Is Bipolar Disorder on the Rise? Unpacking Perceived Increases, Biological Factors, and Lifestyle Risks

Dr. Tracey Marks addresses the common perception that bipolar disorder is becoming more prevalent. She attributes this perceived rise primarily to increased public discussion and reduced stigma surrounding mental health, largely influenced by celebrity disclosures. This shift has encouraged more individuals to seek help and receive diagnoses, rather than suffering in silence or resorting to self-medication. Additionally, a broader understanding of bipolar disorder, including the concept of a spectrum illness and the recognition of "softer signs" like unresponsiveness to antidepressants, has led to a lower diagnostic threshold, contributing to an "artificial elevation" in reported prevalence rates.

While these factors explain an increase in diagnoses, Dr. Marks also explores the possibility of an actual biological increase in bipolar disorder. Epidemiological studies estimate the prevalence at 2-4% of the population, with a peak onset between ages 20-30. She delves into five key risk factors that have strong evidence for increasing an individual's risk of developing the disorder. These factors suggest that beyond improved recognition, there may be genuine environmental and physiological contributors to a rising incidence.

The identified risk factors include obesity (BMI of 30 or greater), which is linked to structural brain changes like larger ventricles, though the causal direction remains unclear. Early and frequent cannabis use is another significant risk, with frequency being a stronger indicator than the absolute amount used. Certain inflammatory illnesses, such as irritable bowel syndrome and asthma, are also implicated, with cytokines proposed as a mechanism linking inflammation to mood disorders. Genetic predisposition plays a substantial role, with a 13-fold increased risk for individuals with a first-degree relative affected. Finally, infection with the parasite Toxoplasma Gondii, commonly acquired from cat feces or undercooked meat, is presented as a surprising risk factor.

Dr. Marks concludes that a combination of lifestyle and environmental changes, such as increased cannabis use, rising obesity rates, and an increase in inflammatory-based medical problems potentially stemming from food sensitivities, could indeed be contributing to an actual increase in bipolar disorder and other mental health conditions. She emphasizes that while genetics are unchangeable, many of these risk factors are modifiable. Practical recommendations include aggressively managing weight, changing diet, increasing exercise, altering smoking habits, and practicing hygiene when handling cat litter. She also directs viewers to her "nutritional psychiatry playlist" for further guidance on improving mental health through lifestyle changes.

My knee jerk response to T's question was that bipolar disorder may seem more common because mental health in general is more popular to talk about publicly than it was even 10 years ago.

The increased attention to mental illness gave rise to more people seeking help and getting diagnosed rather than lurking in the shadows and suffering silently or self-medicating with alcohol or drugs.

Another contributor to this perceived increase is there's been a bit of a redesign of the illness as we've come to understand it more.

You can think of these reasons as causing artificial elevations in the prevalence of the disorder, that is, these reasons don't affect how many people actually have bipolar disorder, just how many people get the diagnosis.

Epidemiological studies that look at prevalence rates estimate bipolar disorder to exist in about two to 4% of the population.

What's not explained by these studies is which came first, obesity causing a smaller brain and then bipolar disorder, or bipolar disorder causing obesity.

Across most of the studies, at least the ones that I reviewed, frequency was a stronger indicator than absolute amount used.

And then increasingly the mood disorders like depression and now bipolar disorder are being linked to inflammation as a causative factor and not just an association.

Having a first degree relative does not mean that it's a given that you will get the same disorder but it can increase your risk 13 fold.

So the answer is, our lifestyle and environment can be the cause of an increase in everything including bipolar disorder.

Fortunately some of these factors are changeable. You can't change your genetics, but you can change your diet, exercise and smoking habits.