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Do we just keep getting worse?


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I have been assessing my current situation and level of insanity and I think I may be getting worse (crazier) over the years.  Is this possible?  This sucks because it isn't like we are treating a static illness or situation, but a constantly growing problem.  No such thing as take this combo and be fine forever, we have to remain constantly vigilant and constantly aware that we have a problem and may start the long road to crappy-dom at any time.  "Is this going to make me spiral down?  Am I safe making changes or will I look back on this as the beginning of an interminable dark period?" 

Either I am have been getting worse over the past few years or I am just in a bad spot now and feel like the last 8 years have been for naught. 

I would really like to know people's thoughts on BP as a progressive (degressive?) illness.  Funky medical talk or brain activity talk is welcome too. 

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I think it tends to get worse on its own, which is part of why people can be sooo enthused about reporting on lithium's neuroprotective effects. Yes, it's degenerative. This is a big part of what all this kindling talk is trying to explain. It's also why some people here were fine for years, then started getting worse, then crashed and had no choice but to get help or die.

The right combination of magical medications ideally slows down (maybe stops) the degeneration, but you're right. BP is ever moving. It's like Snape's lecture about the Dark Arts in the most recent Harry Potter book. We're just trying to not get killed.

On the bright side, a lot of people, maybe even most people, achieve remission for years without major problems. They just don't post a lot here.

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I certainly think my husband's bp has changed over the years. I would only say worse because it seems harder to treat. But then again, he hasn't kept up with any treatment until a few years ago.

The depression was a real pain in the ass. He had never had one before. It almost made me miss the mania.

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Hmmm...good question; provoking and scary.  I was just recently diagnosed correctly after dealing with this for many, many years, and I wonder if what made me finally seek treatment was that it was getting worse.

I was medicated/hospitalized  in my 20's in the 1980's for major depression (which should have been dx as bp but who knew???), and actually had emotional problems my whole life.  Stayed medicated several years but eventually just stopped taking meds because...I guess I was tired of it and wanted to be normal?

Then I struggled with the ups and downs for many years until the downs/crabbiness/irritability/unpredictability of my moods became too much for my family and me to handle. 

So why did it all of a sudden (really gradually) become too much to handle is a good question.  Was it because I'm older and it is getting worse, or did I get tired of fighting it all the time?

Now I'v been medicated on Cymbalta, Xanax and Lamictal and I'm doing really well.  It scares me though.  I'd like to think that I'm going to stay this way and I hate the thought of in a while having to essentially start all over again because my meds will cease to work.

I have never in my life felt this stable -- NEVER!

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I was just in my brand-new pdoc's office today for our first appointment, and she looked at my charts and we discussed kindling and progression of the BP disorder. I'm only 27 but have had this insanity for 20 years. I've been hospitalized for depression once, mania three times, and psychosis once. Three of those hospitalizations happened in '05.

What is there to do but watch ourselves? I have a friend who took Lithium his whole life, only to show some weird signs in his most recent bloodwork. So he switched to Depakote.

We need to acknowledge that BP is progressive. The cycles do hit harder and faster with age. They were too hard and fast for my Dad at 46, and he suicided rather than take the assault.

The only choice we have is meds and often t-therapy. We need to keep ourselves well, keep ourselves in line, and keep our relationships strong.

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All of this brings up, what happens with this in our much older years? I've wondered about how and what changes there are with geriatric treatment of BP. So many meds act very differently in an elderly person than with someone else.

I have no answers on this. Just something I've been wondering about. Though not too hard; I have enough problems with both depression and just putting one foot in front of the other to get too focused on this issue. But it is something I guess I'll have to think about at some point.

Anyone know much about this?

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Guest luli2545

I agree with Imnop; maybe they don't post here. a very cool 73 year old I know is BP; she takes her meds mostly; (missed three weeks this summer and got kind of "low,"  & irritable..per her... but she's been stable on meds for over a decade with no discernable (by her) "degeneration." BTW, she looks about 58. Has a partner, kids, grandkids. Best support for her: friends, grandkids, husband in no particular order.

She says she knows when she's off because she'll get pissed off...sees her pdoc quarterly and tdoc monthly...

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I've gotten more "non-functional" (according to what is usually deemed normal) over the years, but on the plus side, I am getting better at managing my life and avoiding triggers.  Psychotherapy (self-knowledge and self-acceptance) has helped me more than meds.

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I also spent most of my life (since puberty) fighting this disorder, first undiagnosed, then in my 20's misdiagnosed as unipolar depression.  I began to self-medicate with alcohol in my early teens, and things got progressively more crazy after I was pregnant and had my only child in my early 30s.  I went to rehab, and got sober at 37, and my world just caved in.  Multiple hospitalizations, rapid cycling, med changes, no real stability until after another set of hospitalizations at 40. 

I've been relatively stable since, although stable for me means that I have had three depression relapses this year (two requiring med changes) vs. none last year.  I'm 43.  I often think that with menopause coming on (I'm having symptoms), that the whole kindling thing has something to do with that.

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http://72.14.203.104/search?q=cache:WXMJPw...ename%3Dlrn_004

What our research and other peoples' research has recently shown is that mood disorders, while they do entail mood swings or emotional changes, are also associated with changes in important structural areas of the brain. In other fields of neuroscience, we are finding out that what the brain does for a living is adapt to its environment: When an animal learns something, the brain's structure changes. Some of the biochemical pathways that help brains function moment-to-moment are also important for keeping cells alive, growing properly, fortifying them against stress, and making long-term structural changes. Brain imaging studies and studies on the brains of deceased patients (called postmortem studies) are showing us that in many patients with recurrent mood disorders (whether bipolar or unipolar), parts of the brain seem to be atrophied, or shrunken. It is a bad news/good news scenario: The bad news is that we don't want to see structural changes. The good news is that most of the change seems to be cell atrophy, or shrinkage, rather than cell death. At least in some cases you can restore them back to health, which is different than with Alzheimer's or Huntington's, where you can't.

If you do an MRI [brain scan]of areas of the brain such as the frontal cortex, hippocampus, or caudate, you see that these areas are smaller in patients with recurrent mood disorders. If you do postmortem studies and count the number of cells and the number of cellular connections, you find that the cells of these patients are more shrunken. In some cases, they are fewer in number. Both neurons [cells in the nervous system, including brain cells; for more neuron images, click here] and glia [specialized nervous system cells that support, insulate, nourish, and connect neurons, as well as regulating the surrounding fluid] seem to be affected in mood disorders. Glia may show a greater degree of loss, while the neurons are more atrophied. But this is a sweeping generalization, because this is currently under study.

Many of the genes that are considered neuroprotective are being remarkably turned on by lithium. Is lithium actually neuroprotective? We hadn't thought this way before. A number of studies have taken animal cells and tried to kill them by causing stroke, etc. These studies have consistently shown that lithium, if administered before you try to do the bad things (such as induce a stroke), protects the animal's neurons. In lithium-treated brains, the size of the resulting stroke is smaller, the number of neurons that die is lower, etc. That was amazing. Since these studies were done in rats, you need to be careful about jumping to conclusions that lithium is neuroprotective in people. Wayne Drevets' group published a finding in Nature about five years ago that in a part of the pre-frontal cortex of bipolar patients or patients with familial recurring unipolar depression, there was almost a 40% reduction in the amount of gray matter. That was a remarkable finding that you have such a reduction in a discrete part of brain. We spoke to him about our lithium findings and asked him to reanalyze the data. He had a small group of patients who had been treated with lithium for a long time and they did not show the brain atrophy compared with the bipolar patients. Interestingly all of the patients with unipolar depression, whether or not they had been treated with antidepressants, still showed the atrophy. That was a suggestion that bipolar treatments might have a protective effect. Valproate (Depakote) in the prefrontal cortex seemed to have the same type of neuroprotective properties. Lithium and depakote do not have identical effects in every brain area, but in this area they did. Brains treated with chronic lithium or valproate seemed not to have the atrophy in the prefrontal cortex. But it was a very small sample and a crossectional study [type of study whose design restricts its findings to association between variables, not proof of cause]. He studied them once. We don't know if it was a cause or effect. Is it the people who don't have the atrophy who responded to the drug in the first place? We did some studies taking bipolar patients off their meds -- they were referred to us because their treatments weren't working. In every case, they either hadn't been on lithium or had been on lithium sparingly -- had started on it, had side effects, switched, and the new med was not working. These are bipolar depressed patients. We did MRI scans and MRS spectroscopy and then put them on lithium in a blinded fashion for 4-6 weeks. Then we did the scans again. We found that almost every single person taking lithium had an increase in N-acetylaspartic acid (NAA) [an amino acid that is viewed as a marker of neuronal health]. And the actual amount of gray matter was going up when they were treated chronically with lithium. This study was done together with Dr. Greg Moore
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Thank you Glen for the great info.  Goddamn brain atrophy.  What do you think we do about it?  Just make sure to exercise parts of the brain?  I think different kinds of therapy can do that, make different parts of the brain to move again. 

This is an interesting concept from the movie "What the Bleep do we know" - that if a certain part of the brain isn't used, it will atrophy, but you can get it going again.  So that is supported by the info that Glen found.  The cells don't die, they just get lazy.  So maybe there is a way to stimulate those areas so they perk up?  If not, that would be a really great thing for some smarty-pants research people to look into.  Physical therapy for the brain - Neurotherapy maybe? 

I for one am going to fight tooth and nail against getting worse.  I know it can be unavoidable and can totally sneak up on you (hello to the last few years of my life) but I am going to do whatever I can.  Maybe going to school and learning new things really is good for you, it makes different parts of the brain active that get lazy. 

It does get tiring though, doesn't it?  To think that we can never relax and always have to be keeping one step in front of our brains.  That could be part of the phrase "Old and set in their ways".  I know people (my parents actually) that have come to a point where change is incredibly hard.  Maybe that too has to do with parts of the brain atrophying.  Maybe I should go into Neuroscience...  How does one parlay a BA in General Humanities into a Master's in neuroscience?  Maybe I would have to go for Medicine first?  Rhetorical question....

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I'm definitely getting worse. even when i'm feeling slightly better like I am right now, I know I'm getting worse and will continue to get worse. I know that's bleak. I've seen it happen to my parents and I don't see any reason why it's not going to happen to me. I went from being able to handle it all three to four years ago to being hospitalized this year. I went from a 95% average in high school to barely pulling C's in university, all since my first manic episode. I feel like I've suffered permanent brain damage or something --- something I mean to talk to my psychiatrist about.

sorry to be so dreary.  ;)

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I've gotten more non-functional over the past few years.  I used to be able to feign some level of normalcy, but I think it is very obvious to everyone now that I am nuttier than a fruitcake.  I also tend to see/hear/smell things more now...like at least once an hour.

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