Bipolar News: Gene Protects Against Disorder

MONDAY, Sept. 29 ( — People who are missing a snippet of DNA from a brain-receptor gene are less likely to develop bipolar disorder than those with a longer version of the same gene.

The shorter version of the gene, which is called GRIK4, makes a more stable receptor for glutamate, a key brain-signaling molecule.

“This means it is part of the machinery that helps brain cells talk to each other,” says study author Benjamin Pickard, PhD, a geneticist at the University of Edinburgh in Scotland.

About 1% of people around the world have bipolar disorder, also known as manic depression, a psychiatric condition characterized by cycling episodes of depression and mania.

Pickard and his colleagues originally identified the GRIK4 gene in 2006 when they were studying a patient with schizophrenia and mental retardation. More testing suggested the gene might play a role in bipolar disorder as well as schizophrenia, according to the report in Proceedings of the National Academy of Sciences.

In the new study, they tested 356 people with bipolar disorder and 286 healthy people, and found healthy people were more likely to have the short version of GRIK4 than those with bipolar.

However, just because you have a short version of the gene doesn’t mean you won’t get the disease—it just decreases your risk.

For example, about 40% of healthy people have the shorter version, but only 20%–30% of those with bipolar disorder have the short version, Pickard says.

“Obviously this is not the only gene that leads to or protects against bipolar disorder,” says Colleen A. McClung, PhD, an assistant professor of psychiatry at the University of Texas Southwestern Medical Center in Dallas. However, the discovery of this gene variant does bolster the idea that glutamate activity is important in the development of this disease, she explains.

Next: Why it’s a bad idea to get a test for this gene

Why it’s a bad idea to get a test for this geneOne theory is that that too little glutamate signaling in the brain can cause bipolar disorder.

If that is true, it would seem logical that using medication to increase glutamate activity in the brain would be helpful. However, too much glutamate signaling can cause seizures and epilepsy, says Pickard.

“So altering glutamate would have to be a careful balancing act if this is to be a potential target for the design of new drugs,” he says. “There are currently no bipolar-disorder drugs based on this biochemistry—most, like lithium, act as mood stabilizers.”

It’s not a surprise that glutamate may play a role in bipolar disorder, says Gary Sachs, MD, director of the bipolar clinic and research program at Massachusetts General Hospital in Boston.

“In simplest terms, you can imagine in the brain there’s something that’s the equivalent of an accelerator and there’s something that’s the equivalent of brakes,” says Dr. Sachs. Glutamate is the equivalent of the accelerator, and the GABA system, another signaling molecule, is the equivalent of the brakes, he explains.

When patients start to develop symptoms, it could be because “all the cars are piling up because they don’t have brakes. But it might look the same because all the cars are piling up because the accelerator is jammed,” he says.

These “traffic jams” can produce extra excitation in the brain that can cause people to be very depressed or very excited. “The usually tightly regulated neuro-circuitry gets out of control,” Dr. Sachs says.

However, he adds that dozens of as-yet-undiscovered genes may play a role in these traffic jams.

“We really, really don’t want to encourage people to go to the shysters offering these [genetic] tests,” he says. “I think that is a very undesirable outcome.”

Ten years from now, people might be able to get a panel of tests for bipolar-risk genes, but not now, according to Dr. Sachs.

“This is one piece of information in a big jigsaw puzzle,” he says. “Right now we’re really happy to have this piece, but this is a 30,000-piece puzzle—and this is piece number 4 or 5.”

By Theresa Tamkins


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Bipolar News: Children May Not Outgrow Disorder

MONDAY, Oct. 6 ( — About 44% of children diagnosed with bipolar disorder continue to have symptoms of the psychiatric disease in adulthood, according to the first study to follow such children over time.

The study supports the idea that children can indeed get bipolar disorder, once a controversial diagnosis thought to occur only in adults. Although the details are still murky, most psychiatrists now agree that children can have the disease.

In adults, bipolar disease is characterized by dramatic mood swings, from depression to mania. In children, experts don’t always agree which symptoms warrant a bipolar diagnosis, what will happen to youngsters as they age, or which treatments are most effective.

The new study answers a key question. “Do these kids with bipolar—when they grow up—get the adult form of the disease? And this paper says, ‘Yes they do,’” says study author Barbara Geller, MD, a professor of psychiatry at Washington University in St. Louis.

“It’s a pioneering study,” Dr. Geller tells me. “It’s the first study of bipolar in children ever funded by [the National Institute of Mental Health].”

In the study, published in Archives of General Psychiatry, Dr. Geller and colleagues followed 115 children, with an average age of 11, who were diagnosed with bipolar disorder between 1995 and 1998.

Eight years later, 54 were over age 18, and 44% of those adult patients still had episodes of mania. (Researchers don’t consider the rest of the patients “cured,” because they might have symptoms in the future. “Will there be some who don’t have episodes as adults?” Dr. Geller asks. “We’ll have to follow them longer to see.”)

What’s more, about 35% were substance abusers, which is similar to the percentage seen in people who are diagnosed with the disease in adulthood.

Next: Is bipolar disorder the correct diagnosis for these children?

Is bipolar disorder the correct diagnosis for these children?There is still some controversy over bipolar-disorder symptoms in children, but the new study excluded children if the diagnosis wasn’t clear, says Dr. Geller. “Our study only accepted them if they absolutely had the diagnosis,” she says. “Questionable cases were not included.”

It’s not certain if some children with other psychiatric illnesses are being incorrectly lumped into the bipolar category, says Ellen Leibenluft, MD, head of the pediatric bipolar research group at the National Institute of Mental Health and author of an editorial accompanying the study.

“[In] classic bipolar disorder you’re supposed to have distinct episodes,” she says. “It’s probably much more common to find children who just have very chronic irritability without episodes, and many of those children are now being diagnosed as bipolar.”

Less than 1% of children have mood cycles that look like bipolar disorder in adults, according to Dr. Leibenluft, while 2% to 3% have the extreme irritability that may or may not be a sign of the disease. “It’s not clear whether they are bipolar or not,” she says.

However, more research is being done to help determine what bipolar disorder looks like in children. Currently, a diagnosis is based on a child’s symptoms, a family history of the disease, and other factors, she says.

Researchers are now studying how genetics play a role and whether brain scans can help determine if a child has bipolar disorder.

“I would say there’s a lot of work to be done in terms of treatment,” says Dr. Leibenluft. Children are typically treated with a trial-and-error approach using medication with serious side effects that haven’t been adequately tested in children.

“Medications help,” she says, “but they don’t help as much as anyone would like.”

By Theresa Tamkins


Related Links:How to Get Your Depressed or Bipolar Child an Accurate DiagnosisBipolar Kids: Seven Places Parents Can Get Help“Bipolar Disorder Controlled Me”Why Bipolar Disorder Can Trigger Suicide

Antipsychotic Drugs Linked to Risk of Sudden Cardiac Death


By Anne HardingWEDNESDAY, Jan. 14, 2009 ( — Susan Craig’s brother Roger died of a pulmonary embolism in 2007, at age 38. Diagnosed with bipolar disorder in high school, he had been on antipsychotic drugs for years. At the time of his death, he was carrying 280 pounds on his 6-foot-4-inch frame.

Craig, a public relations specialist who works at Columbia University in New York City, knew that Roger’s medications could cause weight gain. But she had never been told that the drugs he was taking might be harming his heart.

“We were never counseled by his psychiatrist or his primary care provider to watch for symptoms of heart disease or any risk of sudden death at all,” Craig says. There’s no evidence that Roger’s medications caused his death, but his family might have been able to get him help sooner if they had known about the risks, Craig explains.

New research published Wednesday in the New England Journal of Medicine shows that antipsychotic drugs are not risk free, and the study’s authors are urging much more caution in their use. The drugs are associated with a risk of sudden cardiac death, particularly at higher doses.

Craig’s brother was taking haloperidol, which belongs to an older class of drugs called typical antipsychotics, which have long been known to increase the risk of sudden death due to cardiac causes. He was also on risperidone, a member of a newer class of drugs called atypical antipsychotics, which had been considered safer.

Doctors prescribe these newer medications, originally developed to treat schizophrenia, for a wide variety of problems—from conduct disorder in kids to aggressive behavior in Alzheimer’s patients. In fact, they’ve become so popular that three of them—olanzapine, risperidone, and quetiapine—are among the 10 top-selling drugs worldwide, with $14.5 billion in sales in 2007.

The new study suggests that among patients taking high doses of atypical antipsychotics, there are about 3.3 cases of sudden cardiac death per 1,000 patients per year, which an editorial characterizes as a risk that’s “between ‘moderate’ and ‘low,’ but not ‘rare.’”

About 325,000 people in the United States each year die of sudden cardiac death, which has an incidence of 0.1%–0.2% per year in adults.

“[The drugs] have potentially very serious side effects,” says Wayne A. Ray, PhD, the director of the division of pharmacoepidemiology at Vanderbilt University School of Medicine, in Nashville. “So whenever a decision is made to use one, consideration of potential side effects needs to be made.” Ray and his colleagues found that atypical antipsychotics doubled the risk of sudden death from heart-related causes, most likely by causing disturbances in heart rhythms.

Next: Antipsychotics double risk of sudden cardiac death

First introduced in the mid-nineties, atypical antipsychotics were praised for having none of the troublesome side effects of their predecessors, including frequent, involuntary movements of the face and mouth that were in some cases irreversible.

But the new study shows that the increased risk of sudden cardiac death seen with the older drugs is nearly identical to that of the newer medications. There had been suspicions that the drugs were risky, especially when used in older patients, but the current study is the first to systematically investigate their association with sudden cardiac death.

Ray and his colleagues reviewed data on Tennessee Medicaid patients, comparing 44,218 people using older typical antipsychotics and 46,089 taking the newer atypical antipsychotics to 186,600 people who had never used the drugs. People with schizophrenia may have a higher rate of cardiac problems, due to smoking and other factors. To account for this, researchers also compared antipsychotic drug users without schizophrenia to non-drug users who had characteristics (in most cases, mood disorders) that made them likely candidates for the drugs.

Overall, people taking typical antipsychotics were at 1.99-times greater risk of sudden cardiac death, while the risk for those on atypical antipsychotics was increased 2.26 times. The increased risk was greater for people on higher doses of the drugs. People who had used the drugs in the past but stopped weren’t at greater risk of sudden cardiac death.

“The drugs are still very effective for conditions that there’s proven evidence for,” says Jeffrey A. Lieberman, MD, a professor and chair of psychiatry at Columbia University, in New York City, and the director of the New York State Psychiatric Institute, who was not involved with Ray’s research. “They clearly need to still be able to be used. I think this [study] really underscores the need to be very judicious about how these medications are used and whom they’re given to.”

While atypical antipsychotics have been used to ease aggressive behavior for patients with Alzheimer’s disease, for example, they are not approved for this purpose by the U.S. Food and Drug Administration; in fact, in 2005, the FDA issued a warning that these drugs increased the risk of death among elderly people, extending the warning to all antipsychotic drugs last year, notes Sebastian Schneeweiss, MD, ScD, an associate professor of medicine at Harvard Medical School, in Boston, who coauthored an editorial accompanying the current study.

Given the lack of better alternatives, these drugs are still widely used in patients with dementia—despite the warnings, he adds. But while there’s anecdotal evidence that they will “cool these patients down” and reduce their aggressive behaviors, there’s no scientific evidence that they really help patients—or their caregivers, Dr. Schneeweiss says.

Next: Do patients need a heart test before taking an antipsychotic?

In his editorial, Dr. Schneeweiss and coauthor Jerry Avorn, MD, also of Harvard, call for patients to undergo an electrocardiogram before and shortly after being placed on atypical antipsychotics, to determine if the drugs are causing any heart rhythm disturbances.

For people who must be on these medications, Ray says, it’s essential for their doctors to treat any other conditions, such as high blood pressure, that can harm the heart. “Sudden cardiac death usually occurs when multiple risk factors are present,” he explains. “When you add one, it’s kind of like the straw that broke the camel’s back.

“Absolutely the lowest dose that works should be used, because we found a strong dose response.”

The FDA has approved atypical antipsychotics for treating bipolar disorder, Ray adds. But the researcher recommends that physicians first try safer alternatives, such as the mood stabilizer lithium. “That’s a very serious illness, and it has important consequences for patients’ quality of life and relationships,” Ray notes. “If the mood stabilizer doesn’t work, I think it’s very reasonable to consider an antipsychotic, but…other drugs should be considered first.”

Finally, he says, a patient should never stop taking any drug without consulting his or her physician. Nevertheless, anyone taking an atypical antipsychotic for a non-FDA-approved use should consult his physician. “I think off-label use should be undertaken very cautiously, and its frequency should be much less than it is currently,” Ray says.

For Susan Craig, the new research makes it clear that treating serious mental illness must go far beyond just prescribing pills. “We need to be supporting these people in a better, more systematic way,” she says. “There’s no magic pill. It’s treating the whole person.”

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Is Charlie Sheen Bipolar?

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By Amanda Gardner

TUESDAY, March 1 ( — Charlie Sheen’s recent and very public unraveling has all the makings of a bad—yet riveting—TV movie. After months of tabloid drama that included a trashed hotel suite, a divorce filing, and a hospitalization following a reported two-day drug binge, Sheen’s hit show, Two and a Half Men, was cancelled for the remainder of the season by CBS executives last week after the star lashed out at its creator in a pair of on-air rants.

In a series of bizarre interviews this week, Sheen appeared increasingly unhinged as he discussed his drug use and his feud with CBS. On the Today Show, he described himself as a “total freaking rock star from Mars” and implied that he had “tiger blood” and “Adonis DNA.” On ABC, he said that he was as a “Vatican assassin warlock” and admitted to using a drug, “a drug called Charlie Sheen.”

This apparent combination of erratic behavior, delusions, and grandiosity—”I’m grandiose,” he told TMZ—has prompted speculation that Sheen may be suffering from bipolar disorder or psychosis brought on by drug use.

Sheen, who has been in rehab in the past, says he is no longer using drugs and passed at least two drug tests given to him by media organizations on Monday. And he has dismissed rumors that he has bipolar disorder, a mental disorder characterized by alternating bouts of depression and a revved-up, better-than-good feeling known as mania.

Related links:

10 Subtle Signs of Bipolar Disorder

Bipolar Celebrities: Does It Make Them More Creative?

9 Ways to Control Bipolar Disorder

However, several psychiatrists—who have not treated Sheen and have no direct knowledge of his case—say the actor’s public behavior could be consistent with the symptoms of one or both conditions.

“When someone seems like they’re operating at the wrong speed, [and] they appear to be grandiose and somewhat irritable and irrational, there are a number of things that would need to be considered,” says Kenneth Robbins, MD, a clinical professor of psychiatry at the University of Wisconsin School of Medicine and Public Health in Madison.

Bipolar disorder, sometimes also known as manic depression, is the condition that has been mentioned most often in connection with Sheen. Although all forms of bipolar disorder have some elements of depression and mania, these moods can appear with varying degrees of severity.

In milder cases, the symptoms of mania—lots of energy, euphoria, and little need for sleep—can fall within the range of normal behavior. “These are the stockbrokers who are able to go, go, go, and take some risks,” says Aly Hassan, MD, an assistant professor of psychiatry at the University of Nebraska Medical Center in Omaha. “They have no break from reality.”

In severe cases, however, people in the grip of a manic episode may seem delusional and exhibit symptoms of psychosis “outside of what we call reality,” says psychiatrist Ihsan Salloum, MD, the chief of the division of alcohol and substance abuse at the University of Miami School of Medicine. “In its extreme stages…they think they are Superman or God, and sometimes they could become psychotic to the point where they start hearing voices and becoming paranoid.”

Bipolar disorder generally first appears in a person’s 20s or 30s or even late teens, experts say. (Sheen is 45.) But especially when it’s not severe, the condition is often misdiagnosed and can go unrecognized for decades, Dr. Salloum says.

Sheen has denied having bipolar disorder. When an ABC News reporter brought up the rumors, the actor replied that he is “bi-winning” and suggested that his brain is “maybe not from this particular terrestrial realm.”

Next page: Is cocaine to blame?

Even though this denial might seem like still more evidence of bipolar disorder, other conditions besides bipolar could help explain Sheen’s behavior. Another possibility, in light of his admitted history of drug use, is psychosis induced by stimulants such as cocaine and amphetamines, which can produce symptoms eerily reminiscent of a bipolar manic episode.

Powerful stimulants “induce hypervigilance, irritability, impulsivity, [and] sometimes megalomania—grandiose behavior,” Dr. Hassan says. “People feel in control of things, and this may be when they get into physical combativeness.”

Hallucinations, delusions, and other symptoms of psychosis occur in a high proportion of chronic cocaine users, research suggests, and people who use crack cocaine appear to be even more vulnerable. Sheen has admitted using crack and, in an apparent reference to the drug, told ABC that he had been “banging 7-gram rocks.”

It can be difficult to untangle the symptoms of bipolar disorder from the effects of substance use, however, because the majority of bipolar people—as high as 80%—also have substance-abuse problems, Dr. Hassan says.

Many people with bipolar disorder enjoy the feeling of being “out of control and on top of the world” that manic episodes can bring, Dr. Hassan says, and they sometimes resort to stimulants such as cocaine and methamphetamine as “a way of perpetuating that state of mania all the time.”

Bipolar disorder and illegal drugs aren’t the only possible explanations for the type of behavior Sheen has been displaying. Symptoms of withdrawal from alcohol or a sedating drug such as Xanax can sometimes mimic mania, Dr. Robbins says, as can the side effects of steroid drugs, which are often taken for legitimate medical reasons.

Medical conditions unrelated to drugs (prescription or otherwise) can also create a mania-like effect, Dr. Robbins adds. For instance, an overactive thyroid gland (hyperthyroidisim) can cause nervousness and restlessness, although these symptoms are accompanied by other telltale signs and are generally less pronounced than the erratic behavior Sheen has exhibited.

Of all of the possibilities, bipolar disorder and substance abuse are perhaps the most difficult to treat, Dr. Robbins says.

Mood stabilizers and other medications for bipolar can be quite effective, but getting bipolar patients to stick to their treatment regimen can be a challenge, Dr. Robbins says. When patients begin to experience the early, mild stages of mania (known as hypomania), for instance, they sometimes start to feel so good that they stop taking their medication because they think they don’t need it anymore.

Similarly, if a person exhibiting the symptoms of mania is not yet being treated for bipolar disorder, it can be difficult to persuade him or her that it’s necessary. “Part of the reason people don’t seek treatment is they lack the insight to recognize they have an illness,” Dr. Robbins says. “When you have a delusion—a fixed false belief—you believe it to be true. When someone tells you to get treatment and you have a delusion, you are likely to believe they just don’t get it.”

Mental Illness Leading Cause of Disability in Youth

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By Anne Harding

MONDAY, June 6, 2011 ( — Mental health problems such as depression account for nearly half of all disability among young people between the ages of 10 and 24, according to a new study from the World Health Organization (WHO).

Researchers looked at data from 191 countries and estimated the number of years of good health lost to disability resulting from disease and injury (known as disability-adjusted life years). Among adolescents and young adults, 45% of disability was related to depression, bipolar disorder, schizophrenia, and other mental disorders, including alcohol abuse.

John S. Santelli, MD, a professor of population and family health at Columbia University’s Mailman School of Public Health, in New York City, says that, fortunately, mental health issues at the root of a young person’s disability generally respond to prevention, early detection, and treatment.

“There’s much better behavioral treatments, there’s much better pharmacological treatments as well,” says Dr. Santelli, who wrote an editorial accompanying the study, which was published in the journal The Lancet. “We know what to do. We just need to do it.”

Related links:

10 Subtle Signs of Bipolar Disorder

9 Ways You Can Help Someone Who’s Depressed

Top 10 Myths About Safe Sex and Sexual Health

The study was the first ever to look at the international burden of disability in young people. Worldwide, the researchers estimated, disability claimed about 236 million healthy years from this group, which includes both estimated and actual years of life lost to illness and premature death.

After mental disorders, accidental injuries were the second largest cause of disability, accounting for 12%, followed by communicable diseases (including HIV, malaria, and tuberculosis) at 10%.

The top risk factors for disability were drug and alcohol use, unsafe sex, failure to use birth control, and iron deficiency, a common sign of malnutrition.

“Youth is considered to be a time of good health,” says one of the study’s authors, Fiona M. Gore, a WHO researcher in Geneva, Switzerland. However, she says, “important health factors and risk factors for disease in later life emerge in these years “

The study revealed some regional and socioeconomic differences. Compared to the world as a whole, for instance, mental disorders account for a greater proportion of disability in the U.S., in Europe, and in nations with high per-capita income. On the other hand, disability due to injuries and communicable diseases was lower in those countries than worldwide.

“There is a need to focus on prevention strategies and on health promotion of noncommunicable and nonfatal causes of disease in young people,” Gore says.

Study: Autism, Schizophrenia May Share Risk Factors

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By Amanda Gardner

MONDAY, July 2, 2012 ( — A family history of schizophrenia may increase the likelihood that a child will develop autism, a new study has found, suggesting the two conditions share some underlying risk factors.

Researchers analyzed data from three large health databases, two in Sweden and one in Israel, and found that a child’s odds of developing an autism spectrum disorder (ASD) tripled if he or she had a parent with schizophrenia.

Two of the databases revealed a similar pattern among siblings. Having a brother or sister with schizophrenia increased the odds of ASD 12-fold in the Israeli population and 2.6-fold in one of the Swedish databases (the only one from that country to include information on siblings).

“This shows pretty strongly that there are most likely genetic components that are shared,” says Keith Young, Ph.D., director of the neuropsychiatry research program at the Texas A&M Health Science Center, in Temple, who was not involved in the study. “There may be a common biology between the two.”

Having a close family member with bipolar disorder—a mental illness that can trigger psychotic symptoms reminiscent of schizophrenia—also upped the risk of autism, although the association wasn’t as dramatic.

These findings, which were published this week in the Archives of General Psychiatry, don’t imply that schizophrenia or bipolar disorder cause autism in subsequent generations.

Autism is a “really complicated” disorder, and the evidence to date suggests that a combination of genes and so-called environmental factors—some of which may increase the risk of both autism and schizophrenia—are involved, says Patrick F. Sullivan, M.D., lead author of the study and director of the Center for Psychiatric Genomics at the University of North Carolina School of Medicine, in Chapel Hill.

This isn’t the first study to show a family connection between autism and schizophrenia. As Sullivan and his colleagues point out, the new findings are in line with those of a 2005 study from Denmark that found a three-fold increase in autism risk among the offspring of parents with a history of schizophrenia-like psychosis.

“When we start to see basically the same results in different studies and different places at different times, the data becomes a lot more believable,” Sullivan says. “I think we need to reconsider the basic split between these disorders.”

Next page: More research could lead to novel treatments

Autism and schizophrenia share certain symptoms, such as a reduced capacity for communication and social interaction, Young says. But autism appears very early in life and schizophrenia generally doesn’t emerge until adulthood.

In addition, people with ASDs do not exhibit the psychotic symptoms characteristic of schizophrenia, which can include delusions, paranoia, and hallucinations. According to the latest version of the DSM, children with a diagnosis of Asperger’s syndrome or “pervasive developmental disorder not otherwise specified”—two types of ASD—cannot, by definition, also meet the criteria for schizophrenia.

The new study may spur doctors to look anew at the links between schizophrenia and ASDs, Sullivan says. In the future, he adds, a better understanding of the overlap between the two conditions could open the door to more precise diagnoses, and therefore more targeted treatment.

That scenario is still a long way off, however. Although scientists have identified a handful of genetic mutations that are linked to schizophrenia as well as autism, the role that specific genes and environmental factors play in the disorders is still largely unknown.

In the shorter term, renewed interest in the shared risk factors for autism and schizophrenia could lead to novel medication strategies, says Young, who is also the chair of an advisory board on brain-tissue research at Autism Speaks, an advocacy organization headquartered in New York City.

“I think these findings will encourage researchers to take a second look at drug therapies that have been shown to be effective in schizophrenia but have not been intensively studied for use in autism,” he says.

It Takes an Average of 6 Years to Get a Bipolar Diagnosis

MONDAY, July 25, 2016 (HealthDay News) — People with bipolar disorder may face a long wait from when their symptoms start to the time they get a proper diagnosis.

In fact, a new study reports the average delay is six years.

That lost time can result in greater frequency and severity of episodes of the psychiatric condition, the researchers said.

“While some patients, particularly those who present with psychosis, probably do receive timely treatment, the diagnosis of the early phase of bipolar disorder can be difficult,” study leader Matthew Large, a professor psychiatry at the University of New South Wales, Australia, said in a school news release.

“This is because mental health clinicians are sometimes unable to distinguish the depressed phase of bipolar disorder from other types of depression,” he added.

The new research reviewed the results of 27 past studies. Those studies included more than 9,400 patients.

Many patients had distressing and disruptive symptoms for many years before they received proper treatment, the researchers noted.

The delay in diagnosis and treatment was often longer for young patients because symptoms such as moodiness can sometimes be mistaken by parents and doctors as just part of being a teen, the study authors said.

“The diagnosis of bipolar disorder can also be missed because it relies on a detailed life history and corroborative information from careers and family, information that takes time and care to gather,” Large explained.

He recommended that doctors look more closely at a patient’s history of mood symptoms, especially distinct changes in mood and mood swings caused by outside events, such as overseas travel or treatment with antidepressants. He also suggested a closer look at mood symptoms in people who have a family history of the disorder.

A long delay in diagnosis and treatment is “a lost opportunity because the severity and frequency of episodes can be reduced with medication and other interventions,” Large said.

The study was published July 25 in the Canadian Journal of Psychiatry.

More information

The American Academy of Family Physicians has more on bipolar disorder.

Demi Lovato Wants to Change How We See Mental Illness

Demi Lovato has never shied away from sharing her struggles with bipolar disorder and addiction. The 24-year-old singer/songwriter is trying to spread a message that’s simple but life-changing: She wants the world to know it is possible to live well with mental illness. “I’m living proof of that,” she told People in a recent interview.

Lovato‘s latest advocacy effort—through her partnership with the Be Vocal campaign—is designed to offer up more proof. The Be Vocal Collection is a series of photographs documenting the real lives of 10 people with mental health conditions.

“Whenever you type into a search engine something like schizophrenia or bipolar disorder, or something like that, the images that pop are very negative and stereotypical,” Lovato explained to HealthDay news. “Pictures of pills, or people with their head in their hands, or someone pulling their hair out.”

The Be Vocal Collection is designed to change that imagery. The subjects in the photographs range in age from 26 to 67, and live in cities across the country. The have a range of conditions, including bipolar disorder, depression, anxiety, borderline personality disorder, and post-traumatic stress disorder.

RELATED: 11 Signs of Bipolar Personality Disorder

All of them allowed photojournalist Shaul Schwarz to capture what their day-to-day actually looks like. “We will make those photographs publicly available and free to use whenever the subject of mental illness comes up in the news,” Lovato said.

Dior Vargas, a native New Yorker who lives with depression and anxiety, is one of the brave people spotlighted in the series. She is also an activist, and founded the People of Color and Mental Illness Photo Project to promote the accurate portrayal of minorities with mental health conditions in the media. 

Suzy Favor Hamilton is another advocate who volunteered for the series. The photos of the three-time Olympian, writer, and mom reveal how she manages her —through medication, a clean diet, running, and her daily yoga practice.

RELATED: 10 Tips for Treating Bipolar Disorder

The images of elementary school social worker and small business owner Yvonne Mendoza, a first generation Mexican-American living with , capture the the value of her support system. Here she is shown embracing her mother at the family’s cake shop. 

These three women and the seven other other people in The Be Vocal Collection are chipping away at the stigma on mental illness. Like Lovato, they are all living proof that while there are dark days, there is also hope. 

The Be Vocal Collection was developed in partnership with Getty Images. For more information on the campaign, visit

8 Times Carrie Fisher Shattered the Stigma on Mental Illness

Carrie Fisher may be most well-known for playing Star Wars’ Princess Leia, but she was a superheroine in real life too. The actress and author, who died Tuesday at the age of 60 after suffering a cardiac arrest, battled relentlessly against the stigma on mental illness, and to raise awareness for the need for treatment. 

Fisher was diagnosed at age 29 with , an illness characterized by episodes of depression and mania. Throughout her life, she used her trademark humor and candor to shed light on the condition, and convey the powerful, life-changing message that there is no shame in a mental health diagnosis.

In honor of Fisher’s legacy, here are just a few of the times she spoke out and inspired us all.

On owning your diagnosis

“I am mentally ill. I can say that. I am not ashamed of that. I survived that, I’m still surviving it, but bring it on. Better me than you.” —December 2000, in an interview with Diane Sawyer on ABC’s PrimeTime Thursday

On the courage that mental illness requires

“One of the things that baffles me (and there are quite a few) is how there can be so much lingering stigma with regards to mental illness, specifically bipolar disorder. In my opinion, living with manic depression takes a tremendous amount of balls. Not unlike a tour of Afghanistan (though the bombs and bullets, in this case, come from the inside). At times, being bipolar can be an all-consuming challenge, requiring a lot of stamina and even more courage, so if you’re living with this illness and functioning at all, it’s something to be proud of, not ashamed of. They should issue medals along with the steady stream of medication.” —Wishful Drinking, her 2008 memoir about her mental illness and prescription drug addiction

RELATED: 10 Subtle Signs of Bipolar Disorder 

On finding the humor

“I thought I would inaugurate a Bipolar Pride Day. You know, with floats and parades and stuff! On the floats we would get the depressives, and they wouldn’t even have to leave their beds—we’d just roll their beds out of their houses, and they could continue staring off miserably into space. And then for the manics, we’d have the manic marching band, with manics laughing and talking and shopping and f***ing and making bad judgment calls.” —Wishful Drinking

On surviving a severe manic episode

“I don’t really remember what I did. I haven’t watched the videos that people took. I know it got bad. I was in a very severe manic state, which bordered on psychosis. Certainly delusional. I wasn’t clear what was going on. I was just trying to survive. There are different versions of a manic state, and normally they’re not as extreme as this became. I’ve only had this happen one other time, 15 years ago, so I didn’t have a plan of action.” —September 2013, in an interview with People about the bipolar episode she had while headlining a Caribbean cruise

On chasing your dreams, despite your diagnosis

“Stay afraid, but do it anyway. What’s important is the action. You don’t have to wait to be confident. Just do it and eventually the confidence will follow.” ―April 2013, in an interview with the Sarasota Herald-Tribune

On why getting help is crucial

“Without medication I would not be able to function in this world. Medication has made me a good mother, a good friend, a good daughter.” —February 2001, at a rally in Indianapolis for increased state funding for mental illness and addiction treatment

RELATED: 10 Tips for Treating Bipolar Disorder

On how to help a loved one with bipolar

“If you feel like your child or friend or spouse is showing signs of this illness, if you can get them in touch with somebody else they can talk to and share their experience with and not just feel like they’re being told they’re ‘wrong’ or ‘bad’ or ‘stupid,’ then they can relate somehow.” —November 2004, in an interview with bp Magazine

On summoning courage

“We have been given a challenging illness, and there is no other option than to meet those challenges. Think of it as an opportunity to be heroic—not ‘I survived living in Mosul during an attack’ heroic, but an emotional survival. An opportunity to be a good example to others who might share our disorder.” —November 2016, in her Guardian advice column, “Ask Carrie Fisher”

Why Up to 50% of People With Bipolar Disorder Attempt Suicide

Ricki Lake recently revealed that her ex-husband, 45-year-old jewelry designer Christian Evans, took his own life last month after a long battle with bipolar disorder.

“I have to spread the word about recognizing this disorder and getting treatment as soon as possible,” the actress and former talk show host told PEOPLE in this week’s issue, on newsstands today.

Bipolar disorder is a brain condition marked by severe swings in mood, and affects 5.7 million American adults. Patients experience high-energy, elevated moods during manic episodes, and sad, hopeless moods during depressive ones. Making the condition more complex, people who struggle with bipolar are also more likely to have psychotic symptoms (like hearing voices or having delusions), , and problems with substance abuse.

Evans disclosed his bipolar diagnosis to Lake when they first started dating, and the couple wed in 2012. It wasn’t until 2014 that Lake experienced one of her husband’s manic episodes. At first, he simply seemed extra happy and motivated, but later “he thought he could fly. He thought he could cure cancer with his hands,” she told PEOPLE. Under the advice of a therapist, she cut off contact from Evans and filed for divorce. Evans was eventually hospitalized, and reunited with Lake when his mental health stabilized. It didn’t last long; last fall, Evans slipped into another manic episode and the couple split for good. Then, on February 11, Lake received a text from Evans’s sister saying she’d received a suicide note via email. Two days later he was found in his car with a self-inflicted gunshot wound. 

RELATED: 10 Subtle Signs of Bipolar Disorder

Sadly, Lake’s story may sound familiar to those who have a loved one with bipolar disorder. The condition is notoriously difficult to treat. About half of people with bipolar will attempt to kill themselves, and as many as one in five dies by suicide. 

The combination of extreme highs and extreme lows is what puts bipolar patients at such high risk for suicide. A study published last month in the journal Bipolar Disorders looked at suicide attempts in bipolar patients over a five-year period and found that they were 120 times more at risk for suicide during “mixed states,” when highs and lows were occurring at the same time. “You have a depressed mood but tons of energy to do something about it. That can be incredibly dangerous in terms of suicide risk,” explains Glenn Konopaske, MD, assistant professor of psychiatry at UConn Health.

Other research suggests brain differences put some bipolar patients at higher risk for suicide than others. A January 2017 study from Yale University compared brain scans of teens and young adults with bipolar disorder and found that those who’d attempted suicide had slightly less volume and activity in the frontal cortex, the part of the brain that regulates emotions and impulses. “That can lead to more extreme emotional pain, difficulties in generating alternate solutions to suicide and greater likelihood of acting on suicidal impulses,” said senior study author Hilary Blumberg, MD, in a release.

The good news is that bipolar “is highly treatable, and if patients are on the appropriate treatment, they can lead very functioning lives,” says Dr. Konopaske. Doctors typically prescribe lithium, a mood stabilizer. “It definitely helps reduce the risk of suicide,” he says. Research indicates lithium is the gold standard for bipolar treatment, outperforming newer mood stabilizers on the market.

Patients who do the best are in regular therapy, take their medications religiously, and have supportive and involved family members. “It takes a team approach for success,” he says. Still, not all patients will respond to treatment, and there can be a lot of trial and error, Dr. Konopaske says.

As for Lake, she told PEOPLE she plans to honor Evans’s life by raising awareness about mental illness. “Christian didn’t want to be labeled as bipolar, but he admitted he was in the note he left,” she said. “That was him finally owning it. That was him giving me permission to tell his story.”