🔑 Key Takeaways
- Bipolar disorder is a complex condition characterized by significant mood swings that can harm the person and their surroundings. Early diagnosis, proper management and treatment like Lithium can help keep the situation under control.
- Psychiatrists assess individuals with at least three symptoms of mania, including distractibility, impulsivity, grandiosity, flight of ideas, physical agitation, and lack of sleep. People with bipolar disorder in a manic episode display extreme symptoms such as purchasing multiple items, jumping between ideas without any logical transitions, and experiencing agitation, which can lead to paranoia.
- A conversation with a psychiatrist is necessary to diagnose bipolar one disorder, based on at least three symptoms lasting for seven days. Rule out medical conditions or medications that may cause manic episodes. Not all bipolar patients experience depressive episodes.
- Bipolar disorder can manifest in various ways, including manic and depressive episodes, hypomania, and may be challenging to diagnose due to symptom-free periods.
- Being aware of bipolar disorder symptoms and risk factors is crucial in detecting and managing the condition, as it can significantly impact a person's life and lead to disability. Developing treatment options can improve quality of life.
- Bipolar disorder has a high genetic contribution, with susceptibility within genes being triggered by environmental factors such as early life stress and trauma. Proper treatment is crucial to manage the condition and prevent it from hindering one's life trajectory.
- Bipolar disorder has a strong genetic component, but no single gene has been identified. Borderline personality disorder is distinct, characterized by dramatic mood shifts in response to environmental triggers. It's important to distinguish between the two and seek appropriate treatment.
- Lithium was discovered by chance and remains one of the most successful treatments for bipolar disorder. Knowing the history of its discovery can help in the development of new treatments. Living with bipolar disorder is challenging and can have negative effects on one's life.
- Lithium was discovered in the 1940s as an effective treatment for bipolar depression after Dr. John Cade experimented with injecting guinea pigs with a solution of lithium and uric acid, and then tested it on humans.
- Lithium treatment for bipolar disorder has been successful, but with potential side effects. Understanding how it works allows for the development of new treatments, as researchers strive for better options.
- Lithium has been shown to protect against the toxicity of certain brain circuits associated with bipolar disorder by preventing their atrophy and hyperactivity, thereby improving the ability to register emotional and somatic states.
- Bipolar disorder is a complex mood disorder with hyperactivity leading to hypoactivity. Neural circuits responsible for interoception are diminished, making communication of symptoms difficult. Reports from people around them play a crucial role in accurate diagnosis and treatment.
- Lithium stabilizes mood in bipolar disorder by preventing the loss of neural circuits and restoring balance through homeostatic plasticity. Proper neurotransmission and interoception limit overactivity and underactivity to manage psychiatric conditions and neuropathic pain.
- Homeostatic plasticity is a balancing mechanism in the brain that ensures optimal activity levels. Drugs that manipulate this mechanism, such as SSRIs, MAO inhibitors, lithium, and ketamine, can help treat mood disorders. Understanding and targeting this system may lead to even more effective treatments.
- An effective treatment for bipolar depression and disorder involves medications such as ketamine and lithium. Treatments should be tailored to individual patients under the close guidance of a board-certified psychiatrist and may include a combination of medication and therapy.
- Talk therapies such as cognitive-behavioral therapy, family-focused therapy, and interpersonal and social rhythm therapy can support drug therapies and reduce side effects by helping patients adjust their responses to triggers, predict and navigate through episodes, and incorporate social aspects in treatment.
- Traditional treatments like talk therapy and lithium remain primary options for bipolar disorder, but emerging treatments like rTMS and ketamine may offer hope for treatment-resistant depression. While siliciden has shown impressive results, caution is needed when considering commercial clinics for rTMS treatments.
- Natural approaches can help manage bipolar disorder symptoms, but medication prescribed by a board-certified psychiatrist is crucial. Avoid unproven treatments like cannabis or psilocybin and consider proven options like lithium and omega-3 fatty acids. Seek professional support for a tailored intervention plan.
- ASA tol and myo-inositol can improve sleep and reduce anxiety, but high dosages can cause gastric discomfort. Omega-3 fatty acids found in fish oil can improve neuron function, offsetting bipolar disorder effects, yet correct dosages and intake methods are crucial.
- Omega-3 fatty acid supplements can be helpful in reducing bipolar disorder symptoms, but should not replace comprehensive treatment plans that include medication, therapy, and lifestyle changes. Consult with a psychiatrist before starting omega-3 supplements.
- Omega-3 supplements can have direct effects on neurons and neural circuits, making it an important consideration to discuss with your doctor as a part of the treatment for bipolar disorder. Creativity is associated with higher levels of bipolar depression, making it important to explore interventions like omega-3 supplementation.
- Not all aspects of mania or sadness are detrimental. However, it is important to distinguish between normal behavior and clinically diagnosed disorders to avoid stereotypes and promote mental health awareness.
📝 Podcast Summary
Understanding Bipolar Disorder and Its Symptoms
Bipolar disorder, also known as bipolar depression, is a severe condition that causes massive shifts in mood, energy, and perception, leading to maladaptive changes that can harm the person suffering from it and those around them. People with bipolar disorder are at a higher risk of suicide, and it affects about 1% of the population, with an onset age of 20-25 years old. The condition is characterized by a manic episode for seven days or more, marked by elevated mood, energy, and impulsivity. However, not all people in a manic mode have bipolar disorder, as there are other factors that could cause similar symptoms. Treatment options, such as lithium, exist, but early diagnosis and proper management are crucial.
Criteria used by Psychiatrists to Diagnose Mania in Bipolar Disorder.
Psychiatrists use diagnostic criteria to determine if someone is manic due to bipolar disorder or other reasons, such as a traumatic brain injury or drug use. They evaluate if the person has at least three symptoms, including distractibility, impulsivity, grandiosity, flight of ideas, physical agitation, and lack of sleep. In a manic episode, people with bipolar disorder display extreme distractibility, impulsivity, and grandiosity, where they purchase multiple items, book numerous trips, or claim to win the Pulitzer Prize or be president. They also experience flight of ideas, jumping between ideas without logical transitions, and agitation, which can lead to paranoia. Additionally, they have very little or no sleep, which is a remarkable symptom.
Diagnosing Bipolar Disorder: Challenges and Criteria
Diagnosing bipolar disorder can be challenging as the psychiatrist has to evaluate the patient's symptoms, such as no sleep, rapid pressured speech, impulsivity, grandiosity, and more. The patient needs to have at least three of these symptoms for at least seven days to be diagnosed with bipolar one disorder. It's also important to rule out other underlying medical conditions or medications that may cause manic episodes. The diagnosis process heavily relies on a conversation to determine if the criteria have been met. Additionally, not all people with bipolar disorder experience the deep depressive episodes that are commonly associated with the disorder. Some only experience manic episodes, and it's possible to be accurately diagnosed with bipolar one disorder without experiencing a depressive episode.
The Different Forms of Bipolar Disorder
Bipolar disorder can take many different forms, and it's not always a sine wave of cycling up and down between mania and depression. Bipolar disorder is characterized by manic episodes that can be euphoric, irritable, and associated with a sense of increased activity and energy. Hypomania, typically seen in Bipolar Disorder two, is similar but characterized by a somewhat suppressed level of mania, and may last for as few as four days. Bipolar disorder can also be associated with depressive episodes, which can lead to difficulty recognizing whether someone is in a manic episode or heading towards depression. People with bipolar one tend to spend about 50% of their time symptom-free, making it difficult to diagnose.
Understanding the different types of bipolar disorder and the importance of symptom awareness.
Bipolar disorder can present differently in different types and can go undetected, but awareness of symptoms is important. Those with bipolar 1 can spend around 50% of their life symptom-free, 32% depressed and 15% manic or mixed manic. Bipolar 2 tend to be depressed more often, but have longer periods of symptom-free time, around 45%, with hypomanic states occurring only 4-5% of the time. Awareness of symptoms and risk factors is crucial in detecting bipolar disorder, as it can have a significant impact on a person's life and lead to disability. Understanding the burden and negative consequences of bipolar disorder can aid in developing treatment options to improve quality of life.
Understanding the Global Burden of Bipolar Disorder and Its Genetic Contribution
Bipolar disorder is a highly debilitating condition with a massive global burden. It is one of the highest risk factors for being in the top 10 of all categories of disabilities. While the total occurrence in the general population is low, the genetic contribution to bipolar disorder is very high and researchers have estimated it to be at 85%. This means that people with bipolar disorder likely have a susceptibility within their genes to environmental influences that can trigger bipolar disorder. Early life stress and trauma are some of the environmental factors that can increase this susceptibility. Proper treatment is crucial to manage this condition and prevent it from slowing down one's life trajectory.
Understanding Bipolar Disorder and Borderline Personality Disorder
While bipolar disorder has a genetic component with 85% heritability, there is no single gene identified for it. If someone in your family has it, there is a likelihood that you may have it too. However, bipolar disorder is distinct from borderline personality disorder, where mood shifts are dramatic and often in response to environmental triggers. A person with borderline personality disorder often experiences 'splitting' where they suddenly shift their emotions towards a person from good to bad. It is important to distinguish between these two disorders as their defining criteria are quite different. Both disorders can cause suffering, and there are emerging treatments for borderline personality disorder.
Understanding the History and Discovery of Lithium as a Treatment for Bipolar Disorder
Borderline personality disorder is often triggered by external factors, while bipolar disorder involves extreme highs and lows that impact the lives of those suffering from it. Lithium is a treatment with a miraculous history, discovered by an Australian psychiatrist who observed his fellow inmates urinating out a chemical that made them manic. Despite its discovery preceding the understanding of bipolar disorder's underlying biology, lithium still shows great success in many patients. Understanding the history and discovery of treatments for bipolar disorder can provide insight into how new treatments may be discovered. Being bipolar may have some benefits in certain contexts, but overall, it is extremely detrimental and challenging to those who suffer from it.
The Discovery of Lithium as a Treatment for Bipolar Depression
In the 1940s, Dr. John Cade discovered that lithium can significantly reduce symptoms of manic bipolar depression in humans. He achieved this after experimenting with injecting guinea pigs with various compounds dissolved in urine from patients with mania. After separating out the urea and uric acid, Cade found that injecting a solution of lithium and uric acid was effective in calming down the manic guinea pigs. He then quickly moved on to testing lithium on humans and found it to be a game-changing treatment for many patients. However, lithium has some toxic side effects and its blood levels need to be monitored closely. Cade's paper on the subject is now a classic in the field of psychiatry.
The Potential of Lithium and Future Treatments for Bipolar Disorder
Lithium treatment for bipolar disorder was not easily accessible due to lack of patentability and low profitability for drug companies. However, it has been proven to be a successful treatment, although with side effects that stimulate a need for better treatments. Understanding how lithium works on a cellular and neural circuit level allows for the potential development of new and improved treatments. Lithium increases BDNF, a brain chemical that is permissive for neuroplasticity and can suppress inflammation in neural tissues and the brain in particular. Researchers and clinicians continue to strive for better treatments for bipolar disorder, even with the success of lithium treatment, because it does not work for everyone and has potential for side effects.
The Neuroprotective Effects of Lithium on Brain Circuits
Lithium is neuroprotective and can prevent neurons from dying under certain conditions. It can prevent neuro toxicity that is associated with hyperactivity of certain brain circuits, which is important for conditions like bipolar disorder. Lithium protects us against the atrophy of neural circuits responsible for interoception. People with bipolar disorder have a hyperactivity that leads to the toxicity of certain elements of neural circuits responsible for interoception. This hyperactivity causes those circuits to diminish over time, leading to bipolar disorder symptoms such as an inability to register emotional and somatic states. Longitudinal studies show hyperactivity of circuits early on, but then hypo reduced activity of those same circuits at a time five or 10 years later. Lithium's anti-inflammatory and neuroprotective effects, along with its ability to increase BDNF, protect against circuit atrophy and hyperactivity.
Understanding Bipolar Disorder and its Neural Root Cause.
Bipolar disorder is a complex condition with hyperactivity and too much activity leading to hypoactivity through the death of circuits. The defining characteristic is oscillations in mood, and treatments must be given for manic and depressive episodes. Neural circuits responsible for interoception registering one's own internal emotions and bodily states are diminished, making it difficult for patients to articulate their symptoms. Accurate understanding of a patient's illness will depend on reports from people around them. Neuroimaging studies reveal that people with high genetic risk for bipolar disorder or who have full-blown bipolar disorder have deficits and reductions in connectivity between the parietal brain regions and the limbic system. The limbic system regulates our sleep-wake cycles, digestion, hunger, etc.
Understanding the Neural Circuits and Homeostatic Plasticity in Bipolar Disorder Treatment.
The limbic system regulates the overall level of alertness or calmness, and disruptions in its circuitry can lead to bipolar disorder. Neural circuits work through electrical and chemical signaling, and different areas of the brain regulate one another. People with bipolar disorder have reduced top-down control over the limbic system, which leads to high levels of revving that are abnormal. Lithium prevents the loss of neural circuits for interoception and top-down control, which is why it is an effective treatment for bipolar depression. Homeostatic plasticity is a particular form of neuroplasticity that maintains a balance or homeostatic regulation of neural circuits that are overactive or underactive. Neurons communicate through neurotransmitters released into the synapse that bind to receptors on post-synaptic neurons, and this is central to all psychiatric conditions and neuropathic pain.
Homeostatic Plasticity and its Role in Mental Health Treatment
Homeostatic plasticity is a balancing mechanism that ensures neurocircuits are never too active or too quiet for too long. This is achieved by changing the availability of neurotransmitter in the synapse through drugs like SSRIs or MAO inhibitors, or by adding or removing receptors in the post-synaptic neuron's surface. Lithium and ketamine treatments exert their actions through homeostatic neuroplasticity. Lithium makes circuits less active, while ketamine makes them more active. This mechanism is important in treating mood disorders, and targeting it could lead to even better treatments. Homeostatic plasticity is a complex concept, but essentially it means that our brain circuits are always striving for a balance, and drugs that affect this mechanism can have a profound impact on our mental health.
Treatment options for bipolar depression and disorder.
Ketamine is an FDA-approved treatment for major depression and bipolar depression, but its effects are transient and it has to be repeated. Lithium, on the other hand, reduces the intensity of manic episodes and symptoms by protecting neural circuits from dying away. It does this by reducing the number of receptors in certain elements in those circuits. Treatment for bipolar depression and disorder involves treating both mania and depressive episodes with appropriate drugs, which should be navigated by a board-certified psychiatrist in close discussion with the patient and ideally, family members. Talk therapy alone is rarely effective for bipolar depression and bipolar disorder.
The Role of Talk Therapies in Treating Bipolar Disorder
Drug therapies are usually necessary for the treatment of bipolar disorder; however, talk therapies such as cognitive-behavioral therapy, family-focused therapy, and interpersonal and social rhythm therapy can be used in combination to support drug therapies and lessen their side effects. Cognitive-behavioral therapy involves exposure to anxiety-provoking elements of life, which can help adjust the responses to triggers and make drug treatments more effective. Family-focused therapy helps bipolar disorder patients navigate through manic and depressive episodes and start to learn to predict what triggers bipolar episodes. Interpersonal and social rhythm therapy focuses on how people are relating to others in different aspects of their life and encourages incorporating social aspects in the treatment of bipolar disorder. Incorporating talk therapies can significantly reduce the destructive nature of bipolar episodes.
Exploring Alternative Treatments for Bipolar Disorder
Electric shock therapy, while invasive and expensive, is an effective treatment for treatment-resistant depression. However, it does not target the manic aspects of bipolar disorder. Other emerging treatments such as repetitive transcranial magnetic stimulation (rTMS) and ketamine therapies are being explored. rTMS is minimally invasive and has been shown to reduce depressive episodes and even the intensity of manic episodes in some cases. Talk therapies and drug treatments, including lithium, are still the primary options for bipolar disorder treatment. Additionally, siliciden, a psychedelic being explored in certain laboratory settings for the treatment of major depression and eating disorders, has shown impressive results in initial studies. Caution is advised when considering commercial clinics advertising rTMS treatments.
The Role of Natural Approaches in Bipolar Disorder Treatment
Natural approaches and lifestyle interventions can support people with bipolar disorder, but these should not be relied on solely for treatment. Drug therapy intervention is needed and should be prescribed by a board-certified psychiatrist. Currently, there are no data supporting the use of cannabis or psilocybin for the treatment of bipolar disorder. Two natural compounds, lithium and omega-3 fatty acids, have been shown to be effective in adjusting the symptoms of bipolar disorder. Therefore, it is important for anyone with bipolar disorder to seek the appropriate treatment and medication from a specialist, as the disorder carries a high suicide risk and requires a proper intervention plan tailored to that individual.
The benefits and risks of Inositol and Omega-3 Fatty Acids explained.
Inositol and omega-3 fatty acids have various uses that include regulating sleep, reducing anxiety and improving bipolar disorder. Taking ASA tol and myo-inositol can enhance sleep quality and have anti-anxiety effects. However, high dosages of ASA tol and inositol can cause gastric discomfort. Omega-3 fatty acids found in fish oil and cod liver oil that have EPA and DHA varieties can be incorporated directly into cell membranes, improving the way neurons work. Studies show that high dosages of omega-3 supplementation can offset the effects of mania and depressive episodes in bipolar disorder, although results vary. The key is to maintain the proper dosage and method of intake, as taking it in capsule form is more palatable for most people.
Omega-3 Supplementation for Bipolar Disorder
Supplementing with high dose omega-3 fatty acids may benefit some individuals with bipolar disorder by reducing depressive symptoms and even some manic symptoms. However, it should not be viewed as the sole treatment approach, as people with bipolar disorder require a comprehensive treatment plan that includes prescription drug treatments, talk therapy, and lifestyle interventions. Omega-3 supplementation has been shown to improve neural circuitry and neuroplasticity in individuals with bipolar disorder, but it is important to approach such treatments with caution and under the guidance of a board-certified psychiatrist. Overall, omega-3 supplementation can provide supportive benefits for individuals with bipolar disorder, but should not be the only management approach.
Omega-3 Supplementation and its Link with Bipolar Disorder
Omega-3 supplementation is a powerful intervention that can have direct effects on neurons and neural circuits. Although disorders like bipolar disorder can impair one's ability to function, they can also be responsible for certain aspects of creativity. Creative occupations like poetry, fiction, art, and nonfiction writing have a higher incidence of things like mania and depression, although there is no causal relationship. Certain individuals of certain occupations tend to be more creative, and that creativity is associated with higher levels of bipolar depression and maybe even other forms of depression. It's important to consider omega-3 supplementation and talk about it with your doctor as a part of the treatment for bipolar disorder.
The Nuanced Understanding of Bipolar Disorder and Major Depression
While bipolar disorder and major depression have many maladaptive effects, it's important to recognize that certain aspects of manic or hypomanic episodes and sadness or grief can lend themselves to creativity and positive outcomes, provided they are not persistent or pathologic. It's crucial to have a nuanced understanding and distinguish between being erratic or having obsessive-compulsive tendencies versus having clinically diagnosed disorders like bipolar disorder or obsessive-compulsive disorder, which are associated with high suicide risk and significant maladaptive weight. One should avoid subjective labeling of people as OCD or bipolar and instead understand the severity of these conditions for better mental health awareness.
- The Long-term Natural History of the Weekly Symptomatic Status of Bipolar I Disorder (JAMA Psychiatry)
- A Prospective Investigation of the Natural History of the Long-term Weekly Symptomatic Status of Bipolar II Disorder (JAMA Psychiatry)
- Lithium salts in the treatment of psychotic excitement (Bulletin of the World Health Organization)
- Longitudinal Changes in Structural Connectivity in Young People at High Genetic Risk for Bipolar Disorder (American Journal of Psychiatry)
- Targeting Homeostatic Synaptic Plasticity for Treatment of Mood Disorders (Neuron)
- Omega-3 fatty acid treatment, with or without cytidine, fails to show therapeutic properties in bipolar disorder: a double-blind, randomized add-on clinical trial (Journal of Clinical Psychopharmacology)
- Omega 3 fatty acids in bipolar disorder: a preliminary double-blind, placebo-controlled trial (JAMA Psychiatry)
- Reduced mania and depression in juvenile bipolar disorder associated with long-chain ω-3 polyunsaturated fatty acid supplementation (European Journal of Clinical Nutrition)
- Omega-3 fatty acid treatment and T(2) whole brain relaxation times in bipolar disorder (The American Journal of Psychiatry)
- Brainstorm: Occupational choice, bipolar illness and creativity (Economics & Human Biology)