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Without treatment, bipolar mood episodes may escalate

The first depressive or manic episode experienced by an individual with bipolar disorder may be sparked by a stressful life event. But as the illness progresses, subsequent episodes can occur without any outside triggers. For some individuals, continuing episodes can become more frequent, more severe and more difficult to treat. Without treatment, one episode fuels the next the way kindling ignites a log in a fireplace. This is the explanation for a model known as “kindling.”

“Kindling is the reason I act early and aggressively at the first signs of mania,” says Dr. Igor Galynker. “I want to prevent future episodes at all costs.” Dr. Galynker is Associate Chairman of Psychiatry and Behavioral Sciences at Beth Israel Medical Center and Professor of Clinical Psychiatry, Albert Einstein College of Medicine, New York.

“Medications can decrease the duration of an episode, increase the time between episodes or prevent them altogether,” he says. “Early intervention is important, because the worse it gets, the worse it gets.”

The doctor tells the story of a young man who goes away to college. He feels isolated, he fails his first exam. He has his first manic episode. His threshold for another episode is now lower, says Dr Galynker.

“But if he takes his medication, maintains a healthy lifestyle and tries to get enough sleep, has structure in his life and doesn’t set unrealistic goals for himself, he may not have another episode for twenty years. Otherwise he might have another in six months, then another and each would take longer to recover from.”While the kindling concern is widely recognized among authorities on bipolar disorder, it is not a certainty and does not necessarily apply to all people who have bipolar disorder.

Individuals who are living with bipolar disorder should watch closely for emerging symptoms of depression or mania. Family members often notice signs before the individual is aware of them. It’s important to develop a trusting relationship where these observations can be shared in a caring way and heard without feeling criticized.

Immediate medical intervention can make a crucial difference.

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