Bipolar disorder (also known as manic depressive disorder) is a quite common and recurrent mental health disorder that occurs in all levels of severity. The World Health Organization has ranked bipolar disorder as the twelfth most common moderately to severely disabling condition in the world for any age group, and estimates a lifetime prevalence of 4 percent in the United States.
While there is no predilection for race, sex or ethnicity, the diagnosis is first entertained under the age of 25 years. Children of parents with bipolar disorder have about a 5 to 15 percent risk of being affected, compared with 2 percent of the general population.
Bipolar disorders consist of episodic mood shifts which may begin with mania and hyperactivity. There is an almost over-involvement in life activities, increased irritability and flight of ideas, easy distractibility and relative insomnia. Sometimes initially seen as an endearing quality by acquaintances and friends, the irritability, rapid mood swings, aggressive behavior and grandiose thinking soon leads to interpersonal difficulties and problems in maintaining relationships. Activities that seem like a good idea at the time can have regrettable consequences, such as overspending, committing to unsustainable relationships, and alienation of friends and family.
Eventually, this feeling is replaced by depression—some are “rapid cyclers” while others are more slow in their course. Unfortunately the depression phase lasts longer than the manic phase and can be quite disabling. These are major depressive episodes and, in fact, those with untreated bipolar disorder have significantly higher rates of death from both cardiovascular causes and suicide.
Suicide rates are 20 times higher in patients with bipolar disorders than the general population and up to one-third of those with this affliction attempt suicide at one time or another—a rate that is among the highest of any psychiatric disorder.
Bipolar disorder is a tough diagnosis at first, because those affected usually present with one extreme or another. Doctors have to get a very detailed history and call on others who have observed these changes on a cyclical basis before they know if the problem is bipolar disorder or major depression.
The medications for manic depression differ for those given for the single diagnosis of depression. Early diagnosis and treatment of the mood disorder is key in reducing the risk of relapse and improving the rate of response to medication.
Previously a disease where life insurance was rarely available, improved recognition and treatment has improved the prognosis for a more normal, productive lifestyle.
The biggest risk is suicide in affected individuals, followed by accidents (putting oneself in dangerous and provocative situations with inappropriate behavior and delusions of grandiosity) and also cardiovascular causes as well.
Insurers look for a stable pattern of adherence to regular psychiatric follow-up and medication use. Most are rated cases—even in the most favorable of circumstances.
Poorest outcome is associated with major and prolonged depressive episodes, severity of illness and increased cycling of symptoms as well as concurrent illnesses besides the psychiatric problem. Even in its best and most favorable presentations, bipolar disorder is a very difficult condition to control and manage effectively over a lifetime.
Robert Goldstone, MD, FACE, FLMI
Goldstone, board certified internist and endocrinologist, is vice president and chief medical officer for Pacific Life and Pacific Life and Annuity. He has extensive brokerage and life insurance experience, having been medical director at both MetLife Brokerage and Transamerica Occidental Life. Goldstone is board certified in insurance medicine and the inaugural recipient of the W. John Elder Award for Insurance Medicine Journalism Excellence. He was also honored as a fellow of the prestigious American College of Endocrinology and has written monthly for Broker World since 1990. Goldstone can be reached by telephone at 949-420-8390. Email: firstname.lastname@example.org.