Untreated Bipolar Disorder

Apparently, the biggest reason for bipolar people to not take their meds is Anosognosia, or being unaware they (we!) have an illness. It comes into play when an episode happens.

… anosognosia is thought to be caused by damage to the brain, particularly the frontal and parietal lobes of the brain’s right hemisphere. The right hemisphere of the brain controls thinking skills, and damage can result in a number of problems, including difficulty with reasoning and problem solving.

From my initial reading, I gathered that the most serious consequences of not being treatment compliant were rampant episodes plus an increased chance of suicide, but there’s a whole lot more. Basically it boils down to the fact that dear old bipolar (insert hollow laugh here) can be progressive.

The consequences of untreated bipolar disorder:

Future manic and depressive episodes will be harder to prevent.
The disease can worsen with time without consistent treatment, meaning that the intensity and frequency of manic and depressive episodes will continue to increase over a person’s lifetime.
Most likely it will be harder to function consistently in various areas of your life, such as school, work, family and peer relationships, or participation in extra-curricular activities without continued treatment.

No meds means a doubled chance of episodes, an increase of depressive over manic episodes and the possibility of developing rapid cycling bipolar disorder. source

I also posted info recently, about the increased health risks and brain damage associated with bipolar, all of which can occur unchecked if medication is not used. The fact that stuck with me most is that it shrinks the hippocampus (see image).

It used to be thought that if you had bipolar disorder, you would return to normal in between mood swings. We now know that this is not so for many people with bipolar disorder. You may continue to experience mild depressive symptoms and problems in thinking even when you seem to be better. more

Natasha Tracy, as ever, has a quality post. This one is about treating bipolar without meds.

See also Taking or not taking medications: psychiatric treatment perceptions in patients diagnosed with bipolar disorder.

Physical Effects of Bipolar

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.

Psychiatrist Appointment

My diagnosis shifted from bdii to bipolar I with mixed episodes today. Citalopram switched to zoloft, so I can take higher doses. Lithium will go up to 1.2

So goddamn shit being alone for this.

We can stop saying mental illness

Neurobiological disorder: An illness of the nervous system caused by genetic, metabolic, or other biological factors. Many illnesses categorized as psychiatric disorders are neurobiological, including autism, bipolar disorders, obsessive-compulsive disorders, schizophrenia, and Tourette syndrome.

Take Your Damn Meds

By the time I was diagnosed with bipolar, I was already meds compliant, having been treated for PTSD and depression for a couple of decades. The more I read about bipolar, the more sure I am that obediently swallowing pills (I have a psychiatrist I trust), is essential.

I rounded up some quotes about being bipolar and taking your meds.

I take my meds. Number one, two, three, four and five is that I take my medication.
Marya Hornbacher

Love is not enough. It takes courage to grab my father’s demon, my own, or – God help me – my child’s and strap it down and stop its mad jig; to sit in a row of white rooms filled with pills and clubbed dreamers and shout: stop smiling, shut up; shut up and stop laughing; you’re sitting in hell. Stop preaching; stop weeping. You are a manic-depressive, always. your life is larger than most, unimaginable. You’re blessed; just admit it and take the damn pill.
David Lovelace

Every pore of you is crying and you don’t even understand why or what. I actually kind of died and got born again as a result of taking the meds and having a chance to, you know, build a life.”
Sinéad O’Connor

“Suddenly I wanted to get better. Mania wasn’t fun anymore. It wasn’t creative or visionary. It was mean parody at best, a cheap chemical trick. I needed to stop and get better. I’d take whatever they gave me, I pledged silently. I’d take Trilafon or Thorazine or whatever. I just wanted to sleep.”
David Lovelace

There were a few things scarier than a bipolar vampire off his meds, but to be honest, not that many.

Rachel Caine, Daylighters (The Morganville Vampires, #15)