Furious Seasons

February 05, 2009

Study: High Risk Of Early Death In Bipolar Disorder, Meds Partly Implicated

This is a very alarming new paper--a literature review actually--just out in Psychiatric Services and asserting that people with bipolar disorder are at a very heightened risks of premature death due to death from general medical conditions. The basic range of premature death versus the general population runs from a 35 percent greater chance to a 200 percent greater chance of early death. The paper is by Wayne Katon and Babak Roshanaei-Moghaddam, psychiatrists at the University of Washington.

The authors don't indicate what constitutes early death--one year less than the average life span? A decade?--or the range of life spans for people with bipolar disorder. So it's unclear whether people with bipolar disorder are dropping dead at 40 or 75 years of age. Either way, the news is not comforting and the deaths appear to be mostly as a result of cardiovascular issues.

They note:

"Patients with bipolar spectrum disorders are more likely to smoke and to smoke heavily and might have higher exposure to second-hand smoke. In addition, bipolar disorder is highly comorbid with alcohol and other substance abuse. These patients are more likely to have a poor diet and sedentary lifestyle with resultant weight gain and obesity, which is more prominent during the depressive phase of the disorder and can further jeopardize health and increase mortality."

I've long suspected that one of the reasons people with bipolar disorder smoke so much is because nicotine excites dopamine receptors that are deadened by various medications. That's my opinion.

What amuses me is that the authors note peoples' diets are crappy, that they don't exercise and wind up overweight, but fail to connect this with the many meds people with bipolar disorder are coaxed into taking that make them sluggish and drive off their basic psychological energy, which you kind of need in order to exercise and eat properly. Speaking of diets, I'm not necessarily convinced that people with bipolar disorder have diets that are wildly at variance from the general population. I say this for two reasons. One, I've known dozens and dozens of people with the disorder fairly closely over the years and I've not observed anything away from the norm in terms of diet (nothing startling at any rate). Two, this nation is supposedly experiencing an obesity epidemic, so it's not like that general population's diet (and exercise) are so swell to begin with.

The authors don't entirely ignore problems that patients may be caused by meds, however:

"Most patients with bipolar disorder are treated with mono or polypharmacy, including at least one mood stabilizer with or without a second-generation antipsychotic. Most mood stabilizers are associated with weight gain. Most second-generation antipsychotics (with the exception of ziprasidone and aripiprazole [Geodon and Abilify]) are also associated with increased risk of weight gain, diabetes mellitus, and impaired glucose and lipid metabolism, all of which can increase mortality from cardiovascular disease. Increased weight gain and change in body fat distribution can lead to insulin resistance, type 2 diabetes mellitus, and dyslipidemia, all of which may result in increased mortality from cardiovascular disease. Second-generation antipsychotics can also increase triglycerides via 5-HT2 receptor blockade and further impair lipid metabolism."

Well, what a lovely picture this all is. The authors don't address whatever contribution to ill health that anti-depressants might be making, but this is as close as I've seen psych docs come to asserting a connection between medications and life spans of people with bipolar disorder. Not bad for a doc who, in Katon's case, lists honoraria from Eli Lilly, Pfizer, Forest Labs and Wyeth. He's also on a Lilly advisory board. His co-author lists no conflicts.

But, in the end, the authors aren't really blaming the meds at all. They suggest that, among other things, doctors monitor their patients with bipolar disorder for unhealthy habits and metabolic syndrome, but don't recommend that docs specifically look for problems generated by medications. So the elephant remains in the room, but no one will say it's there.

And as we know, it's highly unlikely that psychiatrists will monitor patients to whom they give medications.

I'll offer some personal thoughts on this issue later today.

Posted by Philip Dawdy at February 5, 2009 12:03 AM

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Comments

I love it! "elephant remains in the room, but no one will say it's there." The 25 year shorter lifespan elephant. Posted by: mark p.s.2 at February 5, 2009 04:22 AM

Time to take up a collection so as to be able to send every shrink a dainty little scale and blood glucose monitor for the office. Could take up the space no longer occupied by pharma toys.

Posted by: ebliversidge@earthlink.net at February 5, 2009 05:24 AM

I think that the concept of the medications being extremely demotivating and actually sucking the energy out of a person and thus leaving them ill-equipped to forge a healthy lifestyle eludes anyone who has not taken any of these medication before. Including some (maybe even most) of the doctors. It is nearly impossible to adequately explain what it feels like being on this stuff, and even more difficult(I assume) to try to grasp it if you have never experienced it firsthand.

Posted by: Angel84 at February 5, 2009 09:10 AM

Agree with Angel84. Impact of Zyprexa - hardly being able to get out of bed; constant drinking of sweet drinks; sucking food out of the frig., a total recipe for zombie-ism and death from profound hyperglycemia. It ain't all cardiovascular.

Posted by: ebliversidge@earthlink.net at February 5, 2009 11:42 AM

Not Necessarily A Disability

Bipolar Disorder (manic-depressive illness), if it is actually a disorder at all, has been defined as a major affective mood disorder in which one alternates between the mental states of deep and brutal depression and embellished elation- with the depressive episodes occurring more frequently in one who is said to be Bipolar.
The disorder affects one’s cognition, emotions, perceptions, and behavior- along with psychosomatic presentations (such as pain with depressive episodes, for example). It is thought to be due to a physiological dysfunctional brain in one affected with bipolar disorder by many.
The etiology for bipolar disorder, while speculated on such things as genetic predisposition, still remains entirely unknown. As many as half of those suspected as having a bipolar disorder are thought to have at least one parent with some sort of mood disorder similar to bipolar disorder, which suggests a genetic predisposition may be present.
It is also believed that bipolar disorder presents itself when one is between the ages of 15 and 25 years old. The disorder was entered in the psychiatrists’ bible, the DSM, in 1980, although bipolar disorder is thought to have existed for quite some time. Also, those with bipolar disorder are thought to be in possession of heightened creativity during their manic phases, as well as they have accelerated growth of their neurons..
Research has determined that as many as 15 to over 30 percent of bipolar disorder patients commit suicide if they are untreated, or undertreated. Also, as many as half of those affected with bipolar disorder also have at times severe substance abuse issues along with their disorder as well.
Bipolar patients are also often experiencing anxiety issues that vary, and are treated often as a result of these medical issues. The disorder varies as far as severity goes- with some bipolar disorder patients being more severely affected than others. In fact, there are at least 6 classifications of bipolar disorder, according to the DSM.
Bipolar patients are thought to be symptomatic half of their lives. As stated previously, the depressive episodes occur more frequently than manic ones. When symptomatic, bipolar patients are thought to be rather disabled, according to some. The diagnosis has become more frequent recently. In one decade, the assigned diagnosis of bipolar disorder rose from being about 25 per 100 thousand people to being 1000 per 100,000 people.
Most diagnosed with bipolar disorder are not diagnosed based on solid, comprehensive, or psychiatric review that is often absent of valid or standard diagnostic methods. Some believe as many as 5 percent of the human population may be affected by bipolar disorder- which may include as many as 12 million people in the United States. This is if the diagnostic criteria developed by others were to be fully utilized.
A subjective questionnaire called the Mental Status Examination is often utilized when diagnosing one suspected has having bipolar disorder. Many believe the diagnosis has increased recently due to the progressive treatment options now available. It is an argument of increased awareness versus over-diagnosis.
Yet the diagnosis is vague, as children and adolescents are often absent in research with bipolar disorder. Also, there is not any objective diagnostic testing to rely upon for bipolar disorder.
Many younger than 18 years of age are prescribed atypical anti-psychotics as first line treatment, which is largely not recommended as treatment options. In fact, close to half a million of those younger than 18 years of age are prescribed the atypical anti-psychotic Risperdal alone, it has been determined. The class of medications overall is thought to be prescribed to about 10 percent of those non-adults thought to have bipolar disorder.
While not recommended, about a half of all those assessed as being bipolar are prescribed antidepressants, such as SSRIs, as first line treatment. It has been suggested that this class of drugs has decreased the risk of suicide attempts compared with other classes of antidepressants for close to 20 years. Yet tricyclic antidepressants have been determined to be efficacious in over half of those diagnosed with bipolar disorder- with a greater amount of research behind this class of drugs.
The most recognized treatments for bipolar disorder long term are lithium (Ekalith or Lamictal- along with an anti-convulsant. Sugar intake is thought to vex the symptoms of one with a bipolar disorder as well.
Atypical anti-psychotics have been prescribed for bipolar disorder, which change some aspects of the brain, physiologically, as does the disease itself. In fact, one may argue the brain becomes more efficient due to both the disorder and the treatment with the atypical anti-psychotics. Yet many recommend the utilization of this class of drugs with bipolar disorder only if psychosis is present as well.
As many as 15 percent of bipolar disorder patients diagnosed as such are prescribed an atypical presently. This class of medications may be particularly beneficial for those women who are diagnosed with bipolar disorder who are pregnant, however.
Lithium, which is essentially a very light metal with low density in which the salts are obtained for medicinal treatment, and an anti-convulsant are believed to be standard bipolar treatment, pharmacologically, studies have shown. This is due to Dr. John Cade and his examination with lithium and its benefits with those who have psychotic excitement close to 60 years ago.
Ekalith is believed to be both neuro-protective as well as having an anti-suicidal affect in those believed to be bipolar- and is viewed as a mainstay as far as treatment for bipolar goes with many who treat the disorder. Lithium is thought to regulate the calcium molecule in the brain, so this and valporate are historically the medicinal treatment options preferred for those with bipolar disorder.
Bipolar is difficult to detect, and is often diagnosed as major depression with many affected by this disorder. There is no objective criteria protocol available to utilize when assessing any patient believed to be suffering from any mental disorder. So such mental disorders that are diagnosed are ambiguous, yet that does not conclude that such disorders do not exist, such as the case with bipolar disorder.
Yet perhaps a health care provider should be very thorough and knowledgeable when assessing a patient believed to have a mental condition such as bipolar disorder,
Dan Abshear
Author’s note: What has been annotated is based upon information and belief.

Posted by: Dan at February 5, 2009 02:56 PM