July 27, 2008

Expert: Bipolar Disorder Often Unrecognized

By Christine Phelan, The Sun, Lowell, Mass.

Jul. 27--The announcement that state Sen. J. James Marzilli Jr. suffers from bipolar disorder, following his arrest, has some shaking their heads in bewilderment, some in disgust.

But not psychiatrist Gary Sachs, who directs Massachusetts General Hospital's Bipolar Clinic and Research Program. For Sachs, Marzilli's erratic behavior during his June 3 visit to Lowell -- during which he was accused of accosting four women in as many hours, followed by a foot chase and ultimately his arrest in a city parking garage -- is well within the boundaries of the disease that affects some 9 million Americans.

"It's an equal-opportunity condition," Sachs said, noting that the average age of onset is ages 15 to 19, and that half of his clinic's patients are 18 or younger.

Marzilli faces two court hearings this week. Tomorrow, he will be in Lowell Superior Court for a hearing into charges lodged in the downtown Lowell incidents. On Thursday, he faces another hearing in Middlesex Superior Court in Woburn, on a civil complaint filed by three women who say they were harassed by Marzilli in other incidents.

Following his arrest, Marzilli was admitted to McLean Hospital, a psychiatric hospital in Belmont. His attorney said Marzilli was diagnosed with bipolar disorder.

"Jane," a Massachusetts Trial Court employee who did not want her real name used, said she was diagnosed as bipolar about seven years ago at age 35, but had been diagnosed years earlier as suffering from

either depression or manic episodes depending on the phase she was in.

Jane, who is married and has always maintained employment, is now being treated by drugs and therapy to level her moods.

What she doesn't understand is how Marzilli, who as a politician leads a very public life, could show no signs of the disorder until age 50.

"I never did anything crazy, but If you talked to anyone who knows me, they would tell you they knew something was wrong from early on," Jane said.

Sachs said, "There are people who've had episodes that've gone undetected, and those that have their first episode later in life. I don't know Sen. Marzilli, but the kind of multiple incidents where he was using very poor judgment, that is something that, during an episode, is a common symptom. There's no doubt about that."

While just under 3 percent of Americans have bipolar disorder, Sachs said fewer than one in three cases are recognized, despite reliable methods to diagnose the disease. And because it's so often diagnosed in tandem with other mental illnesses, like depression and anxiety disorder, early treatment is critical.

Bipolar patients on average live dramatically briefer lives -- sometimes by as much as two decades -- due to alcohol and drug abuse, or suicide.

Bipolar disorder is characterized by dramatic and uncontrollable shifts in mood, ranging from euphoric highs to, more frequently, debilitating depressive episodes. While its exact origins are unknown, major emotional events -- like death or divorce -- can ignite bipolar mania, as can an overabundance of the stress hormone cortisol, produced by the adrenal gland, and even bodily inflammation, both of which may affect brain circuitry, Sachs said.

Biological stressors of an episode -- especially the lack of sleep -- can exacerbate the intensity of an existing episode.

Treatment usually involves both drugs and talk therapy.

But what makes bipolar disorder -- previously called manic depression -- distinct is patients' almost incredible disconnect with reality, Sachs said.

"With depression, we don't appreciate what is missing: the capacity to experience pleasure," he explained. "But when we get to mood elevation, it's the opposite -- we don't appreciate the downside of anything. You can't make perceptions accurately. It's a kind of colorblindness. You can't see those red lights, and you're going to get a lot of tickets if you get caught."

And while there's intense debate about over-diagnosis, Sachs said there is a larger issue.

"We do have reliable ways to make diagnoses," Sachs said. "But there are a lot of inaccurate diagnoses, we miss cases, or we conclude that because we saw one or another star that the whole dipper is there. We have an absolute duty to our patient to give them a systematic diagnosis."

Sun reporter Lisa Redmond contributed to this story.


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