Getting Older With Bipolar
|George Hofmann||Mar 3|
Here’s the latest from Practicing Mental Illness:
Mood disorders pose unique challenges for people over 40. Issues with family and work can affect the treatment and outcome of a person’s health and wellness, and physical diseases begin to disrupt, and possibly inhibit, one’s quality of life.
I’ve started a support group called Getting Older With Bipolar that meets on Zoom every Thursday to discuss these and other issues that impact our lives. Community is key to healing, as is the opportunity to discuss and share experiences with other people facing similar challenges in life.
For more about the group, or if you have any questions, email me at firstname.lastname@example.org
Mood Disorders and Physical Diseases
Mood disorders are comorbid with many physical diseases. A team of researchers set out to determine which comorbidities, or co-occurring illnesses, seemed uniquely linked to psychiatric conditions such as bipolar disorder and major depression.
Much has been written about the link between mood disorders and cardiac disease, hypertension and diabetes. These seem to strike men with bipolar disorder at high rates.
Yet these diseases are heavily influenced by lifestyle, and people with bipolar disorder (BP) are disproportionally overweight, lead sedentary lives and smoke and drink a lot. Its no wonder lifestyle-based diseases occur commonly in those with BP.
A research study from Australia specifically controlled for age, socioeconomic status, and health risk factors (body mass index, physical activity and smoking) in an effort to see beyond these factors and determine if any physical disease occurred along with Bipolar Disorder at significant rates, regardless of lifestyle.
The study looked at men aged 20 to 97.
The study found no elevated risk of common lifestyle diseases in men with BP. The high occurrence of these diseases was attributable to poor lifestyle and socio-economic factors, not psychiatric diagnoses.
However, they did find that two types of diseases were unusually common in men with BP, and appear to be directly linked to the mood disorder:
Gastrointestinal disease and musculoskeletal disease.
This struck me, because I have both.
Gastro-intestinal disease includes GERD, irritable bowel syndrome, pancreatitis and celiac disease. The link between BP and celiac disease is especially strong.
Musculoskeletal conditions include rheumatoid arthritis and osteoporosis.
What is striking is that many of these comorbidities are autoimmune diseases or are caused or aggravated by inflammation. The role of these factors in the development of BP is cutting edge research and medicine, and its many studies, are beginning to suggest that, for many, bipolar disorder may itself be an autoimmune disease.
Mainstream psychiatry is resistant to this idea, but evidence from immunology is building. These comorbidities may provide some insight to the debate.
The study also found high rates of chronic headaches and, in men over 60, pulmonary disease in the study group with BP. These diseases, too, have roots in inflammation.
Mind/body medicine has long made the case that diseases of the mind are inextricably linked to physical diseases. There is increasing evidence that these diseases are bi-directional, meaning they occur together as opposed to one causing the other.
It’s encouraging that science is beginning to shed so much light on the mind/body connection, and that research on bipolar disorder is at the forefront of this science.
Surely, more accurate diagnoses and more effective treatment will be the result.
Mental Illness and Arthritis
Studies reveal that people with rheumatoid arthritis are at a greater risk of developing bipolar disorder than the general population. Specifics vary across studies, as does conjecture about the cause, but an analysis of several research filings state that people with RA are nearly 3 times more likely to have bipolar disorder.
Many researchers surmise that inflammation is the cause.
RA is an autoimmune disorder, and neurologists are beginning to believe that even BP may be an autoimmune disease. At 57 I’m at an age where everything suddenly hurts, especially my joints. As this pain has spread to my hands it’s time to get checked out for arthritis. I mean, I already have osteoporosis, which may be a result of my bipolar disorder or long-term use of anticonvulsants. Why not RA, too?
Some of the data is contradictory. One study finds that the average person with BP and RA is a 41-year old woman. Another only finds a relationship between the diseases in people under 19 and over 75. But a meta-analysis of a number of studies implies that the co-morbidity holds across populations, and the most common clinical features that co-occur with RA are psychiatric.
It’s easy to point to stress as the common factor between the conditions, or even an inflammatory diet. But there may be a smoking gun lurking behind the data and the results.
That smoking gun is smoking.
It’s well established that smoking is a contributing factor to RA. Any trip to a psych ward or the patio around the entrance of a building where a support group is meeting will quickly show that many people with bipolar disorder smoke. 68.8% of people with bipolar disorder currently smoke, and 82.5% of people with BP have smoked at some point during their lives. Of those who currently smoke, the average number of cigarettes smoked per day is 30.
So when it comes to the co-morbidity between BP and RA, maybe it’s not the BP at all. Maybe the true culprit is heavy smoking. Medical research is hard, and drawing distinctions between correlation and causation is even harder. Just because diseases seem to occur together in lots of people doesn’t mean that one causes the other.
The best way we can mitigate co-morbidity is to live as healthy a life as we can. If you want to prevent or manage RA, you can’t decide to not have BP. But you can manage stress, eat an anti-inflammatory diet and, above all else, stop smoking.
Mental illness is difficult enough. We don’t have to make it more difficult to live with by making choices, like smoking, that invite other health problems into our lives.
Think meditation and a statue of the Buddha or people in a yoga class may come to mind. But that idea of meditation is limiting and sheds little light on the diversity of meditation traditions or the many ways to practice.
While much focus, even mine in this newsletter, turns to Buddhist influences, there is a long tradition of meditative practices in Christianity. With few meditation or centering prayer groups meeting in-person right now, you can find a huge resource on Christian meditation, including instruction, history and community, at the website for the World Community for Christian Meditation.
No matter what your faith, there is a foundation of meditation or contemplative prayer that underpins it. I’ll try to continue to post links to as many traditions as I can each week in this newsletter.