (UTC)

Shouldn't Bipolar III include mania due to electroshock as well as antidepressant drugs? Francesca Allan 00:13, 4 September 2007 (UTC)

The missing link:

Lead on original research...

The lack of focus on 'organic causes' ie undetected bacterial infections of the intestinal system, ie giardia, or lymes disease can cause symptoms that may be taken as being some type of labelled mental illness.

The illness is impacting the mind, it is a mental illness but caused by toxins created by the infection, and/or the infection that corrupts the needed biochemical reactions.

There should be a cross link to the reality that such labels while true, ignore a most likely cause. half-truths

Hopefully someone can google this lead to find other researchers who can provide the necessary links...

Former Chief of Psychiatric Assocation and views on bacterial infections

--Caesar J. B. Squitti  : Son of Maryann Rosso and Arthur Natale Squitti 03:03, 22 August 2007 (UTC)

Cue to identical confused talk page post on Talk:Schizophrenia. JFW | T@lk 03:10, 24 August 2007 (UTC)

Ultra-rapid cycling, ultra-ultra rapid cycling, ultradian cycling

There can be very sever rapid cycling.

P. Thomas, The many forms of bipolar disorder: a modern look at an old illness, Journal of Affective Disorders, Volume 79, Supplement 1, April 2004, Pages 3-8. doi:10.1016/j.jad.2004.01.001

Normal rapid cycling definition is four or more cycles in a year.(citation needed). Ultra-rapid and ultra-ultra rapid cycling means shorter cycles.

There is some scientific references to ultra-rapid cycling.

Mackin P, Young AH. Rapid cycling bipolar disorder: historical overview and focus on emerging treatments, Bipolar Disorders, 2004: 6: 523–529. doi:10.1111/j.1399-5618.2004.00156.x

Also ultra-ultra rapid cycling has some support.

DF Papolos, S Veit, GL Faedda, T Saito, HM Lachman. Ultra-ultra rapid cycling bipolar disorder is associated with the low activity catecholamine-O-methyltransferase allele, Molecular Psychiatry, (1998) 3, 346–349. Abstract: http://www.nature.com/mp/journal/v3/n4/abs/4000410a.html

Ultra-ultra rapid cycling means distinct shifts in mood within a 24-48 hour period.

DF Papolos, S Veit, GL Faedda, T Saito, HM Lachman. Ultra-ultra rapid cycling bipolar disorder is associated with the low activity catecholamine-O-methyltransferase allele, Molecular Psychiatry (1998) 3, 346–349. Abstract: http://www.nature.com/mp/journal/v3/n4/abs/4000410a.html

It is generally quite complicated to find difference between unipolar and bipolar depression or differentiate manic and depressive phases.

Charles L. Bowden. A different depression: clinical distinctions between bipolar and unipolar depression, Journal of Affective Disorders 84 (2005) 117–125.

Therefore diagnosing ultra-rapid or ultra-ultra rapid cycling bipolar patient in practical clinical settings can be problematic.

There is some speculations that different medications, e.g. antidepressants, could induce rapid cycling.

Mackin P, Young AH. Rapid cycling bipolar disorder: historical overview and focus on emerging treatments, Bipolar Disorders 2004: 6: 523–529. doi: 10.1111/j.1399-5618.2004.00156.x

For some rapid-cycling patients lamotrigine has been helpful and therefore effect of lamotrigine for ultra-rapid and ultra-ultra rapid cycling patients could be studied in a scientific way.

Charles L. Bowden, Joseph R. Calabrese, Susan L. McElroy, Linda J. Rhodes, Paul E. Keck Jr., John Cookson, John Anderson, Carolyn Bolden-Watson, John Ascher, Eileen Monaghan, Jing Zhou. The Efficacy of Lamotrigine in Rapid Cycling and Non–Rapid Cycling Patients With Bipolar Disorder. Biological Psychiatry, Volume 45, Issue 8, 15 April 1999, Pages 953-958. doi: 10.1016/S0006-3223(99)00013-X

Yuccara 17:44, 24 August 2007 (UTC)

Comorbid Anxiety in Bipolar Disorder

Comorbidity of anxiety disorders with bipolar disorder is very common. Keming Gao, Antipsychotics in the Treatment of Comorbid Anxiety in Bipolar Disorder, Psychiatric Times, 1 August 2007. http://www.psychiatrictimes.com/showArticle.jhtml?articleID=201201862&CID=rss

(Somebody fluent in that language can say which is Keming Gaos forename and surname. That information is important when adding a reference. There is no discrimination here since author is fluent with badly broken English.)

According to Keming Gao there is not yet systematic studies study designed or done for a cohort of patients with bipolar disorder and a specific comorbid anxiety disorder. She/He(?) proposes series of studies of atypical antipsychotics when patients have bipolar disorder with specific anxiety disorder.

Yuccara 18:37, 24 August 2007 (UTC)

"Bacterial infections" section

In the absence of any references to peer-reviewed medical literature, I have removed this whole subsection from the article. -- Karada 16:23, 4 September 2007 (UTC)

A minor thing

First section: Wouldn't it be better if the phrase "Most people" was replaced by a clearer one? -- 213.6.23.64 09:47, 15 September 2007 (UTC)

A few things...

I am not one to normally edit articles like these, but I'm quite the (OCD) grammar nazi, and I couldn't help but to notice that the title of the page isn't capitalized correctly. The "disorder" in Bipolar Disorder should be capitalized, being the title of the article and all. Is there any way to do this? Also, requesting to archive the talk page again? It's quite... long. Thanks again. Anonymous~Source 16:37, 3 October 2007 (UTC)

Bipolar Disorder

209.244.188.161 02:49, 9 October 2007 (UTC)I understand that we all see each other as human beings. I started reading and it all became robotic. We speak the same language, we see the same stars at night. We all do not have the same atmosphere, I understand that. We are all together as one though. Why do some of us have to sound so much more intellectually significant to say the same things that a layman would say? Bipolar disorder is a mental attitude. Some call it growing up and changing their habits and just not use to the response. Some call it being spoiled. Some call it neglected and abused and the reaction is only what has been learned from the teacher. Stop calling it all sorts of names to make it not sound like what it is. It is clear to me where this will go. Under the wood pile. But at least I have said it. Giving a medical term to an attitude of reality is just an excuse for the medical field and the pharmecutical companies to become rich. If your child did not suffer from a neurological trauma then the reason probably stems from his or hers upbringing. Come on now, enough is enough of the illusions.