Tuesday, August 14, 2018

What Causes Bipolar -- III

No, your genes did not make you do it.

And the Prozac Monologues Tutorial on Bipolar Disorder continues, with installment #3.

Bipolar starts in the genes. But there is no smoking gun. There is no genetic defense. If you mortgaged the house, went to Vegas, lost the money, caught a disease, now you're in divorce court and maybe jail, nope.

Your genes did not make you do it.

The way the scientists put it, genes do not code for behavior. Okay, as last week's post says, it starts in your genes. But you are not doomed to end up in divorce court. You have just got some extra challenges to surmount.

Mental illnesses are developmental. They start with a brain that has certain vulnerabilities which come from genetic variations from the norm. These are vulnerabilities, not scripts.


So here is what happens. Genes program the proteins that make up cells. These big blobs with tentacles reaching out in this image are the cells. Cells build pathways, the wiring that connects cells to other cells. That's what the tentacles are, wiring, known as dendrites in brain-speak. The wiring produces traits, tendencies toward certain brain events and behaviors. The events and behaviors come from messages passed from cell to cell by means of electrical impulses passing through the wiring. If the events and behaviors are repeated, these tendencies are reinforced; the wiring gets stronger. As they, What fires together, wires together. What wires together tends to repeat, until the brain has learned to function in a particular way.

From the git go, by the way, even from the womb, this development is shaped by the environment, illness, diet, exercise, trauma, how people reward behavior, how the brain itself rewards behavior...

All of this is true for everybody. We start out as a mama cell who chooses which squiggly cell gets to be her mate. They come together, each with some embedded instructions, and off we go, from blob to tadpole to sweet little helpless thing to challenging teen to semi-responsible adult. The brain shapes itself, using that original equipment from the original two cells and in response to everything that happens within and without, some of it chosen, some of it not.

What makes for a bipolar brain is variations in the original equipment that are then shaped in particular ways, resulting in some marvelous originality and some problematic glitches. These glitches show up in the many and various ways that the brain has to balance, has to meet events, both internal and external, then respond in ways that range on a continuum, and return, when appropriate, to an earlier state.

People with bipolar have difficulty with balance. I'm not talking about the stay-standing-and-don't-fall-down kind of balance. I'm talking about misfirings and mis-timings of a whole bunch of systems: hormones, neurotransmitters, and immune system cycles that go off-kilter; glitches in communication between brain cells and within brain cells; and wonky wiring among the networks that connect the thinking, feeling, and evaluating parts of the brain.

Not this:


More like this:


It's still a long way from wonky wiring to Vegas. I won't stop at every roadside attraction, just the ones that appeal to me -- though I am willing to take requests. See you next week.

Flair from Facebook.com
Neuron graphic in public domain
The Persistence of Memory by Salvidor Dali, 1931

Thursday, August 9, 2018

Bipolar — What’s That in Your Genes

Your genes — that’s where bipolar gets started. Of all the mental illnesses, bipolar is the most heritable. That means it has the strongest genetic connection. In studies of identical twins, if one twin has bipolar, so does the other in 75% of the pairs. That compares to 60% with depression and 35% with schizophrenia.

If one parent has bipolar, a child is 13 times more likely to develop bipolar than a child with parents who do not have the disorder. If both parents have it, the child is 36 times more likely to develop it.

So you go to your doc and present symptoms of depression. Your doc will ask, Does anyone in your family have bipolar? But that's not the question you will answer. When you say No, the question you are probably answering is, Has anybody in your family ever been diagnosed with bipolar — that you know about?

It took years, but eventually I learned, when my doc asked that question, that my answer was to shrug and say, Not that I know, but my mother was married five times.

He nodded and made his note.

So that’s the deal. You don’t know. Read World Bipolar Day and the Color Red with your parents in mind and that cousin nobody talks about. If it fits, mention it. If your doc doesn’t probe the issue, but prescribes an antidepressant without a mood stabilizer, get a second opinion.

There are many ways that bipolar lurks in a family history, multiple divorces, recurrent depressions, a criminal background, flamboyant behavior, sexual exploits, overspending, even astounding accomplishments.

Alcoholism is another clue. The two often go together, and even when they don’t coincide in the same person (that's called co-morbidity), people with bipolar often have family with alcoholism; people with alcoholism often have family with bipolar. Demi Lovato - Bipolar Warrior has more about that.

But understand, there is no smoking gun, no single genetic bullet either to dodge or bring you down. It’s a whole constellation of genes, little variations in the DNA that nudge in one direction or another. The more nudges, the greater the chance that signs show up, a bit of moodiness, an occasional surge of energy or productivity, a certain originality of thinking, an extra delight in physical sensations, poor sleep patterns, a sensitivity to disruptions of schedule, a tendency to take risks, difficulty recovering from stressful events. Combine enough nudges with early childhood trauma to trip the trigger, you get bipolar.

That's not all there is to it. Lots of people with two afflicted parents are just fine. People with no discernible family history get diagnosed with bipolar.

Or rather, some variation of bipolar. The DSM identifies Bipolar I, Bipolar I, Cyclothymia, and Bipolar NOS (not otherwise identified). But the DSM is referring to symptoms and their severity. The genetics people are exploring the different constellations of genetic variations that produce assorted collections symptoms.

The popular picture of up/down is laughably simplistic. So is the DSM’s symptom counting, five of nine from this column, three or maybe four from that. Someday we will have a different way to diagnose, and probably a different set of diagnoses. Better diagnosis opens a window for better treatment.

Meanwhile, here is the bottom line. Bipolar is treatable. It’s difficult to treat. But it’s treatable. When one medication poops out, chances are a new, more expensive one has been developed. And there is a host of non-pharmaceutical treatments to be tried. But the real breakthroughs are yet to come.

dna graphic created by Zyphyris, used under GNU Free Documentation License
shoe selfie by author
Charlie and Linus from flair

Wednesday, August 1, 2018

What Causes Bipolar?

While Prozac Monologues the book is on its way to publication😲Prozac Monologues the blog is being revived.  I start the revival with a preview/expansion series on the chapter called Balancing Act, aka, The Science Chapter.

A friend who happens to be an academic psychiatrist reviewed The Science Chapter.  He wrote, Pathophysiology of BP is really tough, even for us "bigwigs", and I hope you have some success summarizing it for a non-professional audience.


So I said, Hold my beer.

And here it is:

In a person with bipolar, a whole series of mis-timings and misalignments in our internal and external cycles results in a failure to rebalance.  The list includes: dysregulation of hormones, neurotransmitters, and immune system; irregularities in communication between brain cells and within brain cells; and wonky wiring among the networks that connect the thinking, feeling, and evaluating parts of the brain.

Okay, that will take some unpacking, which I will do over the coming weeks.  Meanwhile,

it's like this:

Stay tuned...


Thursday, July 26, 2018

Demi Lovato -- Bipolar Warrior

The news story caught my ear.  I don't usually follow celebrity news.  But I had just read an article about Demi Lovato in a NAMI magazine.  I listened for some report of who she is and what she represents.  I wondered about a recent depression, a suicide attempt, perhaps.

Nope, not a word.  Celebrity drug overdose.  That's the story.  I swear they wrote this story thirty years ago, periodically pull up the file, change the name, and post.

She deserves better.  I'll just have to write my own post.

Lovato has long been open about her mental illnesses, bipolar, bulimia, self harm, drug abuse, and alcoholism.  Her celebrity as a pop star is significant to the story in one way.  It has given her a voice to advocate for those who have no voice.

Celebrity is not a risk factor for substance abuse.  But an alcoholic father is.  She has the genetic load to develop the condition.

Celebrity is not a risk factor for substance abuse.  But childhood trauma is.  She was bullied as a child, to the point of resorting to home schooling.

Celebrity is not a risk factor for bipolar, either.  But substance abuse and bipolar do often go together.  56% of people with bipolar struggle with addiction.  Why so many?  There are three potential explanations:

1. Kindling:  Both substance abuse and bipolar tend to get worse over time.  Neurons are sensitized by each experience, and push to repeat the stimulus.  The theory is that an underlying genetic disposition to an overactive sensitization process promotes both.

2. Genetics:  Both conditions have a genetic predisposition.  People with substance abuse are more likely to have family members with bipolar than the general population, and the other way round.  So there may be other gene variants, as well, that predispose for both at the same time.

3. Self-medicating:  While mania is the bipolar feature that gets turned into movies, depression is our much more common experience.  And there are scant options to treat it.  Mood stabilizers work better to control the manic side of the picture.  Lamotrigine has some antidepressant effect, and lithium reduces the risk of suicide.  But for the most part, the go-to treatment for bipolar depression is not to get it, to avoid mania, since depression follows mania.  But as time goes by, depression comes on its own with no identifiable trigger.  The brain just gets used to it and keeps going back.  People with bipolar spend a whole lot of time feeling like gum on the bottom of a shoe.  Self-medicating is a way of getting relief.  Not a good way long-term -- it generally makes the problem worse.  But desperate people take desperate measures.

So a recurrence of one condition is linked with a recurrence of the other.  Substance abuse can trigger an episode.  During an episode, one is tempted to self-medicate.

The follow-up stories suggest the third.  She has been depressed, anxious, pushing people away.

If your story, or that of someone you love, includes both conditions, know that both have to be treated.  You can't get better from one without treating the other.

That's what I wish I were hearing in the coverage of this tragedy.  There is more to this than addiction.  You have to treat both.

Bipolar is a remitting, recurring condition, a bitch to live with, and carries a suicide rate of 15%, which is why I wondered when I heard the story.

So what has Demi Lovato done with the cards she has been dealt? -- The best she could.

If I'm going to be a singer, I have to use my voice for more than singing.

And she has.  She has used her celebrity to get access to Capital Hill to advocate for a greater priority on mental health.  She has participated in awareness campaigns.  She has been open with her fans and offered counseling at her concerts.

Well, that's what she has done for us.  She has also done the whole treatment, therapy, medication thing.  I refer back to that Bipolar is a remitting, recurring condition, a bitch to live with... line.  Doing the best you can do does not always prevent recurrence.  That goes for both bipolar and substance abuse.



She'll be back.  She'll tell her own story.

Meanwhile, we thank Demi for the work she is doing on all our behalf.  We are praying and rooting for her recovery. 

Demi Lovato performing All Night Long, photo by Dominique Dinh, 
cropped, used under Creative Commons license
Anastasia Bakss as Wonder Woman by Wonder Woman Bodypaint, 
used under Creative Commons license

Friday, March 30, 2018

World Bipolar Day and the Color Red

Prozac Monologues -- the book -- is coming!  It really is.  Well, a chapter and a half still to go.


Here is a sneak peak that may answer the burning question,

Why are you wearing red on World Bipolar Day?  

It's called:
Three

Have you ever noticed -- flight of ideas, distraction, talking fast/pressure to keep talking -- these are symptoms of a serious mental disorder (we're talking the manic phase of bipolar here) and also kind of -- fun.

Monday, May 1, 2017

Silence Kills -- The Stigma of Mental Illness Redux

It's Mental Health Month again.  Out comes the stigma word, the pleas for understanding, the heart-warming whatever.

I am so done with stigma. Frankly, I am insulted that NAMI et al still use the word.  Is Black Lives Matter about stigma?  It's dangerous to be either in the US, and for the same reason. Prejudice, people.  We are talking about prejudice.


The following was first posted in July 2013.  Alas, we are still trying to get our heads out of our asses.  The Affordable Care Act made some progress, a little, toward mental health parity.  Insurers had to get creative to deny us coverage. But this congressional session, it's all up for grabs again, whether our illness will get covered at all.  And the prejudice of doctors -- don't get me started.

So from July, 2013 --

                              *************************

I don't use the s-word.  I hate this title. I use it only because people who need this post will use it when they google.

I don't use the s-word.  But here it is.

First from Google:

Definition of STIGMA

Noun
  1. A mark of disgrace associated with a particular circumstance, quality, or person: <the stigma of mental disorder>.


Saturday, April 29, 2017

April is the Cruelest Month


I opened my curtain this morning, saw a brilliant blue sky, and remembered, "April is the cruelest month..."  April is when suicide rates start to rise, to peak in June. Then, as is my habit, I said Morning Prayer, a spiritual discipline of prayers, psalms and bible readings. The assigned psalm for today is Psalm 20:


May the LORD answer you in the day of trouble,
the Name of the God of Jacob defend you;
Send you help from his holy place
and strengthen you out of Zion;
Remember all your offerings
and accept your burnt sacrifice;
Grant you your heart's desire
and prosper all your plans.
We will shout for joy at your victory
and triumph in the Name of our God;
May the LORD grant all your requests.

If April is the cruelest month for you, my friend, I prayed this prayer for you.  Now, this sort of thing doesn't always help me. And no blame, God, no blame, if it doesn't help you.  But if it does help you today, there it is.  We will shout for joy, you and me and all of us who know what I am talking about, at your victory.

And while I have anybody else's attention, suicide prevention is not usually a dramatic, last minute intervention.  Suicide happens when pain exceeds resources for coping with pain. Let me repeat that.  Suicide happens when pain exceeds resources for coping with pain.  Every day, in any little way, you are a resource.  Or not.  Kindness.  That's the ticket.  Just pay attention to someone who may be struggling.  And do something, anything kind.

That's all.