bipolar disorder

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Why Don’t Animals Get Schizophrenia (and How Come We Do)? Article in Scientific American

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Short answer: Because their brains aren’t as complex as human brains. Unfortunately that’s the price we people with prefrontal cortexes pay. In bipolar disorder, as in schizophrenia, people with these illnesses can become out of touch with reality. This is called psychosis, or being psychotic. Auditory hallucinations happen to 90% of people with schizophrenia, i.e. they hear voices, this also happens up to 80% of people with bipolar d/o. There are also visual hallucinations (seeing things), even olfactory hallucinations, where you may smell something that isn’t there! (Luckily for me, I have never had auditory hallucinations, I am forever grateful for this! Interestingly enough, I have had olfactory hallucinations, I smelled the scent of Camay soap once when it was nowhere to be found.)

Let’s get back to the point of this article from Scientific American. It basically says that schizophrenia 9and I assume bipolar d/o in psychosis) are the price we pay for a much more complex brain. It is a defect of the gamma amino butyric acid (GABA) system. This is an inhibitory neurotransmitter, meaning it inhibits neurons from firing, in part by suppressing dopamine in certain parts of the brain. So when there is a problem with this system, then neurons that wouldn’t normally be firing are firing, and dopamine is also not suppressed, and this is happening in the prefrontal cortex (PFC). This leads to hallucinations. See quote below.

Yes the psychotic brain, whether in schizophrenia or bipolar d/o runs amok. And it can run so crazily amok because it is so complicated. So complicated that when things go wrong, they go wrong in a big way. Hence hallucinations.

http://www.scientificamerican.com/article/why-don-t-animals-get-schizophrenia-and-how-come-we-do/

“They also found that these culprit genes are involved in various essential human neurological functions within the PFC, including the synaptic transmission of the neurotransmitter GABA. GABA serves as an inhibitor or regulator of neuronal activity, in part by suppressing dopamine in certain parts of the brain, and it’s impaired transmission is thought to be involved in schizophrenia. If GABA malfunctions, dopamine runs wild, contributing to the hallucinations, delusions and disorganized thinking common to psychosis. In other words, the schizophrenic brain lacks restraint.”

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My Short Video For The Healthline.com “You’ve Got This” Series.

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I made this video for Healthline.com (link below.) It’s a series called “You’ve Got This!” and it’s meant to be a positive inspirational message for people who have been newly diagnosed with bipolar d/o. Here’s the link to the video I made. It was quite an emotional experience, even though it’s short, it brought up a lot of emotions about when I found out I had bipolar d/o and when my brother was diagnosed with it, he was the first one in my family to start showing symptoms of this illness. Sort of a hellish time. We didn’t know what to expect, what was going to happen to my brother. Then I was diagnosed with it. A time of upheaval and terror, really. So I am so happy to be able to offer reassurances to people who are newly diagnosed that things will be fine. It is imperative that they stay in touch with their doctor and follow the doctor’s advice. And their lives will be their own again.

https://www.youtube.com/watch?v=10FFEnBtXGY

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Maybe, maybe not…

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Don’t really have anything to say. Tired. Very low energy. Low mood. Beginning of a depressed phase? Don’t know. It’ll become apparent soon enough. If It’s hard to wake up in the morning, if it’s hard to get anything done, if I don’t even want to get anything done, if I have lost interest in activities that were pleasurable, such as taking pictures, or singing, then yes it looks like the beginning of a depressed phase. These things have been happening to me in the past few days, but only the past few days so it’s still too early to tell. It may just be a blah period and not the beginning of a real depression. At least Zumba is still FUN! If that stops being fun, then I am in serious trouble…

Also if I do go into a depression, there is one big problem this time: No Zoloft. My psychiatrist will not let me take Zoloft or any SSRIs (Selective Serotonin Reuptake Inhibitors), because he says that they make people with bipolar disorder cycle more, and apparently research supports his claim. But this is pretty scary for me, because until now, whenever I felt a depression coming on, I would start taking Zoloft and it abated. This time I don’t have that option, that safety net. If I truly do go into a depression, I don’t know what I am going to do. And just this fact is causing me a lot of anxiety and stress.

The drugs he has recommended I go on all have given me very bad side effects in the past. For example Abilify literally gave me Parkinson’s like symptoms, with very stiff muscles, a shuffling gait and muscle tremors. When I took Welbutryn in the past, I thought i was going to burst because of an insane level of anxiety. Latuda gave me blinding headaches and Saphris also gave me a lot of anxiety and severe headaches. Provigil, which is a stimulant is also one that he has suggested, but I will not take it as it can push people with bipolar d/o into full blown mania. I don’t understand how he even suggested that, given the fact that this is a side effect! So there we have it. The one medication I can take without side effects is now forbidden to me and all the ones I am allowed to take are ones I cannot take because of awful side effects. The fear, anxiety and stress of what’s going to happen if I do go into a depression are quite enough to send me into a depression 😦

Going to NYC for Thanksgiving. A lot of close and extended family will be there. Hoping I will be fine. I was so looking forward to this trip to NYC with my husband, my son, my stepdad, my brother, my sister, my cousin, her children and many, many others. And now I don’t know. Oh well, all I can do is hope for the best.

Also wondering if it is time to find another psychiatrist. But what if what this one says is true… then it would be unwise to find someone new… going around in circles and have no idea what to do. Even deleted a whole post I’d written because I thought it was garbage… simply going around in circles. Not so bad that it is definitely a depression, but definitely some symptoms, and maybe on my way to a depression.

Oh yes, bipolar strikes again, as usual with its impeccable timing, and all it does is make my life a living hell. Tired, so tired of this. Of fighting depression, of fighting mania, wtf bipolar d/o, leave me the hell alone.

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As the days get shorter… :((.

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As the days get shorter, unfortunately, my face gets longer. My mood gets choppy…
(A note: Please don’t think I am whining, I am not. At times it feels like the rug being pulled out from under my life, at times, and this is the worst, it feels like my heart is breaking into a million, jagged pieces, and at times it feels like I am living in pitch darkness. None of it is good, and I have lived with this, on and off, for twenty eight years. So please believe me when I tell you, I am not whining or needlessly caterwauling. I am not.)
Getting hard again. Sadness creeping in. Emotions too close to the surface. Crying a lot again. Missing my friends. Missing my precious son. Memories creeping in. Ammi, Farooq, Mamoon, Ammi Khala, Khalid Mamoon, all gone, lost to me. Tears on the brink of falling, hurriedly wiped away. Life is never easy, but it gets much more difficult when bipolar strikes. God, I thought I might escape it this year, with the increased dose of medication. Haha, no such luck. But I go on. I cook, I bake, I even model (!!), I read, I go see plays, I talk to and even laugh with my friends and family. But the heaviness in my heart remains. No one knows. I don’t think anyone suspects. I put on a good show :)). Of course I do. There is nothing else I can do. Uneasy feelings or not, life must go on. I must go on, although thoughts of not going on cross my mind. But I shoo them away, I have a son and nephews and nieces for god’s sake. I would never do anything that would even hurt one little hair on their precious heads. Of course I go on. I summon the strength with which I was lucky enough to have been born. I remember the love my grandmother, and my mother and my aunts and uncles gave me from the day I was born. That is the love that sees me through. I have their faces and their hearts imprinted on my heart. My Amma, my Ammi, my Farooq, my Mamoon, my Ammi Khala, my Khalid Mamoon. All full of love and caring and such steely strength. We are descended from a great Sufi saint named Baba Farid! He preached love, nonviolence, meditation, and living simply, and he practiced it. I am his great, great, great, … grand daughter. I have read his poetry and it’s very sweet and sounds a lot like Buddhism. One of his poems says that he thought he was the only one in pain, but when he climbed on the roof of his house, he saw every house was on fire! Another poem says not to strike someone who hits you, but kiss his feet and go home! Even one step beyond ” turn the other cheek”… He is still worshipped in Pakistan and India, by Moslems, Hindus and Sikhs! What does this have to do with bipolar disorder? Well, in times when I feel weak, I draw my strength from the love my family gave me and the teachings of my ancestors. It’s about having the strength to hang on with the tips of your fingers when the mountain you’ve been scaling, starts to crumble in a landslide. Of course I am going to call my doctor and increase the Seroquel dose or the lithium dose, and then I will be as right as rain again. These medications are a godsend and a blessing for me. Without these, I would be nowhere, so I am very fortunate that we have them and that they work for me. So, as usual, when the days get shorter, my mood goes awry. Seems that I can’t avoid it. But, and this is a big but, I can control the severity of the swing and quickly squash the phase by staying on higher doses of medication all year, and then increasing one or both as soon as I feel bad. That is indeed a great blessing and something for which to be very thankful!

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Impulsivity is a symptom of mania or hypomania!

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One very important reason to take the correct dose of the correct medication is shown below from the article: “Impulsivity and Risk Taking in Bipolar Disorder and Schizophrenia” published in Neuropsychpharmacology in September 2013. Here is the reference if anyone would like to read the whole article: http://www.nature.com/npp/journal/v39/n2/full/npp2013218a.html

Basically what this article is saying is that impulsiveness, which is defined as risky decision making, high risk attitudes, acting without planning, poor inhibition of risky actions, high risk attitudes, and rapid decision making (which basically means making decisions without thinking them through). Please understand that these are symptoms of mania. Once you are in a manic phase, you are going to do this. In a hypomanic phase, you are also going to do this but to a much lesser degree, your actions will not be as risky to your life or health. Please also understand that the only way to stop this from happening is to NOT go into a manic or hypomanic phase. The way to do that is to take the right amounts of the right medication as you doctor had prescribed. And if you feel like your mood is slipping towards mania or depression, to call your doctor and let them know. This is a BIOCHEMICAL disease involving levels or metabolism of neurotransmitters. All these neurotransmitters have certain effects on the brain. When their activity or levels of these neurotransmitters are high, we become impulsive. So, just take the right dose of your medication and head these problems off at the pass, nip them in the bud, stop them before they happen. If you don’t, this disease WILL ruin your life, it will destroy your peace of mind, it will destroy your relationships, it will destroy your friendships, it may even take your life. That is as bluntly as I can put it. I am definitely on the therapeutic dose of lithium and I’m staying on it for the rest of my life, I am not allowing this mood disorder to control my life or take days away from me or most importantly take my family or beloved friends away from me.

Not me, not now, not ever again! I hope you too will make a commitment to your health and sanity and your life, and follow your doctor’s advice to the letter.

Below in quotes are passages from the above mentioned article.

“Impulsiveness is a clinical feature of bipolar disorder. Broadly, impulsivity refers to a predisposition toward unplanned reactions without consideration of consequences and can include risky decision making, self-reported high-risk attitudes, poor response inhibition, and rapid decision making. 

Bipolar disorder is often characterized by impulsive behavior and increased tendency to work toward a reward, often without sufficient planning. Although risky-impulsive behavior is a diagnostic criterion for mania and bipolar patients consistently show abnormalities on self-report measures of impulsivity, they do not consistently show deficits on behavioral tasks that require planning and forethought. These differences may reflect the multi-faceted nature of impulsivity, or the measurement tools used to assess the construct.

Finally, some of the mixed findings in bipolar disorder and schizophrenia regarding impulsivity and risk taking may be attributable to the types of medications patients are taking. The neurochemical basis of impulsivity and risk taking involves dopaminergic, serotonergic, and other neurotransmitter systems, and these systems are affected by antipsychotic (AP) medications. Some studies find a reduction in impulsiveness associated with AP medications, whereas others find no such effect in psychotic samples. Thus, it is important to consider the role of AP medications on measures of impulsivity and risk taking.

This is one of the first studies to examine both self-report and behavioral measures of impulsivity in bipolar disorder and schizophrenia. The study had two goals. The primary goal was to conduct a careful analysis of impulsivity using multiple approaches across three groups: bipolar disorder patients, schizophrenia patients, and healthy controls. The secondary goal was to compare subgroups of bipolar disorder patients who differed in terms of AP medications and history of psychosis on measures of impulsivity and risk taking.”

 

 

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Whether One Takes Medication or Not Affects Outcome of Having bipolar disorder.

Some people with Bipolar disorder are very high functioning. The main thing that distinguishes people who do well from people who don’t is the ability to accept that one has a disease and take medication.

Often, people who have mental illnesses refuse to accept that they have an illness. They refuse to see a doctor and often refuse to take their medication. This obviously makes for a very negative outcome with the illness getting worse and worse and finally hospitalization after hospitalization and maybe even worse. With bipolar symptoms getting worse and worse due to not taking their medication, many people also have problems with the law as in arrests and legal trouble.

As was so tragically illustrated with the death of Robin Williams just recently, mental illness can be a terminal illness.

The best outcomes occur for people who go to their doctor regularly and take the recommended medications at the proper doses. I have found thinking about it in terms of the molecular mechanisms of the disease helps me understand the illness as something totally molecular which is helped by taking medication.

Neurotransmitters such as Serotonin, Epinephrine, Norepinenephrine, and Gamma Amino Butyric Acid (GABA), are the molecules that carry information from one neuron to another. This information may be thoughts, emotions, or feelings.

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Again remember the presynaptic neuron (yellow) and the space which is the synapse, and the post synaptic neuron? Well the presynaptic neuron, upon firing, empties it’s vesicles into the synapse, thereby releasing its supplies of neurotransmitters, eg. Serotonin. The Serotonin then binds to a receptor on the post synaptic neuron and exerts its effect via proteins that are in close proximity to the receptor. How long the Serotonon stays active depends on how fast the post synaptic neuron reuptakes it. If the reuptake is too fast then Serotonin cannot exert its effect. This reuptake is blocked by drugs such as Zoloft, Prozac, Wellbutryn (this actually blocks reuptake of dopamine and norepinephrine.) That is how they are hypothesized to alleviate depression.

SSRI stands for selective Serotonon reuptake inhibitor.

SNRI stands for serotonin norepinephrine reuptake inviter.

DRI stands for dopamine reuptake inhibitor.

Soon to come: mechanism of lithium action :-))

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Thank goodness for Lithium!

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The treatments for bipolar disorder were initially discovered serendipitously. Lithium for example remains one of the most frequently used and effective treatments for bipolar disorder, but lithium has a number of different targets in the brain and so we haven’t learned very much specific information from lithium’s effect. Some of the things that lithium does are now targets for a great deal of research. One of those things is that lithium will decrease the function or change the function of some second messenger systems. And so it will give a way that you could have multiple neurotransmitter systems affected or damped-down by just the one effect of lithium. Another thing that lithium does is that it has very robust neuroprotective and neurotrophic effects. It’s thought that lithium may partly have its effect in the brain by restoring the structure, some of these structural abnormalities that occur in bipolar disorder. For example, the reductions in grey matter volume that exist in the hippocampus and the medial prefrontal cortex, there is now some evidence that suggests lithium can actually reverse those changes. Similarly in those experimental animal models where you’ve got repeated stress causing atrophy in the same structures, lithium has the capability of reversing those atrophic changes. So, one impact of lithium might be on the neuroplasticity of the brain.

http://www.dnalc.org/view/2085-Lithium-how-it-might-protect-the-brain.html