Mariette Hartley Triumphs Over Bipolar Disorder
By John Morgan, Spotlight Health
| Life is a
cabaret' since Mariette Hartley got proper treatment for bipolar disorder.
With medical adviser Stephen A. Shoop, M.D.
Since 1997, Mariette Hartley and James Garner shared a unique chemistry
in their Polaroid commercials. Now Hartley is bringing into sharp focus another
kind of chemistry - neurochemistry -- that debilitates millions of Americans.
"Bipolar disorder is something that is mine," says Hartley, who has played
in the Broadway production of Cabaret. "And it is very difficult to talk
about it. Breaking this silence has been really wrenching for me. I went into
a kind of depression wondering if I really wanted to talk about all this.
finally decided that education is more important."
To that end, Hartley has been hired by GlaxoSmithKline, manufacturers of a
medication recently approved by the FDA for bipolar disorder, to let people
know that their lives can return to balance if diagnosed and treated appropriately.
Bipolar disorder is a serious, chronic illness accompanied by disabling mood
swings from high (manic) to low (depressed). While the National Alliance for
the Mentally Ill reports that bipolar disorder afflicts over three million Americans,
a new study estimates this number could be around seven million.
"The first time I was diagnosed was in 1994 when I was going through a hideous
suicidal depression. I was literally on the 24th floor of the building
I was staying at contemplating what an interesting experience the jump would
be," Hartley recalls. "Because I had suicide in my family, my children's faces
just flashed in front of me and I couldn't do to them what was done to me."
Hartley's father committed suicide in 1963. Her mother attempted to take her
life shortly afterwards. Not surprisingly, bipolar disorder is an inherited
brain disease, devastating families generation after generation.
"I also lost an uncle in 1959 to suicide," Hartley adds. "And five years ago
I lost a beloved cousin who struggled with bipolar disorder."
"If bipolar disorder goes untreated or if you treat it inappropriately, it
almost always gets worse with time," states Dr. Frederick Goodwin, research
professor of psychiatry at George Washington University and the former Director
of the National Institute of Mental Health. "And that can be dangerous."
According to Goodwin, the death rate from suicide in bipolar disorder is over
10%, or 40 times the death rate you would expect from suicide in the general
As opposed to depression, what is different about people with bipolar disorder
is the manic phase often starts out with the person feeling more energized,
creative, productive as well as hypersexual.
"More often than not it keeps escalating so that at a certain point the person's
mind is racing so fast they can't keep up with themselves," reports Goodwin,
who also hosts the Infinite Mind on public radio. "Their grandiosity
prevents them from seeing the negative consequences of their actions."
"That was certainly historically true for me," notes Hartley, who co-founded
the American Foundation for Suicide Prevention. "One symptom of bipolar disorder
is hyper-sexuality. I couldn't say no. I didn't have that word in my vocabulary.
When you are that sexual at that early an age, it really wreaks havoc internally."
To numb her social and sexual discomfort, Hartley says she began drinking at
age 14 and was "clearly an alcoholic from the very beginning of my drinking."
In fact, Goodwin reports that more than 50% of bipolar individuals experience
problems with alcohol or drugs.
The Emmy-winning actress says she hit rock bottom with depression six years
into her sobriety.
"In 1994, I was going through a terrible divorce and someone said I needed
to get help," Hartley recalls. "I ended up in the doctor's office, and he immediately
assumed I was depressed. So I started on a round of anti-depressants but that
caused me to go into a manic state. That was when I first really began realizing
that something else was going on."
Goodwin says correct diagnosis is difficult because those afflicted are usually
only willing to go to the doctor when they're depressed - so the doctor sees
the depression but not the high. Studies indicate that patients wait an average
of eight years before obtaining an accurate diagnosis.
"On some level being diagnosed as bipolar was a surprise for me because I had
been misdiagnosed twice," Hartley notes. "First with depression. The second
time I was misdiagnosed with attention deficit disorder."
"Even if the doctor asks about highs, often the patient doesn't recognize his
behavior as a high - they experience it as normal," Goodwin explains. "About
half the time people who are bipolar are misdiagnosed as being simply depressed
- or what we call unipolar depression. This can be a very costly mistake."
Costly because depressed patients are typically prescribed antidepressants,
medications which can make bipolar symptoms worse and cause it to cycle more
and trigger manic episodes.
In order to help make the proper diagnosis, Goodwin suggests that a family
member be present at the examination to help fill in the history because often
the patient may have very little insight into their manic behavior. The expert
also advocates the use of a screening instrument called the Mood Disorder Questionnaire
which is a series of questions which can be imbedded in regular general medical
Once properly diagnosed, the standard medical treatment for this disorder is
"Psychosocial treatments are very important but without the mood stabilizers
these treatments will have no real impact on the disorder," Goodwin says. "You
can't have effective psychotherapy with someone who is either deeply depressed
or wildly manic."
The two most commonly prescribed mood stabilizers for bipolar disorder are
lithium and Depakote, an anti-convulsant.
"The problem that we face with lithium and Depakote is that they are quite
effective in treating and preventing mania but are less effective in preventing
or reversing depression," Goodwin notes. "When you look at bipolar patients
over time, it turns out that 75% of their disability is attributable to the
depressive phase of the illness. So in the past when these patients got depressed,
we would add an anti-depressant. Unfortunately, research shows that the antidepressants
can cause the cycling of the bipolar condition to increase even in the presence
of mood stabilizers."
But a new drug, Lamictal, just approved by the FDA is the first drug ever developed
that is a mood stabilizer that stabilizes "from below."
"That is it stabilizes and enhances mood and it is a very activating drug,"
explains Goodwin, who is a consultant to several pharmaceutical companies, including
GlaxoSmithKline. "Most bipolar patients when they are depressed have a kind
of shut down depression."
The most serious side effect is a severe rash that was linked to one death.
The drug should be discontinued at the first signs of rash. Some other side
- Somnolence (drowsiness)
- Back pain
- Abdominal pain
Hartley is not on Lamictal but reports that one of her family is and is doing
"fantastically." But the actress also knows that not every drug is right for
"If you are on the right medication for you now for God sakes stay on it and
don't change," urges Hartley, who is enjoying her 15th year of sobriety
and is feeling better than ever. "But if it doesn't seem to be working, then
go to a doctor and find the right one for you."
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Created: 8/17/2003  - Donnica Moore, M.D.
Reviewed: 12/18/2003  - Donnica Moore, M.D.