Margaret Trudeau

Margaret Trudeau understood she risked societal censure when she spoke out about the bipolar disorder that has plagued her for years.

"I suffered tremendous loss because of my reluctance to come forward for help and not recognizing what was happening to me," the former wife of the late prime minister Pierre Trudeau said this month in Ottawa, where she was helping raise awareness for a psychiatric hospital.

More than 40 years after bipolar disorder was first recognized as a distinct form of mental illness, sufferers continue to struggle not only with their symptoms, but with the taboos linked with the condition.

Trudeau said she decided to go public in the hope that it might encourage others suffering from mental illness to seek treatment.

So what is bipolar disorder and what can someone seeking treatment expect?

Bipolar disorder is also known as manic depression. Its symptoms include extreme mood swings. According to the Centre for Addiction and Mental Health, a teaching hospital in Toronto, the disorder typically consists of three states:

• A high state, called "mania."
• A low state, called "depression."
• A well state, during which many people feel normal and function well.

Dr. Pierre Blier, a psychiatrist with the Royal Ottawa Hospital where Trudeau made her illness public, said people with the disorder "oscillate between periods of euphoria - with its decreased need to sleep, racing thoughts and risky behaviours - and depression."

Sufferers often liken the illness to a wild emotional roller-coaster ride, alternating between euphoric highs and devastating lows.

When they are manic, they seem to have limitless energy and may do dangerous or unusual things because they feel invincible. When they are depressed, they may have trouble just getting out of bed and feel suicidal.

Blier says there are two distinct types of bipolar disorders - Type 1 and Type 2.

Those with Type 1 often need to be hospitalized because their mood swings are so severe that they can endanger themselves. Type 2 individuals experience milder symptoms.

Pregnant women at risk

Blier estimates bipolar disorder affects about two per cent of the population, plaguing men and women in equal numbers.

Women may begin showing symptoms after pregnancy, as was the case for Trudeau, whose disorder began with post-partum depression following the birth of her second son, Alexandre, in 1973. In this case, symptoms of depression are more common than symptoms of mania.

According to the Centre for Addiction and Mental Health, some people with bipolar disorder may also experience psychotic symptoms such as hearing voices or becoming convinced of things that are not based in reality.

They may also have problems with movement, called catatonic symptoms. This includes "extreme physical agitation or slowness, and odd movements or postures [that] occur in up to 25 per cent of people experiencing episodes of depression or mania."

People with bipolar disorder who have psychotic or catatonic symptoms are sometimes incorrectly diagnosed with schizophrenia, another mental illness.

There is no lab test or brain scan that definitely proves a person has bipolar disorder. Instead, doctors diagnose the illness through a careful screening of a group of symptoms.

Meanwhile, a study published in the September issue of Archives of General Psychiatry, found that the number of American adults diagnosed with bipolar disorder doubled between 1994 and 2003. In children, aged 19 and under, the diagnoses of the disorder soared from 25 cases per 100,000 in 1995 to 1,003 in 2003.

The researchers say bipolar disorder was either historically under-diagnosed in children or adolescents and that problem has been corrected, or it is currently being over-diagnosed in that age category.

The researchers say it's critical that the medical community reaches a consensus regarding diagnostic assessment methods, as many include symptoms of attention deficit hyperactivity disorder (ADHD) in their criteria for bipolar disorder.

The symptoms of ADHD, which is usually diagnosed in children, include inattention, hyperactivity and impulsivity.

Almost two-thirds of young people diagnosed with bipolar disorder were male, while just over two-thirds of the adults diagnosed with it were women.

Seek help late in illness

"Unless patients are totally out of control in their manic phase, most will come to a doctor in a depressive phase," said Blier.

But with a bit of prodding, a doctor familiar with the illness can uncover manic phases that help in making a diagnosis, he said.

No one knows for certain what causes bipolar disorder, but mental health advocates stress that it is not the patient's fault.

"It is not caused by bad parenting, nor is it a consequence of a personality disorder, moral weakness or a fault in character," according to literature from the Mood Disorders Society of Canada, a charitable group that advocates on behalf of those with mood conditions.

Stress or difficult family relationships do not cause the illness, but they can trigger an episode in someone who already has bipolar disorder.

Research suggests genes may play an important role and cause changes in brain chemistry that bring on bipolar disorder.

The Mood Disorders Society estimates people with the illness will see three to four doctors and spend more than eight years seeking treatment before they are accurately diagnosed.

And diagnosis is important, say mental health advocates, because it means doctors can then prescribe treatment, which usually involves a combination of medication and psychotherapy.

Medications even out moods

Drugs typically prescribed for bipolar disorder affect chemicals in the brain called neurotransmitters, which transmit messages from one nerve cell to another.

Medications include mood stabilizers such as lithium, lamotrigine and valproic acid. The later two are also anticonvulsants. Anti-psychotic drugs and anti-depressants are also often prescribed.

"The most important point is that we do have a variety of treatments and it is possible to treat patients to full remission, provided they take their medication," said Blier.

But it can be difficult to convince patients to consistently swallow their pills. When they experience a euphoric phase, people can be energetic and productive. British Prime Minister Winston Churchill had bipolar disorder, for example.

"They enjoy it. That's when they stop their medication," said Blier, who warns of the risk of sinking back into depression and suicidal thoughts.

Trudeau, who sought treatment after her son Michel died in an avalanche accident in 1998 and after the death of the former prime minister two years later, said treatment has made a huge difference in her life.

"I felt I was broken for a long time, and now I am whole," she said. "I have my life back after years of struggle."