I was describing the physical pain of bipolar disorder to a friend of mine and she acted surprised. She said, with great shock, “It physically hurts?”
Yes, bipolar disorder is about physical pain as much as it is about mental anguish.
Bipolar disorder is an inescapable mistress. No matter what you do, no matter how hard you work, no matter how many medications you take, she is always there, ready to hit you over the head with a 2 X 4. True, some people are lucky enough be experiencing remission. In that case, the mistress is forced to take a few steps back. But for people not in remission, people in full-blown bipolar disorder, that mistress is relentless. Every minute of every day she steals your brain and makes life unbearably painful.
And I have found that if you also happen to be bipolar and anhedonic, almost nothing allows you escape from that reality. Anhedonia is the inability to feel pleasure and when truly anhedonic, no matter what you do, no matter how theoretically pleasurable that activity is, you will not feel that pleasure – no matter what. This is a concept that most people cannot fathom but believe me, an inability to feel pleasure is real.
I have, however, found one tiny escape. It’s something I do all the time. It’s a little embarrassing, actually. I manipulate physical sensations and responses. Yes, I have orgasms.
In the book I’m writing on electroconvulsive therapy (ECT) I’ve had to address the question as to how ECT works. However, in spite of the fact that ECT has been in use since the 1930s we really don’t know how ECT works.
But recently we may have gotten a bit closer to figuring it out.
[Note: I am running a survey on real patients’ experiences with, and perspectives on, electroconvulsive therapy (ECT). If you’ve had ECT and want your voice heard, please take the survey here. More detailed information on the ECT survey can be found here.]
My Twitter bio says I have, “a damaged brain and a mind trying to deal with it.” This confuses a lot of people. It’s OK. I get it. Most people don’t differentiate between the mind and the brain. But I do. In fact, I consider it a critical distinction for people with a mental illness.
Your mind is who you are; your brain is just what you are.
It seems it’s more politically correct these days to say “behavioral health” rather than “mental health.” Hospitals and governments are changing their programs from mental health programs to behavioral health problems. And somehow this is progress. Somehow this is less stigmatizing.
How’s that again?
Did my behavior suddenly become a problem while I wasn’t watching? Because, quite frankly, I found the notion there was something wrong with my mind to be insulting enough, to find out that now, my behavior is the problem has pushed me over the insultant edge.
Last week I didn’t post three new things but don’t take that to mean I wasn’t learning because I certain was, and always am. For this week I have these three new pieces of information to share:
- Repetitive transcranial magnetic stimulation (rTMS) treatment for depression to be free for (some) Canadians
- Brain changes are noted in depressed females
- Why are some doctors anti-benzodiazepine?
1. Free rTMS in Manitoba (Canada)
RTMS stands for repetitive transcranial magnetic stimulation and is a treatment for treatment-resistant depression. RTMS is considered a neurostimulation therapy, like electroconvulsive therapy (ECT), but is non-invasive. RTMS has its pros and its cons.
- Pros – rTMS is drug-free, has few side-effects and can produce remission from depression in some people
- Cons – rTMS is expensive, intensive and its therapeutic effects are generally temporary
Cost of RTMS
Most people don’t get rTMS due to the cost. Repetitive transcranial magnetic stimulation requires 2 sessions per day for 10 days (weekends off) plus and additional possible 5-10 sessions depending on the reaction to treatment. Needless to say, this is one expensive therapy. In Canada that works out to $5000 – $7500 and in the States lord only knows how much.
And Manitoba is taking the very civilized step forward of offering rTMS as part of the public health care system, which is how it should be. The only reason why it isn’t is cost. You can get rTMS in Canada, but this is the first time I’ve heard of it being free.
Congratulations to Manitoba for taking a step forward in helping people with a mental illness. I hope this is the sign of things to come across the country.
2. Brain Changes Noted in Depressed Females
Women are twice as likely to develop depression as men but no one knows why. This study takes a look at female brains to look for biological identifying markers between depressed brains and well brains.
. . . depressed women had a pattern of reduced expression of certain genes, including the one for brain-derived neurotrophic factor (BDNF), and of genes that are typically present in particular subtypes of brain cells, or neurons, that express the neurotransmitter gamma-aminobutyric acid (GABA.) These findings were observed in the amygdala, which is a brain region that is involved in sensing and expressing emotion.
BDNF and GABA in Depressed Brains of Women
BDNF is something I’ve mentioned before as to a biological cause of depression. Yes, just another fact to chalk up for all the people saying depression is just “in your head.”
And work toward identifying the gene that contributes to depression:
. . . researchers tested mice engineered to carry different mutations in the BDNF gene to see its impact on the GABA cells. They found two mutations that led to the same deficit in the GABA subtype and that also mirrored other changes seen in the human depressed brain.
I keep telling people: We’re getting closer to effective treatments and understanding every day.
3. The Religion of Benzodiazepines – Why Some Doctors Don’t Prescribe Benzos
I’ve taken benzodiazepines (benzos) of one type or another for a decade and never once had a problem with them, but many people do develop tolerance, dependence and drug-seeking behavior around this type of medication.
My opinion is that benzodiazepine medications can be used quite safely when properly handled, but that some people have the tendency to get addicted to medications, and for them, these medications may be contraindicated. In other words, it’s down to the individual and prescription of benzos cannot be characterized as “bad” or “good” in a blanket statement.
I plan on writing a whole article about this, but if you’d like a sneak peek about why some doctors are anti-benzodiazepine, check out this article in Psychiatric Times.
Until next week all, when I shall learn more and do better.
Major Depressive Disorder: it isn’t just “all in your head.”
This paper discusses seven research areas relating to the neurobiology of major depressive disorder (MDD). In other words, it talks about the biological evidence of depression, mental illness. It discusses the strengths and weaknesses of biological theories of depression via evidence and aims to point out some of the reasons our current treatment isn’t as successful as it should be. Hasler’s article talks about the neurobiology of mental illness and how depression treatment effects that neurobiology.
The paper cites 88 other studies and was published in the Journal of World Psychiatry in 2010. It’s pretty educational.
Neurobiology of Depression – Depression Is In the Brain
The neurobiology (biology of the brain) of major depression research areas discussed include:
- Psychosocial stress and stress hormones
- Neurotransmitters such as serotonin, norepinephrine, dopamine, glutamate and gamma-aminobutyric acid (GABA)
- Neurocircuitry (neuroimaging)
- Neurotrophic factors
- Circadian rhythms
(That brain scan for mental illness stuff I mentioned a little while ago is covered in more detail in the article.)
Biological Evidence for Depression Layperson’s Articles Available
I wrote a layperson’s version of the article on Breaking Bipolar at HealthyPlace: Biological Evidence for Depression – Mental Illness exists, part 1 and part 2. I take out the big words and try to explain the crux of central ideas in English rather than scientist. (And if you’re super lazy, there is a table in the article that summarizes the neurobiological theories of depression along with their strengths and weaknesses.)
Here are a couple of notes that didn’t make the Breaking Bipolar article.
Aspirin May Make Antidepressants Work Faster
This very small cited study suggests acetylsalicylic acid (ASA) (also known as aspirin) taken with a selective serotonin reuptake inhibitor (SSRI antidepressant) can make antidepressants work more quickly. This is pre-clinical data so it may end up meaning nothing, but it is interesting. It’s discussed in Stress Hormones and Cytokines section of Hasler’s article.
Protein Involved in Stress Response, Neurogenesis and Depression
(How do Antidepressants Encourage Brain Cell Growth?)
Consistently, studies show parts of untreated depressed brains shrink, but we don’t really know why. We also know antidepressants (and electroconvulsive therapy) increase neurogenesis (making of new brain cells) but again, we aren’t sure why.
Hasler’s article discusses glucocorticoid receptors. It mentions their possible role in depression, specifically, in The Neurotrophic Hypotheses of Depression section it mentions glucocorticoid neurotoxicity as a possible mechanism of brain volume loss seen in depression.
Interestingly enough, scientists have just figured out the glucocorticoid receptors are essential for neurogenesis and they “turn immature stem cells into adult brain cells.” And what’s more, antidepressants activate these glucocorticoid receptors.
Why Care About Biological Evidence of Depression?
The answer to this one is pretty obvious if you read the comments here: people think mental illness, depression, bipolar don’t exist as diseases. People think mental illness isn’t biological. People think there is no evidence of physical mental illness. People say there is no science behind mental illness. People say there is no science behind mental illness treatment.
Well, they’re just wrong.
I recommend you read the whole paper, or read my layperson’s translation. Reading about the real studies, the real people, the real images and the real research behind the biology of mental illness brought me back to reality.