Bipolar blog

How to Make the World Better for the Mentally Ill

→ May 2, 2010 - 3 Comments

It’s understandable that people who love those of us with a mental illness tend to feel powerless. But here are some ways you can help make the world better for the mentally ill.

Six Ways to Help People with Mental Illnesses

Bipolar is one of the most commonly diagnosed psychiatric conditions among teens and twenty-somethings, but there has been little written about it from a younger person’s perspective and few people know how to approach the topic. In her new book, Welcome to the Jungle: Everything You Ever Wanted to Know About Bipolar but Were Too Freaked Out to Ask (Conari Press, May 2010), Hilary Smith fills in the gap with an upfront and empowering approach to the challenges of being diagnosed with bipolar. Here she shares with us six tips for making the world a better place for people with mental illnesses.

  1. Meet a person with a mental illness. – The best way to learn about mental illness is from a person who lives with one. The National Alliance on Mental Illness (NAMI) has a new program called In Our Own Voices in which people living with serious mental illnesses give presentations in their communities. These free presentations are a great way to learn about what day-to-day life with a mental illness is like, and presenters (who live with conditions such as bipolar disorder and schizophrenia) are more than happy to answer questions from the audience.
  2. Believe passionately in recovery. – The next time you’re walking down the street and you see a homeless person with schizophrenia, try to picture what his life would be like if he was getting adequate care for his symptoms. With proper treatment, the same man might be at home throwing a baseball with his young son, or growing prize tomatoes at his apartment. Severe mental illness does not have to equal homelessness, but until we learn to see people with severe mental illnesses as capable of recovery, their plight will all too often be seen as inevitable.
  3. Talk openly about your own experience with mental illness. – Even if you’ve never struggled with a serious disorder like bipolar or schizophrenia, you’ve probably had a friend or relative who has.
  4. Support legislation that helps people with mental illnesses. – Campaign for health care reform banning health insurance companies from discriminating based on pre-existing conditions. Vote yes on bills for affordable housing and increased funding for mental health programs. Support campaigns to keep people with mental illnesses out of prisons and receiving the treatment they need.
  5. Teach your children about mental illness. – Children often absorb their parents’ attitudes towards people who are different. Explain to your children what it means when they see people with mental illnesses acting or speaking in unusual ways. Emphasize the need for compassion and tolerance, and always put the person first, not their disorder. Teach your children not to see a “crazy lady,” but a woman struggling with a disease.
  6. Support community organizations that help people with mental illnesses. – Give time or money to an organization in your community that provides outreach, shelter, job training, counseling, or health care services to people with mental illnesses. Mental illness affects millions of Americans every year. One day, the person most in need of these services might be a friend, relative, co-worker–or even you.

Dimensional Diagnosis of Mental Illness

→ April 23, 2010 - 9 Comments

There is a recognition among many of us crazies, as well as the professionals that treat us, that most of us do not simple fall into one camp – we’re bipolar with a hint of ADD; we have a borderline personality disorder with depressive and psychotic features; we suffer from schizoaffective disorder with post-traumatic stress disorder (PTSD) and addiction mixed in. Humans are complex, and their brains even more so.

My Depression Isn’t Your Depression

And what’s more, my depression isn’t like your depression. In fact, so much so, that using the same word is almost nonsensical. I sleep 15 hours a day, but you only sleep 3. I have a successful job, but no family or friends. You have neither but participate in online support groups 10 hours a day. I think about killing myself every day but you actually plan for it once a week. You never cry but I cry all the time. Are we the same? Am I more depressed than you, or less?

And things get more complicated when you compare personality disorders and bipolar and ADD and PTSD combined with comorbid conditions like addiction. And yet somehow we’re supposed to suss this all out, find a label, and a treatment that goes with it. That’s pretty tough.

Mental Illness Doesn’t Fit in a Box

The medical community recognizes that mental illnesses frequently occur together and that each person has unique symptoms. More at Bipolar Burble blog.So some doctors would like not to put people in boxes, but to place them on continuums. You would become a multi-dimensional person, probably with severity ratings attached. So, I might be 80% bipolar, with a severity of 7/10, 10% anxiety, severity 3/10, and 10% PTSD, severity 2/10. (The scales used here are coming out of my head, not from any published source.)

And if you know mentally ill people, and you’re educated about disorders, you can see that continuums really do fit more people than boxes do. Boxes are, naturally, self-limiting.

But there are some problems here. Well, too many to count, really. First off, how would you measure how depressed a person is? Or how schizophrenic? Or how bipolar? There are many scales that have been developed for this but there is no standard as none have been proven to be wholly accurate. The scales we do have are more effective at measuring change over time, to tell if you’re getting better or worse, than objectively coming up with a score indicating how much you are of something.

Mental Illness Severity

And severity. Severity is a personal thing. If I can’t work because of a disorder, then naturally that is severe, but it can be just as severe to have nothing in your life but work. Doctors feel that planning your suicide is worse than thinking about suicide but if all you do is think about your death all day long, is that not severe? What if you cut yourself but never really suffer any grave injury, is that severe or not?

It’s personal. Severe to me probably isn’t the same as it is to you. And it probably isn’t the same from doctor to doctor either, so coming up with a measurement is rather difficult.

Mental Illness Definition

But even if we could measure how much of an illness you had, and how severe it was, and we could assign you a magic number that represented all of that, what good would it do? It doesn’t change the treatments we have available. It still doesn’t change the drugs, or the therapies, or the electroconvulsive therapy (ECT), or the vagus nerve stimulator (VNS). All that remains. And as it stands now a doctor might prescribe any medication for any disorder anyway so what’s the point in being so numerically specific? Whether you’re 100% bipolar or 75% with some PTSD doctors are going to try lithium, mood-stabilizers and antipsychotics anyway. It really doesn’t matter.

I applaud a system working to recognize that we’re all different and that through standard diagnoses we almost always get it a little bit wrong, but at this point I just don’t see a way around it. Mental illness isn’t like a burn where you can measure the percentage of skin affected and burn depth. It just isn’t that simple. And maybe one day we’ll know more and we’ll be able to attach numbers to the illness of a brain but unfortunately we’re just not there yet. I suspect until we really have a biological way of identifying issues: 25% excess serotonin, not enough dopamine and so on, we’ll be stuck with the muddy mess of trying to categorize seemingly infinite variations on the human brain. Broad strokes are really the best we can do until not just something better, but something more useful, comes along.

Psychiatric Disorders in Children – Diagnosed and Medicated

→ April 20, 2010 - 13 Comments

I have bipolar-disorder-type-II-ultradian-cycling. I diagnosed myself when I was 20 years old, and once I finally agreed to see a doctor, he agreed sometime thereafter. My diagnosis was fairly easy for me. I’m very self-aware and I could pick out discrete moods and swings. But as a 20-year-old, in university, using research, and having a fairly high IQ, this is not terribly surprising. If I were five-years-old, the picture would have been a little different.

Epidemic of Children Diagnosed with Mental Illness

There is an epidemic of children, as young as two, being diagnosed with psychiatric disorders in North American right now. It’s made the cover of Time magazine and countless articles have been written on the phenomenon.

So, Antipsychotics are Now Approved for Children

It was once thought that disorders like bipolar did not occur before adulthood, but thoughts on this seem to be changing as diagnoses go up and more drugs are approved for treatment of children.

Antipsychotics FDA-approved for use in children (under 18) is:

And so on. And of course, doctors are free to prescribe any medication off label to children just like adults.

Antipsychotics Can Fuck You Up

I have been on all three of those antipsychotics and all three have fucked me up. Specifically seen has been weight gain, blood pressure changes, twitching, extreme fatigue, incurable hunger, and in the case of Geodon, psychosis. Among other things.

What Do Antipsychotics Do?

Antipsychotics turn down the dopamine in your brain. That’s what’s the do. They also turn down serotonin. These are two of the “feel good” chemicals in your brain, and you are turning these down. This seems to help with certain disorders like schizophrenia, but dopamine in integral for motivation, reinforcement, learning, and memory. If, for example, your five-year-old eats his peas, and you praise him, he feels good because a shot of dopamine is released. This then reinforces the pea-eating behavior, so that next time, he will again eat his peas. If you take away dopamine, he may not be able to make this link. And if you take away dopamine from a child’s (naturally developing) brain for a long period of time, no one has any idea what would happen.

I cannot, in any world, imagine giving these drugs to a child.

We Don’t Know How to Diagnose Bipolar In a Child

The truth is, no one knows what bipolar looks like in a child, or if it even exists. There is no diagnostic criteria in the DSM. Psychiatrists are using relaxed versions of symptoms seen in adults for diagnoses. This is patently ridiculous.

Children are Naturally Crazy

Kids blur the line between fantasy and reality. Kids act out. Kids throw tantrums. Kids ignore you. Kids break rules. Kids often don’t show a great regard for their safety or the safety of others. Kids throw broccoli across the kitchen table. Kids do, the darndest things. They’re kids. It’s what they do. None of this makes them crazy.

Recently a friend of mine was talking about a girl who hallucinated a dead robot baby. Moreover, this same girl spent her recent birthday having an elaborate funeral for a bird found dead in her back yard. Sound crazy? Not for a seven-year-old. It might be a bit unusual, but to me this speaks of intelligence creativity and compassion, not a mental disorder.

And let’s face it, some kids are very challenging to handle. Some are overly aggressive, or sad, or obstinate. They hit their sister, break a vase, or refuse to stay in their room for a time-out. This still doesn’t make them crazy, this just makes them challenging. Parents don’t get a pass just because their job is harder than they thought it was going to be.

Kids Can Be Crazy and Still Perfectly Normal

Basically, kids can have almost any pattern of behavior and still be pretty darn normal. And that doesn’t take into account all of the environment factors that are effecting kid’s behaviors. I’ve never seen great parents with a kid with huge behavioral problems. Yes, I’m sure it happens, but generally, kids are a reflection of their home lives. And kids with bad home lives don’t need or deserve drugs. They deserve better home lives.

And on top of all of this, if a child really is having behavioral problems there are specialists who can help with that, they’re called child psychologists. They help children and parents all day long. And they don’t cause weight gain and high blood pressure.

And don’t get me started on how idiotic it is to diagnose a two-year-old with a mental disorder. Two? Really? It can take an adult two years for an adult to get a diagnosis of bipolar. That sounds like a parent disorder if ever I heard of it.

Children on Antipsychotics and Other Psych Medication Seem Like Lab Rats

It feels to me like these children are being treated as lab subjects, and not real people. I am highly suspicious of any doctor that would medicate a child. Could it possibly be a reasonable thing to do? Well, maybe. But you’d be hard pressed to convince me.

Mental Illness as Self-Fullfillment

And in addition to whatever drugs are being fed to these children, they are also being saddled with a diagnosis – for the rest of their lives. As an adult it can be extremely detrimental to be labeled “crazy”, but as a child I can only imagine it would be infinitely worse. These children don’t even have a chance to find an identity before they’re told they’re crazy. How can that label not result in self-fulfillment?

Victims of Fad Diagnoses

When the movie Cybil based on a woman with “multiple personality disorder,” came out, the diagnosis of this disorder exploded across the US. A disorder that had virtually never been seen was suddenly everywhere. But over the decades that followed, medical professionals were able to determine that these were not genuine cases. In fact, some doctors feel that there has never been a documented case of “multiple personality disorder” as featured in the film. There are other disorders with similar features, but the giant outbreak seen after the film, just didn’t exist.

Is Childhood Bipolar a Fad Diagnosis?

And one has to wonder if we’re seeing something similar here. If more adults are being diagnosed as bipolar, then naturally, we are looking for markers of it at younger ages, and in their genes. We want this information to help people, to help treat the disease, but it can just as easily be used to further label people before we even know how to do it properly. Multiple personality disorder looked like a correct diagnosis until we figured out it wasn’t.

And if someone as young as a toddler gets diagnosed with some behavioral disorder, don’t these children deserve time to correct this issue via safer methods than drugs? It seems that out of an eight year life, it’s impossible that enough other treatments have been tried to warrant drugs.

Now, it’s true, I’m not a doctor, or a parent. And I do have a strongly held belief that doctors and their patients should be able to choose treatments without judgment from the outside world. But I also think any doctor worth seeing is going to try the least harmful treatment first, especially in a population that has been radically understudied. True, behavioral therapy might not work, but it’s unlikely to cause debilitating side-effects. And what about waiting for a child to grow out of behavioral issues? I hear that was a thing that used to happen. Before we got all diagnos-y.

I’m not suggesting that no one under 18 is sick, or that no one under 18 should be treated with medication. What I am suggesting is that diagnosis and treatment of children needs to be handled with extreme care and caution. I’m an adult and I give informed consent to fuck with my brain; children do not have that ability, and yet, they will be the ones that have to live with the results. They deserve every possible solution that avoids nasty, unknown side effects. Parents need to be held to a higher standard of decision-making and not pick what is easiest for them, but what is best for their child. Doctors need to be held to a higher standard to care with children, ideally with third party monitoring of underage drug-treatment. This is not something to be taken lightly on any front.

Someone needs to sanity-check the parents. Kids need to be able to act crazy, without getting labeled crazy.

Who Do You Trust for Mental Illness Medication Information?

→ April 11, 2010 - 3 Comments

As you might have noticed, I’ve been writing about bipolar and mental illness for a really long time. Seven years in internet time is a lifetime or so.

I Write About and Research Mental Illness

Trusting Mental Health SourcesAnd in all that time, in addition to the writing, I’ve been reading, or more commonly, researching, mental illness. I’ve been looking up information on mental disorders, psychiatric medications, mental illness treatments, supplements and everything else of which you can think. This is because I like to be educated about my bipolar disorder, healthcare and treatments. I often share researched information with my readers because I think others should be educated about mental illness too. I strive to make anything I write accurate and provide links to reputable information sources.

Who Do You Trust for Mental Illness Information?

But what information should you trust? Who should you trust for mental health information? Should you trust me, a random blogger? People on discussion groups? Information sites? Drug company sites? Doctor sites?

Almost always, no.

Here are a few ideas about trusting information online:

  1. Do not make any decisions about your mental health or treatment without talking to a real, live doctor in person. Period. You can take all the self-assessment questionnaires you want, but you can’t pick a mental illness treatment or a diagnosis without the help of a professional. These tools can help you bring information to your doctor, but nothing is a substitution for a real professional.
  2. If you can’t check out a person’s credentials, don’t trust them. Anyone can claim to be a psychiatrist, nurse or have a Phd, but that doesn’t mean they aren’t actually a teenage, mosquito trainer practicing pirouettes in a tent in rural Lesotho (although they’re probably not). If someone is offering you professional health advice, they should have no problem supplying their credentials. One of the reasons I love Jim Phelps’ site is the fact he is forthright about who he is, and how he’s funded.
  3. Check how a healthcare site is funded. If a site doesn’t tell you who’s supporting it, who’s funding it and where the information comes from don’t trust them. As a general rule, sites funded by drug companies or special interest groups should be treated with extreme suspicion. Special interest groups can include religious groups and even some charities. While they may have good intentions it’s likely their information is slanted and partial.
  4. If there are no links to actual data or research studies approach with extreme caution. I could be a doctor making the claim carrots cure depression, and that might be a very appealing claim to a lot of people as anyone can buy carrots. I can even say, “I’ve seen it work over and over,” but if I can’t back that up with real scientific data, then the claim holds no water. (That being said, there’s no harm in asking your real-life doctor about even questionable mental health treatments, if you’re interested. That’s what they’re paid for.)
  5. Any referenced study must be published in a reputable journal. Psychology Today is a magazine not a journal, the Journal of Clinical Pharmacology is a reputable journal. Real studies are listed here and are published in peer-reviewed journals. Also, in reputable studies any conflicts of interest must be disclosed. Implications from research can be confusing so print out the study and ask your doctor about it. Some groups are really good at making information look authentic but if it wasn’t published in a reputable peer-reviewed journal, it’s not to be trusted.
  6. HONcode accreditation. About.com’s Nancy Schimelpfening suggests that HONcode accreditation is also a good thing for which to look.

I have to stress, there are many medical sites out there that are trying to sell you a product or idea. Please keep in mind there are some groups that are very anti-psychiatry and anti-medication and try to push that agenda. They masquerade as self-help sites, discussion groups, individuals on discussion groups, and drug rehabilitation/addiction sites. There are people pushing products that use the same techniques.

Be Skeptical About Mental Health Information Sources

Be skeptical. If the information doesn’t sound right, ask a professional. Please don’t let random online weirdo’s make choices for you or influence how you feel about yourself and your mental disorder. You’re better than that.

[And just for the record, I don’t portend to be anyone other than a mouthy bipolar writer with a lot of tears, screams and things to say. I’m pretty smart and try to help people, but that’s about it. Oh, and I’m essentially funded by no one. Just ask my landlord.]

Mental Illness Resources I Trust

Curious about who I trust for mental illness information? See my resources list here.

Update: I just found this open-access peer-reviewed journal online. Interesting.

Free Gift with Depression – A Tale of Anxiety

→ March 29, 2010 - 4 Comments

Anxious and DepressedAnxiolytic Isn’t Even in the Dictionary

I grit my jaw. I bite the skin around my nails. I pull at my hair. I bunch my fists. My breaths are shallow. I twitch and clench erratically.

I tell myself not to grit, bite, pull, bunch, twitch and clench. I tell myself to intake more air. Those instructions are followed. For moments. And then they’re not. While I wasn’t looking I started gritting, biting, pulling, bunching, twitching, and clenching all over again.

Anxious. Anxiety.

These are tiny, little words. The barely seem to warrant entries in dictionaries bloated with words like crunk (a type of hip-hop or rap music) and yogilates (a combination of Pilates and yoga), and yet somehow they have achieved great significance in my life.

Anxiety and Depression, Like Peas and Carrots

Anxiety and depression always come in pairs. The each cover half a sphere. How much you feel of each of them depends on your point of view of the sphere.

I was never an anxious person before. Or at least, I was never inordinately anxious, I think. But then came the psych meds and so the anxiety. Anxiety – the side effect that’s it’s own mental illness.

And now I worry. And I’m overwhelmed. Frozen with the fear of things not getting done . . . leading to the very obvious result of things not getting done.

Anxiety. A self-replicating organism.

Anticonvulsants as Calcium Antagonists in Mood Stabilization

→ March 20, 2010 - 2 Comments

This is a paper I wrote for a psychology course I am taking so the level of discourse is quite high, sorry about that. I promise though, it is comprehensible. What I’m basically talking about is calcium-channel blockers and other calcium antagonists (they turn calcium down). This refers to calcium in your brain and not calcium in your blood.

Mood Stabilizers and Bipolar Disorder

Because inadequate response, poor compliance, chronic recurring symptoms, and functional disability are constant challenges is the treatment of bipolar disorder, (Gitlin, 2006) efforts have been made to search out new mood stabilizing medication and determine new methods of action. There has been an effort to treat bipolar disorder with a class of medication termed “mood stabilizers”, most notably consisting of some anticonvulsants (also known as antiepileptics) in addition to the traditional lithium.[1] [push]I will show that these anticonvulsants, stabilize mood in bipolar disorder, at least partially, through their ability to act as calcium antagonists.[/push]

While anticonvulsants are widely used in the treatment of mood disorders, their method of action in mood stabilization is mostly unknown.[2] Recent research has indicated that disrupted calcium homeostasis is present in bipolar disorder, and that anticonvulsants and lithium effect calcium channels and concentration in the brain (Amann, 2005). The mood-stabilizing effects of calcium channel blockers like Nimodipine (Levy, 2000) further add to the evidence that calcium antagonism is useful in the treatment of bipolar disorder. I will show that these “mood stabilizers”, anticonvulsants, stabilize mood in bipolar disorder, at least partially, through their ability to act as calcium antagonists.

Bipolar Disorder and Calcium Levels

A review of hypercalcemia and hypocalcemia shows links from calcium blood levels to depression, irritability, delirium, and psychosis – symptoms that are similar to a bipolar disorder. Additional to calcium’s powerful abilities in the blood, it also plays a vital role both as primary and secondary messengers in the brain and according to Gargus (2009), is known to regulate “physiological systems at every level from membrane potential and ion transporters to kinases and transcription factors”. Calcium also plays a role in long-term changes to the architecture of a neuron (Amann, 2005). Disruption of intracellular calcium homeostasis is now thought to underlie many diseases such as Autism, Migraine, Seizures, and psychological disorders like bipolar (Gargus, 2009). Additionally, atrophy and glial death now found in mood disorders may be avoided by increasing cellular plasticity, accomplished through reducing intracellular calcium concentrations (Landmark, 2008).[pull]Atrophy and glial death now found in mood disorders may be avoided by increasing cellular plasticity, accomplished through reducing intracellular calcium concentrations.[/pull]

In some studies, the bipolar population has been found to have abnormally elevated intracellular calcium, elevated basal platelet and lymphocyte calcium concentrations, and elevated B-lymphoblast calcium (Silverstone, 2005). Found more consistently the bipolar population, both in the manic and depressed phase, is an enhanced calcium response to agonist stimulation (Silverstone, 2005). This may partially be explained by the enhanced platelet intracellular calcium mobilization found after stimulation by serotonin in bipolar disorder (Suzuki, 2003). This research suggests that not only are calcium levels elevated, and calcium activities dysregulated, but this may become worse if the patient is treated with a selective serotonin reuptake inhibitor (SSRI), which is often the case.

Lithium and Calcium

Lithium has long been the standard therapy for bipolar disorder both for acute and maintenance treatment due to its quality and quantity of supporting evidence (Gitlin, 2006), (Levy, 2000). Part of lithium’s biological effects is to both inhibit the entry of calcium intracellularly acting as a calcium antagonist, and to block calcium channels directly. This, in turn, inhibits other cellular responses of subtypes adrenergic, serotonergic, and cholinergic (Levy, 2000). Moreover, adding Verapamil, a calcium channel blocker, to unresponsive lithium treatment, improves outcomes, (Mallinger, 2008) suggesting that both calcium itself and calcium channels benefit from antagonists.[3]

Calcium Channel Blockers as Mood Stabilizers

A number of calcium channel antagonists have been studied with varied results likely resulting from their specific affinities to different calcium channel subtypes and their individual ability to cross the blood-brain barrier. Verapamil, one of the most studied calcium channel blockers, is not the most lipophilic and is likely not as effective as other calcium channel blockers like nimodipine (Gitlin, 2006), although Verapamil has been shown effective in some studies and does work on calcium ions in a way similar to lithium (Levy, 2000).[pull]Nimodipine is not only a calcium channel blocker but has also been shown to have anticonvulsant properties and has shown great potential as a mood-stabilizer particularly for cycling forms of bipolar disorder.[/pull]

Nimodipine is not only a calcium channel blocker but has also been shown to have anticonvulsant properties and has shown great potential as a mood-stabilizer particularly for cycling forms of bipolar disorder (Goodnick, 2000). While its efficacy needs further study, there have been positive results shown for bipolars in manic, depressed, and rapid cycling states.

Anticonvulsants spawn a broad range of medication and methods of action. Useful actions for treatment of psychiatric disorders are thought to be: increases in GABAurgic transmissions, decreases in glutamate, inhibition of voltage-gates sodium and calcium channels, and interference with intracellular modulators (Landmark, 2008). For the treatment of bipolar disorder, specifically mood stabilization, carbamazepine and Lamotrigine, have been identified, and accepted as treatments through their inhibition of voltage-gated sodium and calcium channels (Landmark, 2008).[push]Anticonvulsants that work on calcium channel blockers are also known to be helpful in the treatment of neuropathic pain, which some researchers believe is closely tied to psychological pain, here in the form of bipolar disorder.[/push]

Carbamezapine and Lamotrigine have also been seen to positively affect mood while GABAurgic transmitting anticonvulsants have not. The general decreased excitability found with Carbamezapine and Lamotrigine may also be responsible for their role in preventing affective episodes (Landmark, 2008). Valproate is also considered an accepted treatment although likely functions more from the combined actions mentioned above, making it an anti-mania treatment as well as possibly useful for mood stabilization (Landmark, 2008). The effects of anticonvulsants are compared to the therapeutic effects of lithium on calcium, calcium channel blockers, and inositol concentrations, another secondary messenger indirectly acting on calcium signals (Berridge, 1993). Anticonvulsants that work on calcium channel blockers are also known to be helpful in the treatment of neuropathic pain (Landmark, 2008), which some researchers believe is closely tied to psychological pain, here in the form of bipolar disorder.

Lithium acts in the body as a complex agent, making it difficult for scientists to specify exactly how it stabilizes mood in the bipolar population, in spite of its being used for decades. It is clear; however, that part of its biological action is to antagonize calcium concentrations as well as calcium channels. This action is shown to have positive mood stabilizing effects as proven by successful treatments with calcium blocking agents like Verapamil and Nimodipine. These same mood stabilizing effects are seen with some anticonvulsants which also act as calcium antagonists. Therefore, it is reasonable to assume that part of the reason why some anticonvulsants stabilize mood is because of their ability to work on calcium, calcium channel blockers, and inositol, as seen in Lithium and calcium channel blockers.

_________________________

[1] There are several antipsychotics also in this list but are outside the scope of this paper.
[2] Treatment of bipolar disorder and mood stabilization in this paper will refer to non-acute treatment, although some of the drugs mentioned can be used in acute treatment also. No distinction will be made between types of bipolar.
[3] It should be noted that Mallinger (2009) posited that the positive effects of combining Lithium and Verapamil may also be due to the inhibition of protein kinase C (PKC) activity provided by the Verapamil.

References

(I apologize for the departure from APA style, blog formatting issues.)

Amann, B., & Grunze, H. (2005). Neurochemical Underpinnings in Bipolar Disorder and Epilepsy. Epilepsia (Series 4), 4626-30.
doi:10.1111/j.1528-1167.2005.463006.x.
Retrieved from EbscoHost Mar. 14, 2010 AN = 17118993

Berridge, M. J. (1993). Inositol Trisphosphate and Calcium Signaling. Nature 361, 315-325.
doi:10.1038/361315a0
Available online: http://www.ncbi.nlm.nih.gov/pubmed/8381210

Farooq, M., Moore, P., Bhatt, A., Aburashed, R., & Kassab, M. (2008). Therapeutic Role of Zonisamide in Neuropsychiatric Disorders. Mini Reviews in Medicinal Chemistry, 8(10), 968-975.
Retrieved from Academic Search Complete database.
Retrieved from EbscoHost Mar. 15, 2010 AN = 34436130

Gargus, J. (2009). Genetic Calcium Signaling Abnormalities in the Central Nervous System: Seizures, Migraine, and Autism. Annals of the New York Academy of Sciences, 1151133-156.
doi:10.1111/j.1749-6632.2008.03572.x.
Retrieved from EbscoHost Mar. 14, 2010 AN = 35830926

Gitlin, M. (2006). Treatment-resistant bipolar disorder. Molecular Psychiatry, 11(3), 227-240.
doi:10.1038/sj.mp.4001793.
Retrieved from EbscoHost Mar. 14, 2010 AN = 19892243

Goodnick, P. (2000). The use of nimodipine in the treatment of mood disorders. Bipolar Disorders, 2(3), 165.
Retrieved from Academic Search Complete database.
Retrieved from EbscoHost Mar. 15, 2010 AN = 6500123

Landmark, C. (2008). Antiepileptic Drugs in Non-Epilepsy Disorders. CNS Drugs, 22(1), 27-47.
Retrieved from Academic Search Complete database.
Retrieved from EbscoHost Mar. 15, 2010 AN = 28088990

Levy, N., & Janicak, P. (2000). Calcium channel antagonists for the treatment of bipolar disorder. Bipolar Disorders, 2(2), 108-119.
Retrieved from Academic Search Complete database.
Retrieved from EbscoHost Mar. 14, 2010 AN = 5788405

Mallinger, A., Thase, M., Haskett, R., Buttenfield, J., Luckenbaugh, D., Frank, E., et al. (2008). Verapamil augmentation of lithium treatment improves outcome in mania unresponsive to lithium alone: preliminary findings and a discussion of therapeutic mechanisms. Bipolar Disorders, 10(8), 856-866.
doi:10.1111/j.1399-5618.2008.00636.x.
Retrieved from EbscoHost Mar. 14, 2010 AN = 35323933

Silverstone, P., McGrath, B., Wessels, P., Bell, E., & Ulrich, M. (2005). Current Pathophysiological Findings in Bipolar Disorder and in its Subtypes. Current Psychiatry Reviews, 1(1), 75-101.
doi:10.2174/1573400052953574.
Retrieved from EbscoHost Mar. 14, 2010 AN = 18882320

Suzuki, K., Kusumi, I., Akimoto, T., Sasaki, Y., & Koyama, T. (2003). Altered 5-HT-Induced Calcium Response in the Presence of Staurosporine in Blood Platelets from Bipolar Disorder Patients. Neuropsychopharmacology, 28(6), 1210-1214.
doi:10.1038/sj.npp.1300159.
Retrieved from EbscoHost Mar. 15, 2010 AN = 22436847

Can’t Not Talk About Shock Therapy (Electroconvulsive Therapy, ECT)

→ March 10, 2010 - 6 Comments

I hadn’t planned on discussing my electroconvulsive therapy (ECT) experience with many people. I found it terrible, scarring, not to mention futile and immensely embarrassing; those aren’t generally feelings I like to talk about. I still find the idea of shock therapy, well, shocking. Incomprehensible. Absolutely impossible.

[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.]

Write About What You Know — I Know ECT

The problem with being a writer is that you write what you know, and you’re driven to write what plagues you most. At least I am. I can’t write about fluffy bunnies and sparkling rainbows, because these aren’t the things that occupy my conscious mind. But ECT. Ironically it erased pieces of my brain only to seemingly permanently occupy others. I’m acutely aware of its happening and yet find it completely unbelievable.

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Caffeine and Mental Illness and Caffeine Disorders

→ February 21, 2010 - 13 Comments

Caffeine and Mental Illness and Caffeine Disorders

Caffeine is the world’s most popular psychoactive substance. So many of us love it a la Starbucks, Tim Hortons or just out or our home coffee machine. Me, I love coffee and I’m a fan of caffeine too. Coffee’s the nectar of the gods and nothing will convince me otherwise.

It seems though, caffeine can actually hurt you. I know, I never thought my beloved coffee could harm me, but I suppose anything that you abuse, will abuse you back. So, here is everything you ever needed to know about caffeine, caffeine disorders and caffeine and mental illness but were afraid to ask.

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They Liked Me, Again!

→ October 28, 2009 - 1 Comment

The kind people at PsychCentral have voted me one of the top ten bipolar blogs again this year. I’m honored. Thanks. Here’s what they have to say:

Caught in my Bipolar Burble.
She’s been blogging since 2003 and is consistently brilliant. Intimate and raw, very descriptive and at times hard to read. She’s been through a lot and her treatment-resistant disorder is still not responding to treatments, including a recent failed attempt at ECT (which led to the spin-off blog ECT: Electro-Convulsive Terror (has since been removed)). Harrowing.

Being called brilliant is enough to make an unstable girl cry. Again, thank-you.

Calcium Channel Blockers (Verapamil) and Bipolar

→ October 28, 2009 - 4 Comments

For anyone who is wondering, I am currently trying a calcium channel blocker to control my mood. This is a last-line treatment really as there are conflicting reports as to whether it works at all, but when you’re me, last-line treatments are really all you have left. However, some studies say that calcium channel blockers DO work and the upside is that woman can even take them during pregnancy which typically isn’t true of psychotropic medications. I’m copying information on this directly from psycheducation.org which I link to frequently. If you’re bipolar, and you haven’t checked out that site, you need to. It has the most comprehensive treatment information I have ever seen. (There is a book with most of the information as well, which is handy because it’s much better laid out.) So, as Dr. Phelps says:

A long time ago several randomized trials were done which confirmed that verapamil had “mood stabilizing” properties. This may be related to it’s action on calcium channels, the small pores in cells that allow calcium to move in and out. Calcium seems to be part of the story of what causes bipolar disorder (for more on that subject, go to that heading from the Diagnosis Details page). However, there were two “negative” trials later, meaning that the data did not show verapamil had mood stabilizing effects.

As a result of this “mixed” evidence, interest in verapamil has been very limited (in addition, because it is available in multiple generics, there is no manufacturer willing to pump money into research and advertising for this medication, so it “looks” less attractive than it really is). I tried it with several patients and was not particularly impressed myself.

Then I met Dr. Steve Dubovsky, an eminent researcher from University of Colorado, who had done much of the original work on this medication. He said “you have to use the non-slow-release version!” So, I’ve since tried it again in that form, and sure enough, I’m pretty sure I’ve seen people respond to it, as with other recognized mood stabilizers. Then, a recent surge in interest has come along from several researchers concerned about the effects of conventional mood stabilizers on women’s hormones. They point out that verapamil may also be safe to use in pregnancy, which is not true for any of the “big three” (lithium, Depakote, Tegretol/Trileptal). And they have just published a study showing further support (although in “open trial” design, there were actually quite a few more patients in this study than in Dubovsky’s original workDubovsky; not conclusive, but strongly supportive evidence) for verapamil’s effectiveness in women with bipolar disorder. Some of these women were pregnant.Wisner et al They used the non-slow-release form, if I am interpreting their methods correctly.

There is some concern about immediate-release versions of verapamil having a negative effect on heart function. American Academy… But this issue is still being studied (e.g. Hilleman) and does not appear to be an issue in terms of the use of this medication as a bipolar disorder treatment. For a patient who has known heart disease, or for a patient who is already on a blood pressure medication, a discussion with her/his doctor prior to starting verapamil in either form would probably be wise.

Where verapamil fits in the list of mood stabilizers is unclear because we have so little information on it, and that which we have is conflicting (e.g. see a review by Janicak, 2000). However, it carries relatively few risks compared to other commonly used mood stabilizers and must be kept in mind for cases in which the better-studied medications have not been effective or tolerable. It is also a consideration for a woman contemplating pregnancy, if it can be established before the pregnancy that this is an effective agent, which can take months or even years depending on the woman’s usual course of bipolar symptoms.


Causes of Mood Disorders – Serotonin, Dopamine, Norepinephrine

→ July 26, 2009 - 4 Comments

Today, I was watching a Comcast On Demand program about the causes of bipolar. I thought I’d watch and see how ridiculous it was because obviously, no one knows the cause of bipolar disorder.

However, the spot had some interesting information on the brain, neurotransmitters and bipolar disorder, which I then transcribed so I could share it with you. (Yes, I really did transcribe the whole thing.)

It’s in fairly layperson terms, so give it a look. At the bottom is a bit more information about dopamine, norepinephrine, and serotonin. This, unfortunately, is not in layperson terms, but is interesting nonetheless.

Brain Chemistry and Bipolar Disorder

And for the info:

…but research has shown that chemical imbalances in the brain play an especially key role in the onset of the disease. Every adult has more than 90 billion brain cells, or neurons. These neurons communicate with each other through chemical messengers called neurotransmitters. Neurotransmitters help control a range of bodily functions such as thinking, reasoning, and mood. But when they don’t function properly then problems can occur.

Here’s how neurotransmitters work, each neurons is composed of an axon, a dendrite, and cell body. When a neuron fires, an electrical signal is sent to the axon, and down a long slender tube that functions like an antennae. At the end of the axon the signal is transferred to the neurotransmitters. These neurotransmitters then travel across a synapse, or gap, to a dendrite of another neuron which receives the chemical messages. Once the process is complete the neurotransmitters are pumped back into the releasing neuron.

Under normal circumstances, just the right amount of a neurotransmitter is sent across the gap to communicate with other neurons, but in cases of bipolar disorder levels of certain neurotransmitters are abnormally high or low which experts believe can trigger mood abnormalities. For example, bipolar depression has been linked to low levels of serotonin in the synaptic gap. Serotonin is a neurotransmitter that helps regulate moods. Manic episodes have been associated with high levels of norepinephrine; the neurotransmitter that contributes to our fight or flight response. And too much dopamine, a neurotransmitter effecting emotions and perceptions, is linked to psychotic symptoms such as hallucinations.

Breakthroughs in diagnostic imaging have revealed that the brain structure of those suffering from bipolar disorders also differs from those of healthy individuals. Using advanced MRI and PET scanning technologies, experts now have evidence that experiences of sever episodes of bipolar depression can lead to changes in different parts of the brain. For example, the brain has two hypocampii, each located in the temporal lobes. One of the functions of the hippocampus is to help control learning, emotions, and memory. In some bipolar patients the hippocampus appears to shrink over time. Other areas of the brain’s temporal regions may shrink as well.

Since bipolar disorder often runs in families, scientists are trying to identify the specific genes that cause the condition. But genes are likely not the only explanation. Studies on identical twins reveal that if one twin develops bipolar, the other twin has an 80% chanced of developing bipolar as well. This suggests that while genes are a primary cause, other factors may also be needed for the disease to manifest itself. People born with the possibility of bipolar may find that stressful events like divorce, job loss or emotional strain can trigger the illness…

Serontonin, the Brain and Bipolar Disorder

Serotonin can also do the following:

1. It gives us self-confidence, a feeling of safety and security.
2. It causes us to feel sleepy.
3. It increases our appetites.

The part of the brain where it does each of these 3 things is a different part of the brain from the part where the other 2 things occur. Thus, for example, increasing serotonin in the part of the brain where self-confidence is will increase your self-confidence, but not your sleepiness. Unfortunately, we have no medications to increase only the serotonin in one part of the brain. This explains why medications to increase serotonin in the brain can also cause increased appetite and sleepiness.

Medications which increase serotonin in the brain (SSRI’s such as citalopram, escitalopram, fluoxetine, paroxetine, and sertraline and SNRI’s such as venlafaxine and duloxetine) give us more self-confidence, and a feeling of safety and security.

By the way, serotonin also exists in our gastrointestinal tracts. In this location, it stimulates digestion. This is why such medications can cause gastrointestinal upset. But they can also help constipation.

Norepinephrine, the Brain and Bipolar Disorder

Norepinephrine is a catecholamine with dual roles as a hormone and a neurotransmitter.

As a stress hormone, norepinephrine affects parts of the brain where attention and responding actions are controlled. Along with epinephrine, norepinephrine also underlies the fight-or-flight response, directly increasing heart rate, triggering the release of glucose from energy stores, and increasing blood flow to skeletal muscle.

However, when norepinephrine acts as a drug it will increase blood pressure by its prominent increasing effects on the vascular tone from α-adrenergic receptor activation. The resulting increase in vascular resistance triggers a compensatory reflex that overcomes its direct stimulatory effects on the heart, called the baroreceptor reflex, which results in a drop in heart rate called reflex bradycardia.

Dopamine, the Brain and Bipolar Disorder

Dopamine

Dopamine has many functions in the brain, including important roles in behavior and cognition, voluntary movement, motivation and reward, inhibition of prolactin production (involved in lactation), sleep, mood, attention, and learning.

A common hypothesis, though not uncontroversial, is that dopamine has a function of transmitting reward prediction error. According to this hypothesis, the phasic responses of dopamine neurons are observed when an unexpected reward is presented. These responses transfer to the onset of a conditioned stimulus after repeated pairings with the reward. Further, dopamine neurons are depressed when the expected reward is omitted. Thus, dopamine neurons seem to encode the prediction error of rewarding outcomes. In nature, we learn to repeat behaviors that lead to maximize rewards. Dopamine is therefore believed to provide a teaching signal to parts of the brain responsible for acquiring new behavior. Temporal difference learning provides a computational model describing how the prediction error of dopamine neurons is used as a teaching signal.

 

Diet and Depression / Bipolar

→ July 20, 2009 - Comments off

I’ve written about this before, but due to the amount of misinformation on the internet on this topic, I feel compelled to write about it again.

  • Omega-3 and Depression
  • Folic Acid and Depression
  • Low-Carb Diets and Mood

Now, first off, I do not believe you can cure depression or bipolar using diet. Let me be clear, people who tell you this are mostly flakes. There are ways though that you can possibly improve your treatment plan using dietary components.

Omega-3 and Depression

Omega-3: This is the most well-known and probably well-studied supplement, and it shows a lot of promise. Omega-3 also has been studied for other reasons too and it appears to be good for your heart also, so there are actually a few good reasons to take it.

Omega-3 is, of course, a long chain monounsaturated fat found in a number of foods including fatty fish like salmon. However, understand that you cannot eat enough fish to actually get into a clinical range to help depression. Feel free to eat salmon all you like, but don’t expect it to make you better. Again, people suggesting that you “eat more fatty fish” just really don’t know the research.

Omega-3 Over-the-Counter Supplement

Omega-3 supplements over-the-counter are a little different. They can bump up your omega-3 intake by quite a bit. But don’t by fooled. The big number on the front of the bottle is NOT the amount of omega-3’s you actually get in each capsule. Turn the bottle around to see the ingredients and you’ll see that the amount you get in each capsule might be only a third or less than the number reported on the front. So you might be thinking you’re doing something good for yourself, but just not getting the benefit from it.

So what’s going on here? It’s simple really, supplements are not regulated by anyone and so you never really know what you’re getting. If you’re trying to treat a life-threatening illness, I don’t think this is OK.

Luckily, there is an easy way to solve this problem. There is a pharmaceutical grade omega-3 supplement available for purchase. You just need to go to your doctor or psychiatrist and ask for it. Keep in mind, you should be asked for at least 2 GRAMS of omega-3 because that’s what the studies used. 3 grams would be OK too (and is what I take). Bring in the study abstract for your doctor for review if you don’t think he would be up on it, but it’s pretty widely known. And make sure he knows about the possible side-effects from taking large amounts of omega-3s. Thinning of the blood is one that I know of and so omega-3s should always be stopped several days before surgery. Definitely make sure that your doctor discusses with you anything that may effect yoaffectsonal medical issues.

Assuming you don’t have any specific risks, I have seen no side effects. Yay!

Folic Acid and Depression

Folate / Folic Acid: to be clear, folate is the substance in the body, and folic acid is the supplement you find on the shelf (pregnent woman are generally advised to take it). Folate definitiancies have been studied in depressives along with several other nutrients like B12. However, it appears that folate itself is not the part that’s definitiancy, it’s actually l-methylfolate, which is a compound that is created from folate. And the key here, is that one study has found that no matter how much folic acid you consume, your body may not be able to create enough l-methylfolate to actually fix your deficiency. So by telling you to take folic acid you may be doing absolutely nothing.

Again, luckily there is an easy fix. Your doctor can prescribe you a cheap pharmaceutical grade l-methylfolate supplement. Keep in mind, the number of people who respond to this supplement is very low, but as there don’t seem to be any side-effects (talk to your doctor) there’s no real downside to trying it.

Both of these supplements can/should be taken in addition to your conventional treatment.

Low-Carb Diets and Mood

And one final note. There is some thought that a low carbohydrate diet (like Atkins or South Beach) may adversely affect the serotonin in your brain which may effect mood and cognition. However, there is also evidence suggesting that this is not that case. Personally, I think long-term extreme low-carb diets may be a concern, but over the short term, no difference will probably be noticeable. However, if you have a serious mood disorder, like me, that might affect your choice of diet even if the evidence isn’t clear.

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