The sad news that actress Catherine Zeta-Jones was hospitalized this week for treatment of her bipolar depression puts the spotlight on a condition that affects some 4 percent of Americans at some point during their lifetime. With regards to Zeta-Jones, no doubt her stressful life circumstances -- her husband's battle with advanced throat cancer and recent court fight with his first wife over movie proceeds -- put her at higher likelihood of getting the telltale mood swings if she already had a genetic susceptibility.
"It's where nature meets nurture," explains Dr. Jane Erb, a psychiatrist at Brigham and Women's Hospital Outpatient Psychiatry Clinic. "Psychological stressors can be translated into a physiological brain disorder if there's a genetic predisposition."
Some news reports have speculated that the actress may have been exhibiting manic symptoms when she accepted her Tony award last June for her role in the Broadway musical, A Little Night Music. At the end of her speech, shown in the video above, she points to her husband and gushes about him being a movie star and that she gets to "sleep with him every night." She later expressed regret at her "crass" remarks, according to this article.
Zeta-Jones has been diagnosed with bipolar II disorder, according to her spokeswoman, which Erb says is distinguished from bipolar I by the milder form of its mania. "The highs are in the realm of clearly heightened energy and productivity where a person may blurt out things that she later regrets."
Unlike bipolar I, the mania doesn't involve outrageously inappropriate acts, Erb explains, like disrobing in a crowded airport, maxing out all the credit cards, or standing on a sidewalk and preaching about the end of the world.
"The degree of inappropriate behavior isn't nearly so extreme," she adds.
What usually brings a bipolar II patient in for treatment is the deep despair that can make it tough to get out of bed, go to work, or interact with family and friends. I was surprised to learn, though, how tough the depression can be to treat.
The drug lithium -- which is the first drug of choice for bipolar disorder -- isn't sufficient for most patients, Erb tells me. "But there's ongoing controversy over how effective antidepressants are in terms of their durability," she adds. "The drugs may provide partial relief at first before they poop out down the road."
The anti-seizure drug lamotrigine appears to be more effective over the long haul, she says, at least for some patients.
Above all, though, patients need to stick with a routine to prevent relapses. "They should really try to be consistent with their behavior," recommends Dr. Ofra Sarid-Segal, a psychiatrist at Boston Medical Center, "getting up and going to bed at the same time each day, keeping a steady diet, and not taking on too much."
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