Depression and Bipolar info explaining the latest research in everyday English


Effects of alcohol on Bipolar Disorder

Water's Edge. Copyright Lee Hopkins

An interesting article from out of the Netherlands on the effects or otherwise (there’s a clue) of alcohol on mood state, in particular looking to see if excessive drinking leads to excessive mood states.

Previous research has shown a link between heavy drinking and onset of either depression (in women) or mania (in men). But this research was novel in that it followed up with research participants every day for a year, so it could see if increased drinking led to an adverse effect (depression or mania).

It turns out the effect is limited — AS LONG AS you stick to your medication. The participants in this study (137; 66% Bipolar I, 34% Bipolar II) all stuck to their medications and the effects of their drinking was limited.

But what wasn’t able to be determined was whether increased drinking led to minor depression or hypomania — the study hadn’t been designed for such eventualities. Something for a repeat study to consider, perhaps.

So the message is clear — ensure you stick to your medications and the likelihood of excessive drinking bringing a full-on adverse reaction are reduced.


van Zaane J, van de Ven PM, Draisma S, Smit JH, Nolen WA, van den Brink W. (2014). Effect of alcohol use on the course of bipolar disorder: one-year follow-up study using the daily prospective Life Chart method. Bipolar Disorders 2014: 16: 400–409

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Bipolar in the new DSM-5

Windpump. Copyright Lee Hopkins 2015

The DSM-5 sees greater clarity in how Bipolar Disorder is viewed. There is now less risk of seeing oneself put in a vague NOS ‘not otherwise specified’ group, and several new subthreshold groups of depression, bipolar disorders and mixed states are now operationally defined.

These subthreshold groups will stimulate research and allow for a more dimensional view of Bipolar Disorder and Depression. For depression, for example, recurrent brief depression and even short-duration depressive episodes (4 to 13 days), as well as 2-week episodes with insufficient symptoms, now have their place.

But, for no apparent reason, DSM-5 classifies some patients as having subthreshold bipolar disorders who would formerly have been diagnosed with manic episodes or bipolar I or II disorders.

It is estimated that DSM-5 bipolar II disorder will be diagnosed about twice as often as it has previously been and will have a prevalence approaching that of bipolar I. A more frequent diagnosis of bipolar II disorder is both justified and logical: a milder condition (in this case hypomania) is usually more prevalent than a severe one (mania). Over the long-term course of their illness, bipolar patients spend much more time in milder conditions, mainly minor depression, than in major syndromes (Phillips and Kupfer 2013).

Overall, then, the growth of bipolar II disorder into a disorder recognised in its own right, rather than a ‘lite’ version of bipolar I disorder, will continue.


Angst, J. 2013. Bipolar disorders in DSM-5: strengths, problems and perspectives. International Journal of Bipolar Disorders 2013, 1:12

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Bipolar disorder from the clinician’s perspective

I recently came across this great video by Dr. Jeffrey Applebaum, a Family Medicine physician at UC Davis in the USA. He provides a cool, calm look at Bipolar Disorder and seems to 'get it'. Well worth the watch.

Depression from the clinician\'s perspective


I’m back

Apologies for being away for so long, but the bipolar took hold of me and threw me around a fair bit in the last nine months. Please expect more regular updates now.

Also, I want to let you know that I've just launched a sister site to this one,, where you will find books and dvds hand-picked to help you care for yourself or for those you love who suffer from this evil disease. Please feel free to visit the site often, as I'll be updating the information on there regularly.

Thanks for still being around,

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When to suspect bipolar disorder

The Journal of Family Practice has a useful practitioner’s guide to identifying when a patient may be presenting with bipolar disorder symptoms.

As the authors say, bipolar disease is often misdiagnosed, sometimes repeatedly.

The authors—Muruga Loganathan, MD, Kavita Lohano, MD, R. Jeanie Roberts, MD, Yonglin Gao, MD, and Rif S. El-Mallakh, MD—report that close to one-third of patients with bipolar disorder seek medical care within a year of the onset of symptoms, but nearly 70% do not receive an accurate diagnosis until they’ve seen four physicians.

The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) defines 4 types of bipolar illness: bipolar I, bipolar II, cyclothymia (the most mild form), and not otherwise specified The key feature of all 4 types—and the distinguishing characteristic that diagnosis typically hinges on—is a manic or hypomanic episode.

Although a full-blown manic episode may not be hard to identify, hypomania is easily missed. By definition, hypomania—with its heightened sense of well-being and productivity—is not problematic and is rarely a patient’s primary complaint.

Mixed mania, a feature of bipolar I, is the worst of both worlds: It is a state in which a full manic episode is superimposed on a full depressive episode—a depression with all the energy and force of a mania. Patients who have experienced one episode of mixed mania have a 12-fold increase in mixed states, 6.5 times more depression, and 1.7 times more dysthymia than those who experience manic episodes without the overlay of depression.

I and countless others can attest as to how horrible it is.

The authors recommend using the Mood Disorder Questionnaire (MDQ) constructed by Hirschfeld et al. as a useful guide to bipolar disorder identification. There’s a copy of the MDQ in the JFP’s article, as well as the original source article.

If you or someone you know is wondering if they might have bipolar disorder (and one psychiatrist I know of is convinced that all ‘depressive’ patients have an element of mania within their history and should therefore be considered in a new, bipolar, light) then ask their GP to administer the MDQ, or refer them to someone who can.

It could be the help they need to get them on the path to managing their illness appropriately.


Hirschfeld RM, Williams JB, Spitzer RL, et al. Development and validation of a screening instrument for bipolar spectrum disorder: the Mood Disorder Questionnaire. Am J Psychiatry.

Loganathan, Muruga; Lohano, Kavita; Roberts, R. Jeanie; Yonglin Gao; El-Mallakh, Rif S.  When to suspect bipolar disorder. Journal of Family Practice, Dec2010, Vol. 59 Issue 12, p682-688, 7p

Please see our medical disclaimer.


Today is World Suicide Day

World Suicide Prevention Day is observed on September 10 each year to promote worldwide action to prevent suicides. Various events and activities are held during this occasion to raise awareness that suicide is a major preventable cause of premature death.

One hand holding another hand.
World Suicide Prevention Day promotes issues such as suicide prevention. This photo is used for illustrative purposes only. It does not imply the attitudes, behaviour or actions of the models used for this photo. © Casarsa

Nearly 3000 people on average commit suicide daily, according to the World Health Organization. For every person who completes a suicide, 20 or more may attempt to end their lives. About one million people die by suicide each year. Suicide is a major preventable cause of premature death which is influenced by psycho-social, cultural and environmental risk factors that can be prevented through worldwide responses that address these main risk factors. There is strong evidence indicating that adequate prevention can reduce suicide rates.

World Suicide Prevention Day, which first started in 2003, is annually held on September 10 each year as an IASP initiative. The World Health Organization co-sponsors this event. World Suicide Prevention Day aims to:

  • Raise awareness that suicide is preventable.
  • Improve education about suicide.
  • Spread information about suicide awareness.
  • Decrease stigmatization regarding suicide.

In Australia our annual toll of deaths by suicide is greater than the number of deaths on our roads, yet we only hear about the road toll. Mental health organisations are making slow but steady inroads into the macho culture of Australia and getting politicians and fund holders to realise that reducing the mental health burden of our country is good for our country’s health – fiscal, physical and mental.

There are plenty of places to go if you think you or someone you know might be in need of help to cope with anxiety, depression of suicidal thoughts. Try any of these:

  • Lifeline Australia – tel 13 11 14
  • Kids Helpline - 1800 55 1800
  • Suicide Line (only in Victoria, Australia) – 1300 651 251
  • SANE Australia – 1800 18 SANE (7263)


A review of findings from the world’s largest study of Bipolar Disorder

The Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) ran from 1998 to 2005, with over 4,000 sufferers of Bipolar Disorder (BD) taking part in various trials and assessments over a two-year period.

Researchers were looking at how BD progresses through a person's life, how related it is to other psychiatric disorders, and how related it is to suicidality.

It found that few treatments alone were successful in treating BD, however psycho-social interventions (such as Cognitive Behaviour Therapy) and psycho-education interventions combined with mood stabilizers showed the most positive results.

BD was also shown to be strongly related to substance abuse and smoking, both of which affected the success or otherwise of chemical and psychological treatments.

Interestingly, paroxetine or bupropion were shown to be no more effective than a placebo in achieving sustained recovery (in this instance, determined as eight weeks of 'stable' behavior). So, too, were lamotrigine, risperidone, and inositol found to deliver minimal positive effects.

To the vexed, 'hidden', taboo subject of suicide -- the 'S' word not spoken of by the media (although thankfully that is slowly changing, at least in Australia). Suicidality persists with BD, even when treatment outcomes are good. The biggest predictor of suicidality being previous attempts.

The authors' conclusions
The authors of this review paper note seven contributions of the STEP-BD program:

1. Antidepressants remain poorly effective in treating BD;

2. BD is particularly disabling (tell me about it), and frequently doesn't respond to medications;

3. BD does respond modestly to intensive psycho-social interventions;

4. Other psychiatric disorders are common and destabilizing, yet anxiety disorders and smoking are able to be treated and when treated positively impact on BD;

5. An early age on onset of BD usually results in a more severe course of the illness, but rapid-cycling usually diminishes;

6. The sub-syndrome of Depression may be so strong as to mask the manic pole of BD, therefore careful symptom appraisal by psychiatrists is essential;

7. Suicidal thoughts persist in BD sufferers, and a previous attempt is a good indicator of a future event. However, by reducing feelings of 'hopelessness' in particular, there is the possibility of reducing the risk of suicide.


Source: Parikh, S.V., LeBlanc, S.R., & Ovanessian, M.M. 2010. Advancing Bipolar Disorder: Key Lessons From the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD). The Canadian Journal of Psychiatry, Vol. 55, No 3, p.p. 136-143.


Please see our medical disclaimer.


Creativity in Bipolar Disorder – are we all geniuses?

Actually, no. Sorry to burst a bubble.

It’s a good myth – that Bipolar Disorder (BD) sufferers are creative types that can burn the midnight candle and produce work that changes the world. Unfortunately, too much clinical evidence exists that points out extreme mania in BD is actually counter-productive to creative output. You might be outputting lots of work, but the quality is probably less than you would accept in normal circumstances.

Greg Murray and Sheri L. Johnson have reviewed the medical literature on BD and creativity and give us some interesting results:

  • Only 8-10% of BD sufferers can be considered ‘creative’ (put down that brush, Eugene);
  • There is an association between the psychological trait of ‘openness to new experiences’ (O) and BD, as there is with ‘psychoticism’ (P), suggesting that not only are BD sufferers more likely to be impulsive and take risks in order to do something different, but they are also more likely than the general populace to occasionally lace their impulsivity with a disregard for others;
  • If you suffer from BD and are strongly extrovert, you may well be drawn to the performance arts if you do have that creative bent;
  • Many of the creative professions can be counter-productive to the mental wellbeing of sufferers, because of disruption of sleeping patterns, irregular activity/work patterns, exposure to alcohol and narcotics, challenges to goals that are often set extremely high, an unusually strong identification with one’s occupation that allows no other income/lifestyle choice, and increased reinforcement of emotional sensitivity.

So what hope is there for creative types who have BD? Murray and Johnson suggest that we:

  • Continue our medication regime;
  • Where possible, limit the amount of travel, especially across time zones;
  • Find a psychoeducation program that will help us recognise our symptoms of mania and depression, recognise the triggers behind them and help us discover what we can do for ourselves to keep ourselves more stable;
  • Consider Interpersonal and Social Rhythm Therapy if our schedules involve intense sleep disruption or travel;
  • Consider signing up for a Cognitive Behavioural Therapy (CBT) course that will allow us to examine our thoughts and re-appraise unproductive core beliefs; and finally
  • Get some Family Focused Therapy so that we and our families can work together to manage our illness and its expression (especially because creativity seems to run in families and just because one member of the family has BD doesn’t mean that they’re alone).

Source: Murray, G. & Johnson, S.L. 2010 The clinical significance of creativity in bipolar disorder. Clinical Psychology Review 30(2010), pp.721-732

Please see our medical disclaimer.



Psychoeducation intervention for bipolar sufferers

I recently completed a 10-session therapy course for bipolar suffers and can attest to the help that such courses can offer.

The course first looked at the causes of bipolar disorder, what medical treatments are available, then moved on to the individual experiences involved, including identifying triggers and relief behaviours.

Each of the sessions lasted for three hours, including a mid-session tea/coffee break, and comprised not only individual self-assessment exercises but also group discussions where we shared our experiences – the frustrations and the benefits – of our bipolar lives.

I’m sure you can understand that the ‘frustrations’ far outweighed the ‘benefits’.

But even after only 12 weeks after the end of the course I find it difficult to remember any of the material we explored, suggesting that repeat, follow-up sessions would be advantageous. Naturally, no such sessions exist because there’s no funding for them in the Australian mental health system.

Emily Griffiths and David Smith from the department of psychological medicine at the University Hospital of Wales have briefly outlined in Mental Health Practice some of the findings their own research has uncovered into psychoeducation.

Psychoeducation, they say:

involves providing clients and their families with accurate and reliable information about their diagnosis to empower them to better manage their illness.

In the course I attended there was no space for family members, nor do I think they would have been invited – self-disclosure amongst peers is fraught enough with risk; disclosing our experience of our illness to non-sufferers would have potentially generated emotional responses no one would have welcomed. As it was, of the two facilitators our group had only one was a psychologist; the mental health-trained nurse seemed less flexible and less able to comprehend – other than academically/intellectually – our psychic pain.

Griffith & Smith’s group sessions involve:

  • Introduction
  • Diagnosis of bipolar disorder
  • Causes of bipolar disorder
  • Rôle of medication
  • Rôle of lifestyle changes
  • Relapse prevention and early intervention
  • Psychological approaches
  • Women and bipolar disorder
  • Advice for family and carers
  • Conclusions

They go on to point out that the mood disorders research team at their department has developed an online interactive psychoeducational tool for bipolar disorder, currently undergoing clinical trial with a view to becoming a cost-effective way of delivering high quality education to large numbers of bipolar sufferers. You can find the tool at

You can also find out more about the Hospital’s bipolar programme at

Source: Griffiths, S. & Smith, D. 2010. Psychoeducation intervention for people with bipolar disorder. Mental Health Practice, 13, 9, pp. 22-23.


Social Media panel at VicServ 2010 conference

I was fortunate to be a panellist at the VicServ conference, “Unfinished Business”, discussing the use and potential of social media with relation to mental ill health services in Australia.

  • Factoid from Professor Patrick McGorry (Australian of the Year) that seemed to generate a lot of discussion: Each year about 40 MCG Stadiums full of people require some sort of mental ill health service, yet only 13 MCGs will receive help of any kind.

On the panel with me were Michelle Blanchard of Inspire, Tim Reid, Joanne Spain and the panel organiser Janet Hopkins (no relation), the CEO of Lantern (formerly ‘ReachOut’).

Here’s the recording of our panel:

And here’s some photos:

The panel
The panel
Joanne Spain and Lee Hopkins
Joanne Spain and Lee Hopkins
Janet Hopkins
Janet Hopkins
Tim Reid
Tim Reid
Joanne Spain
Joanne Spain
Tim Reid and Michelle Blanchard
Tim Reid and Michelle Blanchard

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