Jane Pauley Discloses Bipolar Disorder

Pauley's Book: Steroid Treatment, Antidepressants Unmasked Mood-Swing Illness..

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"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, Risperdal, 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.

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"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."

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