It was one of the highest highs that Joanna had ever felt.
“You basically feel on top of the world,” she explains. “Like you have some kind of special purpose or role. So, I thought my purpose was spreading happiness. I started to believe that I had this special code.”
What Joanna didn’t know at the time, was that she had bipolar disorder, and that it had progressed. “I have bipolar type 1, so I actually became delusional. I was afraid people were going to come after me to get this code,” she says.
Bipolar disorder affects people’s mood and causes them to experience episodes of depression and mania.
Before her diagnosis, Joanna was a medical student who had everything going for her. “I was kind of excited for the future. I had plans for finishing med school and becoming a doctor. Everything was going great.”
Bipolar disorder changed that, “When I got sick, my first episode was really severe depression. And, all of a sudden, all those things you used you to be, like outgoing and happy and confident, are all of a sudden gone and you’re very different than the person you used to be.”
Fast-forward 10 years to present day, as Joanna balances her career as a psychiatrist alongside her role as a mother, and reflects on how far she has come.
“I never would have believed that I would finish medical school, get married, have a child, and have a successful career in medicine, when I experienced my first episode of the illness,” she says.
Experts say while bipolar disorder is a challenging mental illness to both diagnose and treat, continued research means patients will have more treatment options.
How exercise can help with treatment of bipolar disorder
Dr. Benjamin Goldstein, Director of the Centre for Youth Bipolar Disorder at Sunnybrook Health Sciences Centre and his team, are studying the concept of “exercise as a medicine” as a treatment of bipolar disorder, with a focus on aerobic or cardio respiratory fitness, “A lot of our psychiatric diseases have, it’s believed at their core, a problem with energy metabolism in the brain. So, if we could potentially increase people’s aerobic fitness, the question arises; can we increase how well their brain is working?”
A Sunnybrook brain imaging study showed that after just 30 minutes of cycling, aerobic exercise can affect emotions, attention span and overall brain response, reflecting a so-called “normalizing effect.”
Dr. Goldstein’s group is looking at different ways to get people moving by “Involving family members, involving a coach, and another would be involving friends”, as well as an educational process to learn about the potential value of exercise to bipolar disorder.
“Human will and human volition is something challenging to shift, and it’s a challenge we have to be up for if we want people to be living healthful lives, which is important for all of us, but uniquely important for people with major mental illness.”
Are apps useful for tracking bipolar moods?
Look online and there are many apps, or applications, that can be used on a computer or smartphone to help people with bipolar disorder track their moods.
“Monitoring and mood are critical to bipolar disorder,” says Dr. Anthony Levitt, Chief of the Hurvitz Brain Sciences Program at Sunnybrook. “Sometimes just knowing how your mood is changing can allow you to preempt it, and do the positive things you need to do to improve your mood. Or, to do the quiet things you need to bring your mood down.”
Tracking mood can be done using technology or with a notebook or journal. Dr. Levitt says it is valuable for the patient and the treatment team to determine the best course of action. “We can see that, ‘Oh, when we started this medication, the mood started cycling. Or, we stopped this medication, they become more depressed.”
Apps can also be used to help people focus on mindfulness, “If they get distressed, people an open up an app and use guided breathing or relaxation, which can be valuable for a lot of people,” says Dr. Goldstein.
Experts say while these technological tools can be helpful, they are not a substitute for treatment and it’s always important to seek advice from a professional.
How guidelines for medication are helping with treatment of bipolar disorder
“There have been changes with regards to our sophistication in treating bipolar disorder with medication,” says Dr. Ari Zaretsky, Psychiatrist-in-Chief at Sunnybrook, who adds this is a result of created guidelines from the Canadian Network for Mood and Anxiety Treatments (CANMAT). “What’s happened over time is more scientific, evidence-based research on which treatments work for the different manifestations of the illness.”
“These are guidelines that were developed in Canada and actually have worldwide impact on standardizing the treatment of bipolar disorder,” he says. “And a lot of that work came from a network of Canadian researchers, including some from Sunnybrook.”
Dr. Zaretsky adds, along with medication treatment, it is important for a person to be educated about the illness, along with family members, who can learn how to help a loved one with bipolar disorder
Advancement of treatment options for bipolar disorder
In more recent years, researchers have gained more understanding about how the brain is wired and how that can play a role in the advancement of treatment options for bipolar disorder. Direct-to-brain treatments, such as transcranial magnetic stimulation, have become increasingly studied recently as potential stand alone or adjunctive treatment for bipolar disorder.
“These new forms of ‘neuromodulation’ address brain circuitry,” says Dr. Levitt. “If we can understand which circuits are misfiring, and we can address those circuits with a variety of very direct treatments, it offers new possibility for the treatment of bipolar disorder.”
He adds that bipolar disorder is, in part, a vascular disorder. “The structure and function of blood vessels inside the brain are important for the occurrence and progress of bipolar disorder,” Dr. Levitt explains. “In addition, there is growing evidence that inflammatory factors may play a part in the progression of the disease. If we can understand which areas are inflamed and which areas have issues with blood vessels, we may be able to target our treatments to that specific area of the brain, we may be able to control and suppress and perhaps even cure the illness.”
Hope for bipolar disorder
Dr. Levitt says with the availability of multiple treatments, there is a lot of hope for people living with bipolar disorder.
“They can get better and they can stay better,” he says. “They can function well in-between episodes. You can reduce the number, the frequency the duration and the severity of the episodes. So, I’d say there’s a lot of hope, and it’s important that someone who is not doing well with bipolar disorder, needs to see an expert, because it’s a complex illness.”
Joanna’s journey with bipolar disorder
Today, Joanna says her son has provided a whole new meaning to her life and a new level of dedication to staying well. “Lucas also brings a lot of love, happiness, joy and FUN into my life, so he is the best ‘therapy’, I could ask for!”
She credits her family, friends, and psychiatrist with her success, “I have been really blessed to have a lot of amazing people in my life who have supported me along the way and I could not have done it without them.”
Joanna is sharing her story in Out of Darkness, a short film series exploring the raw reality of living with bipolar disorder that will be premiering at Sunnybrook on May 10, 2018. She is one of five people featured in the films.
She has this advice for those who have been diagnosed with bipolar disorder, “I think it is important to know that it is a medical condition, not a personal weakness.” Joanna adds, “There is a lot of hope. With the right help, surrounded by the right people, and with some dedication to self-care, you can live a full life.”