I am traveling in Europe; the light is bright, the days are longer. I can admire the sunset over the water while holding a drink and delay dinner until later, or even just enjoy the abundance of hors d’oeuvres that are offered with cocktails in this part of the world. A call comes through from the office, six hours behind in New York, where it is the middle of a working day. It’s an urgent one. My young patient is missing, I am told. Her parents are calling frantically; they need advice and support about what steps to take. Their daughter is not a minor. At 24, she lives independently and has a part-time job while getting her master’s in fine arts.
Emily was diagnosed with bipolar disorder-manic when she was a sophomore at Columbia five years ago. A very bright, gifted student involved in many social and political activities at school, she seemed to have unlimited energy. At the time, she was dating and preparing for her finals. It was spring semester in early June. She did not seem to have much time for sleeping or eating, always busy, always “on the go.” Looking at herself in the mirror, she was pleased with the new, slim, model-like figure she had always aspired to have. Emily felt “on top of the world.”
Then one night, she was picked up by the police, wandering in the streets of the Upper West Side, talking incoherently about how she had a “great plan to save humanity,” transmitted by God, with whom she had a direct line. Brought to the ER of a nearby hospital, she was hospitalized in Psychiatry and discharged with a first-time bipolar diagnosis. She was told she would have to take mood-stabilizing medications for the rest of her life to correct the chemical imbalance in her brain. If she followed this recommendation, she would be stable; she could have a successful career and good relationship prospects. And she did—until now.
It’s June again, the anniversary of her first breakdown. The excitement of the bright sunlight, the long days, the diminished need for sleep and food made her feel she was in touch with her “true self.” She had told her parents on the phone that she did not believe her bipolar diagnosis and had stopped all medications. She rented a car and started an adventurous trip cross-country with the intent of joining a meditation program in Sedona.
Summertime… It’s a source of pleasure for most of us and can trigger a manic episode for bipolar disorder patients. Increased stimulation by light, heat, and a frenzy of activities may be responsible for this shift, where body and mind are on a vorticous spin produced by the excess of a “feel good” neurotransmitter, dopamine.
According to the National Institute of Mental Health (NIMH), “2.8% of US adults aged 18 and older had bipolar disorder in the past year, with similar rates for men and women.” I often reassure my patients that with the diagnosis of bipolar disorder, they are in good company: Ernest Hemingway, Winston Churchill, Vincent van Gogh—all were bipolar, unfortunately before pharmacological help for this condition was available.
Nowadays, it can be successfully treated with mood stabilizers, such as Lithium and Valproic Acid, most commonly used for prevention, and neuroleptics (Olanzapine, Clonazepam) in the acute phase, like the episode that eventually got Emily hospitalized in Arizona.
Nothing works better than personal experience: most people with bipolar disorder arrive at the conclusion that they have to adhere to treatment, sometimes after a few painful episodes of mania a little later in life. And they learn to beware of summertime.
