Susan Kilbride Roper suffered silently for decades with depression and extreme periods of manic behavior and, at one point, turned to alcohol to self-medicate her fluctuating moods. Eventually, she was diagnosed with bipolar I disorder and was able to get the help she needed to turn her life around — thanks in large part to the QEII’s Mood Disorders Clinic. Susan credits a nurse at the clinic with helping to save her marriage early on in her treatment.
“To have a team to treat this complex illness is so important, ” says Susan, who works in mental health promotion. She founded and helps co-ordinate a Halifax peer-support group for people living with the disorder.
Bipolar disorder, formerly known as manic depression, is a debilitating psychiatric condition characterized by abnormal shifts in energy, activity levels and mood. In Canada, bipolar I disorder affects about one per cent of the population, while bipolar II disorder affects between one and two per cent. Given its prevalence, the illness is a significant public health issue in Canada.
At the QEII’s Mood Disorders Clinic, patients with bipolar I and II disorder, as well as people with severe depression that is recurrent or treatment-resistant, and those with a family history of bipolarity or suicide, are treated by a team of specialized healthcare professionals. Severe depression, which affects between three and five per cent of Canadians, is also a debilitating illness.
“Bipolar and depression disorders carry a high risk of suicide,” says Dr. Martin Alda, one of four psychiatrists working in the clinic. The clinic, which includes a social worker, two nurses and psychologist, receives up to 400 referrals a year from doctors seeking a diagnosis or a treatment consultation for their patients. The clinic also regularly monitors about 500 patients over the long-term to ensure they are receiving the best possible care. In addition, it runs the Maritime Bipolar Registry, a voluntary registry that acts as a resource for those looking for information about bipolar disorder and invites interested people to participate in research projects.
“People come to treatment after a considerable delay,” says Dr. Alda.
Research from Canada and the United States shows it typically takes a decade for a person experiencing the first symptoms of the disorder to be diagnosed. “A lot of people with bipolar are initially misdiagnosed,” says Dr. Alda.
Like Susan, many people with bipolar disorder initially think they are suffering from a minor depression and delay seeking help. Instead, they often turn to alcohol and illegal drugs to self-medicate their symptoms and may be misdiagnosed with a substance use disorder.
Left untreated, a person with the disorder can lose as much as a decade of productive life. While depression is among the leading causes of disability in the workforce, bipolar disorder ranks sixth, says Dr. Alda. Both conditions also carry increased risk of suicide, cardiovascular disease, diabetes and thyroid problems.
Research is essential to a better understanding of the disorder and treatment options. Dr. Alda, a clinician scientist, is interested in the role that genes play in pre-determining bipolar disorders, which have been shown to have a strong, but complex genetic link.
“We know that if you have a family member with bipolar disorder, you are at significantly higher risk of developing the disorder,” he says. “We are interested in coming up with ways to diagnose and see the risk of the illness early.”
One area he is looking at is genetic risks and whether certain genetic factors affect how someone responds to drug treatment, such as how well they respond to the drug lithium. Lithium is considered the gold standard for people with bipolar disorder and has an anti-suicide effect, says Dr. Alda.
For example, if a person has a close relative who did well on lithium, Dr. Alda’s research has found that the person would have a four times higher chance of responding well to the drug than someone chosen at random.
Being a participant in Dr. Alda’s research has been an additional bonus for Susan. “I like that way of helping to better the care of people living with bipolar disorder,” she says.
“Mood disorders are one area in psychiatry where you can make a difference — where you can often help people get really well,” says Dr. Alda.