Bipolar blog

Are bipolars crazy? I am. It’s OK to be Crazy.

→ June 10, 2010 - 4 Comments

CrazyI am crazy. I tell this to people in my personal life. It’s not a secret. I figure there’s no point in trying to cover it up; it’ll come out eventually. I’m crazy. The approximately 20 scars on my forearms rather give away that something is amiss.

But people really don’t like the word “crazy”. In fact, most often, what people say to me is, “no, you’re not!”. Well, actually, I am. I have a mental illness, I’m bipolar and I’m crazy.

more at Breaking Bipolar: Are bipolars crazy. I am.

Bipolar Natasha Tracy’s Interview with HealthyPlace

→ June 9, 2010 - Comments off

Breaking Bipolar at HealthyPlaceHere is today’s interview with me, Natasha Tracy, complete with call-in questions. I think it went well. We discussed some of the negative impact bipolar has had on my life.

I talked about bipolar disorder, depression, suicide, coping and how my writings at HealthyPlace have been controversial.

 

Watch live streaming video from healthyplace at livestream.com

 

See more video and audio at Breaking Bipolar at HealthyPlace.com.

Self-Harm: Stabbing Yourself is Bad

→ May 28, 2010 - 13 Comments

Stabbing is bad. It just is. If you have to pick self-harm options between cutting, hitting, and stabbing, don’t pick stabbing.

Unless you’re trying to kill someone, in which case I think stabbing would be pretty good. And satisfying. I’m surprised more murderers don’t pick stabbing.

Anxiety, Impulse Control Self-Harm and Stabbing

I’m having anxiety issues. And impulse control issues. And stabbing issues. Well, that last one is really a function of the other two, but it’s an issue nonetheless.

I’ve always been attracted to stabbing. I think that’s because when you start wielding a blade with force, you can’t change your mind. And it’s so easy to did deep. And draw a lot of blood.

Stabbing and Scars

And as I considered stabbing, I also thought it had the advantage of leaving a minimal scar. You cut down, not across.

This turns out not to be the case. Stabbing doesn’t produce a large incision, but the one it does produce tends to gape and cause more scarring than you think. Just trust me. Don’t try it.

And so, as much as I like the force, and blood, and bruising associated with stabbing, I’ve really written it off as a self-harm method. Death method, probably decent, self-harm, not so much.

Anxiety and Self-Harm

Self-Harm, Stabbing is Bad

But as I’ve said, I’ve been having issues.

For whatever reason, for whatever cocktail, for whatever brain misfire, I seem to be turning in super-anxious-suicide-girl at night. Like, way more than usual. And on top of that there seems to be a real lack of impulse control on my part, last notably seen with the cutting of my wrist with broken glass.

Hitting is Bad Too

And so I had been hitting myself with a blunt object, went into the kitchen to cut up a yellow pepper, and then as I was removing the core I thought to myself, I wonder what it would be like if I hit myself with this knife. And then I just did. And then there was a lot of blood. I was standing next to the sink so I just tried to keep standing while the blood went down the drain.

It just kind of, happened. Like stubbing your toe. An accident.

And it’s fine. My arm is fine. There does seem to be some nerve damage going into my thumb, but it seems minor and may get better, I don’t know. This isn’t really my area of expertise.

Self-Harm Without Control is Really Bad

And I don’t know. It’s a scary thing. To do something, without intention. One of the problems is I really don’t care if I die. I mean, like, really don’t care. I’m so over it’s unbelievable. So when something pops into my head, whatever filter I did have doesn’t exist. So I just do it.

And then there’s the drinking. Crazy people shouldn’t drink. Crazy people on meds really shouldn’t drink. Crazy people on meds and tranquilizers really, really shouldn’t drink. But I feel so irreparably horrifically self-loathing and suicidal that I couldn’t care less that it’s a bad idea. I’ll take any idea at all that would mask the pain. Even a little.

Sigh. All roads lead to scar tissue.

Again, try not to worry, OK? You’re scared, I know. I am too. But there’s nothing you can do. There’s nothing I can do. I’m suppose to see my GP on Monday and maybe she’ll be able to get me in to see a psychiatrist. Of course the psychiatrist won’t have any answers so it’s a bit moot. More moot than usual. Ultra-moot. Now with more brightening power.

Depression: Silence of Being Ignored Feels Like Loss

→ May 14, 2010 - 6 Comments

This silence feels familiar. I despise the deafening, familiar sounds of silence. They terrify me. I suppose the silence strangles me. Strangled, alone, screaming.

I Hate Being Ignored

People who know me, know this about me. They know how much I hate being ignored. They know that when they don’t return my calls or my emails my mind riles in negative and catastrophic scenarios. People who actually like me don’t want to do that to me. It’s the depression. It turns the pain of being ignored up to unmanageable levels.

Of course, there aren’t many people left who actually like me. Or at the very least, they don’t treat me like they do. I don’t know what it takes to be treated with care and respect. Most people just don’t treat me that way. (And yes, there are exceptions.)

Being Ignored Feels Like Loss

To lose another person I love. To lose another person I thought loved me. Not only does it prove to me that no one really does love me, but it also proves that no one ever will. That I can never trust that anyone actually does. Even the people who say they do, can watch me slip, screaming into the worst deadly mire without even blinking.

And here’s the question I leave to you: how many emails from a suicidal girl would you ignore? Even if you didn’t like her. I mean, really.

(Upon pushing the publish button I actually did receive a 1-word email. Perhaps I’m not being ignored, I’m simply immensely unimportant. Sort of not news.)

Will ECT Work for Me? – Predictors of ECT Efficacy

→ May 12, 2010 - 2 Comments

It would be nice to know ahead of time if a treatment would work. Unfortunately, no one cal tell the future: not for cancer treatment and not for mental illness treatment like electroconvulsive therapy (ECT) either.

Will Electroconvulsive Therapy Work for Me?

But very smart people try to figure out what might predict the outcome of treatments. Especially treatments like ECT, a hotly debated, and much maligned treatment. That’s the good news. And the bad news.

In a retrospective chart review of depressive and bipolar patients in a Netherlands hospital, of those who received  ECT, 65.8% met the standards for remission. The only predictor of response found was duration of index series.

The good part here is that medication failure did not predict response; so theoretically, no matter how many medications you have failed you have an equal chance of response to ECT.

The bad part is that the more times you get ECT in your initial series, the more likely you are to respond. I say this is bad because the more times you do ECT the more chances are you’re going to suffer more and worsening cognitive side effects too.

It’s something to consider when thinking about starting or stopping ECT treatment.

Image by rolffimages / 123RF Stock Photo.

People Who Attempt Suicide Don’t Want To Die

→ May 7, 2010 - 276 Comments

There are frequent reports that of the people who survive suicide attempts, they realized sometime after the pills, or the gun, or the jump, they didn’t want to die. This is obvious. No one wants to die. People who attempt suicide don’t want to die.  They want to be out of pain.

Read more

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.)

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