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The princess at the heart of bipolar disorder

Although the cause of Carrie Fisher’s death was reportedly a massive heart attack, one could say that she actually died of bipolar disorder. It is well known that heart disease is society’s leading killer. In contrast, it is largely unrecognized that people with bipolar disorder are at particularly high risk of heart disease. Shining a light on the heart-bipolar connection serves a number of important parallel purposes, including the promotion of assertive approaches to optimizing heart health, reducing the ongoing stigma toward bipolar disorder and other forms of mental illness, and encouraging further research efforts on this topic.

Carrie Fisher was not only a luminary artist, she was also a luminary advocate for mental health, focusing especially on bipolar disorder, a condition from which she suffered. Because of Ms. Fisher’s profession and talents, hers is an epic and singular story that has and will continue to touch the world for many years. But hers is also a typical story, albeit tragically so, of a young woman who experienced the onset of bipolar disorder early in life, who survived decades of the effects of bipolar disorder on her mind and brain, and who, it could be said, was ultimately felled by the impact of bipolar disorder on her heart.

Based on the most recent data from the United States general population, not only are people with bipolar disorder more likely to have heart disease, they also experience heart disease up to 17 years earlier, on average, than people who do not suffer from mood disorders. A sixty year-old woman with bipolar disorder may have the heart of a mentally healthy woman in her late seventies. The extent to which bipolar disorder increases and accelerates the risk of heart disease exceeds what can be explained by smoking, drug and alcohol use, sedentary lifestyle, nutrition, physical side effects of psychiatric medications, and even traditional heart disease risk factors such as high blood pressure and obesity. All of these factors are particularly common among people with bipolar disorder, but they are only part of the story.

Almost certainly, the distress caused by the symptoms of bipolar disorder, alongside the stress caused by the impact of those symptoms on people’s lives, contributes in part to elevated heart disease risk. There are a number of biological processes that could form the heart-bipolar bridge, including elevated levels of inflammatory markers, which have been shown to coincide with the episodes of mania and depression that define bipolar disorder and which increase the risk of heart disease.

Studies have also found evidence of poor blood vessel health among people with bipolar disorder, in the brain as well as the body. The scientific literature on this topic is so compelling, and yet so under-recognized, that a recent scientific statement from the American Heart Association positioned bipolar disorder (as well as major depressive disorder) among youth as a risk factor for early heart disease.

It is worth noting that among teenagers, bipolar disorder is twice as common among girls than boys. It is also worth noting that the extent of increased risk of heart disease attributable to bipolar disorder is even greater for females than it is for males. In losing Carrie Fisher, the world has lost a warrior princess who gifted us with valiant efforts both on and off the screen. As we each consider the ways in which we will honor her memory, let us consider all of the young warrior princesses (and princes) with bipolar disorder for whom the prospects of a long and healthy life rest on early and assertive approaches to heart health.

About the author

Dr. Ben Goldstein

Dr. Ben Goldstein

Dr. Ben Goldstein is a psychiatrist and Director of the Centre for Youth Bipolar Disorder at Sunnybrook.

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