Photo by Rachel Seymour

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Kindra Hanke’s heart rate shot up as the doors opened to the elevator in Fraser Hall. She rushed in and anxiously jabbed the button for the 8th floor. A spurt of excitement pulsed through her veins as she thought to herself, “What a rush it will be to soar off the building and glide through the air!”

When she reached the door to the roof, it was locked, and her excitement turned to deep disappointment. By that time, her roommate had raced up and found her, dampening any chances for a flight that day.

Hanke’s failed attempt at a fatal flight is congruent with bipolar disorder, a psychiatric disorder of which an estimated 300 KU students suffer. Once known as manic-depressive, bipolar disorder is most commonly diagnosed in people of college age, and those who have it experience drastic mood swings that can make them think they can fly sky-high and then sink them into dark depressions, which put them at a higher risk of committing suicide than any other psychiatric disorder. Those who have it often struggle to maintain relationships, perform well at work and in school and they often use effective mood stabilizing drugs to control their roller coaster of emotions.

Human Impact

Hanke’s best friends these days are her two roommates at home in Overland Park: her mother and her French bulldog, Monty. She understands why her friends have tapered off.

“Dealing with someone that’s not the same everyday is probably difficult,” she said, pointing out that her irritability makes most of her relationships fall apart.

Linda Keeler, psychiatrist at Watkins Student Health Center, said that the frenetic level of activity, intrusiveness and disruptiveness in those with the disorder had a negative effect on family and friends who were exposed to it, especially roommates.

“Untreated, it can be a devastating illness,” she said.

Keeler said the switches in mood states could lead to poor judgment and increased promiscuous behaviors and could be detrimental to a person’s life.

Hanke, 22, enrolled in 12 credit-hours this semester, but that number quickly dropped to six. She has tried a Western Civilization course three times, but she ended up dropping it each time, as she does with other classes. She blamed the disorder and her medications for her trouble reading, retaining information and staying enrolled in classes.

Leslie Niswonger, Leoti graduate student, said the disorder had caused her trouble with setting long-term goals and following through with them.

“The tiny decisions are agonizing,” she said.

Niswonger recalled going through the grocery store line during one manic episode, when she knew she couldn’t afford to buy something for $80, but she contemplated the decision over and over until she ultimately bought it.

Niswonger has a husband and a son who suffer with her through the disorder. She said when her son was a baby, she sometimes forgot to feed him. She said she was lucky her husband could pick up the pieces when things got crazy or when she withdrew from family and friends.

John Niswonger, her husband of 11 years, said he had learned to carry all the weight and not depend on his wife when she was in her manic and depressive states. He has even made a list of the specific characteristics that she has when swinging into either mood and posted it on their file cabinet.

“I look at it to see if she’s meeting too many characteristics,” he said. “I guess you could say it’s my guideline to what’s normal.”

Suicide Risk

Withdrawal from activities, family and friends can accelerate suicidal thoughts.

Bipolar disorder patients have a 20 to 25 percent increased risk of committing suicide, said William McKnelly, Jr., professor and psychiatrist at the University of Kansas Medical Center, who has specialized in treating the disorder for more than 50 years.

David Holmes, professor of psychology, said the rate for suicide among bipolar patients was higher than any other psychiatric disorder.

He said suicidal thoughts and attempts occurred most during rapid cycling when an individual was switching from manic and depressive episodes. During manic episodes, individuals might be more likely to commit suicide because they are impulsive, he said.

Hanke has attempted suicide twice before while struggling with her disorder. At 16, she held a gun to her head and pulled the trigger, but failed because she forgot to chamber another round. During a second attempt at 20, she swallowed two bottles of Tylenol caplets. Her roommate found her and brought her to the hospital where was treated with a formulation called Mucomyst, an antidote for Acetaminophen poisoning, which she said tasted and smelled like rotten eggs.

Symptoms

Two alternating, broad states are associated with bipolar disorder: wild mania and deep depression. They are referred to as highs and lows, and they must have underlying, more specific symptoms to be diagnosed.

Mania, according to the Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition, is classified as having a euphoric mood, along with three or more other major manic symptoms for one week. Major manic symptoms can include: irritability, less need for sleep, inflated self-esteem or grandiosity, hallucinations, and impulsiveness.

Niswonger recalled one manic situation when she decided she had to do something drastic about her messy home. Instead of doing the laundry or picking up around the house, she irrationally decided the kitchen cabinets needed a full make-over. She got out a drill and took off all the cabinet doors, only to become bored with the project after an hour. She said her kitchen cabinets were doorless for more than a year, until family helped finish the project.

Hanke said that during her highs, she slept two to three hours a night, compared to the 16 she sleeps during her depressive state. She said she engaged in “risky” behaviors, like speeding through red stop lights.

Niswonger suffers from a milder form of mania called hypomania, in which she has the same manic symptoms, but they are less severe. Her symptoms last at least four consecutive days, and individuals with alternating episodes of hypomania and severe depression are diagnosed with Bipolar II Disorder.

Individuals with bipolar can be deeply depressed for two weeks or more. They suffer from a decreased interest in pleasure, fatigue, feelings of guilt and suicidal thoughts.

While Niswonger suffers from rapid cycles of depression and mania that could last for an hour and switch, Hanke’s cycles are much longer. She said she tended to be depressed most of the time, but she had experienced three to five manic high cycles.

Niswonger has what her physicians call rapid cycles; cycling that occur at least four times each one year.

Psychotic symptoms, like those found in individuals with schizophrenia, also are common in those with bipolar disorder. Hanke’s belief that she could fly was part of a delusion, or irrational belief, that accompanied her thought disruptions.

Hanke said she once believed that energy beams in the air were amplified by cell phones, so she went through a period of time when she wouldn’t talk to people with cell phones.

A hallucination, or the sense of seeing or hearing something that doesn’t exist, is another psychotic symptom associated with the disorder. Niswonger said she had periodically heard voices since she was 11 years old.

Diagnosis

McKnelly said the problem with diagnosing any form of the disorder was the fact that the depression, not mania or highs, was often the only symptom complained about. Often the person is diagnosed first as having depression unless a physician sees a patient with different mood alterations including manic symptoms.

“No one goes to the dentist because their teeth feel too good,” he explained.

Hanke said she planned to stay an extra year at the University to be involved with a research project with Holmes, who will focus on the diagnosing criteria; specifically, the extent to which relatively few symptoms might disrupt a lifestyle, as opposed to the amount of symptoms present.

Not only is bipolar difficult to diagnose based on symptoms, but it also is often difficult to identify where symptoms are coming from, Keeler said. Patients might have other disorders, such as substance abuse, combined with bipolar. She said it was hard to determine if one caused the other or if yet a third variable was involved.

Physicians are often at fault and misdiagnose the disorder because they do not ask the patient the right questions, Holmes said.

Hanke said more were diagnosed as having bipolar than should be. Holmes said that he, too, worried that physicians were over diagnosing, but it might be that the prevalence of the disorder was just surfacing.

Background

Bipolar disorder affects a little more than one percent of the U.S. adult population-about 2 million Americans. National Mental Health Association statistics show that 80 to 90 percent of people with the disorder have a relative with some form of depression.

Those suffering from bipolar tend to have a genetic predisposition or a chemical imbalance, and stress and biological trauma can affect the tendency to develop the disorder as well, Holmes said.

The chemical imbalance is difficult to treat because of unstable neurotransmitters in the brain, he said. At times of mania, levels of neurotransmitter levels are high, whereas they are low during periods of depression.

Holmes said that inheritance of bipolar disorder was the highest among all psychiatric disorders, with 80 percent of those diagnosed having some family history.

Prenatal stressors, such as the mother’s diet, illnesses and substance abuse, in a fetus have shown to be correlated with the disorder, as well as birth complications, he said.

Hanke said stress factors, along with a genetic connection to the disorder, triggered her onset of depression in middle school. She moved from Missouri to Kansas in 6th grade, and her parents got divorced shortly after that. When she was 16, the birth of her sister caused an already growing depression to worsen.

Treatment

Psychiatrists prescribe a variety of medications to treat the illness individually, including mood stabilizers, anti-convulsant drugs, antidepressants, anti-psychotic drugs and sedatives. Other traditional therapies can be used in combination with medication.

McKnelly said the most effective treatment option, without question, was the stabilizer lithium because it reduced the suicide rate more then five-fold. He was one of the first in the region to use the drug when it became available after its surprising effects in calming pigs in France in a 1940s study.

According to the NMHA, lithium is effective for treating mania in 60 percent of individuals with bipolar disorder.

Like mood stabilizers, anti-convulsant drugs approved by the Food and Drug Administration reduce mania, but are not used as much as mood stabilizers. According to the National Institute of Mental Health, they are used on patients with more difficult-to-treat episodes and are used in combination with lithium for maximum effect.

Antidepressants are used for those with depression, but physicians are reluctant to use them for individuals with bipolar disorder because they don’t want to trigger a manic episode.

Neuroleptic drugs, also known as anti-psychotics, can be used to help a patient who has hallucinations and delusions. John Niswonger said his wife took the anti-psychotic Seroquel, and that it had done miracles by ending her night hallucinations and allowing her to think more clearly.

“I had forgotten what it was like to get a full night’s sleep,” he said.

Individuals taking any of these medications often have to deal with side effects.

Hanke, who is prescribed lithium, said her most noticeable change, besides controlling her mania, was weight gain. The lithium also causes her to have hand tremors.

Holmes said there were other approaches to treatment than medication. One proven to be effective was psychoeducation and cognitive behavior therapy. With these approaches, a patient and his or her family learns about the disorder and specific symptoms to his or her case. This allows an individual to receive social support, and adjust everyday activities to cope.

Electroconvulsive therapy, most commonly known as electric shock therapy, is a short-term treatment option that Hanke is thinking about trying. She rates the way she feels everyday a five on a scale of ten. Unfortunately, the mood stabilizer and the two anti-psychotics she’s taking aren’t bringing her out of her depressive episodes, she said. Electroconvulsive therapy is very effective for reducing both symptoms of bipolar, especially for a patient who isn’t improved by medication, Holmes said.

The Depression and Bipolar Support Alliance, like other support groups, focuses on helping patients and families learn about and cope with the illness together. It has more than 1,000 support groups nationwide.

Charlie Ross, facilitator for the Douglas County chapter, said the support group in Lawrence met twice every month to be educated and engage in camaraderie.

“By large, I don’t think KU students know about it,” he said.

Keeler stressed the importance of encouragement and support by those around an individual with bipolar disorder. She said having a regulated and supportive environment free of drugs and alcohol and with stress management skills could make a big difference.

Coping

Holmes said it was important to note that bipolar disorder is most commonly diagnosed in the same age range as most college students. It isn’t clear why the onset of symptoms hits individuals in late adolescence and early to mid-twenties, he said. Men and women have the same risk to develop the disorder.

Hanke fights every day for a smooth ride into normalcy. She continues her daily routine with the hope that she will find medication to influence her moods. Unlike medication users who don’t suffer from bipolar disorder, she isn’t looking for a high — just a calm middle.

— Edited by Vanessa Pearson