Saturday, September 8, 2018

Bipolar and Mitochondria

Misfirings and mis-timings of a number of systems affecting: 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 -- that's bipolar disorder in a nutshell.  Okay, a very full nutshell.  Last week I explored one example of hormone cycles gone off-kilter, cortisol.

This week, we go inside cells to discuss my favorite little critters, mitochondria.  I first learned about mitochondria from Madeleine L'Engle, from the second of her Wrinkle in Time series, A Wind in the Door.  Charles Wallace is sick, dying, because of a problem inside his cells.  His mitochondria are not doing their job.

Mitochondria are organisms (technically, organelles) that crawled inside the cells of animals back when animals were being formed out of the ooze.  It is a beautiful relationship.  We are their hosts and meal ticket; they are the power plants that convert food into energy.  If they don't work well, neither do we.  Since the brain uses bucket loads of energy, a problem with energy production has serious consequences for anything the brain is supposed to do.

What Do Mitochondria Do?

Lots of genes implicated in bipolar code for mitochondria, particularly in the hippocampus.  Memory formation, emotional regulation, focus, these are hippocampus tasks that suffer when mitochondria in the hippocampus aren't up to snuff.

Mitochondria play critical roles in communication between cells, modulating communication, and controlling neurotransmitter release.

They participate in the creation of new brain cells and the death of old ones.

Poor mitochondria functioning may be involved in oxidative stress, read: the equivalent of ten years premature aging.

So, like, let's take care of these critters!

Healthy Mitochondria

The die are loaded against them by our genes.  But there are ways we can tilt the odds back in our favor.  People who take medication have better looking hippocampi than those who do not.  But once again -- there's more we can do.

Life style, life style, life style.

This is not my first post about my favorite little critters.  Minding My Mitochondria, my review of a book by Dr. Terry Wahls, is my all-time most read post.  Dr. Wahls, confined to a wheelchair by MS in 2007 outlines an eating plan that helped her get onto a bike in 2008.  It's all about mitochondria.  The diet is applicable to anyone with a disease related to mitochondrial failure, like people with bipolar disorder.

I have adopted parts of the diet to the extent that I am able.  Dr. Wahls has modified it since, acknowledging that whatever steps a person takes in the right direction are better than staying stuck in eating habits that are harmful.  Simply put, when I eat my veggies, lots and lots of them, my brain fog lifts.  I have energy for life.

Eat your veggies.

Bipolar is a systemic and global condition, involving many systems in the brain.  But there are work arounds for many of the issues.  Next post goes after the wonky wiring.

Book covers from
Flair from
Hippocampus graphic from Grey's Anatomy
Women Working at a Bell System international Telephone Switchboard U.S. National Archives

Saturday, September 1, 2018

Bipolar and Cortisol

Y'all know about Bipolar as the mood disorder of Up and Down.  You have seen the movies, watched the soap operas and dramas.  The medications promise to reduce the number of trips around the loop de loop.

That's important, because what goes up must come down, and the fall can be mighty.  But there is more to is that that.

In a person with bipolar, a whole series of mis-timings and misalignments in our internal and external cycles results in a failure to maintain balance.  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.

In other words,

Over the next few weeks, I will sample this list, especially the items that are true all the time, even when not on that roller coaster.

Dysregulation of cortisol is one of my favorites, to use the term loosely.  Cortisol is the get-up-and-go hormone.  It gets you out of bed in the morning and manages energy throughout the day in response to stress.

In a healthy body, cortisol fluctuates throughout the day.  Its high morning level gets you out of the door on time.  An occasional spike when it's time to give a presentation at work gives you the energy to marshal your resources.  By evening, the level drops so you can drop off to sleep.

If your stress levels are chronic and your cortisol level stays high, you get weight gain, high blood pressure, weak muscles, mood swings, anxiety, fuzzy brain, compromised immune function, poor sleep...  Any of this sound familiar?  You do not have to have bipolar to experience chronic high cortisol levels and the poor health that comes as a consequence.

In general, healthy means higher in the morning, lower at night.  Sort of like this:

Bipolar moves the whole curve up from the base line and flattens the curve.  So, not quite enough in the morning, making it a struggle to get out of bed and get going in the morning, and too much at night, leading to difficulty falling asleep.  The upshot is not enough sleep, causing fuzzy brain in the morning, leading to poor performance at work, raising anxiety and cortisol levels as the day goes on, leading to poor sleep, and repeat.

Here is the big deal.  People with bipolar have this flattened cortisol curve and chronically higher baseline even when not in an episode, not depressed, not manic.  This issue could account for much of our lowered life span, on account of cardiovascular disease and metabolic disorders.

Here is the REALLY big deal.  The more episodes of mania and depression, the flatter this curve.  There are those who like to play with mania, or at least hypomania.  If they could get just a little up, they could get an energy surge, accomplish whatever it is they think they need to accomplish.  When they do that, they are damaging their brains.  Full Stop.

Okay, so what to do about it.

When you are digging yourself into a hole, the first thing to do is stop digging.  Don't play with mania.

But how to manage the cortisol curve on a daily basis: life style, life style, life style.  You can do better if you do more than take your meds.

I allow for my difficulty getting up.  I usually plan my day around ninety minutes of brain dead in the morning.  If I have to leave the house early, I wake up early.  I give myself more than the bare minimum to run out the door.  I prep the night before, set out clothes, make a list of the last things I have to pack in the morning, whatever.  Protect myself from my own zombie.

On the other end of the day, I guard my wind-down time.  Agitating or energizing television watching -- most of it is scheduled at my bedtime.  I don't watch it.  Or I watch it on youtube the next day.  I go home early from parties, or skip them altogether if agitating people will be there.
Life style, life style, life style.

There are hundreds of these little tricks.  Sometimes it's a pain in the butt.  But health and stability are worth it.  So future posts will follow this pattern: describe the wonkiness; provide a work around.
Keep your stick on the ice.  We're all in this together.

photo of roller coaster at Wild Adventures by WillMcC,
used under GNU Free Documentation License
The Persistance of Memory by Salvidor Dali
graphic of wave by VOG Designs, used under Creative Commons License
Zombie by Jean-noël Lafargue, used under Free Art License
Flair from

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
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:

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.