Wednesday, July 22, 2020

Understanding Kanye West's Bipolar Disorder

Today Kanye's wife Kim Kardashian West asked the world for compassion and privacy as their family battles the realities of living with someone with Bipolar Disorder. 

Understand, then offer understanding. Learn more about mental health so you can help others and drop some of the judgement. 

Understanding Kanye West's Bipolar Disorder
— From a presidential bid to Satanic vaccines -- could this represent a full-blown manic episode?
by Michele R. Berman, MD, and Mark S. Boguski, MD, PhD July 15, 2020
There have been several reports that Kim Kardashian-West is "concerned" about her husband, rapper and entrepreneur Kanye West, and some of his recent behavior. Kanye, 43, was diagnosed with bipolar disorder in 2016 and Kim is concerned that West may be going through a manic period.
On the Fourth of July, West announced that he was running for President. A few days later, he did a 4-hour rambling interview with Forbes magazine. Some of the unusual statements he made included:
  • He's running for president in 2020 under the new banner of the Birthday Party. Tesla/Space X founder Elon Musk is giving him advice, and he will name a preacher from Wyoming as his vice-presidential candidate. In addition, he said, "I'm speaking with experts, I'm going to speak with Jared Kushner, the White House, with Biden."
  • He no longer supports President Trump: "I'm taking the red hat off."
  • He's suspicious of a potential COVID-19 vaccine, as vaccines are "the mark of the beast."
  • He believes "Planned Parenthoods have been placed inside cities by white supremacists to do the Devil's work."
  • He envisions a White House organizational model based on the fictitious country of Wakanda in the "Black Panther" film.
In a 2019 interview in Vogue magazine, Kardashian-West openly discussed her husband's mental health issues. She said that, in the past, West found it hard to accept that he has bipolar disorder, telling people that he was instead suffering from sleep deprivation. However, she said that he now accepts his diagnosis. "'I think we're in a pretty good place with it now,' she said, adding that West has a newfound sense of purpose -- to show that you can live a normal life with mental illness. 'It is an emotional process, for sure. Right now everything is really calm. But we can definitely feel episodes coming, and we know how to handle them.'"
But for West, "handling them" doesn't include medications. According to Kardashian-West, "For him, being on medication is not really an option, because it just changes who he is."
Speaking with David Letterman last year for his Netflix series My Next Guest Needs No Introduction, West explained that taking medication every day can "ramp him up" which can be a double-edged sword: "[W]hen you ramp up, it expresses your personality more" and you have "a heightened connection with the universe," as well as more energy and productivity. But West also admitted that during his manic periods he may suffer from racing thoughts, irritability, sleep loss, and paranoia or psychosis. "When you're in this state, you're hyper-paranoid about everything.... Everything's a conspiracy. You feel the government is putting chips in your head. You feel you're being recorded. You feel all these things."
Whether West will actually run for president remains to be seen. On Wednesday, he reportedly filed some of the paperwork necessary to appear on ballots, but he has already missed deadlines for certain states and more filings are needed for the rest. Even as a write-in candidate, some states require paperwork filed in advance for those votes to be counted.
Bipolar Disorder
Bipolar disorder is a mental health condition that causes extreme shifts in mood, energy, and behavior. People with bipolar disorder experience both dramatic "highs," called manic episodes, and "lows," called depressive episodes. These episodes can last from hours to weeks, and many people have no symptoms between episodes.
According to the National Alliance on Mental Illness, there are four types of bipolar disorder:
  • Bipolar I Disorder is an illness in which people have experienced one or more episodes of mania. Most people diagnosed with bipolar I will have episodes of both mania and depression, though an episode of depression is not necessary for a diagnosis. To be diagnosed with bipolar I, a person's manic episodes must last at least seven days or be so severe that hospitalization is required.
  • Bipolar II Disorder is a subset of bipolar disorder in which people experience depressive episodes shifting back and forth with hypomanic episodes, but never a "full" manic episode.
  • Cyclothymic Disorder or Cyclothymia is a chronically unstable mood state in which people experience hypomania and mild depression for at least two years. People with cyclothymia may have brief periods of normal mood, but these periods last less than eight weeks.
  • Bipolar Disorder "other specified" and "unspecified" is when a person does not meet the criteria for bipolar I, II, or cyclothymia but has still experienced periods of clinically significant abnormal mood elevation.
Bipolar disorder affects nearly 6 million adults in the U.S., or about 2.6% of the population over 18 years of age. The median age of onset is 25 years, although the illness can start as early as childhood or as late as the 40s or 50s. It affects men and women equally and is found in all racial and ethnic groups and all social classes.
Much has been written about the depressive side of bipolar disorder, while much less material is available about the manic side (it doesn't even get its own page on the National Institute of Mental Health, NIMH website). This article will focus on mania.
The primary symptoms of mania include:
  • Talkativeness
  • Rapid speech
  • Decreased need for sleep
  • Racing thoughts
  • Distractibility
  • Increase in goal-directed activity
  • Psychomotor agitation
  • Expansive mood
  • Mood lability
  • Impulsivity
  • Irritability
Mania also commonly presents with psychotic features, which include delusions or hallucinations. Many patients endorse grandiose delusions, believing they are high-level operatives such as spies, government officials, members of secret agencies, or that they are knowledgeable professionals despite lacking such background. These individuals may also experience auditory or visual hallucinations, which only present when they are in the manic phases. Some of the most common delusions are delusions of paranoia, in which patients believe that people are stalking, targeting, or surveilling them. They may believe this to be done by government agencies, gangs, or others.
These patients are highly unlikely to respond to outsiders' views on their psychosis as well as their mania. A component of the manic phase is that the individuals themselves generally do not realize what is happening (poor insight). The problem is mainly noticed by others, including family members, friends, and even strangers or police.
Unlike full-blown mania, hypomania does not cause major difficulties in social or occupational function. In addition, it tends to last at least 4 days, but usually not as long as a week.
Treatment of Bipolar Disorder
Treatment can help many people, including those with the most severe forms of bipolar disorder. An effective treatment plan usually includes a combination of medication and psychotherapy, also called "talk therapy."
Bipolar disorder is a lifelong illness. Episodes of mania and depression typically come back over time. Between episodes, many people with bipolar disorder are free of mood changes, but some people may have lingering symptoms. Long-term, continuous treatment can help people manage these symptoms.
Medications generally used to treat bipolar disorder include mood stabilizers and second-generation ("atypical") antipsychotics. Treatment plans may also include medications that target sleep or anxiety. Health care providers often prescribe antidepressant medication to treat depressive episodes in bipolar disorder, combining the antidepressant with a mood stabilizer to prevent triggering a manic episode. Examples of these types of medications include:
Mood stabilizers: To control episodes of mania
  • Lithium (Lithobid)
  • Valproic acid (Depakene)
  • Divalproex sodium (Depakote)
  • Carbamazepine (Tegretol, Equetro, others)
  • Lamotrigine (Lamictal)
Antipsychotics: Added if symptoms of depression or mania persist despite treatment with other medications
  • Olanzapine (Zyprexa)
  • Risperidone (Risperdal)
  • Quetiapine (Seroquel)
  • Aripiprazole (Abilify)
  • Ziprasidone (Geodon)
  • Lurasidone (Latuda)
  • Asenapine (Saphris)
Antidepressants: Used to control depressive symptoms. Because an antidepressant can sometimes trigger a manic episode, it's usually prescribed along with a mood stabilizer or antipsychotic. An extensive discussion of the many types of antidepressants is beyond the scope of this article.
Michele R. Berman, MD, and Mark S. Boguski, MD, PhD, are a wife and husband team of physicians who have trained and taught at some of the top medical schools in the country, including Harvard, Johns Hopkins, and Washington University in St. Louis. Their mission is both a journalistic and educational one: to report on common diseases affecting uncommon people and summarize the evidence-based medicine behind the headlines.

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