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Biology 103
2003 Third Paper
On Serendip

The "Gemini" Disorder: What We Know and Are Still Discovering About Bipolar Disorder

Patricia Palermo

"You must understand something about Andrew... he's a Gemini." This was a simple phrase I heard very often in the company of my dear friend and his clever well-intentioned mother. It was discovered a short time later that the aforementioned statement was justification for the earliest symptoms of Bipolar disorder (or manic depressive illness.) As Andrew and I matured into our twenties, it seemed that he was going to need to understand a bit more than his astrological sign to gain control of his life and his mental and emotional well-being. Thus, we sought this information out together.

It is important to consider the magnitude of people who are affected by this disease and the multitude of forms it can take. Bipolar disorder affects approximately 2.3 million American adults, or about 1.2 percent of the U.S. population age 18 and over in a given year. (1) Of this population, approximately 75 percent have at least one close relative with manic-depression or severe depression. (5) Men and women are equally likely to develop bipolar disorder. Children and adolescents may show signs or have symptoms of bipolar disorder, yet a person's first manic episode usually strikes in their early 20s. Bipolar disorder is also more common among those who have family members, specifically first-degree relatives, with this disorder than with those who do not. (6) Unfortunately, many people suffer for years before properly diagnosed and treated or the illness may be never recognized at all. (4) Generally, bipolar disorder causes dramatic mood swings—from overly "high" and/or irritable to sad and hopeless, and then back again, often with periods of stable moods in between. Severe changes in energy and behavior follow these mood swings. (4) However, this description of bipolar disorder does not delve into the specifics of the disease which often branch into separate diagnosis and needs for treatment. Bipolar 1 Disorder is the more classic form of this illness, easy to recognize due to its frenzied and often psychotic episodes of mania. During these episodes, people may experience hallucinations (hearing, seeing or sensing a presence that isn't actually there,) or delusions of grandeur (such as believing they are the President, invincible, all-powerful, or extremely wealthy.) During depressive episodes, the person may experience feelings of worthlessness, hopelessness, pessimisms toward the future, and thoughts of death and suicide or even suicide attempts. Bipolar 2 disorder is characterized by its more mild to moderate form of mania known as hypomania. People experiencing episodes of hypomania may feel extra alert, productive, and tremendously brilliant: "At first, when I'm high, it's tremendous... ideas are fast... like shooting stars you follow until a brighter ones appear... All shyness disappears, the right words and gestures are suddenly there...uninteresting people, and things become intensely interesting. Sensuality is pervasive; the desire to seduce and be seduced is irresistible. Your marrow is infused with unbelievable feelings of ease, power, well-being, omnipotence, euphoria... you can do anything." (4) Unfortunately this form of hypomania alternates with a proportionately mild form of depression. Between each episode, a person may be free of symptoms. Many are symptom free for surprisingly long periods of time. However, when 4 or more episodes take place within a year, a person may be diagnosed as having rapid cycling bipolar disorder. With some people, the symptoms occur in what is known as a mixed bipolar state, where symptoms of mania and depression transpire together.

It is important to recognize that manic depression doesn't only drastically affect the diagnosed individual's quality of life, but also his/her entire family and network of those he/she is close to. People close to those with bipolar disorder are often coerced into riding this painfully unpredictable and irregular emotional roller coaster. And even though this is not a physically deteriorating disease, it is not without its injuries or fatalities. Those who are ill often find sanctuary with the use of drugs and alcohol. Many people who suffer from this disease will also cause physical harm to themselves or others during a severe manic or depressive episode. Devastatingly, 10 percent to 15 percent of those diagnosed are successful in their suicide attempts. (3)

Right now, bipolar disorder is combated with a variety of methods. Unfortunately, as with many mental illnesses where the source of the problem is uncertain, treatment is complicated and less direct. People are commonly prescribed one of many available mood stabilizers, with other medications added in order to control specific episodes of mania or depression (such as antidepressants.) The key to medication is to find the one that reacts best to your body, effectively treats your symptoms, and allows you to maintain your feeling of self. The most commonly used mood-stabilizing medications used today are Lithium and Valproate. However, there are varieties of mood-stabilizing, antidepressant, and even anticonvulsant drugs used to treat more specific or rare cases. People continue this treatment over periods of years, as the medication does not cure, but rather lessen the severity of symptoms. Strategies that combine medication and psychosocial treatment are optimal for managing this disorder best over time. (4) Keeping your doctor current with your progress and finding an optimal combination of strategies is key. But is there reason to have higher expectations for treatment in the future? Possibly even a cure?

Now that we understand the people effected by, symptoms associated with, and differing diagnosis and treatment for this life altering disease, one might wonder about the missing piece of the puzzle: Why? Why do people develop bipolar disorder in the first place? Is it hereditary? If so, is it genetic? Explanations of bipolar disorder have ranged from a shortage of Lithium in the brain to dog bites in childhood! (6) Researchers have previously argued over whether manic depression was a "mental illness" or more specifically, a "brain disorder." For example, some resources warn, "Like other mental illnesses, bipolar disorder can not be identified physiologically—for example, through a blood test or brain scan. Therefore, the diagnosis is made on the basis of symptoms, course of illness, and, when available, family history." (4) However, further research provides hope for alternatives.

The initial ray of hope is provided by inheritability. The chance of two adults without bipolar disorder having a bipolar child is only about 1 percent. However, if one parent has the disorder, the offspring's chance of becoming bipolar raises to about 5 percent. Furthermore, if that same child has aunts, uncles, or another relative with the disorder, their risk rises to about 14 percent. In the unlikely occurrence that both parents have bipolar disorder, the child is at a 30% risk, rising even greater if sibling or other relatives suffer as well. (3) Although the risk for disease increases with heredity, it is not based on any concrete principle of inheritance or ratio as with single gene disorders, again, making it hard to study. We must also reconcile with the fact that someone who seems genetically susceptible to bipolar disorder will not necessarily develop it. Thankfully, this link to heredity serves as a starting point for biological answers.

It is among popular research to focus on the neurotransmitter system specifically. Mostly, this is because the drugs we are prescribing today are aimed at controlling neurotransmitters, and have been successfully controlling depression and anxiety disorders for some time now. Some studies indicate that secret may be high or low serotonin, norepinephrine, or dopamine levels. Others feel that the issue is with the balance or equilibrium of these substances, and not simply an incorrect quantity in the body. (6) The problem may also be the way in which these substances interact with the sensitivity of receptors on nerve cells. A recently published study from the American Journal of Psychiatry reports that within patients suffering from bipolar disorder, two major areas of the brain contain 30 percent more cells! These cells are specifically responsible for sending signals to other brain cells. (6) It is conceivable, based on the exaggerated emotional symptoms of bipolar disorder, that these extra cells are responsible for a type of over stimulation occurring in the brain. Prior to this study, three independent research teams, two supported by the National Institute of Mental Health, reported a genetic link to bipolar disorder. The studies found that chromosomes 6, 13, and 15 were partly responsible. (7)A short time later, researchers of the National Institute of Mental Health Genetics Initiative Bipolar group found "several different chromosomes that seems to be important for bipolar disorder, not only chromosomes 18 and 21, which were reported before, but also 1, 6, 7, 10 and possibly others." (2) Although the scientific world is not yet able to come to consensus on which chromosomes may be responsible, they raise hope for a cure that is more than just the treatment of symptoms. These studies lead us in the right direction for a possibly biological cure for a psychologically experienced disease, which is in itself a huge step!

The most recent science brings us to the conclusion that it appears to be slightly more of a biologically responsible disorder than an environmental one, experienced as a psychological one, and exerting its power in all functions of a person's life- emotional and physical. The disease can be treated from many angles, but with our focus on biological possibilities, we may gain genetic knowledge allowing us to "intervene in the disease process to control or reverse it." (3) The potential for identifying specific chemicals, chromosomes, or genes also allows us possibility to step in before the disease has had any effect on the person. If we can identify people at risk, we may be able to prevent the development of the disorder all together.

The more we discover about bipolar disorder, the more we are drawn to ask about it. Are we looking to control and stabilize a person's environment who is deemed to be at risk? Are we looking to target specific cells? Are we looking to target specific genes? Will people one day get tested for genes that are associated with bipolar disorder? Will the discovery of those genes lead to a cure for the disease? From Andrew's perspective, there is a genuine fear that creeps into his head when he considers beginning treatment: 'Will I loose my identity?' 'Will I discover that those moments of artistic genius and emotional enthusiasm are curable symptoms of a terrible disease?' What is important to recognize right now is that there is information available and that it is ever expanding and decidedly improving. With a better understanding of this disease, its origins, and its treatments, we will also begin to bridge huge gaps between the behavioral and possibly the genetic. Whether there are definite environmental factors, cells, chemicals, genes, or actual specific strands of DNA, or multiple interacting causal factors, scientists are reasonably sure of one thing: Andrew's behaviors are not likely the result of being a Gemini!


WWW Sources

1) The Numbers Count: Mental Disorders in America , A huge source of well sited statistics on mental disorders, suicides, etc.

2) Researchers find Genetic "Hot Spots" of Manic-Depression , A write up on a specific genetic study designed to find chromosomes responsible for bipolar disorder.

3) The Foundation for Genetic Education and Counseling: Genetics and Bipolar disorder , A very helpful question-and answer sheet set up by the Foundation for Genetics. It is particularly interested in explaining genetics and the implications of its possible connection in this disease.

National Institute of Mental Health: Bipolar Disorder
, Contains absolutely anything about bipolar disorder that is reasonably concrete information: treatment, symptoms, diagnosed types, and everything in between.

Evidence of Brain Chemistry Abnormalities in Bipolar Disorder
, Discusses connections between brain cell count and brain chemicals as possible explanations to bipolar disorder.

What Causes Bipolar Disorder?
, A discussion of causes for bipolar disorder. Specifically looking closer at cell counts and the neurotransmitter system.

Scientists Close in on Multiple Gene Sites for Manic Depressive Illness
, A genetic study contradicting the one introduced prior. It focuses mainly on chromosone links to bipolar disorder.

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