Ask Us Anything About… Bipolar Disorder

Description – The video begins inside the Penn State Milton S. Hershey Medical Center, inside the office of Dr. Erika Saunders, Chair, Department of Psychiatry and Director, Mood Disorders Program at Penn State Medical Group. Two individuals are standing together looking at the camera. From left to right is, Dr. Erika Saunders and Scott Gilbert.

Scott Gilbert  – Ask Us Anything about bipolar disorder, I’m Scott Gilbert. Life is a series of ups and downs. Happiness followed by sadness, that’s normal. But how do we know when either of those moods may last for a week or more, how do we know if it may indicate something more severe. Perhaps we’re having trouble staying focused or even having trouble sleeping? That my indicate bipolar disorder. Also referred to as manic depression. Here to talk with us about that today is Dr. Erica Saunders, she’s chair of psychology here at Penn State Health Milton S. Hershey Medical Center. Dr. Saunders I appreciate your time today. Let’s start by talking about the fact that we all feel happy sometimes and sad sometimes, that’s a matter of life. So how do I know if it’s possibly a more serious series of ups and downs I am experiencing?

Dr. Erica Saunders  – Thank you have having me today Scott. That’s a very good question, because of course, we all have ups and downs in our moods and we actually need that to think well, to make good decisions about our life we need to have that emotional reaction and that’s perfectly normal. The problem that is experienced in bipolar disorder and in depression is that the moods get stuck outside of that normal range. So usually you week up in the morning, if you happen to wake up on the wrong side of the bed and have a low mood you might do something without even realizing it to make yourself feel better. I like to have a hot cup of something in the morning. You might talk to somebody that you love, that sort of thing. And it might make you feel better. But, when the biological processes start in the brain that lead to bipolar disorder the moods get stuck outside of that normal range and the usual things you want to do to help yourself feel better, to make yourself feel less anxious, to concentrate better, just done work. And we know from research that actually the parts of the brain that control thinking and cognition and the parts of the brain that control emotion aren’t as well connected when there’s an active depression or mania going on.

Scott Gilbert  – So as a clinician how do you diagnose something like bipolar disorder? What are some of the things you look for?

Dr. Erica Saunders  – So the first thing that we ask about is mood. A low mood, feeling said, feeling down, depressed or being unable to enjoy things which we call anhedonia. Those are problematic moods that if they last long enough or cause significant enough problems in somebody’s life we are concerned about. The other type of mood that we ask about and is important in bipolar disorder is a mood that’s too high, too elevated. Where people feel perhaps so much energy, so reeved up that they can’t think and make good decisions for themselves and those around them. And in that case that’s called hypomania or mania. So we ask about mood specifically but the other things that are affected include: sleep, appetite, energy, concentration, memory. So it’s really a consolation of problems that of course affect people’s functioning.

Scott Gilbert  – We’re talking about periods of mania and periods of depression. Well I am less likely to seek clinical help of course if I’m feeling fantastic. Even if I am feeling way up perhaps. So I would think the fact that people seek treatment more often when they feel depressed, could that possibly lead to a misdiagnosis of depression if the clinicians not careful?

Dr. Erica Saunders  – Absolutely. Absolutely. And so bipolar disorder can present for the first time as depression so a good assessment and evaluation will ask about all types of moods that a person has experienced in their life if they become problematic. Sometimes when somebody’s experiencing an elevated mood that’s abnormal they may not realize it and loved ones in their life may help them to understand that there’s something that could be problematic. Sometimes even an elevated mood can be uncomfortable and a person might actually realize it themselves, it could be either way.

Scott Gilbert  – If you’re watching ask us anything about bipolar disorder from Penn State Health, Milton S. Hershey Medical Center, I’m Scott Gilbert. This is Dr. Erica Saunders, she’s chair of psychology here. She welcomes your questions, you can add them as a comment below this Facebook post whether you’re watching this live here on Friday or if you’re watching it after the fact we can still track down an answer to your question. So feel free to ask away in the comment field below this post. And of course if you find this information useful we hope that you’ll share it on your Facebook page. Dr. Saunders, at what ages does bipolar typically get diagnosed? When does it become most noticeable?

Dr. Erica Saunders  – Most people who experience bipolar disorder begin to b problems during the teen years with moods. And often with anxiety as well. So low mood, high mood, as we talked about before. But generally the age between 15 and 25 is the most common age that this becomes problematic for an individual.

Scott Gilbert  – And we talked about some of the things that clinicians look for, but what are some of the things at family members, friends can look for? Some warning signs, you may know somebody for a while. You may know them as somebody who’s happy sometimes, sad sometimes. What’s that sign that maybe a loved one might need some help?

Dr. Erica Saunders  – Problems with relationships and problems with social functioning in general that might relate to feeling down or feeling too high and excited that people aren’t able to really interact. Those are warning signs. In depression, unfortunately people can feel so hopeless and sad that they may not think that things will ever get better and that can lead to thoughts of suicide and that of course is attended to very quickly.

Scott Gilbert  – As with many medical conditions there are different types of bipolar disorder. It’s not an across the board diagnosis necessarily. Can you walk us through briefly a couple of the different types?

Dr. Erica Saunders  – Certainly. There are two types that we really talk about; Bipolar 1 disorder and Bipolar 2 disorder. And the difference comes in that Bipolar 1 disorder has periods of what we call mania. Which is severe elevated mood. And when I say elevated it’s not just happy, but it can be happy, it can also be uncomfortable. But elevated energy, inability to sleep. Inability to make good decisions, impulsivity often leads to people doing things that they never would have otherwise do that can get them into legal trouble and be very dangerous. So that’s mania and that is the hallmark symptom or hallmark episode of Bipolar 1 disorder. And Bipolar 2 disorder individuals experience what we call hypomania, which is elevated mood but not to the severe extent that you can have in Bipolar 1 disorder, and frequently long and severe depression.

Scott Gilbert  – We’re learning about bipolar disorder today from Dr. Erica Saunders. She’s chair of psychology here at Penn State Health Milton S. Hershey Medical Center. We welcome your questions. Just add them to the comment field below this Facebook post and we’ll pose them to Dr. Saunders, either live or after the fact we’ll get you some answers as well. Now Dr. Saunders not just a clinician but also a researcher. And you had a recent study that found that while bipolar disorder occurs at similar frequency in men and women there’s some differences in how each gender experiences episodes of media or depression. Can you tell us a bit about that and why that’s a significant finding?

Dr. Erica Saunders  – So that’s something that we’re very interested in. So bipolar disorder is prevalent in about 1 to 2% in the population, equally prevent in men and women. However, the experiences are different. And so what we’ve found in a series of studies is that women tend to have more anxiety with bipolar disorder. Some studies have found that women have more depressive episodes. And we found that difficulty sleeping, even when people with bipolar disorder are feeling well or not in a depression or mania, can tend to be more problematic for women than men. We’re interested in this because there’s different underlying biology that may be important for men and women and we hope to really learn more about that so we can better predict which treatments will match best for each individual patient. We really want to get to the point — we have a nice — we have a number of different treatments for bipolar disorder. Both medications and psychotherapy, we really want to be able to predict early on in the course of illness, which treatment is going to help which patient.

Scott Gilbert  – Is there different biological causes depending on gender possibly?

Dr. Erica Saunders  – Possibly. So we’re looking at different inflammatory factors that might be involved, the inflammatory system has now been linked to a number of different conditions including obesity, mood disorder, depression, bipolar disorder. Perhaps others as well. And so we’re look at whether specific inflammatory changes in the body may be important or predictive of symptoms in men and women. And that may tell us something in the future about what treatment is best.

Scott Gilbert  – Now what do we know in general about the causes and risk factors for bipolar disorder?

Dr. Erica Saunders  – So we know in general that one of the biggest risk factors for bipolar disorder is that it runs in families. So it’s what we call hereditary. There’s a genetic component to bipolar disorder but it is not — so it may pass from generation to generation but it’s not something that’s a certainty in a family. So, if you

Scott Gilbert  – If one of my parents have it I am not definitely going to have it?

Dr. Erica Saunders  – You’re not definitely going to have it buy you have a higher risk than the general population of having bipolar disorder. So family history is a component of it. There are environmental factors that might lead someone to be more likely to have bipolar disorder. Environmental triggers of mood. Then we know that there a number of different biological systems that are involved. And there’s a lot of really exciting research going on right now to try to understand what biological factors are important.

Scott Gilbert  – We have a question online from Andrea and this is something I think a lot of parents and grandparents can relate to, she says, “My grandson is three and there are times he goes on a rage and then when you tell him no, then he goes and cries. Can you tell what could be wrong”? So, I mean is this possibly normal behavior for a three-year-old?

Dr. Erica Saunders  – So that’s a very good question and so one of the things we do when we evaluate people for bipolar disorder is to understand at whatever age they are what is the usual behavior that’s expected for that period of development? And what might be abnormal behavior. So there are a lot of different factors that can play a role in anger and in rage and in different moods at every stage of development. And so it’s a little hard to say whether that’s bipolar disorder specifically. Also, just taking that question a bit more general, when we look — when we have children who are experiencing difficulties with mood, sometimes it can present a bit differently than an adult. And so we have to understand what those factors are for that individual child. And that’s part of an evaluation.

Scott Gilbert  – And that’s kind of related to a question we just got from Tara who’s asking with the signs are of bipolar disorder, specifically in children?

Dr. Erica Saunders  – So in children, due to emotional development, children don’t always present with the same words to describe emotional feelings. It may be very difficult for children to describe their emotions. And emotional development happens in a progression throughout childhood. So we look for disturbance in school, difficulty with grades, difficulty with social functioning and then try to understand whatever moods that child is experiencing. What are they like? But you may not see what we call the classic euphoric or elevated mania that we see sometimes in adults. For children it might be more irritability, more anger and more being just unable to control emotions.

Scott Gilbert  – You’re watching Ask Us. Anything about bipolar disorder. From Penn State Health Milton S. Hershey Medical Center, this is Dr. Erica Saunders. She’s answering questions here today and some great questions so far so thank you very much and please keep the questions and comments coming. I’d like to ask about what some of the consequences of bipolar disorder can be? That is, to what extent can this disrupt somebody’s life?

Dr. Erica Saunders  – So the consequences can unfortunately at times be very severe. So, as I said before, bipolar disorder can lead people to feel hopeless and feel like taking their own lives. And that’s a horrible tragedy that can be the outcome of this severe illness. Additionally, people can have such difficulty at work or school that they’re unable to continue with the job that they want or continue schooling. And difficulty in – it can be a problem in disrupting relationships. So, we work very carefully with the patients and families that we see to understand what the impact has been of mood problems on the life of that individually so far and do whatever we can to prevent having those types of problems in the future. We work to educate people about what is bipolar disorder, what steps can you take to improve the mood functioning. And sometimes that’s of course focus of our treatment. But there are also a lot of other ways that we help individuals with regulating mood.

Scott Gilbert  – I was going to ask about treatments a bit. It seems as with many psychiatric conditions there is mediation as an option, there’s therapy as an option, and what kind of determines the path of treatment for a given patient?

Dr. Erica Saunders  – So we have medications for bipolar disorder which we call mood stabilizing medications which both treat manias and depressions and prevent future episodes. So this is an episodic illness where people tend to be affected for a while and then maybe not affected for a while.

Scott Gilbert  – When you say a while, that’s like a week or two sometimes?

Dr. Erica Saunders  – Can be a week or two, can be up to months. And the natural course of the illness is to go into what we call remission, which is not to have any mood symptoms that the time but then to come back and reoccur. So treatment with medication can help prevent future episodes which is really important for overall health and for overall brain health. So, there are a number of medications that can be helpful. We also use different types of psychotherapy. Cognitive behavioral therapy or interpersonal therapy. Dialectical behavior therapy. There a number of different types to match the situation the patient might be experiencing. And that helps patient and families really build up the resilience needed to deal with these devastating illnesses in their life and to regulate emotion. They are very well tested, evidence based techniques to help someone regulate emotion that we teach.

Scott Gilbert  – Is there a temptation among people who have bipolar disorder to maybe self medicate with drugs, alcohol, even caffeine, that extra cup of coffee?

Dr. Erica Saunders  – Absolutely. You know, when any of us feel down, low, bad, angry, we try to do something to change that feeling. That’s completely natural. And so many people turn to substances for that same reason, because substances do change how we feel. Unfortunately that often becomes a vicious cycle and substances that are commonly abused alcohol, drugs of abuse, even caffeine at times can set someone up for maybe feeling better in the moment but long-term it usually leads to much worse problems with mood, sleep, anger, irritability and sometimes can even trigger addiction and a physical addiction dependence process that is a separate illness but also very severe.

Scott Gilbert  – This is Ask Us Anything about Bipolar disorder from Penn State Health. I’m Scott Gilbert along side Dr. Erica Saunders. She’s chair of psychology here at Penn State Health Milton S. Hershey Medical Center. She’s been answering my questions and yours. So we welcome any additional questions you may have here as we bring things to a close. And of course, an important question is, if people want more information I understand they can go online to PennStateHealth.org/psychiatry. Is that the best place to go?

Dr. Erica Saunders  – Yes, that’s correct. So we provide services here through Penn State Health. We also have an affiliation with the Pennsylvania Psychiatric Institute in Harrisburg that has services available there as well.

Scott Gilbert  – A very robust psychiatry department so people can take advantage of those services. Even it’s just to call and maybe learn a little bit more. What should that first call be if somebody feels that maybe they personally might be experiencing this? Should they talk to their primary care physician or go beyond that?

Dr. Erica Saunders  – So, primary care physicians are often a very good place to start. So I would say primary care physicians, psychiatric specialty services, psychologists, psychiatrists, therapists. Therapists can be nurses, social workers. We all work together as a team to provide treatment for patients and for individuals. If somebody’s experiencing a crisis there is crisis help in counties in Pennsylvania. It’s available through the county. The local emergency room for emergencies and there are numerous help lines for suicide. If someone’s experiencing thoughts of suicide, which is also a place to turn.

Scott Gilbert  – A lot of places to turn for good information. Thank you. Thank you for the good information today Dr. Saunders. Dr. Erica Saunders, she’s chair of psychology here at Penn State Health Milton S. Hershey Medical Center. She was our guest. Thank you for being the viewers here for Ask Us Anything About Bipolar Disorder from Penn State Health.