Wednesday, October 29, 2008

"Going up in smoke: tobacco smoking is associated with worse treatment outcomes in mania."

Bipolar disorder, to me, is a fascinating disorder. It seems to affect some very intelligent and creative people, and that, I believe, is precisely why it is so hard to treat. The manic episodes it can produce can be part of the thrill of having the disorder. I've had more than one client who accepted medical treatment for bipolar disorder complain that the medication took away the "edge". People started to ask if anything was wrong. We kind of like manic people for their charisma, for the creative performances, work output, etc., that they give us. And, because mania is a natural kind of high, giving it up can be somewhat of a chemical straight jacket.

However, bipolar disorder is also neurodegenerative. Meaning if it progresses unchecked, all that extra brain energy that's requiring oxidation of glucose to fuel all those charismatic neurons is also creating a process that's not unlike a "rusting out" of the brain. So, if we want to preserve the creativity and contributions of people born with this kind of hardwiring, we have to work harder to understand the hardwiring, and develop medications that don't leave people feeling zombied. Plus, we have to encourage lifestyle choices that promote longevity.

One of the worst risk factors, it appears, (in other words, a group of people we now know we have to work extra hard to learn how to help), is people with bipolar disorder who smoke. In this study, what was found was that the subjects who smoked did not respond as well to the medications they were given.

What is really interesting about this study, is that the medications tested happened to be antipsychotics that have been found to be helpful in some cases of bipolar disorder. No traditional mood stabilizers, such as lithium, were used. I wish that had been included in this study, because this study may not be saying that bipolar smokers have worse treatment outcomes, as much as it says when a patient is diagnosed with bipolar disorder who smokes, they may do better with a different category of medication.

Our patients depend on us to be diligent with scientific process and not let our bias interfere with their well-being.

Berk M, Ng F, Wang WV, Tohen M, Lubman DI, Vieta E, Dodd S. Going up in smoke: tobacco smoking is associated with worse treatment outcomes in mania. J Affect Disord. 2008 Sep;110(1-2):126-34. Epub 2008 Feb 15.

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