Depression and Bipolar info explaining the latest research in everyday English


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.


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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

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