John Preston, PsyD
Untreated or inadequately treated bipolar disorder (BD) has been shown to cause significant health risks.
Top of the list is vascular disease (leading to heart attacks or strokes). The risk of death from these disorders in BD patients is twice that seen in age matched peers that do not have BD. The main culprit appears to be toxic levels of the hormone cortisol seen during depressive episodes. This is called “hypercortisolemia”. Chronic high levels of cortisol scar the interior walls of arteries and play a role in developing atherosclerosis (what used to be called hardening of the arteries). Over a period of many years this can take a significant toll and set the stage for heart attacks and strokes.Other disorders that are caused by or intensified by BD hormonal changes are: osteoporosis, respiratory diseases and infections. Once again, chronic, high levels of cortisol cause immuno -suppression. This can lead to poor immune responses to infections such as the flu or a cold. But also immuno-suppression is dangerous if a person develops a severe infection such as pneumonia. The rates of death from infections are 3 times the number compared to those who do not have BD. Hypercortisolemia also has been shown to cause brain damage. This is seen in untreated or inadequately treated BD. It does not affect the brain globally. Rather it selectively damages parts of the frontal lobe (anterior cingulate) and the hippocampus. Both of these brain structures play a crucial role in regulating emotion. With significant and progressive damage, this leads to more severe BD symptoms. Also damage to the hippocampus can result in memory problems. Fortunately some bipolar medications can protect and help to repair some of this damage (especially in the hippocampus). The drugs that do this are: lithium, Tegretol, Depakote, Lamictal, and Seroquel. All of these drugs increase BDNF: a protective protein.
Migraine headaches, obesity, and type II diabetes are also 3 times more common in BD. To complicate matters, 2/3 rds of the drugs used to treat BD can cause significant weight gain that contributes to obesity and type II diabetes.All of the aforementioned disorders are significantly less common in people who receive adequate treatments for BD.