My research on bipolar disorder is ongoing. Not only do I read hard copy and peruse the Intranet, but my life is a never-ending real-time accumulation of information on the disorder. I learn from its presence in my life daily. Recently, however, I came upon new information about bipolar disorder that I have not seen in past research, and I also had conformation that many of the things I have been practicing for a number of years as a way of dealing with my illness are supported by research. I am very encouraged by what I have found.

My sister, Jayme, attended a seminar on bipolar spectrum disorder. I was too broke to attend or I would have, but she came away with lots of notes and a book produced by the speaker, Dr. John D. Preston. Dr. Preston is a professor of psychology at Alliant International University in Sacramento. He has also been on the faculty of UC Davis, School of Medicine. He has written many books on psychotherapy, psychopharacology, spirituality, healing for emotions, and neurobiology. Preston is the author of a chapter in The Encyclopedia Americana entitled Drugs in Psychiatry.

I have been aware from other research I have conducted that there is a need for a revamp of the Diagnostic and Statistical Manual's criterion for bipolar disorder (Phillips, 2006). Preston reiterated that a change was in the works for the Manual and that bipolar disorder would be called bipolar spectrum disorder. There would also be an addition of a bipolar III. Bipolar III would consist of highly reoccurring symptoms that dip from mood balance to severe depression. Changing the way bipolar is diagnosed will help everyone involved because it allows for co-morbidity that most often accompanies it. It is often these other ailments that cause instability.

The top three psychological ailments to accompany bipolar disorder are: anxiety disorder at 93%, substance abuse at 71%, and binge eating disorder at 30%. I wasn't surprised at the first two as I have battled both in my long experience with bipolar, but I was surprised to find binge eating to be next in line. And finding that more men than women binge eat was even more surprising.

Next are the medical ailments. Migraine tops the list, followed by obesity, and type II diabetes. I was not really surprised by any of these, though I had thought heart disease might be one of them.

Preston offered statistics on morbidity & mortality that I found interesting. The lifetime suicide rate in those with bipolar is the highest of any other mental illness at 15.5%-19%. The lifespan of someone with bipolar is decreased by nine years and they lose eleven years of good physical health. I feel that these numbers are fairly accurate base on my other research and personal experience with the illness, though nothing is beyond questioning.

Another piece of information I learned about was the way in which antidepressants can have and adverse effect. First there is activation. There is a sudden onset that shows as agitation and anxiety. Then there is switiching. Switching happens in the first 2-3 weeks of taking an antidepressant. It provokes hypomania, mania, and increases not only agitation, but also insomnia and restlessness all within the parameters of depression. An indication of switiching is racing thoughts that prevent sleep. From there comes cycle acceleration. Symptoms of depression exacerbate. I have had this experience many times over the past decade while trying to find medications that would work together to balance out my moods. It is helpful to see a definite pattern so that I can identify it with my own symptoms if they should ever occur again.

I discovered through Preston's information that thyroid plays a large role in bipolar II depression. I often have my levels checked because I am on lithium. What I didn't know is that there is a level call the TSH level. This is a particular way of measuring thyroid that needs to be looked at by the physician if an individual is on lithium and has bipolar II. Normal for the TSH level in most individuals is between 1.3 and 3.0, but in those who are on lithium, the level should be below 1.3. If the level is higher than that it can make depressive episodes very difficult to regulate. My level was at 2.535 last time I had a chemical panel done. I am in the process of getting something done about that. My depressive episodes are very hard to manage, and maintain a somewhat productive lifestyle.

Another thing I learned about has to do with anxiety. When we are under duress, say a bear is chasing us, our hypothalamus produces a chemical called CRF or corticotrophin releasing factor. CRF goes to the pituitary, which sends a message to the adrenal cortex. The adrenal cortex produces cortisol. Cortisol is what empowers us to go beyond our usual levels of endurance. Once we have outrun the bear and are safe, the hypo campus sends a message to the hypothalamus to stop the cortisol. Cortisol is good. It increases our glucose and our cardio output so that we may perform at the level needed. Unfortunately, in bipolar II cases, with every depressive episode, the brain becomes damaged and is unable to shut off the cortisol. When that happens cortisol becomes hypercortisol in the brain and body. Depression is increased dramatically, brain cells or nerve endings are killed, the kind of sleep necessary for rest is impaired, and vascular damage is done. Cortisol pumps through the entire body and if not stopped damages blood veins, causing increase in cholesterol and other heart issues. Because of this there is twice the risk of cardiac death and increased risk of stroke.

Kind of depressing. But I had some very good news. First off, I finally understood statistics saying that those with bipolar have increased risk of heart disease. I wanted to know why. What was the correlation? Well, cortisol damages arteries, and a lifetime of that pumping through the body would cause heart problems. But cell repair can be done. Brain-derived neurotropic factor or BDNF must be restored to the brain for it helps in cell repair, reduces impact of cortisol, reduces major depression, is responsible for neurogenesis, and helps in reducing major depression. It may be restored to the brain by antidepressants, lithium, and exercise. I've been doing all three of these things for years and I didn't even know they were saving my brain. Lithium is the only medication that is proven to regenerate nerve endings, and this information I have not just read about from Dr. Preston (Morgan, 2007).

The process where cell death occurs is called apoptosis. Lithium is the only thing that has been shown to reverse such brain damage. Doctors in the United States are not prescribing it because they have made deals with drug companies to push their newer medications and to down play lithium. Countries in Europe, however, are using lithium more than most other medications because it is so effective with all types of bipolar, including rapid cycling, and especially mixed states. It is very inexpensive. I think I paid 28 dollars for my last prescription versus the 100 dollars I paid for Neuronton. That is not to say that lithium works for everyone but I'm sure glad, way back when, I stumbled into a lifetime use of it. I was thrilled to know I've been doing things right and there is evidence to support it.

People who have bipolar should not do shift work, have time zone changes, or have interrupted sleep. Our circadian rhythms get thrown off very easily and take a very long time to level out. Daylight savings messes me up for a month, and flying to a different time zone is hell. I don't feel good the whole time I'm in the other time zone. It is not worth it to me to even do it. Apparently people who have bipolar disorder have very delicate systems. Balance is not easily attained for us in all areas, and is very easily lost. Sleep patterns can be disrupted very easily and once sleep is lost, it is difficult to maintain control of moods. All this I knew from my own experience but was glad to have some outside information on it.

Much more was addressed in the seminar and book, but what I've outlined here is what has most impacted me. I felt real assurance that I am on the right track. I've spent most of my war with this illness finding the answers on my own and trying things out as a way to see if they were right. When you go to the experts and they have no answers, you still have to go home with your illness whether they help or not. That means you are the one who has to play physician to yourself. I was just never sure if I was doing things rightly or if I was going round to the back door when I could have been going through the front. Now I know I was practicing the best of medicine on myself.