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What Happens In The Brain With Bipolar Disorder

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The Effects Of Bipolar Disorder

What Are Mixed Episodes In Bipolar Disorder? | Mental Health 101 | Kati Morton

Bipolar disorder is identified by periods of manic episodes.

During a manic phase, you have above-average energy levels, and may not sleep much. You can also experience irritability, restlessness, and an increased sex drive.

If you develop depression, this phase can have the opposite effects on the body. You may feel a sudden lack of energy and require more sleep, along with feeling depressed and hopeless.

Appetite changes can also occur if the person develops depression. As with mania, depression can also cause irritability and restlessness.

Its also possible to experience a mixed-state of mania and depression. You might notice symptoms from both phases.

The Protein Kinase C Signaling Pathway

Protein kinase C exists as a family of closely related subspecies,has a heterogenous distribution in brain , and, together with other kinases, appears toplay a crucial role in the regulation of synaptic plasticity and various formsof learning and memory . PKC is one of the major intracellular mediators of signalsgenerated upon external stimulation of cells via a variety of neurotransmitterreceptors ,which induce the hydrolysis of various membrane phospholipids.

In view of the pivotal role of the PKC signaling pathway in the regulationof neuronal excitability, neurotransmitter release, and long-term synapticevents ,it was postulated that the attenuation of PKC activity may play a role inthe antimanic effects of lithium and VPA. In a pilot study it was found thattamoxifen ) may, indeed, possessantimanic efficacy . Clearly, theseresults have to be considered preliminary, due to the small sample size thusfar. In view of the preliminary data suggesting the involvement of the PKCsignaling system in the pathophysiology of BD, these results suggest thatPKC inhibitors may be very useful agents in the treatment of mania. Largerdouble-blind placebo-controlled studies of tamoxifen and of novel selectivePKC inhibitors in the treatment of mania are warranted.

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Can Bipolar Disorder Be Prevented

There is no known method to prevent bipolar disorder. Because its exact cause has not yet been determined, it is especially important to know its symptoms and seek early intervention. Regular and continued use of medication can help reduce episodes or mania and depression. Some people who experience bipolar disorder may become suicidal. By knowing how to recognize these symptoms, there is a better chance for effective treatment and finding coping methods that may prevent long periods of illness, extended hospital stays, and suicide.

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Integration Of Neurobiological Findings

As we noted at the beginning of this review, from a neurobiological perspective, there is no such thing as bipolar disorder. Rather, it is almost certainly the case that there are many somewhat similar, but subtly different, pathological conditions that produce a final common pathway disease state that we currently diagnose as bipolarity. This heterogeneity reflected in the lack of synergy between our current diagnostic schema and our rapidly advancing scientific understanding of the condition puts a hard limit on all attempts to articulate an integrated perspective on bipolar disorder. Also posing a challenge to the integrative enterprise is the fact that nothing could be further from a static condition than bipolar disorder. Whereas, most psychiatric conditions vacillate within a single register between symptom exacerbation and various degrees of recovery, those attempting to fully understand bipolar disorder must contend with the fact that exacerbations come in two distinct flavors manias and depressions and that often these exacerbations can take any of a nearly infinite number of combinations of these two mood disturbances.

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Why Choose Amen Clinics For Bipolar Disorder Treatment

Bipolar Disorder

Bipolar disorder is often misdiagnosed as depression, ADD/ADHD, or even schizophrenia because some of the symptoms are very similar. Making the distinction between bipolar disorder and other conditions is critical because following the wrong treatment plan can make symptoms much worse. For example, when someone with bipolar disorder is misdiagnosed with ADD/ADHD and given stimulant medication, it can dramatically exacerbate symptoms and cycling. At Amen Clinics, we use brain imaging as part of a comprehensive evaluation to help distinguish between bipolar disorder, ADD/ADHD, depression, schizophrenia, and other conditions. This means youll get a more effective treatment plan.

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How Is Nimh Addressing Bipolar Disorder

The National Institute of Mental Health conducts and supports research on bipolar disorder that increases our understanding of its causes and helps develop new treatments. Researchers continue to study genetics and bipolar disorder, brain function, and symptoms in children and teens who have bipolar disorder, as well as family history in health and behavior.

Learn more about NIMHs research priorities and current studies.

Imaging Studies Of Bipolar Depression

The limited number of imaging studies in bipolar depression have also highlighted changes in prefrontal and subcortical activity A resting state positron-emission tomography study in a notably large group of patients with bipolar depression reported decreases in prefrontal cortical metabolism, and increases in subcortical metabolism, compared with healthy controls. Both of these effects were correlated with depressive severity on the Hamilton scale. Using cognitive activation designs, decreased activation in the prefrontal cortex has also been reported, where attentional or executive tasks have been employed. In addition, resting state activation in the subgenual cingulate region was positively correlated with target detection performance on a CPT performed outside the scanner. Decreased blood flow in medial prefrontal cortex was also reported during a sad mood induction in remitted and depressed patients with type 1 bipolar disorder, although this study did not, include a healthy comparison group.

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The Brain And Bipolar Disorder

Experts believe bipolar disorder is partly caused by an underlying problem with specific brain circuits and the functioning of brain chemicals called neurotransmitters.

Three brain chemicals — norepinephrine , serotonin, and dopamine — are involved in both brain and bodily functions. Norepinephrine and serotonin have been consistently linked to psychiatric mood disorders such as depression and bipolar disorder. Nerve pathways within areas of the brain that regulate pleasure and emotional reward are regulated by dopamine. Disruption of circuits that communicate using dopamine in other brain areas appears connected to psychosis and schizophrenia, a severe mental disorder characterized by distortions in reality and illogical thought patterns and behaviors.

The brain chemical serotonin is connected to many body functions such as sleep, wakefulness, eating, sexual activity, impulsivity, learning, and memory. Researchers believe that abnormal functioning of brain circuits that involve serotonin as a chemical messenger contribute to mood disorders .

Changes In The Intracellular Signaling Cascades

What is bipolar disorder? – Helen M. Farrell

It is becoming increasingly evident that current mood-stabilizing agents have actions that extend beyond binding to neuronal membrane surface receptors. Therapeutic actions of psychotropics utilized in the treatment of bipolar disorder most likely rely on an interface with intracellular signaling cascades and eventual enduring changes in gene expression, accompanied by alterations in neurotransmission and neuroplasticity. Better understanding of intracellular signaling cascades may therefore provide valuable insights into the underlying causes of bipolar disorder and subsequently to more effective treatment strategies.

The phosphoinositide-3-kinase /AKT pathway is a general signal transduction pathway for growth factors, including BDNF and consequently for BCL-2. The GSK-3 signaling pathway modulates apoptosis and synaptic plasticity. Increased activity in the GSK-3 pathway supports apoptosis. Attenuation of GSK-3 activity leads to up-regulation of BCL-2 and beta-catenin and consequent enhancement of neuroplasticity and cellular resilience. This pathway is also involved in circadian regulation .

Interestingly, manipulation of the GSK-3 pathway produces both antimanic and antidepressant effects. Many agents with mood-stabilizing properties, such as lithium, valproate, and atypical antipsychotics, directly and indirectly modulate the PI3K, GSK-3, and Wnt signaling pathways, the very same ones implicated in genetic studies of bipolar disorder .

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Can The Brain Recover From Bipolar Disorder

There is no cure for bipolar disorder, and changes to the brain can be permanent.

However, treatments for bipolar disorder, such as lithium, may have a normalizing effect on the brain. The author of a concluded that the use of lithium or mood stabilizers is associated with increases in gray matter volume.

What Are The Treatments For Bipolar Disorder

Bipolar disorder is a long-term illness that requires management throughout a person’s life. People who have numerous episodes of mood changes in a year can be much more difficult to treat. Medication is the primary form of treatment, but the additional use of psychotherapy or “talk” therapy is sometimes recommended to help prevent future episodes.

There are many drugs available to treat bipolar disorder. Proposed guidelines for treatment options are based on the three main phases of bipolar disorder, which include the acutemanic/mixed mood states, acute major depressive episodes, and finally the continuation/maintenance phase. As a general rule, avoiding antidepressants and taking two mood stabilizers has proven to be an effective strategy for most patients.

Mood-stabilizing drugs

Lithium is a mood-stabilizing drug. It has proven helpful in controlling mania and depression and preventing depression and manic episodes. Lithium will reduce symptoms of mania within two weeks of starting therapy, but it may take weeks to months before the condition is completely controlled. Thus other drugs like antipsychotic drugs or antidepressant drugs may also be used to help control symptoms.

Common side effects of lithium include:

  • Frequent need to urinate
  • Nausea

The following are signs of a lithium overdose. Call your doctor immediately or go to the nearest emergency room if you experience:

  • Blurred vision
  • Weight gain
  • Slight trembling of hands

Atypical neuroleptics

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Bipolar Disorder And Endocrinology

Neurotransmitters are not the only important chemical messengers in the body. The body also uses hormones as chemical messengers. Produced in the endocrine system, hormones circulate from one organ to another through the bloodstream. Receiving organs in the body interpret hormonal signals and respond to their messages.

The endocrine and nervous systems are linked by the hypothalamus. This is a centrally located ‘switching station’ within the brain. The hypothalamus is an exceptionally complex brain region. It controls many different body functions such as blood pressure, appetite, immune responses, body temperature, maternal behavior, and body rhythms dealing with circadian and seasonal rhythms. This coordination of circadian and seasonal body rhythms is particularly important when discussing bipolar disorder. .

Another component of the endocrine system which is known to cause mood fluctuations when not being regulated correctly is the reproductive system. As reproductive hormones are known to affect mood, most prominently in women, the source of this effect is thought to be the ovaries which secrete estrogen and testosterone. Although the role sex hormones play in mood conditions are well documented , exactly how these hormones affect mood is unclear. There is little information available currently regarding their possible role in causing or maintaining bipolar symptoms.

Frequently Asked Questions About Bipolar Disorder

Bipolar disorder made by viveka m.

Bipolar disorder, formerly known as manic-depressive illness, is a brain and behavior disorder characterized by severe shifts in a person’s mood and energy, making it difficult for the person to function. More than 5.7 million American adults or 2.6 percent of the population age 18 or older in any given year have bipolar disorder. The condition typically starts in late adolescence or early adulthood, although it can show up in children and in older adults. People often live with the disorder without having it properly diagnosed and treated.

Bipolar disorder causes repeated mood swings, or episodes, that can make someone feel very high or very low . The cyclic episodes are punctuated by normal moods.

Mania Episode Signs and Symptoms:

  • Increased energy, activity, restlessness
  • Racing thoughts, fast talking, jumping between ideas
  • Sleeplessness
  • Abuse of drugs, such as cocaine, alcohol and sleeping medications
  • Provocative, intrusive or aggressive behavior
  • Denial that anything is wrong

Depressive Episode Signs:

  • Sad, anxious or empty-feeling mood
  • Feelings of hopelessness and pessimism
  • Feelings of guilt, worthlessness and helplessness
  • Loss of interest or pleasure in activities once enjoyed, including sex
  • Difficulty concentrating, remembering or making decisions
  • Restlessness and irritability
  • Sleeplessness or sleeping too much
  • Change in appetite, unintended weight loss or gain
  • Bodily symptoms not caused by physical illness or injury
  • Thoughts of death or suicide

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Mental Illness And The Brain4

The term mental illness clearly indicates that there is a problem with the mind. Butis it just the mind in an abstract sense, or is there a physical basis to mentalillness? As scientists continue to investigate mental illnesses and their causes,they learn more and more about how the biological processes that make the brain workare changed when a person has a mental illness.

Who Experiences Bipolar Disorder

Bipolar disorder usually begins in older teens and young adults, with at least half of all cases appearing before age 25. Children and adolescents, however, can develop this disease in more severe forms and often in combination with attention deficit hyperactivity disorder . Some studies have indicated that bipolar depression is genetically inherited, occurring more commonly within families.

While bipolar disorder occurs equally in women and men, women are more likely to meet criteria for bipolar II disorder. Women with bipolar disorder may switch moods more quickly this is called “rapid cycling.” Varying levels of sex hormones and activity of the thyroid gland in the neck, together with the tendency to be prescribed antidepressants, may contribute to the more rapid cycling seen in women. Women may also experience more periods of depression than men.

An estimated 60 percent of all people with bipolar disorder have drug or alcohol dependence. It has also been shown to occur frequently in people with seasonal depression and certain anxiety disorders, like post-traumatic stress disorder .

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Understanding Manic Episodes Of Bipolar Disorder

The way bipolar disorder symptoms manifest, the duration of symptoms, and the overall effect on a person may vary greatly from person to person. The manic symptoms of bipolar disorder may be especially difficult for some people to understand as people may react differently during these episodes. For example, when manic episodes occur, one person may experience mania or hypomania episodes with feelings of frustration or irritability while another may exhibit a decreased need for sleep, accelerated thinking, or hyperactivity.

When manic symptoms of bipolar disorder emerge, its not uncommon for one to experience feelings of creativity, heightened energy, or euphoria. Some people may feel they are destined for greatness or are invincible.

While the overall feeling of increased energy and euphoria may feel good at first, manic episodes can cause a spiral in emotions. For instance, during this phase, some people engage in dangerous or inappropriate behavior. They may become sexually promiscuous, gamble, or go on spending sprees. Some people are easily angered, may start fights or lash out at others, or blame those who criticize their behavior.

Some common symptoms of manic episodes include:

Warning Signs That Indicate Bipolar Mania Episodes

Treatment for Bipolar Disorder

Because bipolar disorder is a chronic, relapsing condition, it requires long-term treatment. This is true even when symptoms are not obvious.

Getting Help for Bipolar Disorder

You Are Not Alone

What Does A Person With Bipolar Disorder Experience

The Untold Story of LIVING WITH Someone With Bipolar Disorder

Bipolar disorder does not have a set pattern and differs from individual to individual. Patients may feel a particular emotion several times before switching to another state.

Symptoms of mania are:

  • Patients may feel that they are on the top of the world
  • Highly irritable

When medication therapy is ineffective, electroconvulsive therapy might be considered. During electroconvulsive therapy, an electric current is passed through the brain to treat the disorder. In some, talk therapy has proven to be beneficial in treating mood episodes. Another part of treatment is psychoeducation where patients and their families are educated regarding symptoms and importance of medication compliance.

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What Can I Expect After Treatment

For most people, a good treatment program can stabilize severe moods and provide effective symptom relief. Treatment that is continual has proven more effective in preventing relapses. Those who also have a substance abuse problem may need more specialized treatment.

Last reviewed by a Cleveland Clinic medical professional on 01/27/2018.

References

Brain Damage From Bipolar Disorder

If you have a broken leg, you can tell people you have a fracture in your left tibia. If you have a bad heart you can let people know you have a weak aortic valve. But what do you say if you have a mood disorder? Most of us settle for the explanation that we have a chemical imbalance, which is about as satisfactory as your mechanic handing you a bill with this one item: “Engine Imbalance.”

Then there is the matter of collateral damage. We know depression can stop the brain it its tracks while mania runs it off the rails, with corresponding deficits in our ability to think and reason, but we are led to believe these are only temporary occurrences, right? Maybe not.

If only a mood disorder were just a mood disorder. A lengthy review article by Carrie Bearden PhD et al of the University of Pennsylvania published in Bipolar Disorders cites “findings of persistent neuropsychological deficits” in long-term bipolar patients, even when tested in symptom-free states. The relationship between these deficits and length of illness led the authors to suggest that “episodes of depression and mania may exact damage to learning and memory systems.”

An article by FC Murphy PhD and BJ Sahakian PhD of Cambridge University in the British Journal of Psychiatry draws a similar conclusion: “The balance of evidence … supports a hypothesis of residual cognitive impairments.”

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What Can We Do About It

So how would you know if youre experiencing cognitive deficits? The gold-standard assessment is a battery of standardized tests administered by a trained neuropsychologist. Unfortunately, such testing is costly and difficult to access. There are validated computerized testing programs that are simpler to administer you may be able to access these through specialized mood disorder clinics.

If well treated, long term studies in bipolar disorder show improvements over time in memory, working memory and processing speed.

There are few treatments specifically targeting cognition in people with bipolar disorder. No medication has yet shown reliable enough cognitive-enhancing effects to be routinely recommended. Group functional remediation programs, which address common cognitive deficits, have been shown to improve real-world functioning, but again are not widely available .

The most practical advice is to try to maintain mood stability and a healthy lifestyle. Though individuals with bipolar disorder who are not experiencing mood symptoms may still experience cognitive difficulties, on average these deficits are less pronounced compared to individuals with current mood symptoms. Also, a healthy diet, regular sleep and exercise may lower inflammation and enhance neurotrophic factors specialized proteins in the brain that promote the growth and function of neurons .

Other tips:

Dr. Trisha Chakrabarty

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