Pauley's Book: Steroid Treatment, Antidepressants Unmasked Mood-Swing Illness
Treatment with steroids and antidepressants unmasked Jane Pauley's bipolar disorder, the TV news personality reveals in her new autobiography.
Drug treatments do not cause bipolar disorder, according to experts. But they can make the symptoms much worse. And this may be the first time people with the disorder find out they have the mental illness.
Fortunately, USA Today reports, Pauley says treatment with lithium keeps her symptoms under control. But in the spring of 2001, Pauley writes, she spent three weeks in a New York psychiatric hospital.
"I mourned 'Janie,' the person I had thought I was - the 'most normal girl on TV' - the girl who never was," Pauley writes in Skywriting: A Life Out of the Blue. An excerpt from the book, scheduled for release later this month, is available on the Barnes & Noble web site.
Bipolar disorder is a serious psychiatric disease, once known as manic-depressive disorder. It greatly increases a person's risk of suicide, says Charles Raison, MD, assistant professor of psychiatry and behavioral science at Atlanta's Emory University.
The illness may begin with either a depression or a manic episode. This may be followed years later by another episode, either of depression or of mania. Left untreated, the interval between these mood swings gets shorter and shorter. A particularly bad sign is called "rapid cycling," in which a person has four or more mood swings in a single year.
"These people become less responsive to treatment and more disabled in their lives," says Raison. "One month they are full of energy and making all kinds of unrealistic plans. The next month they can't get out of bed and all their plans are dashed. It is devastating to a person's life. It's more common in women, more common to see what we call 'bipolar II disorder,' characterized by depression and minor manias."
How can such a serious illness go undiagnosed? Raison says that many patients suffer "hypomania" during their manic swings. This may be experienced as irritability or as a euphoric, energetic "high."
A Case of Hives
Pauley writes that her bipolar diagnosis came a year after treatment for a bad case of hives. Doctors treated her with steroids, often used to relieve the painful swelling and itching of this allergic skin condition.
After her first steroid treatment, Pauley says she was "revved." But a second treatment left her depressed. Treatment with antidepressants threw her into a manic state. At age 50 -- a year after her first treatment for hives -- Pauley was diagnosed as having bipolar disorder.
"It is unusual to be diagnosed with bipolar disorder so late in life," Raison says. "Fifty is definitely old, but the average time from a first episode of bipolar disorder to a correct diagnosis averages eight to 10 years. So most people are not diagnosed, or are diagnosed with unipolar depression. This is more likely for women, who are more likely to have their first episode of bipolar disorder as depression."
And when bipolar disorder goes unrecognized, an experience like Pauley's is not uncommon.
"There is no doubt that steroids can make people manic," Raison says. "Sometimes they make people depressed, sometimes they make people irritable and wired, and sometimes they make them euphorically manic. ... It is not just steroids, but antidepressants, too. All of us in psychiatry have seen first-episode mania after putting a person on antidepressants. Most people with antidepressant-induced mania will go on to have the disease spontaneously generate itself in future mood swings. Whether it is just a canary in the coal mine signaling a person's vulnerability, or whether the drugs cause harm, is not known."
That's why it's important for doctors to find out whether a patient's depression is bipolar before putting them on antidepressants, says Dorothy K.Y. Sit, MD, assistant professor at the University of Pittsburgh's Western Psychiatric Institute and Women's Behavioral Health Care clinic.
"If we have a patient who has, in fact, an [unrecognized] underlying bipolar disorder, the patient is treated with a single agent antidepressant without properly addressing the bipolar component of the illness," Sit says. "It may help at first. But the risk is we can induce not just mania but mixed mania with symptoms of both mania and depression."
Multiple Treatments Available
Lithium -- to which Pauley is reported to be responding -- is the initial treatment for bipolar disorder. If patients can tolerate the drug, it can exert a powerful mood-stabilizing effect. It works for up to half of all patients with bipolar disorder, Sit says.
Some patients may get better results with valproate than with lithium.
Controlling manic episodes often requires another drug. For this, the seizure drug Depakote can be useful. Recently, doctors have begun to prescribe a class of drugs known as atypical antipsychotics: Zyprexa, Abilify, Risperidal, and Geodon.
"They started as anti-schizophrenia treatments but now appear to work very well for bipolar disorder," Raison says. "And they work very well for acute manias and for maintenance. They all have different side effect profiles. So there is a growing armamentarium of useful agents."
After getting psychiatric drugs, patients generally benefit from psychotherapy to help manage the illness and associated difficulties.
The important thing is for people with bipolar disorder to get diagnosed and treated. There's no cure for bipolar disorder, so patients must remain on treatment for the rest of their lives.
"The most important thing is finding a treatment that works, one you can tolerate, that you can commit to taking for an extended period," Raison says. "It is like diabetes. If you want to avoid these devastating episodes, you will be on these drugs for an indefinite period. It is a lifetime condition. And as a person gets older, there is a tendency to have more episodes, with more depressions and fewer manias. It is a bad deal. And there is growing social dysfunction. If left untreated, bipolar disorder causes alterations in the brain not conducive to optimal functioning in life. So it is important to find a drug that works and that one can stay on."