Francis Mark Mondimore - Bipolar Disorder: A Guide for You and Your Loved Ones

BIPOLAR DISORDER

A JOHNS HOPKINS PRESS HEALTH BOOK

FOURTH EDITION

A Guide for You & Your Loved Ones

FRANCIS MARK MONDIMORE, MD

JOHNS HOPKINS UNIVERSITY PRESS

Baltimore

Note to the Reader: This book is not meant to substitute for medical care, and treatment should not be based solely on its contents. Instead, treatment must be developed in a dialogue between the individual and his or her physician. This book has been written to help with that dialogue.

Drug dosage: The author and publisher have made reasonable efforts to determine that the selection of drugs discussed in this text conform to the practices of the general medical community. The medications described do not necessarily have specific approval by the US Food and Drug Administration for use in the diseases for which they are recommended. In view of ongoing research, changes in governmental regulation, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert of each drug for any change in indications and dosage and for warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently used drug.

1999, 2006, 2014, 2020 Francis Mark Mondimore

All rights reserved. Published 2020

Printed in the United States of America on acid-free paper

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Johns Hopkins University Press

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Library of Congress Cataloging-in-Publication Data

Names: Mondimore, Francis Mark, 1953 author.

Title: Bipolar disorder : a guide for you and your loved ones / Francis Mark Mondimore, MD.

Description: Fourth edition. | Baltimore : Johns Hopkins University Press, 2020. | Series: A Johns Hopkins Press health book | Includes bibliographical references and index.

Identifiers: LCCN 2019059864 | ISBN 9781421439051 (hardcover ; alk. paper) | ISBN 9781421439068 (paperback ; alk. paper) | ISBN 9781421439075 (ebook)

Subjects: MESH: Bipolar Disorder | Popular Work

Classification: LCC RC516 | NLM WM 171.7 | DDC 616.89/5dc23

LC record available at https://lccn.loc.gov/2019059864

A catalog record for this book is available from the British Library.

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Johns Hopkins University Press uses environmentally friendly book materials, including recycled text paper that is composed of at least 30 percent post-consumer waste, whenever possible.

About 2 percent of the population suffers from some form of bipolar disorder. If one includes the milder forms of the illness known as soft bipolar conditions, that number rises to nearly 5 percent.

Winston Churchill, George Frederic Handel, Lord Byron, Virginia Woolf, Edgar Allan Poe, Napoleon Bonaparte, and Vincent van Gogh are only a few of the politicians, writers, artists, and musicians who, despite having bipolar disorder, left a mark of greatness upon the world. The list could go on and on.

Most persons who are affected by this illness, however, are just ordinary people who want nothing more than to get back to their everyday lives after they or their family members have been diagnosed with it. This book is written for them.

We psychiatrists have at times become a little complacent about this disease. When lithium became widely available in the United States in the mid-1970s, many psychiatrists thought the battle to control the illness had been won. Indeed, lithium wasand still isa miracle drug for many people who suffer from what was then known as manic depression. More recent studies indicate that a substantial proportion of patientsaccording to some studies, as many as halfhave a relapse of their illness despite taking lithium. But even as we become more aware of the sobering facts about the difficulty of successfully treating bipolar disorder, an explosion of developments in science and medicine holds great promise for those affected by the disease. In this new edition, I shall relate this good news.

Clinical research has shown again and again that many relapses of bipolar disorder occur not because of medication failure but rather because patients stop taking medication and drop out of treatment. Perhaps they dont understand that relapse and repetition of illness episodes are the hallmark of the disease, that abruptly stopping medication has been shown to be especially risky, that medication side effects can often be treated or controlled, and that new medications are becoming available all the time. I hope this book helps those who face difficult treatment decisions to make well-informed and intelligent choices.

A survey of patients with bipolar disorder and other mood disorders, carried out by the National Depressive and Manic-Depressive Association (now, the Depression and Bipolar Support Alliance) in the early 1990s, found that 36 percent of those who responded to the questionnaire had not

Why is this illness so difficult to identify correctly? One reason is that the easily diagnosed most severe form of the illness, called bipolar I disorder, is only one of the several forms this chameleon disorder can takeand bipolar I, in fact, is probably less common than the milder forms, in which symptoms of mild depression and subtle mood swings may be the only manifestations. We are realizing that many patients with these milder forms of the disorder benefit from treatment with mood-stabilizing medications, too. But they can do so only if they seek treatment and are correctly diagnosed. We shall see why many patients who have a bipolar disorder are told they have only depression or a personality disorder, and we shall also see the consequences of these and other diagnostic errors.

Like any other serious illness, bipolar disorder affects not only the person who suffers from the disease but family, friends, and colleagues as well. Family support is crucial to the effective management of symptoms. The disrupted relationships and interpersonal conflicts that the symptoms of the illness can cause make bipolar disorder all the more difficult and complicated to treat. Information and understanding are definitely part of the treatment for this disease, and this book was written not only for the patient but for the patients family and friends as well.

Bipolar disorder can be a fatal disease. Although the figures vary among studies, 10 to 15 percent of persons with bipolar disorder die from suicide, These are preventable deaths, because very effective treatments for this illness exist. So, yes, I hope that the information this book provides about the treatment of bipolar disorder will save lives.

Many thanks to all who have contributed to this new edition.

I want to especially thank all of the editors and staff at the Johns Hopkins University Press, who have been a pleasure to work with, as always. Special thanks to my editors, Joe Rusko and Juliana McCarthy.

Thanks to Carrie Watterson for her expert copyediting as well as her suggestions for improvements to the content of the manuscript that have made this a better book, and also to Juliet Wilkerson for helping me navigate some thorny stigma issues.

Thanks to Jenna Macfarlane for her handsome illustrations and her patience in dealing with a sometimes persnickety author.