James Claims - Manic Depression and Philosophy

I’m home for thanksgiving. So far, I’ve fared well with my sister and brother in law. They suggested that I get tested for ADD since it seems to run in the family and is often comorbid with bipolar disorder. Over all, we’ve been getting along swimmingly. But now that they’re gone, I can feel the emotional cracks starting to form.

The cracks are chiseling away my patience and my emotional strength. I’m snapping at my parents over little things that don’t matter. I’m taking practically everything personally. Then on top of it all, I feel like crying. Just straight crying over nothing. It’s wearing my emotional armor thing. Mind you, this is all on klonopin as well.

And then there is the general feeling of being overwhelmed. That I’ve failed as a student to get myself known at my college for good letters of recommendation. That I’m failing at getting anything remotely good done on my thesis. And because of this I won’t get into a good grad school, which will total my career and leave me teaching in some crappy little college and I’ll hate myself for the rest of my life. And then on top of it, I feel like I’ve just lost part of my life from this past month.

It’s also just flooding over me the realization that I now have psychosis attached to my diagnosis. I feel like I have so little fight left in me that I can barely stand it. Instead, I feel like crumbling. I feel like every week that has passed and left me waiting for results just cuts a little more out of me. I just want to stop feeling. I often cut when I’m like this, but I can’t get away in time to do it while my parents are around. Cutting often releases the emotional energy that’s built up. But instead, I’m just left feeling too much. I should probably give my psychiatrist a call. No, I think I will.

“My Ideal is a certain coolness. A temple providing a setting for the passions without meddling with them” - Wittgenstein

My ideal as well for wellness in these turbulent times with bipolar disorder.

In individuals with bipolar disorder and schizophrenia, smoking is heavily present. The British Journal of Medicine found that approximately 56% of those with bipolar disorder smoke; with psychosis, this number jumps to 70%. The Royal College of Psychiatrists found that almost 90% of those with schizophrenia smoke. This is far higher than the national average which the CDC estimates at around 20-25%. So something must be driving the use of tobacco, and in particular nicotine, in these two disorders.

So what’s going on? Is it being driven by the disease or is it self medication. Well, it appears that there is some evidence for self medication. Theassociated content referencing Science Magazine reports that one of the roles that nicotine is playing is in the GABA receptors. Nicotine bound in the prefrontal cortex and the hippocampus inhibited the enzyme DNMT1, which breaks down GABA, allowing for more GABA to be produced. The effects of nicotine on GABA is profound. In a study conducted by the American College of Neuropsychopharmacology, they found that GABA rose by 10% in the brain after smoking an inhaler and then, 45 minutes later, continued producing GABA at a four-fold rate compared to a normal brain.

So what is this magical GABA and what does it do to the brain. The Associated Content provides a nice outline of what GABA does in the brain:

“GABA is the communications speed controller, making sure all brain communications are operating at the right speed and with the correct intensity”, writes Joseph M. Carver, Clinical Psychologist. When there is too little GABA, we become overstimulated and engage in excessive and impulsive behavior. When there is too much GABA, we become overly relaxed and sedated. The levels of GABA are low in schizophrenia and bipolar disorder as well as in epilepsy and other seizure disorders.”

So that’s what GABA does in our brains, it acts as an inhibitor in the hippocampus region of our brains and slows down the firing of the neurons.

What does this mean for those with schizophrenia and bipolar disorder. For schizophrenia, the results are good. Ripoll et al. found that a 14mg nicotine patch improved sustained focus in schizophrenic patients while there was no gain in control subjects. It was also found to enhance smooth eye movement. Smooth eye movement is a complex task involving the visual cortex and the motor cortex. The complexity of this task is difficult for those with schizophrenia, indicating that cognitive improvements can be measured by how well movement tracking is performed. In more general terms of cognitive enhancement they found that “attention, sensory gating and eye movements, and more generally in cognitive, sensory and memory disorders” were improved with nicotine. In addition to these findings, there are previous studies showing that schizophrenic symptoms return when nicotine intake is reduced.

So the comorbidity of schizophrenia and smoking appear to be self medicative in a positive way. In addition to that Dépatie et al. found that such improvements with a 14mg nicotine patch were not found in the control groups. This indicates that nicotine use in schizophrenia is not merely a matter of habit or addiction, it is a matter of self medication for symptoms.

Now for bipolar disorder. For similar reasons as above mentioned, the impact of increasing GABA in the brain acts as a mood regulator by sedation. Acting as a neurotransmitter inhibitor, the effects of the nicotine slows down the brain and reduces symptoms like anxiety. But this comes with a double edged sword. According to the Journal of Affective Disorders, non-smokers fared better in the Young Mania Rating Scale than smokers did. Indicating that smoking has some negative impacts on mania. Why is this? Serotonin. Nicotine also stimulates the production of other neurotransmitters, such as dopamine, noradrenaline, GABA and glutamate. Serotonin acts as a type of antidepressant for the brain, the same way that SSRIs do operate. So the influx of more serotonin may actually counter act the inhibition due to GABA. However, when depressed, this may be reversed. So depending on what mood you are currently in, nicotine might be beneficial or detrimental to one’s mental health.

But the short term effects of GABA are what primarily interests me in these studies. The sedating and calming effect of nicotine may well be what is needed for short term relief from manic symptoms. And though it may play a role in prolonging mania with elevated serotonin levels, the short term is positively impacted with sedation. Hence the reason for sometimes needing a cigarette to calm down when agitated is so needed while manic.

More work needs to be done on studying the interplay between mental illness and nicotine. There is very little done in studying the effects of nicotine and bipolar disorder, but there is some literature on it regarding schizophrenia. So from what I can glean, the use of tobacco for the nicotine is not something that is merely an addiction that is difficult to shed by a particular class of mental illness, but instead appears to have therapeutic effects as well.

Hope you enjoyed this bit of research.

http://www.news-medical.net/news/2007/12/10/33328.aspx

http://www.cdc.gov/chronicdisease/resources/publications/AAG/osh.htm

http://www.ncbi.nlm.nih.gov/pubmed/11435266

http://apt.rcpsych.org/content/6/5/327.full

http://www.medscape.com/viewarticle/483888_4

http://www.associatedcontent.com/article/1690861/why_nicotine_calms_the_brain_in_schizophrenia_pg2.html?cat=70

http://www.medwire-news.md/47/76704/Psychiatry/Smoking_interferes_with_treatment_for_bipolar_mania.html

http://www.jad-journal.com/article/S0165-0327(08)00038-4/abstract

I’ve grown to hate the haze that klonopin has wrecked on me. The zombie daze and unproductive days are really getting to me. I can’t stand to spend so much time doing nothing at all; even if it is for my own good. So yesterday I spent less time in the haze by taking less. And I learned a lot. Either it’s withdrawal or it’s my moods, but something is still wrong.

My agitation around 4pm was too intense. I had to move and so I took a walk. I often find walks calming when agitated. They get the legs moving, which is what my brain is screaming at me to do. But it also gives me a chance to be mindful, to focus on the present senses and take in the world rather than spending all the time inside my warped head. It wasn’t doing the trick. Rather, I was walking and chain smoking trying to calm my moods down. As soon as I got out the doors, I just started to lose grip on my mind.

I had felt it coming. I bottle up my inner turmoil pretty well when around my parents. I don’t know if this is a good thing. But because of it, I lack catharsis here at my parents. Before going out, I went from feeling agitated and wanting to get to work all the way to nearly crying over a walmart ad. And since it was for walmart it made me feel even dirtier. And then outside, I just sort of lost it. I started to have suicidal thoughts. I heard a train coming and saw the tracks down below and I just wanted to stop everything. I felt overwhelmed. I must have stared at the tracks for a good 5 minutes thinking about it. Meanwhile, I smoked yet another cigarette, quickly. And mind you, if you know cigarettes, american spirit blacks require a lot of heavy smoking to finish in 5 minutes. The whole time I just kept thinking about how overwhelming this entire ordeal has been. I’ve lost weeks of productivity, I’m on new medication that I’m just hoping will do their magic soon. I have a thesis to contend with, grad school coming up. I just felt tired of constantly battling every last facet of this disease and trying to live a productive life. And that quick snap of thoughts is what really makes me frightened right now. I can be agitated and emotional without suicidal thoughts one moment, and the next I’m planning things out that would be executed in a matter of minutes. There’s no rope buying or carefully thought out plan, it’s just like my first suicide attempt, I just do it with no warning to myself or others.

But the nicotine buzz somehow snapped me out of it. I’m not going to advocate smoking, and if you don’t do it, there is no reason to begin, but I can honestly say with a strong sense of irony that cigarettes saved my life. It gave me time to pause and the nicotine buzz really did the trick to get me back to reality and push the thoughts away. What I take away from this is probably of minimal insight, but it might be useful in the future. What the smoking did was two fold. One was nicotine, which I’ll probably post something later about its psychtropic properties. The second of which was the act of smoking gave me time to stop my action and slow me down a bit. My mind was still racing with thoughts, not as fast as usual, but it was still going pretty quickly. It seems that my suicidal impulses are just that, very strong impulses, and I need something to slow down that impulse and let it settle. In the end, I continued my walk smoking the entire way home. I think I did 4 or 5 in a matter of about 20 minutes.

By the time that I got back, I just hunkered down and watched the Packers’ game. It was a nail biter at the end. That helped as well. The adrenaline rush really soothed out the warped passages of my thoughts and got me going again. But I was still agitated to some degree. I just wanted to be left alone, but my parents were around. Yet, instead of snapping at them to just leave, I went away and nestled myself in the corner of the couch with Wittgenstein’sCulture and Value which is essentially a short book of his aphorisms; often witty and funny ones with a little philosophical punch to them.

And that made me realize another aspect of my life. I haven’t been giving myself any me time. I’ve been so centered on writing my thesis and polishing it and thinking about it, then reading for two grad classes, I just hadn’t read anything fun. Somewhere along the way I lost it, but now I’m bringing it back. I’m going to start reading for fun again. Somehow, I just need to learn to balance things out a little more, hopefully with the new meds and maybe lithium I’ll be more stable. But for now, this episode has really thrown me a new aspect of my bipolarity, it’s going to be a deadly disease if I don’t manage it.

So it’s the third day on zyprexa. Already I’ve noticed that I’m agitated, just like I was when going on abilify. This time it’s not nearly as extreme because I have klonopin on hand, but I’m very bouncy and fidgety. I’ve also noticed that I do not need to take klonopin as much as before. Before zyprexa, I literally craved to have it in my system to give me some temporary control back, now that feeling is gone. Hurray antipsychotics!

As for brain fog, maybe I’m unique in this regard, but I don’t feel like I have it. I don’t feel slow or off balance mentally. In fact, I feel sharper and things seem easier than before. But that might just be residual mania creeping in. Perhaps it’s switched my paranoid mania into a regular mania. Let’s hope so, because I like those. Hunger. That’s something that I did not experience on abilify. Quite the opposite, I couldn’t stand food and I would dry heave in the morning from nausea. Now, everything seems delicious and I want more of it. I have to fight off the snack attacks by reminding myself that it’s the drug talking and not my stomach. I’m resolved not only to stay at the same weight that I’m at now, but to start exercising more and losing weight while going on this medication. If I do that, I’m going to give myself a good pat on the back for dodging that bullet. Paranoia. Not quite gone yet. The klonopin/zyprexa combo has really reduced my suspicious thinking. Even on a lower dose of klonopin, I can feel my brain wanting to think that way, but it’s not delusional. It doesn’t transform itself into a belief.So I don’t have to fight it, it just flits in and then out of my head. I can live with that. It makes me more delightfully eccentric than before. So far the effect from the drug is mild, but it’s only the third day. I can feel it acting in my system, but hurrah for it having a mild impact. I’ll keep tabs on it for the next few days and see how it performs in the long run. I’ll have to make sure that I get back to mood journalling soon to keep track of all of these changes.

There isn’t much to do where my parents live, except for shopping. And I’m a little bit on the manic side even with the sedation. Plus, I’m agitated as all get out with the zyprexa really starting to kick in. So I did a little shopping. My first impulse was to go to best buy and look at some tablet computers. Bad idea, stayed away from that one. Probably would have bought several with the intent of returning all but one and then never getting around to it. My second impulse was clothes shopping. That can get just as expensive as electronics, if the clothing is new. But I decided to take myself to all the consignment shops in town and browse through them to see if there are any finds. And I did find some new shirts that were classic and in excellent shape.

Looking back on this, this really settled a lot of my symptoms. Primarily, it got me moving which was a great way to rid myself of my agitation. My legs feel very calm and settled right now and I’m ready to write without interruption. But it also really got me going on a different tack than normal shopping. Normally, it’s just buy buy buy, but here it’s hunting. There’s prey in the fields of clothes waiting to be found. One just needs to be persistent and comb through them looking for the right patterns and fit. That really tapped into the manic side of me where it expended my energy on the hunt rather than the buy. And I still got the shopping high off of it. I got what I wanted and I bought it. Overall, I spent less than $20 and got a sweet new sweater and shirt that I couldn’t way to try on and wear. That really lifted my spirits.

So in the future, when I get this shopping spree feeling, I’m definitely hitting the thrift stores and try to find something that works. It gets me outside and on the move, plus gives me that shopping high that I’m looking for.

Also, Jill was right, chewing something does help a lot with the agitation. There’s something about it that helps calm me down. I wish I knew why that worked, but it does.

So I managed to get into my psychiatrist today despite being late because I wasn’t sure of the time (thank you klonopin). We’re reducing the dose, but she’s keeping me on it for the next month. The next month. Dear god, I don’t know if I can take it that long. At least the dosing is being adjusted so that I can function better during the day and I can take care of the sundowning that I’ve been getting. Although, tonight I’m not going to take it. I’m taking another drug, zyprexa. That’s right, now I’m on two antipsychotics. And there’s discussion of lithium. Yippee. So I guess I get to look forward to sleeping for the next few days from zyprexa if it’s anything like what abilify did. Or, it’ll turn me into a manic nutter in which case I’m glad I have the klonopin on hand.

Over all, the session went really well. She’s really good, and she’s fast at learning the ins and outs of my peculiarities. She’s describing what I’m currently going through as a psychotic breakout or something close to that. She also said that I’m one of the clearer examples of bipolar disorder that she’s come across. And that I’m a danger to myself because of how quickly I can become suicidal. Tell me something I don’t know. But, she’s really committed to helping me. She wants to see me every week for the next month at least to make sure that everything is going according to plan. I get the sense that she’s concerned about my symptoms and how quickly they appeared. It’s at least nice to know that someone who is treating me really cares. I also feel that the hour long sessions really allow more connection between me and her than the half hour sessions that I had with my previous psychiatrist.

So today’s been a long day of classes, prescriptions, two trips to the psych office. Emotionally I’m entirely unbalanced. I feel at one moment ready to bawl my heart out and the next I want to rewrite my entire thesis. I guess this is a clear sign that I can’t do a whole lot in one day and still expect myself to function well under the present circumstances. So tonight is going to be a night of waiting to see if zyprexa knocks me out and lots of tv. I don’t feel that I have the cognitive capacity to read and the klonopin is still screwing with my eyesight. Well, it’s wait and see, what else is new.

I’m interested to hear your thoughts, ask me anything, I might write a post about it.

The circadian rhythm, responsible for the sleep-wake cycle has been implicated in bipolar disorder, specifically rapid cycling.

So, what is the circadian rhythm. This is the rhythm controlled by our internal clocks to control our sleep cycle. It’s associated with CRY2 mRNA expression in our bodies. Meaning that it’s associated with a particular protein in our bodies. In our human brains, this is controlled by the suprachiasmatic nucleus, a small lobe located by the hypothalamus. Taken from wikipedia (the mother of all explanations):

The SCN takes the information on the lengths of the day and night from the retina, interprets it, and passes it on to the pineal gland, a tiny structure shaped like a pine cone and located on the epithalamus. In response, the pineal secretes the hormone melatonin. Secretion of melatonin peaks at night and ebbs during the day and its presence provides information about night-length.

Several studies have indicated that pineal melatonin feeds back on SCN rhythmicity to modulate circadian patterns of activity and other processes

So it’s a complex process as we can see above. Light modulates the SCN, then that sends signals to the pineal gland, responsible for hormonal control in our brains, releasing melatonin causing us to sleep. How does this relate to bipolar disorder?

Well, in a normal human, the expression of this is diurnal, meaning twice a day, associated with the circadian rhythm. It’s expressed more at night, and less during the day. But in patients with bipolar disorder who are depressed, even with sleep deprivation, the expression of this gene is very low, as opposed to the higher levels in normal brains. Additionally, it was nonresponsive to sleep deprivation. So something is screwy there. This also marks a difference between bipolar depression and seasonal affective disorder, which finds that there are higher levels of CRY2 mRNA expression throughout the day in SAD patients.

The findings get more interesting, there are also protective and risky haplotypes for the CRY2, AGGA and GGAC. These haplotypes were found in the seasonal affective disorder patients in sweden, indicating that there are genetic markers and genetic reasons for winter depression. But, in rapid cycling, there is a difference. The protective haplotypes were the opposite of the SAD haplotypes, they were AAAC and GGAC.

The results of this study are two fold. First, gene variations are in congruence with the usual findings that the circadian rhythm is disfunctional in bipolar individuals; where individuals have low melatonin levels. Secondly, it indicates that lithium might be a corrective agent in this process. Lithium stimulates the GSK3B regulator for the circadian rhythm. Thus, it can correct the imbalance in the circadian rhythm that is found in individuals with bipolar disorder. This adds to my previous post that lithium might actually be corrective rather than suppressive in medicating bipolar disorder.

In addition to this mumbo-jumbo, one finds an additional element to all of this there is a marked difference between bipolar 1 and bipolar 1 with rapid cycling. That is, the genetic markers were different, specifically the RORB gene variations. So in response to these findings, the study suggested that bipolar 1 was found to be corrective with just lithium, but with rapid cycling they suggested that a combination of anti-epileptic drugs and valproate acid should be used in conjunction with lithium.

I apologize for the technical nature of this piece, it’d take a lot of research to break down what each of these genetic markers do, but I think that you get the basic ideas. In summary, there are not only marked differences between Seasonal Affective Disorder and Bipolar 1, but also between Bipolar 1 and Rapid Cycling. This variation is specifically genetic and also tied to the circadian rhythm. Personally, I always find that the findings of genetic differences between the different classifications of bipolar disorder to be interesting because it provides an empirical basis for different classification as well as the possibility for testing. Not to mention, it also allows us to understand the interactions of the brain itself with bipolar disorder and how the drugs impact it. The fact that lithium appears to have corrective properties is also fascinating. But that’s it for now. Hope you enjoyed my morning research project.

References:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2939397/

Please don’t diagnose yourself with Bipolar disorder or anything else for that matter. 

Here’s the deal. First, everyone probably is a little mentally ill. That’s what Freud thought. But that doesn’t mean that your moodiness and poor memory are signs of bipolar disorder. Just because you’re a little hyper doesn’t mean you’re manic. I was just recently in a dysphoric mania, I ended up cutting myself and getting close to being committed. Other times I’ve gone on 2 week long drinking binges and bought thousands of dollars of things I don’t need and can’t afford. Is that what hyper means to you? Probably not. It probably means that it feels like too much caffeine. And as for depression, everyone struggles with some sort of sadness in their life. But sadness does not equal depression. Depression must also have anhedonia (a clever term for lack of pleasure in doing things) and a host of other things, there’s also guilt, feelings of worthlessness, and everything that your mind can muster up to make you feel pathetic. Being sad is horrible I’m not trying to diminish it, but being depressed is not the same thing, it’s a disease of the brain that is causing the sadness and negative thoughts.

Same goes for other mental illnesses. If you see that you have the symptoms, go see a psychiatrist, ASAP, don’t self diagnose. You wouldn’t self diagnose syphilis without a doctor, you shouldn’t self diagnose mental illness. It’s just as complicated and requires expert knowledge.

Furthermore, please don’t act it out like you do have a mental illness and know what it means to have one. What I mean by this is that maybe you took an online quiz and found out that you show some warning signs of mental illness; which, by warning signs they mean warning, not definitive diagnosis. But just because this came up doesn’t mean either that your life is in shambles or that you suddenly know the plight of the mentally ill. I’ve lived with my illness for about 5 years now, and it really hit and forced me to be diagnosed a year ago. I still don’t know what it is like to live with mental illness, I know of it, and I can empathize, but there are plenty of sufferers out there that I know nothing of their plight. I’ve had it easy and breezy compared to some of them, and I don’t pretend to know what they’re going through. I just hope that I don’t have to go through it either.

And finally, it’s not cool to have a mental illness. A Beautiful Mind might make it seem being an insane genius is cool, but it’s not. There’s a reason that people with mental illness medicate and go to some really insane extremes to medicate their illness. Try electroshock therapy for depression and bipolar disorder. Sound cool to have your brain zapped with electricity no matter how precise it’s done? Probably not. Individuals with mental illness at times take a half dozen pills or more that make it difficult to function in everyday life just to avoid their symptoms. Mental illness leaves people disabled, a burden on their families (which is really hard to deal), and dead. 

So if you think it’s cool, or will make you interesting, or any such nonsense, you’re a fucking idiot.