World Bipolar Day is for You.

Whether you know this illness intimately, because it’s part of every hour of every day for you, or whether you love someone who suffers. And even if you don’t, you can help with support, kindness, and funds. Make this world a better place. World Bipolar Day is for you.

How does bipolar disorder start?

Bipolar symptoms can begin at a variety of ages, and in a variety of ways. This is one person’s story, and you can see how, in this case, seemingly “normal” symptoms gave way to the full blown illness.

As a toddler and preschooler, his tender heart and sparkle in helping others gave him the reputation as the sweetest child with the most disarming smile in the neighborhood.

But he also cried.  Long, mournful weeping…for no apparent reason. His mother would hold him and rock him…try to comfort him for hours. Eventually, the sorrow would pass and he could play happily again.

Later, came waves of guilt and shame. His first-grade teacher disapproved of his constant activity in the classroom… and the pain of it was so severe he’d sit in the dark in his room after school overwhelmed with shame too intense to cry. Just shut down with his own feelings of worthlessness… He told his mom he was a juvenile delinquent.

What causes a 7-year-old to feel worthless? Where does suffocating shame come from for an innocent child?

His parents thought he was just especially sensitive, and tried to console him.

Accidental Blows to the Head Can Cause Damage

At the age of 9, he had his fifth blow to the head. It was always something. An accidental blow with a baseball bat, falling on his bike and hitting his forehead with the handle bar. Baseballs would come out of nowhere and hit him squarely in the temple or forehead. It was uncanny. One massive goose egg after another.

Years later his family learned that serious blows to the head can lead to psychiatric disorders, like bipolar disorder.

By the time he was 10, he was old enough to know something was wrong. His pain, his torment, his humiliations at school, plus corrections from his teachers were piling up. The nitpicking from his friends was too painful to overlook.

His long periods of sad emptiness had become too hard for him to endure. His mom had always told him it would pass. But he told her that it never has and he can’t bear it any longer.

He wanted to die.

How often do you hear a 10-year-old say such a thing?

A Disordered Brain that Can’t Read

During middle school he had more and more difficulty reading even though he had learned to read well when he was 4. He could see the words on the page, but couldn’t make sense of them. To make it worse, they danced around the page and he lost his place every 2-3 words.

The humiliation.

And the scandal…A difficult thing that kept emerging consistently, was his fascination with sex. As a preschooler, he was punished for cajoling the little kids in the neighborhood to remove their pants so he could explore, or later having sexual experiences with friends, and all sorts of exploration … And more shame.

**Hyper-sexuality emerged before the manic mixed states, though he had had many times of extreme excitement since he was born. Was that mania? Or just a little boy being a little boy..?

Then, he was 14, and felt new feelings for a pretty girl he knew. It wasn’t long before he had coaxed her into bed, telling her he would “take care of everything”…to not be afraid. “He knew what he was doing.”

Painful Conflict Leads to Outburst

Then, when his parents told him he couldn’t see her any more, he had his first manic episode.

He exploded, shouting and spitting out curses as if he couldn’t say them fast enough, and his lips sort of popped as he pushed out the words, like the way they do when you say the word “bubble.”

His family had never seen this before. This fourteen-year-old spoke as though he was a grown man. That he was in love and would marry this girl, and their relationship wasn’t his parents’ business.

They’d never seen him like this. He stormed around, cursing, and screamed as he slammed the door.

“Was this just the erratic emotions of a 14-year-old teenager?” his parents wondered.

Super Human Strength During a Mixed States Episode

Outside, he grabbed a 4ft. tall shrub with both arms and pulled it straight out of the ground by the roots, screaming with rage.

**Superhuman strength would always accompany his mixed states mania…this was a sign of things to come.

Scenes like this happened more and more often. Whoever was with him when it happened, would see a look in his eye, then his veins would stand out on his forehead and neck while words pounded out and exploded from his mouth expressing his frustration and rage and hurt.

Nothing within reach was held sacred. He threw whatever was available whether it was a full Coke can, a prized porcelain heirloom, or a boot. Or… a TV or chair through the window…or a dresser… His family became familiar with these “episodes” over time, and most would leave the room or the house to avoid it. His mom stayed close so he wasn’t alone.

**It’s noteworthy that he never turned his rage and strength toward a person…always inanimate objects.

High Risk Behavior Leads to More Pain

By the time he was 15, his girlfriend was pregnant. But, there had been a variety of sexual encounters of all types by then. Sometimes his parents knew …sometimes they had no idea. This time, a baby boy was placed for adoption and his heart broke. It was the most painful loss of his life.

**It’s important to recognize that hypersexuality is a strong symptom in over 57% of people with bipolar disorder. Don’t be afraid to talk about it. It’s real. And needs treatment.

New Diagnosis for Improved Treatment

In between these cycles, he was gentle, considerate, creative, affectionate. He lived to help others feel good about themselves. He was born friendly, never met a stranger, but was quick to  get acquainted and help anyone who needed it. Not a shy bone in his body.

He loved to create music with this guitar and jammed with others and played in a church band. His humor brought delight to every situation.

**It’s been said that a person with bipolar disorder is really two people. The wild, out of control, risk-taking trouble maker…and the gentle person who pays for the fallout.

When he was admitted to a psychiatric hospital for teens, he was given the  diagnosis of bipolar I disorder, with rapid cycling and mixed states. He’d been diagnosed with Major Depressive Disorder a few years before, and had been taking medicine that didn’t improve the way he felt.

But now, this diagnosis explained the unexpected explosions, the gnawing drive of hypersexuality, the pressured speech, the guilt and shame, grandiosity as in the belief he could control unpredictable forces to his own desired outcome… it all began to make sense.

His changes in appetite, sleep, feelings of worthlessness, his difficulty concentrating and reading, and his obsession with death and the desire to die, led his psychiatrist to the bipolar disorder diagnosis.

A Family’s Observations Help Doctors See What the Patient Overlooks

His parents explained to the doctor that he often felt desperately depressed, wanting to die, locking himself in the bathroom to try to hang himself.  Then after awhile… he finally became quiet and within a couple more hours he played his guitar, wrote lyrics, and genuinely apologized for all that had happened that morning.

Until something reminded him of the girlfriend he lost, and he’d rise into a rage, shooting words like bullets with blood in his eye, slamming doors, crashing lamps, throwing dishes…until he broke down in tears and sobbed and sobbed.  And eventually he fell asleep.

**Rapid cycling like this was the hallmark of all his cycles.

Sleep Can Reboot A Shattered Mind

He often woke from sleep with a clean slate. Peaceful and thoughtful. When he was awake during the night while others slept, he’d make imaginary creatures out of pieces of fruit and take pictures of them and send them to people he cared about with a cute greeting. Or write letters filled with cartoon characters.

He wrote poetry, lyrics to songs, played the guitar… riffing along with a song on a CD…  It seemed he never stopped.

**The triad of care that’s vital for anyone with this disorder: sleep, healthy food, and medication. If any one of these elements is missed, it can trigger an episode.

Never-Ending Cycles + Self-Medication

He’d be doing fine, then a few days would pass and he would become agitated, describe the feeling of “fire ants on his brain.” Before long he was escalating into a suicidal rage again.

This scenario defined his life, through his teens and twenties. He learned to shave in jail, never completed high school, and got his GED in rehab.

His profound desire to just feel better…just be happy…drove him to try various forms of intoxication, from beer to marijuana, from paint thinner to meth, from cocaine to crack.

It’s no surprise that this guy’s misery and anguish were then complicated by the throes of addiction. Risky behaviors like unprotected sex and illicit drugs always called to him like ancient sirens who lured sailors to shipwreck.

And his bipolar disorder was getting worse.

Self-medicating Made Everything Worse

He took every medication his doctors prescribed but nothing made a real, lasting difference. And the chemicals he turned to for relief magnified the chaos in his mind and body.

Then another girlfriend…another pregnancy. And he determined to gain control of his life, determined to be a good father. This was a second chance…

Voluntary surrender to a drug rehab for nearly a year…it helped the addiction, but bipolar raged on.

**IV ketamine treatment is bringing balance to so many people now who have suffered with treatment-resistant bipolar disorder. But it was unheard of in his day.

After rehab, he tried his hardest to be a good dad to his new son. They played games, shared long walks and talks. They shared their love for music and rhythm. But he was often too ill to function. Often unable to sleep. Insomnia plagued him.

Insomnia Undermined Everything He Worked For

By the time he was 31, he had achieved 6 months sobriety, stayed away from crack cocaine long enough to realize it was good to be at home, be with family, and eat home cooking. But his suicidal thoughts became more and more frequent and dominating. Unable to sleep, awake for days on end, he feared the mania would return. And it did. Way too often.

And with the mania there was torment.

He always loved a party with his family, and special times with his son, but far too often good times would trigger mania again, and he’d lose control of his life.

His sense of humor still kept everyone laughing.

The problem with his hilarious humor was that enjoying it, even laughing hard, the brilliance of his gift exploding… he’d be on a roll…and that could trigger another nightmare of mania, drinking, arrest, etc. So he tried hard to stay calm and even-tempered, the same way you try not to laugh if you’ve just had an appendectomy.

There were times that he broke out in hives trying to hold his bipolar reactions inside.

Bipolar Disorder Can Wear Out Even the Strongest Person

His 33rd birthday passed, and after studying medical books about the brain for years, learning about the amygdala and hippocampus, learning more about the pathology in his brain that had held him captive for 30 years, after months of suicide attempts a few times a week, slicing his arms every direction and watching the blood pump out in spurts, he told his closest, most trusted friend he didn’t think he’d live much longer.

He resigned himself to accept there was no escape that would work, but he had a nagging gut feeling his time was coming. He was weary of the ER visits, the whispers and cruel comments of hospital staff. And he was weary of the fight.

The last week of April and the first week of May, an overwhelming mania sent him running and running and running. Coming home in the middle of the night to hose off and put on dry clothes then back out running and running and running some more. Sort of Forest Gump style.

He couldn’t stop. The meds didn’t stop it. The emergency meds — for times like this — didn’t stop it, either.

He began “seeing” various people and talking to them… feeling offended that they didn’t answer him.

He told his family these people were camping in the woods where he ran.  After that, he was talking to people at home that his family couldn’t see.

**Times like this had by now earned him the diagnosis of Schizoaffective… because of his auditory and visual hallucinations.

The running continued for two weeks, until on the afternoon of Cinco de Mayo someone walking her dog stumbled upon a man’s body at the edge of his beloved woods. 

The police said it appeared he decided to lie down for a nap. His family, through their tears, later thought it was fitting he exited this world on Cinco de Mayo … because he’d always loved a party.

The autopsy showed dehydration and a slightly enlarged heart.

His family called it death by bipolar disorder.

——————

World Bipolar Day is for YOU

World Bipolar Day has been established to help us all see what those who suffer experience in their private lives. To motivate us to find solutions. Treatments that work.

This is the true story of one man who lost the fight.

But there are millions who have similar stories to tell. And others with different stories of their own. It’s easy to point the finger and criticize another person’s behavior, without knowing the brain changes that cause it. And without walking in their shoes yourself.

World Bipolar Day was celebrated last week on Friday, March 30. Let’s keep it going. Please consider contributing to organizations that are searching for understanding and better and better treatments. Brain and Behavior Research Foundation, for example.

And seek out those who struggle to live with this illness, and treat them with support and compassion even though you may not understand them. There’s something better than stigma. It’s called kindness.

World Bipolar Day is for you. Whether you’re suffering with this disorder, or whether someone you love is suffering.  Because if that’s the case, you’re suffering too.  And… if it’s not about your suffering, it may be about your support.

At Innovative Psychiatry, in South Windsor, Connecticut, we’re seeing very encouraging outcomes in bipolar disorder with IV ketamine treatment. Its effects are dynamic with the depression aspect of bipolar disorder. But that’s not all. We’re seeing overall improvement in mental organization and executive function, too.

There’s so much to learn about this amazing medicine, and, of course, so many questions we still seek answers to. But we’re pleased by the positive outcomes we see.

It’s likely IV ketamine treatment could have saved our friend’s life. He was a perfect candidate for it. But, he didn’t know about this treatment. However, now you do.

If you suffer from bipolar disorder in any form, and medications aren’t helping you maintain a healthy, fulfilling life, call us. Or schedule an appointment.

We believe in your recovery and health. We believe in hope.

To the restoration of your best self,

Lori Calabrese, MD

How Can We Relieve Those Who Suffer so Terribly…?

Mania goes way back. And the destruction it causes goes way deep.  We’ve searched for centuries for a way to bring relief to those who suffer so terribly.

Sometimes we in medicine go out on a limb, or strike a new path. Other times we fiddle to get things just right–or just calmed down enough to get through the night. Still other times we could tear our hair out in frustration. Getting it right could mean the difference between life and death.  

Bipolar disorder is a poorly understood illness, with great and terrible symptoms. It’s one of the most debilitating psychiatric illnesses that exists.  And despite all the advances in psychiatry and neuroscience, doctors still reach for lithium.

Pretty incredible, right? Who does that? Old fuddy-duddies? The docs who don’t read, who don’t keep up? Surely, a digital native would never prescribe lithium. Or take it. It’s an old drug, past its prime. No news there… Right?

Wrong. 

What we’re learning about what lithium actually does is going to help turn bipolar disorder on its ear.

“Mood Swings,” As If They’re Fun

You read about “mood swings” and it’s almost as if they’re a simple and harmless variation from one frame of mind to another… but that doesn’t even scratch the surface.

Picture yourself in the middle of your day, mowing the lawn or cleaning up the kitchen or checking your phone.  You begin to notice an intensifying anxiety coupled with agitation rising up inside you … thoughts race through your mind of an experience where you were deeply hurt by someone.

How Do You Heal…?  How Do  You Forget?

The hurt escalates to bitterness, then to thoughts of vindictive retaliation. You’ve completely dropped what you were doing, as you storm through the house or office.

It feels as though you’re about to lose it.

Before you know what’s happened, you’re in a rage.  Could be a seething, jaw-clenching, lip-pursing internal rage … or one of those really awful ones — throwing dishes and glasses, lamps or staplers, shattering them against the wall. Impulsive actions mix with unbearable emotional pain and you throw whatever you can grab… or knock over a table, hurl a chair across the room, spew the most diabolical phrases you can imagine.

This may go on for minutes or hours. 

Bipolar Episodes

Eventually, it passes. You look around you and see the destruction you left in your wake… faces of people you care about looking crestfallen and shell-shocked. You realize what you’ve done and you don’t know why. Shame fills you up and overflows. You look for privacy to try to stabilize. Then, you realize how much it’ll take to start repairing the damage to property and relationships. The sorrow you feel about this ugliness…the helplessness you feel to control it….the constant humiliation that follows you like a cloud … it all becomes too overwhelming.

And you feel your emotions sinking… sinking… nosediving…. til the despair and futility of living your own life seems utterly insurmountable, and the only solution in your mind is to end it.

For some people who suffer from bipolar disorder, this pretty much describes their day. For others, an episode like this might occur once a month, or maybe once a year.

The Whiplash of Terrifying Highs and Life-Threatening Lows

And there’s more.

There are times when you could feel on top of the world, capable of doing anything, and the longer you feel that way, the more super human you may feel. You might begin to believe you can fly, and you might even try it … from a rooftop.

Or you might believe you can lead your followers to conquer the world or the markets…or…you might believe you can have sex without risk of pregnancy, just by “willing” the sperm to never find the egg.

You might believe you’re destined to change the world, or become famous, or be adored. Or that you have unlimited wealth and will never feel the loss of money spent.

The scenarios are as broad as there are people with this illness.

But, one thing you learn: The higher “UP” you go in mania, the farther down you’ll probably nosedive in depression.

Mood swings? 

More like Saturn V mega-rockets that zoom to the moon — but then take a U-turn and dive right into hell. These are more than moods…and the changes are far more intense than “swinging.”

No one should have to live with these careening, catastrophic whiplashes.

Lithium: Old Drug Lights Path to New Hope

Medical studies have found little to understand what really causes these actions, these “mood swings.” There are so many factors that come into play that it’s dizzying. But we have found medications that seem to help some of the time.

The first medication that was found to be useful in some cases was lithium, which helps about a third of people with bipolar disorder. What does lithium do in bipolar disorder…? Quite a lot, in those who respond to it.  But how it works has been a mystery.

Until recently. A network of neuroscience researchers across the globe set up an incredibly elegant way to study the action of lithium within brain cells so they could better understand what lithium actually does to help someone suffering from bipolar disorder, and in doing so, they were able to see a new target for this illness.

Learning the Mechanism of Bipolar Disorder, through Lithium

Sort of like following the bread crumbs back to the beginning to find new solutions for better outcomes.

Since lithium only helps about 35% of people who suffer with bipolar disorder, the plan was to find out HOW it works to help those people, then develop new treatments that might help them and possibly the other two-thirds whom lithium doesn’t even touch.

The Problems with Lithium

Because, even for those 35% whose brains respond to lithium, many abandon it because of the serious problems it can sometimes cause.

For one thing, there’s a tiny window within which lithium is helpful…or “therapeutic.” Not a lot of swing room in the narrow little range before side effects begin, and they’re obvious when they happen:  nausea, diarrhea, tremor, thirst, excessive urination, weight gain.  Go too high and the body gets toxic.  

For some, lithium works–in fact for some, it’s the only thing that’s ever worked, despite its risks–but not all people.  Why is that?

Neuroscientists Keep Probing

To explain their amazing work, and what they learned from it, we’re going to have to get a bit “science-y”… so grab your lab goggles and get ready to roll.

These researchers started with a certain type of stem cell. They used pluripotent stem cells, that is, the type that can develop into every type of cell found in the human body.  (There are other types of stem cells, such as those that only develop into particular types of cells. Forget about them.)

These pluripotent cells were taken from people who suffered with bipolar disorder, and who were already being helped by lithium. That’s the key. They wanted to watch what happens when lithium is introduced into the cells of a person who IS responsive to lithium, to learn how it helps, and why.

Lithium’s Pathway

The outcome of their in-depth study was this: they found a pathway lithium follows to bring relief to those who respond to it. They found that people with bipolar disorder have abnormally elevated CRMP2, which is a protein necessary for sending signals through the neurons.

Dendrites are the structures on the neurons that receive electrical messages. The dendritic spine is a tiny little protrusion from the dendrite that’s a storage compartment for the synapse…you know, the connection that sends out a messages to another neuron . . . or to millions.

Hefty Science, but Exciting News!

Ok, ok, a lot of vocabulary here … but stay with me.

• CRMP2 – a protein necessary for sending signals through the neurons that influences their structure
• dendrites – structures on the neurons that receive electrical messages
• dendritic spines – tiny protrusions from the dendrite that are storage compartments for the synapse
• synapse – the connection between neurons that sends out messages

So these researchers discovered that with lithium in someone who is responsive to it, the CRMP2 protein is instrumental in changing the dynamics in the neuron at the dendrite and dendritic spine formation. To bring it into more normal function. It normalizes the set-point. And that helps stabilize that person’s mood.

The discovery that lithium has this effect on the CRMP2 protein helps us better understand what it is that goes awry in bipolar disorder. It’s not simply a question of a gene. There’s actually a protein that can be toggled off and on in real time to create a better set point for mood and behavior. To create more longer and more dense branching in dendrites. More dense dendritic spines. Growth.

We know there are other ways that lithium acts, too.  But understanding this opens up a promising pathway for researchers to explore and target with new treatments. This is lithium: old drug lights path to new hope for bipolar disorder sufferers. It’s a big step forward.

The more that’s understood about bipolar disorder, the more we can do to help those who suffer.

Lithium Helps 35% – What about the rest?

So, since lithium is one of only a very few medications that help people who have bipolar disorder stabilize, and it’s only effective in about 1/3 of bipolar patients, we clearly need more means of treatment.

Ketamine treatment and TMS have both shown a strong tendency for treating depressive episodes in bipolar disorder. There are other medications that can be used as mood stabilizers, too (although none of the ones tested affected CRMP2), and lifestyle changes that can help create and maintain well-being and minimize mood swings.

Now…the mood swings of bipolar disorder. What if you could take the depression part of bipolar disorder out of the mix?

Erase Suicidal Thinking

And what if you could erase suicidal thinking? The suicide rate for people with bipolar disorder is somewhere between 30-50%. And keep in mind, that statistic is for those who succeed in ending their life. The rate of those who attempt suicide, or think about and plan it, is much, much higher. What ketamine treatment can do, that lithium can’t, is erase suicidal thinking rapidly.  Within four hours. It takes five days to achieve a therapeutic level with lithium.  Five days.

When the suicidal thinking stops, the suicide attempt thankfully doesn’t happen. It not only saves the life of the person suffering with the disorder, but it also spares the family.

As we continue to work with these advances, we encourage you to reach out to us if you’ve suffered with a mood disorder without relief from your treatment. Our practice specializes in patients who’ve found no help in other treatments.  We’ll do a thorough evaluation to determine if you’re a candidate for one of the innovative new treatments in psychiatry that are giving our patients their lives back. 

We’re here to help you find your most happy and fulfilled self.

Call us or arrange an appointment for a thorough evaluation to determine the best treatment for you.

To your best self through science,

Lori Calabrese, M.D.