How to Clean Your House with Bipolar Disorder and a Toddler, part I

toddler.jpg

Credit to flickr.com user LeAnn.

This is part one of two-part series.
Part I | Part II

People with bipolar disorder often have overwhelmingly messy houses, and it’s arguably more difficult to clean when you suffer from mental illness. When we’re depressed, cleaning up is a herculean effort. When we’re manic, we’re usually too busy turning in circles to worry about tidying.

I previously posted a threepart series titled “How to Clean Your House When Your Brain is a Mess.” In it, I explained how executive dysfunction–the inability to set and meet goals and self-monitor–interferes with the ability to keep a clean house. I suggested a game plan for tidying, including tracking where your time goes and seeing if you can squeeze in a ten-minute burst of laundry duty.

Yes, there are strategies for scrubbing, but what if you not only need to clean the house with bipolar disorder, but you have a toddler to look after? Read on for tips and tricks to get your house tidy while dealing with both bipolar and a young child.

Strategy #1: How to Manage Your Own Expectations and Limits

Revisit your definition of tidy. I’m sure you’ve noticed, but when you have a toddler in the house, things just don’t stay where you’ve put them. Toys wind up everywhere, baby food jars stink up the coffee table, and fingerprints cover the windows. That’s all okay. Your kids are only little once, so enjoy them rather than constantly trying for damage control. While you may feel like your house will never be company ready, I guarantee people who like you aren’t judging you on the state of your house. As long as those baby food jars don’t have mold on them, it’s all good.

Set a time limit to avoid getting overwhelmed. I use the 20/10 method, popularized by the profane cleaning site, Unf*ck Your Habitat. Set a timer for twenty minutes of focused cleaning, and one for a ten-minute break following. With my toddler around, I rarely manage a whole twenty minutes. Sometimes our ten-minute break is more of an hour and a half of outside play. But some time cleaning is better than none. My hope is that my daughter will start to respect the timer, though I suspect I’ll have to wait a bit longer for her to really understand why the oven timer is beeping and what that means for her.

Similarly, setting a time limit helps prevent me from getting too focused on chores when I’m hypomanic. If I force myself to take breaks, I’m less likely to be turning in circles by the end of the day.

Strategy #2: Include Your Kids In the Cleaning Process

Involve your children in cleaning the house according to their abilities. Training your children to clean the house with you is incredibly important for both your sanity and their future ability to keep their own houses clean as adults. You can start young, letting your toddlers help by putting away their toys or sweeping the floor with a child-sized broom.

Don’t expect great results right off the bat. Your toddler won’t have the attention span or manual dexterity to handle most chores. Just get done what you can, and try to be realistic about how much you’ll actually be able to get done, even with “help.”

Put toys away every night. Keeping  your toddler’s toys corralled is a nightly endeavor. Take a little while before bed or whenever is most convenient to put toys away in covered bins (more on those later). Try to let your kiddo put away as many items as possible. If you label the bins with pictures–car pictures for the car bins, etc.–then your child can help put toys away with you.

Cut down on toy clutter. Store your child’s toys in covered bins, and make sure all the toys fit in these bins. When the toy bins are overflowing and the lid doesn’t fit anymore, donate some of them. Older children generally understand the concept of giving toys to other people who might not have them, but toddlers usually don’t. Involve your kids in the donation process at your discretion.

Don’t, don’t, don’t redo your kids’ work. Whatever you do, don’t do your child’s work over. That sends the message that what she does isn’t good enough for you, and she’ll get discouraged. If your toddler can’t fully make the bed, simply let her do as much as she can and move on.

Thank your child for his work. Make sure to show your appreciation for your toddler’s efforts, but don’t praise him insincerely for an unsatisfactory job. There is a time and a place for praise, such as when the job your kiddos complete is well done. If that’s not the case, simply thank your child.

The Bottom Line

Cleaning the house with a toddler and bipolar disorder may seem impossible. It’s not. The effort required is immense, true, and you need to be patient with your kid, but that’s similar to any other task you complete with children. You can do this.

Keep an eye out for part II, a room-by-room cleaning guide.

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How to Follow a Mediterranean Diet to Help Manage Bipolar Depression

salm

Credit to flickr.com user Annette Young. Used with permission under a Creative Commons license.

As several studies have pointed out, eating a healthy diet is crucial for managing bipolar disorder. I recently linked to a study demonstrating that a Mediterranean diet helped alleviate the symptoms of depression. New research shows that following such a diet can even help prevent depression in the first place. If you eat these prescribed foods, then you may be able to alleviate or prevent bipolar depression as well.

In addition, following this diet may lower “bad”  cholesterol, reduce the risk of heart disease, and help reduce the incidence of Parkinson’s, Alzheimer’s, and some cancers–including breast cancer, when supplemented with mixed nuts. So why not give the diet a try?

But what is a Mediterranean diet? It emphasizes:

  • Eating fruits, vegetables, beans/legumes, nuts, and whole grains as primary food sources
  • Replacing butter with healthier fats such as olive oil
  • Avoiding salt, and using herbs and spices instead
  • Only eating red meat a few times per month, and eating fish and poultry twice a week instead
  • Drinking moderate amounts of red wine (optional)

To follow the diet more fully, aim for seven to ten servings of fruits and veggies per day. Switch to whole-grain bread, cereal, pasta, and rice. Keep cashews, walnuts, and almonds around for snacking, but don’t eat too many, as they’re high in calories. Don’t eat butter; try olive oil and canola oil as a substitute. Eat healthy fats in general. Nosh on water-packed tuna, trout, or salmon once or twice a week, but avoid fried fish.

Don’t eat red meat unless it’s lean; avoid sausage and bacon. Choose low-fat cheese, fat-free yogurt, and skim milk. Avoid sugar. If you drink alcohol, have a glass of wine at dinner, but purple grape juice can be an alternative. For a sample meal plan that breaks down consumption by calories, click here.

There are a couple of downsides to the Mediterranean diet, however. One is the high cost. A personal finance blog, The Simple Dollar, posted a detailed breakdown of the costs of switching from butter to olive oil, and red meat to salmon, as well as other foods. According to the breakdown, salmon is almost twice as expensive as ground beef, so if you have a large family, then you might want to change over to ground turkey instead.

The other downside of the diet is its complexity. Not only is overhauling your regular eating patterns hard, balancing your intake of proteins, fats, and carbohydrates over several different meals is difficult. I know that when I’m depressed, I choose to make one of these twenty-two easy, delicious meals, most of which are carb-heavy. Those are great, but if you’re trying to follow the Mediterranean diet, then that link is not for you.

But don’t let the cost or complexity of the Mediterranean diet throw you. In-season produce, the backbone of the diet, is generally cheaper than meat, be it red or fish or poultry. And switching from butter to olive oil is easy. You don’t have to follow a diet to a T to get some of the benefits.

By following this diet, you may be better able to manage bipolar depression, which can take all the help you can get. The bottom line is, just do what you can. Eat more fruit. Swap ground beef for ground turkey. If eating more vegetables or switching some unhealthy fats for healthier ones is all you can do, that’s still great. You’ve got this.

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What is Hypergraphia, and How Does It Relate to Bipolar Disorder?

writing

Credit to flickr.com user Fredrick Rubensson. Used with permission under a Creative Commons license.

Hypergraphia–where “hyper” means “extremely active” and “graphia” means “to write”–is a condition where a person compulsively writes. The writings may be coherent, ranging from poetry to academic books, or scattered thoughts, with different sizes of texts.

Hypergraphia is difficult to define, as it’s not part of Merriam-Webster’s dictionary of words. The condition was only identified in the 1970s, by Drs. Waxman and Geschwind–the latter of whom has a mental disorder named after him, of which hypergraphia is a symptom. Hypergraphia is often associated with temporal lobe epilepsy, in patients who have endured multiple seizures.

While there are plenty of studies connecting epilepsy and hypergraphia, the link between the condition and bipolar disorder hasn’t been studied and should also be considered. The neurological literature is extensive, but the psychiatric literature is severely lacking. The condition appears to be a common manifestation of mania.

Only a couple of studies have looked at how hypergraphia relates to bipolar disorder. The linked study, by hypergraphia sufferer Alice Flaherty (author of The Midnight Disease, describing her experiences), only examines the link between creativity and bipolar, not hypergraphia specifically.

As far as anecdotal accounts go, author Dyane Harwood extensively describes her experience dealing with hypergraphia in her book, Birth of a New Brain, saying that she wrote so much, she suffered severe hand cramps–and even penned notes while on the toilet.

In my case, I experienced hypergraphia during a manic episode following my son’s birth. A flood of ideas struck my brain, and I was soon writing things down so I’d remember them. In the short span of a week, I felt compelled to handwrite over a hundred to-do lists. Some of the lists overflowed with a hundred items or more, while other lists held only two.

Hypergraphia as a manifestation of mania appears rather common, just unstudied. A PubMed search for “mania, hypergraphia,” shows five hits, only one of which actually relates to the topic. Whereas searching the same site for temporal lobe epilepsy and hypergraphia ends up with 28 hits. Meanwhile, a Google search for “mania, hypergraphia” shows 16,600 hits, and that’s just the websites that use the scientific term.

This means that there are stories out there linking bipolar disorder and hypergraphia. They just haven’t shown up on medical sites yet.

I hope that future studies will take into account the link between bipolar disorder and hypergraphia, a manifestation of creative output and idea generation. If you have suffered from hypergraphia during mania, you are not alone.

Does your mania manifest as hypergraphia?

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My Manifestations of Bipolar Mania: Crafting and Frugality

Different people have different manifestations of bipolar mania, but they tend to be consistent. Hypersexuality, overspending, not sleeping–all are symptoms and manifestations of mania. When I’m manic or hypomanic, I have two different types that appear most frequently: a desire to craft, and an obsession with frugality, both of which go hand in hand more often than not, but can sometimes conflict each other. Let’s take a closer look.

I love craft projects. Paintings, wreaths, cross stitch–you name it. DIY is my cup of tea.

Unfortunately, I am also bipolar. I’ll bet you can tell where this is going. One of my first signals that I’m going hypomanic is a burst of creativity. I get delusions of grandeur, and think I can handle any DIY regardless of my skill level. I tend to rush through projects, not using the right tools or waiting for paint to dry, and the crafts end up looking terrible. I’ll also stock up on tons of unneeded craft supplies “just in case” I think of a future project.

spray paint

Credit to flickr.com user Daniel Naish. Used with permission under a Creative Commons license.

That’s how I ended up with a massive shelf of spray paint in my garage, with many, many colors ranging from navy blue to black to forest green. Nobody needs that much spray paint. Nobody.

During a recent hypomanic episode, I purchased four more cans of white spray paint, as well as other painting supplies and a second hot glue gun, for a total of $111. This might not seem like an exhorbitant amount compared to other people’s manic spending sprees, but the items were all unnecessary. I didn’t have a project in mind; I just wanted the stuff.

Another reason I think that’s a large amount to spend is the other manifestation of my mania: an obsession with frugality. I normally read personal finance blogs and keep a tight rein on my spending, but when I’m hypomanic, I’ve done things like Dumpster diving for an infant’s room decor (using items broken beyond repair) and hoarding food to the point of rotting.

I even grew my own container “garden” from seed out of soil I bought at a farm for pennies, planted in sauce cans. While I was manic, I overwatered the plants. After the mania ended, I sank into a huge depression and didn’t water them at all. Nothing grew, of course, except for some tiny, shriveled carrots, which at the time was devastating. Despite my husband’s high-paying job, I was convinced that my family would starve because I failed as a gardener.

All of these thoughts–from my thinking that I can handle any craft project to my worries that we would starve–are irrational. I know that now.

But mania is a hard dragon to slay. I used to get wrapped up in crafting to the exclusion of anything else, like eating. I decided when my second child was born to keep myself from crafting entirely in order to prevent my neglect of her. She’s a toddler now, and I’ve realized that this idea of mine turned out to be a mistake. Crafting feeds my soul, just as much as writing, and I’ve missed it just as much as I’d miss a missing finger.

So what did I do? I decided to try to have both a healthy amount of parenting time and the ability to craft DIY projects. With her in the room, I glued burlap and pinecones to a wreath form. This project only took ten minutes, and I was pleased with the result. The week after that, I wore her in my Ergo front-pack baby carrier

cherry-blossom.jpg

A painting of cherry blossom branches on a teal background, by Cassandra Stout. Protected under a Creative Commons license.

and painted a large canvas with some cherry blossom branches, which took thirty minutes.

So I’ve found a way to strike a balance with crafting. In the future, I’d like to continue to work on projects and be frugal without going overboard. So I’ll set alarms on my phone to take a break every twenty minutes during a craft project. I’ll set limits on how much  I can get done per day. I’ll stop reading personal finance blogs when I’m hypomanic, and wait until I’m on a more even keel to look over budgets. I’ll repeat self-affirmations to control my urges to craft or engage in overly-frugal activities.

And I’ll keep taking my meds, keep a good handle on my sleep, and try to nip delusions of grandeur in the bud, before I commit to buying anything or spending an inordinate amount of time. All I can do is manage my bipolar disorder, and try to prevent hypomanic episodes. Wish me luck.

How does your mania manifest?

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Tackling the Clutter Demon With Bipolar Disorder

For those of us living with bipolar disorder, the battle to control the mess in our houses is very real.

Anyone who has ever been depressed knows that cleaning is a struggle, to put it mildly, especially when you can’t even shower or feed yourself. And when we’re manic, we either can’t concentrate to clean the clutter, start new tasks without picking up our messes, or purchase frivolous items to soothe anxiety. In persons with bipolar I specifically, the wiring in their frontal lobes is so tangled that they suffer these executive functioning difficulties even during stable periods.

konmari

The Life-Changing Magic of Tidying Up: The Japanese Art of Decluttering and Organizing, by Marie Kondo. Also known as the Kon Mari Method.

Studies have even shown that hoarding is linked to bipolar, for the same reasons. We’re just wired to create messes.

But there is hope. I’ve just started decluttering using the KonMari method, based on the book The Life-Changing Magic of Tidying Up: The Japanese Art of Decluttering and Organizing, by Marie Kondo. In short, you tidy by category. In order to start the process, you first search the house for items (clothes, books, papers, miscellany, and then sentimental clutter). Then you lay them out on the floor. Then you hold each item and ask if it “sparks joy” before making a decision to keep it and put it away, donate it, or toss it.

I feel a little silly doing this, but so far the method has really worked to tidy up my clothes closet. I got through my closet and dresser in three hours, and donated two full garbage bags. I now only have five items hanging up, one full-sized drawer full of clothes, and an underwear drawer. I’m exhausted.

One caveat to the method for bipolar I people especially is that I can easily see how it could trigger a hypomanic episode. The elation from throwing things out is very real, and it might be difficult for a person with mental illness to stop once he or she has started. It’s almost ritualistic, which might spell trouble for people suffering from Obsessive Compulsive Disorder.

This is also not a method to use when you’re depressed. Laying out all my clothes on the floor was overwhelming, and I was fortunate to have my sister to walk me through the KonMari process. I confess that first, we had to clean up the floor to make enough room to sort through the clothes, which took half the time we’d allotted to going through them (three hours total).

So, I have a mixed review of the KonMari method. It’s effective, but dangerous. I’ll hold off on giving a full review until I’ve completed the six months the book says the method takes.

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Book Review: Dyane Harwood’s Birth of a New Brain

birth of a new brain

Dyane Harwood’s brilliant memoir, Birth of a New Brain.

Dyane Harwood’s brilliant breakout memoir, Birth of a New Brain, chronicles her heartbreaking struggle for stability after the onset of postpartum bipolar disorder. Dyane’s battle to reestablish her mental health from the ravages of mania and the pits of depression is recorded in a gripping account with an almost-journalistic flair.

An often overlooked and misunderstood perinatal mood and anxiety disorder (PMAD), postpartum bipolar disorder is listed in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as part of the bipolar spectrum. In Dyane’s case, she suffers from a severe form of “treatment-resistant” bipolar I disorder, which spirals high into manic episodes and deep down into soul-sucking depressions.

Dyane deserves all of the praise her novel has received from various sources. It’s a fascinating account with a structure unique to memoir: Dyane takes us from her birth in the beautiful Pacific Palisades to her first boyfriends to her seven hospitalizations. She spends a great amount of time describing her attempts to live medication-free and the disastrous results. She deals with over-prescribing, unethical psychiatrists, powerful electroconvulsive therapy treatments to negate her suicidal thoughts, and, eventually, finds a medication that works: a monoamine oxidase inhibitor (MAOI) called tranylcypromine. Other useful contributors to her mental health are getting enough sleep, exercising thirty minutes for six days a week, and “forest bathing”–taking frequent long walks in a redwood forest.

Above all, Dyane is honest. She’s candid about her many failures–as well as her many triumphs!–on the road to recovery. She tells us about her relationships with her father–who suffered from bipolar I himself–and her mother, and their relationship with each other. Dyane even tells us about the fights she had with her husband. All of this contributes to a beautifully-written memoir.

Harwood’s book is crucial for understanding the postpartum bipolar experience. She references writers and doctors with experience dealing with bipolar disorder. Her memoir, Birth of a New Brain, is one of the greats.

Disclaimer: Dyane is one of the frequent commenters on this site. She offered me a PDF of Birth of a New Brain for review, which I was glad to do. Dyane blogs at DyaneHarwood.wordpress.com.

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Good, Good, Good Nutrition, Part II: Foods to Avoid When Managing Bipolar Disorder

We all know that an unhealthy diet can affect our bodies in negative ways. But did you know that some foods are especially bad for mental health? Studies show that the following foods are really, really bad for you if you have bipolar disorder, or suffer from depression.

Caffeine

Caffeine is a stimulant which can make you jittery and on edge, and cause you to miss out on sleep, which is crucial for managing your mood–and may tip you into mania if you don’t get enough sleep. If you’re trying to stop eating or drinking caffeine, make sure you wean yourself off of it gradually, as stopping abruptly can have adverse effects on your body.

Caffeine is found in the following:

  • coffee
  • soda
  • chocolate
  • tea
  • weight-loss pills
  • energy water
alcohol

Credit to flickr.com user Peter Anderson. Used with permission under a Creative Commons license.

Alcohol

Alcohol is a depressant, even though it can seem to raise your spirits (pun intended). Drinks can also lower inhibitions and increase impulsivity. In a recent study in the journal Addiction, researchers found that alcohol misuse doubled the risk of the development of major depressive disorder. Even for people who are not alcoholics, drinks may fuel suicidal ideation. As with caffeine, doctors recommend weaning yourself off alcohol gradually.

Tyramine

If you take monoamine oxidase inhibitors, like my dear friend Dyane Hardwood, then there are some dietary requirements you need to pay attention to. Most importantly, you need to avoid tyramine, which can cause the amino acid to spike, which increases blood pressure to dangerous levels. Tyramine is found in:

  • aged cheeses
  • cured, processed, and smoked meats
  • fermented foods such as sauerkraut and kimchi
  • soybeans
  • dried fruit

Nitrates

A recent study shows that nitrates, which are chemicals used to process and cure meats, can contribute to mania. They’ve also been linked to pancreatic cancer and Alzheimer’s disease, and children under six should avoid them in general.

Nitrates can be found in:

  • bacon
  • pepperoni
  • salami
  • hot dogs

Supplements

Supplements like St. John’s wort aren’t really food, but some of them can interact negatively with your bipolar medications, making them less effective, or spiking their levels. Talk to your doctor about what interactions occur with supplements and herbal therapies.

Sugar

In bipolar disorder patients especially, refined sugars can cause wild mood swings. Too much sugar can contribute to obesity, which makes some bipolar medications less effective, especially if the weight is gained around the middle. Instead, look to complex carbohydrates, like whole grains and vegetables.

All in all, diet is extremely important to mental health. If you stay on top of your food and supplement intake, you’ll be able to manage your brain’s ups and downs much more effectively.

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Good, Good, Good Nutrition, Part I: Foods to Eat to Help Manage Bipolar Disorder

food2

Credit to flickr.com user jrsnchzhrs. Used with permission under a Creative Commons license.

Food is important. That’s undeniable. While there’s no specific diet that helps manage bipolar disorder, studies have shown that an unhealthy diet can trigger manic episodes. New research shows hat depression symptoms decline with a Mediterranean-style diet. So, what you put into your body is crucial. Although the foods that follow won’t cure bipolar disorder, they can help you feel better, making it easier to cope with mood episodes.

Omega-3s

Omega-3 fatty acids are largely used to manage heart disease, though some studies have suggested that they can help with mental health as well. According to a recent review by Peet and Stokes, “Epidemiological studies indicate an association between depression and low dietary intake of omega-3 fatty acids, and biochemical studies have shown reduced levels of omega-3 fatty acids in red blood cell membranes in both depressive and schizophrenic patients.” This basically means that people who eat fewer omega-3 fatty acids tend to deal with more depressive symptoms. This is a big deal!

Other results have been more mixed, showing that there’s a lot more research that has to be done before omega-3s can be used to definitively treat bipolar disorder or depression.

Omega-3s can be found in:

  • fatty fish, like salmon, tuna, mackerel, herring, trout, halibut, and sardines
  • flax seeds and their oil
  • eggs
  • soybeans
  • walnuts
  • wild rice

Magnesium

Preliminary studies suggest that magnesium is useful for reducing the symptoms of mania. Still others report that the vitamin is good for warding off depression and migraines. There’s a whole host of other dietary benefits for magnesium as well, such as keeping muscles and nerves functioning, regulating blood sugar, and treats hypertension. The recommended daily amount (RDA) is 420 milligrams (mg) for adult men and 320 mg for adult women.

Magnesium is found in:

  • almonds
  • avocado
  • beans
  • bran cereal
  • brown rice
  • cashews
  • chocolate
  • cereal (Shredded Wheat)
  • edamame (immature soybeans)

Selenium

Selenium is a trace element that’s essential for smooth brain function. The element helps stabilize moods. Deficiencies in selenium, of which adults need at least 55 micrograms (mcg) daily, have been linked to anxiety and depression.

Selenium is found in the following foods:

  • Brazil nuts
  • tuna
  • halibut
  • sardines
  • ham
  • shrimp
  • steak
  • turkey
  • beef liver

Tryptophan

Tryptophan is an amino acid which helps make melatonin and serotonin, which help you sleepy and happy, respectively. A recent study–the same one that showed magnesium can reduce mania symptoms–showed that tryptophan, too, can help mania. 

Tryptophan is often associated with Thanksgiving dinner, specifically turkey, but in reality, turkey only boasts as much of the amino acid as chicken. A pork chop has more, as does soybeans. Tryptophan can also be found in eggs, tofu, and cheese, so don’t worry if you don’t like turkey; you have plenty of options.

Probiotics

Probiotics are foods that contain live bacteria that is healthy for your gut. Research about the biome of our intestines is a hot topic. The microbes there have been shown in studies to release serotonin, which helps keep bipolar people on an even keel.

Probiotics can be found in:

  • yogurt
  • kefir
  • kombucha
  • sauerkraut
  • kimchi
  • miso

Dark Chocolate

One-and-a-half ounces of 70% dark chocolate daily is the recommended dose to lower stress hormones, according to a recent study. And who doesn’t like dark chocolate? However, be careful with your dose of chocolate, as cacao beans contain caffeine, and chocolate itself contains sugar, both of which are foods you want to avoid (see Part II).

Saffron

Saffron is a red spice shaped like a thread found in dishes from India. Studies have shown that saffron extract is as effective an antidepressant as Prozac. The spice is expensive on its own, however, so take care when filling the shopping cart and cooking with it. A little goes a long way.

In short, while there is no specific diet for bipolar disorder, incorporating these foods may help manage your manic and depressive episodes. However, foods are no replacement for a comprehensive treatment plan from your doctor. Experiment with diet, but keep to your psychiatrist’s recommendations. Happy eating!

Keep an eye out for Part II: Foods to Avoid.

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Bipolar Disorder Manifests Differently in People Who Binge Eat

food

Credit to flickr.com user Percy Germany. Used with permission under a Creative Commons license.

According to a 2013 Mayo Clinic study, bipolar disorder manifests differently in people who also binge eat than those who are just obese. The research is published online in the Journal of Affective Disorders.

The Mayo Clinic, Lindner Center of HOPE, and the University of Minnesota scientists found that just under ten percent of people with bipolar disorder binge eat, a higher percentage than the general population. Binge eaters who also suffer bipolar disorder are more likely to develop other mental health issues, including suicidal thoughts, psychosis, and substance abuse.

Contrast this to bipolar patients with obesity, who are more likely to suffer physical problems, such as diabetes and arthritis. Binge eating and obesity were both more common in women than men.

The researchers also found that when bipolar patients are suffering from a mood episode, they are more likely to binge eat. More studies are planned to pinpoint whether binge eating has a genetic link to bipolar disorder.

The Mayo Clinic team is hopeful that more personalized treatments that do not have weight gain as a side effect will become available in the future.

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Family Study Emphasizes Distinct Origins for Bipolar Disorder Subtypes

family

Credit to flickr.com user Kat Grigg. Used with permission under a Creative Commons license.

The most common subtypes of bipolar disorder, bipolar I and bipolar II, stem—at least in part—from different biological causes, according to a new study published in Biological Psychiatry. Despite genetic overlap between the two subtypes, each subtype tended to cluster within families, suggesting a distinction between bipolar disorders I and II.

The study, by Dr. Jie Song of the Department of Clinical Neuroscience, Karolinska Institutet, Sweden, and colleagues helps settle controversy over the relationship between bipolar I and bipolar II disorders. Although genetic similarities indicate overlap between the subtypes, the new findings emphasize different origins. According to Song, this is contrary to a common notion among many clinicians that bipolar II disorder is merely a milder form.

“We have tended to view the two forms of bipolar disorder as variants of the same clinical condition. However, this new study highlights important differences in the heritable risk for these two disorders,” said Dr. John Krystal, Editor of Biological Psychiatry.

The study is the first nationwide family study to explore the difference between the two main subtypes of bipolar disorder. Dr. Song and colleagues analyzed the occurrence of the bipolar disorder subtypes in families from the Swedish national registers. Although a strong genetic correlation between bipolar I and bipolar II disorder suggests that they are not completely different, the family occurrence for each subtype was stronger than co-occurrence between the subtypes, indicating that bipolar I and bipolar II disorders tend to “run” in families separately, rather than occurring together.

“Within the context of our emerging appreciation of polygenic risk, where gene variations are implicated in several disorders, the new findings point to only partial overlap in the risk mechanisms for these two forms of bipolar disorder,” said Dr. Krystal.

The study also provided some additional clues that bipolar I and II disorders have distinct origins. Only bipolar disorder II showed gender differences—the proportion of females to males was higher in bipolar disorder II but not bipolar disorder I. And bipolar I clustered together in families with schizophrenia, which was not apparent for bipolar disorder II.

“Hopefully, our findings increase awareness of the need for refined distinctions between subtypes of mood disorder,” said Dr. Song. The distinction between the subtypes also has implications for treatment strategies for patients. Dr. Song added that future research is warranted to characterize new biomarkers to improve treatment and prognosis.

Text provided by Elsevier.

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