Mariette Hartley Triumphs Over Bipolar Disorder
By John Morgan, Spotlight Health; With medical adviser Stephen A. Shoop, M.D.
For seven years, Mariette Hartley and James Garner shared a unique chemistry in their Polaroid commercials. Now Hartley is bringing into sharp focus another kind of chemistry – neurochemistry -- that debilitates millions of Americans.
"Bipolar disorder is something that is mine," says Hartley, who has played in the Broadway production of Cabaret. "And it is very difficult to talk about it. Breaking this silence has been really wrenching for me. I went into a kind of depression wondering if I really wanted to talk about all this. I finally decided that education is more important."
To that end, Hartley has been hired by GlaxoSmithKline, manufacturers of a medication recently approved by the FDA for bipolar disorder, to let people know that their lives can return to balance if diagnosed and treated appropriately.
Bipolar disorder is a serious, chronic illness accompanied by disabling mood swings from high (manic) to low (depressed). While the National Alliance for the Mentally Ill reports that bipolar disorder afflicts over three million Americans, a new study estimates this number could be around seven million.
"The first time I was diagnosed was in 1994 when I was going through a hideous suicidal depression. I was literally on the 24th floor of the building I was staying at contemplating what an interesting experience the jump would be," Hartley recalls. "Because I had suicide in my family, my children's faces just flashed in front of me and I couldn't do to them what was done to me."
Hartley's father committed suicide in 1963. Her mother attempted to take her life shortly afterwards. Not surprisingly, bipolar disorder is an inherited brain disease, devastating families generation after generation.
"I also lost an uncle in 1959 to suicide," Hartley adds. "And five years ago I lost a beloved cousin who struggled with bipolar disorder."
"If bipolar disorder goes untreated or if you treat it inappropriately, it almost always gets worse with time," states Dr. Frederick Goodwin, research professor of psychiatry at George Washington University and the former Director of the National Institute of Mental Health. "And that can be dangerous."
According to Goodwin, the death rate from suicide in bipolar disorder is over 10%, or 40 times the death rate you would expect from suicide in the general population.
As opposed to depression, what is different about people with bipolar disorder is the manic phase often starts out with the person feeling more energized, creative, productive as well as hypersexual.
"More often than not it keeps escalating so that at a certain point the person's mind is racing so fast they can't keep up with themselves," reports Goodwin, who also hosts the Infinite Mind on public radio. "Their grandiosity prevents them from seeing the negative consequences of their actions."
"That was certainly historically true for me," notes Hartley, who co-founded the American Foundation for Suicide Prevention. "One symptom of bipolar disorder is hyper-sexuality. I couldn't say no. I didn't have that word in my vocabulary. When you are that sexual at that early an age, it really wreaks havoc internally."
To numb her social and sexual discomfort, Hartley says she began drinking at age 14 and was "clearly an alcoholic from the very beginning of my drinking." In fact, Goodwin reports that more than 50% of bipolar individuals experience problems with alcohol or drugs.
The Emmy-winning actress says she hit rock bottom with depression six years into her sobriety.
"In 1994, I was going through a terrible divorce and someone said I needed to get help," Hartley recalls. "I ended up in the doctor's office, and he immediately assumed I was depressed. So I started on a round of anti-depressants but that caused me to go into a manic state. That was when I first really began realizing that something else was going on."
Goodwin says correct diagnosis is difficult because those afflicted are usually only willing to go to the doctor when they're depressed – so the doctor sees the depression but not the high. Studies indicate that patients wait an average of eight years before obtaining an accurate diagnosis.
"On some level being diagnosed as bipolar was a surprise for me because I had been misdiagnosed twice," Hartley notes. "First with depression. The second time I was misdiagnosed with attention deficit disorder."
"Even if the doctor asks about highs, often the patient doesn't recognize his behavior as a high – they experience it as normal," Goodwin explains. "About half the time people who are bipolar are misdiagnosed as being simply depressed – or what we call unipolar depression. This can be a very costly mistake."
Costly because depressed patients are typically prescribed antidepressants, medications which can make bipolar symptoms worse and cause it to cycle more and trigger manic episodes.
In order to help make the proper diagnosis, Goodwin suggests that a family member be present at the examination to help fill in the history because often the patient may have very little insight into their manic behavior. The expert also advocates the use of a screening instrument called the Mood Disorder Questionnaire which is a series of questions which can be embedded in regular general medical questionnaire.
Once properly diagnosed, the standard medical treatment for this disorder is mood stabilizers.
"Psychosocial treatments are very important but without the mood stabilizers these treatments will have no real impact on the disorder," Goodwin says. "You can't have effective psychotherapy with someone who is either deeply depressed or wildly manic."
The two most commonly prescribed mood stabilizers for bipolar disorder are lithium and Depakote, an anti-convulsant.
"The problem that we face with lithium and Depakote is that they are quite effective in treating and preventing mania but are less effective in preventing or reversing depression," Goodwin notes. "When you look at bipolar patients over time, it turns out that 75% of their disability is attributable to the depressive phase of the illness. So in the past when these patients got depressed, we would add an anti-depressant. Unfortunately, research shows that the antidepressants can cause the cycling of the bipolar condition to increase even in the presence of mood stabilizers."
But a new drug, Lamictal, just approved by the FDA is the first drug ever developed that is a mood stabilizer that stabilizes "from below."
"That is it stabilizes and enhances mood and it is a very activating drug," explains Goodwin, who is a consultant to several pharmaceutical companies, including GlaxoSmithKline. "Most bipolar patients when they are depressed have a kind of shut down depression."
The most serious side effect is a severe rash that was linked to one death. The drug should be discontinued at the first signs of rash. Some other side effects include:
Hartley is not on Lamictal but reports that one of her family is and is doing "fantastically." But the actress also knows that not every drug is right for everyone.
"If you are on the right medication for you now for God sakes stay on it and don't change," urges Hartley, who is enjoying her 15th year of sobriety and is feeling better than ever. "But if it doesn't seem to be working, then go to a doctor and find the right one for you."
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