My theory about mania

[Loon-A-TiK]

I personally think mania is a defense mechanism, just like developing new identities is a coping method for Dissociation disorder. Mania lifts this hell and introduces a different kinds of hell, but at least the (short in my case) way up is a powerful rush of 1000000x all the energy of every person in the world put together. Invinsibility. Freedom from depression. What depression?

So,  like many manic-depressives, sometimes I long to induce mania. I just feel it in me to do it. The problem is that going off meds could resullt in a number of things, mania being only one of them. Usually nasty withdrawl is involved before any powerful toxicity sets in, and that's no fun at all 

Sorry to trigger any manic ideas. I just had to share this.

[AirMarshall]

Well, I think that the the psycho-neuro-biologist would disagree with you on firm grounds.

[Dweii]

Even though it's probably not correct per se, it's interesting from a more spiritual viewpoint. Sometimes when things get really, really bad I feel like I "deserve" a hypomanic episode to make up for it. (Would never wish for mania though. They're scary.)

[SerraGeorge]

What about meeting in the middle? When I look at my history with mania, I notice that sometimes they have come at times when by all rights I should be huddled on the floor wishing for death... so maybe some of it could be defensive? Like my brain saying "Well this is better than that, so here we go." BUT, they've also come at times when nothing of particular note was going on, and they've come at times when everything was completely wonderful... So... uh, maybe not so much on the defense thing, but maybe sometimes. Who the hell even knows. Lol.

[Squirlygrl]

It's the Melanie Klein (early, very influential analyst) manic defense against depression, and it still turns up a bunch of times in a PubMed search.

I buy it too; while it doesn't explain seasonal or kindled episodes, a lot of mine, even now, seem to be responses to fear or loss.

How do you suppose this applies to mixed states; are they a partially failed defense?  I find myself nostalgic for those, too, a tiny bit (better to be vivid and miserable than gloomy and drugged), but it's nothing like the longing for the euphoric states.  The only thing that seems to help with that (besides filling ordinary life with good things) is writing it down; it turns out there was less to them than I remembered.

sg

[resonance]

I have had hypomania (not the fun kind) in response to really upsetting things happening.  I suspect that's what it is: sometimes a response to stress. 

[Thomas]

My hypomania seems to come out of nowhere, Wham!, especially during mixed episodes which seem to be where I am most of the time now.

Tommy

[Unregistered]

OK, so I posted this over on 'Pharmacology Geeking Out', but I thought it might be relevant here...

So we believe that bipolar has both genetic and environmental components.

We clearly all have the ability to change moods from up to down and back. Everyone does it all their lives. I suspect there is a feedback mechanism in our brains that stops these swings from getting too extreme and from going on too long. It works just like the dampers on your car: if you had no dampers, just springs, everytime you hit a bump, the car would start bouncing up and down and would go on doing this for a long time. Add the dampers, and the bounces are limited to one or two, and they get much smaller very quickly.

Our genes may give us a slightly lower degree of feedback than 'normal' (whatever that is). If we never hit a big pothole, we might go our entire lives without becoming BP. But hit a big bump, a big stressor in our lives, a trigger, then that can be too much for our limited feedback systems. Then we start to bounce around, though as long as we have enough negative feedback we can return to normal spontaneously (until the next trigger).

Presumably, then, there are also people with no negative feedback at all who will just cycle indefinitely with no apparent triggers, and those with positive feeback who, once triggered swing more and more until the wheels finally fall off.

Kindling theory tells us that if we've had a wobble once, it will take less of a knock next time to start another wobble. So untreated, we wobble more and more each time life triggers us, and we start to wobble more easily each time. This would certainly apply to those with some negative feedback (damping). Does kindling happen in the other scenarios? Are the other scenarios (i.e. zero and positive feedback) actually real? Does anyone experience them as described?

Some people will have more feedback than others: the lucky ones may go a very long time before they're tipped over the edge and may show no symptoms until middle age. Others have very little feedback available at all to help stabilise them, so they get triggered much earlier in life.

A big bump and very little genetically inherited feedback can start a series of huge swings, but like a big pendulum, they move very slowly: Behold, we have BPI.

A smaller bump and a reasonable amount of feedback to damp things down: BPII, with smaller but faster swings (ever seen a metronome? push the weight down towards the pivot and watch it speed up).

All well and good so far, but I'm unsure how and where mixed episodes figure in here, and exactly why there can be such variability in frequency of episodes.

Although on the surface bipolar resembles epilipsy in terms of electrical activity in the  brain (which is supposedly why anticonvulsants are used to treat BP), the timescales are incomparable - ever heard of a six month seizure?

So what sort of mechanism would be present to provide this 'slow damping' effect? What would be the zeitgebers that controlled the periodicity (if any), or are episodes always triggered, rather than happening 'spontaneously'?

[ncc1701]

Heya,

Well, Unregistered, I have to think about it, and I'm on a mission to not-think today, but I'll get back to you.

The prevailing medical POV is that in BP, the eps are not necessarily triggered.  As opposed to personalities, where moods are almost/always triggered by a definable event.

Loon, I think I see where you're coming from, and hey there's room for a lot of hypotheses here.

In terms of etiology (what I think):

Yes BP is a brain disorder.  But it comes from somewhere, like diabetes and heart disease come from somewhere.

Genetics and environment are *so* intertwined.  And now, they're looking at proteomics.  This is the science of our proteins and what they do to/for us.

Turns out that people with the same genes can end up with different proteins, and this is opening up whole new worlds for genetic researchers.

Like, how my great-aunt lived to 86 smoking and drinking, while others in the same family died young of heart or liver disease.

We don't know where it comes from or how some of us get it.  I have BP, my sister has MDD, my brother is fine, whatever that is, I define it by him.

Unregistered presents an interesting hypothesis that includes some questions I don't feel up to addressing at the moment.  I'm on vacation.  Well, doctor-imposed vacation.

But, Loon, in your hypothesis:

How do mixed eps fit in? 

I would rather be curled up in my room wishing I had the energy to crash the car and eating Oreos (depressed) than drinking, hitting DH, and constantly (while commuting) resisting the impulse to crash the car (mixed).

OK, except in mixeds I can work overnights and make more money.  But they're not predictable, so that's not really practical.

That's a serious question.  I say that, b/c I'm becoming sensitive to how things can be misconstrued, and I don't want you to think I'm being sarcastic!

I really think you have an interesting approach and am curious how you think about mixeds.

(Interesting, as an aside, how thinking about misconstruing etc. on the internet has helped me with my social skills in real life.  Not something I would have foreseen.)

--ncc--

[Glen]

In terms of etiology (what I think):

Yes BP is a brain disorder.

[NARS]

Early on after diagnosis I came up with a "functional BP" idea.  My people were peasant Jews in northern Ukraine.  Long cold winters with only root vegetables and cabbage to eat and more or less permanent poverty and oppression.  It made sense to slow down, way down, when resources were thin and you couldn't do much about it. But when things were happening, when there was something to do about it, you needed tons of energy and imagination to respond so you could lay in resources for the lean times.  This might not necessarily coincide with seasons, but with the flow of commerce and the few opportunities you might get.

I thought that someone prone to radical mood swings might be useful in such an environment.  I understand that BP episodes are not necessarily triggered, but I know for myself that when depressed I used to do things that would trigger mania--I'd stop sleeping, drink and use hallucinogens, and do what I could to escape from the pain.  Eventually this would trigger hypomania, at least, which from an early age quickly turned into mixed states.  During grad school I'd spend the first 3/4 of the semester in a deep weepy hopeless black funk.  Then exams would loom, and the prospect of flunking out triggered anxiety, which stopped sleep, increased my drinking, and drove me into a highly functional but highly painful hypomania.  After finals and papers were done I'd crash and be back where I started.

I've also heard the idea that BP episodes aren't triggered, while PD episodes are.  I'm not so sure, though.  There's starting to be some literature supporting the idea that most PDs are likely forms of treatment-resistant BP (psycheducation.org, for instance), and that in many, if not all, cases, a diagnosis of a personality disorder is a cop-out way for a pdoc or therapist to throw up their hands and declare the patient untreatable.

I dunno.  I do know, however, that my therapist tells me that before treatment for BP it seemed possible I had BPD.  After medication and the deeper therapy I was open to once my BP symptoms were relieved, she figured out that the "BPD" symptoms had pretty much been BP symptoms aggravated by trauma.  With BP more controlled we could work on the trauma, which allowed me to get even more control over the residual BP symptoms. 

[groovyone]

I'm really tired and would love to engave more fully in this discussion but for now, I'll just insert one of my favourite expressions:

"Genetics loads the gun; environment pulls the trigger."

Discuss amongst yourselves.

*grin*

Karen

[ncc1701]

Heya,

Glen, sodium channels are an important area of investigation.

True, NARS, that it took *long* for BP to be sorted out from personalities.

Most people (like me; I think I'm more schizoid personality than Aspie) have a personality of some kind.

Those personalities are either useful/adaptive or not.

Mine, not so much.

Those (like mine) that aren't, so much, *useful/adaptive,* are considered "personality disorders."

Borderline, who knows.  It's so prevalent, it's either way-over-found or is very, very common.

Or, mis-characterized.

At any rate --

Meds might help the moods.  Or, therapy might help the moods.  This varies b/w people.

The other features -- whether used as part of a DSM formulation or on their own -- will help a treating professional figure out what kind of meds/therapy might help.

--ncc--

[Loon-A-TiK]

I luv that so many of you have replied! Really, I usually feel like my ideas/topics are stupid. This one seems to have invited several different views.

I know that in the midst of depression and mixed episodes (which for me are very fun- they include the terror and thought flights of mania with the killing knives of depression) when I wish I would just have a brain anyrisum (sp?) and die, I wish for salvation in the form of a strong hypomania/mania.

Yes, it is a brain disorder, however mania unleashes brain chemicals that can be addictive. A lot of BPers go off meds because they long for the high of mania. I feel like I am out of control but the control is pointed and there. I feel like the mania and depression are fraternal twins that lock me in their own amusement park and force me to ride all the rides.

But about my topic...I think that within our organic brain disorder that once you taste the terror and exhileration, the change of pleasurable pain to terrifying heights, you can't help  but wish one mood would switch to the other. It becomes too much.

And I'm not too sure about how it applies to DID. I just threw that out there. I'm not very informed on DID.

[NARS]

"Genetics loads the gun; environment pulls the trigger."

I love it.  So guns don't kill people; people kill people, right?

As you know, I'm way into the therapy + meds thing.  Without meds I couldn't go through what I need to do in therapy; without therapy I'd probably mess up and abuse the meds.  I'm a very, very lucky girl to be able to find and afford both a great therapist and a fine pdoc.

(edited for silliness)

[daemongrrl]

Yes, it is a brain disorder, however mania unleashes brain chemicals that can be addictive. A lot of BPers go off meds because they long for the high of mania. I feel like I am out of control but the control is pointed and there. I feel like the mania and depression are fraternal twins that lock me in their own amusement park and force me to ride all the rides.

But about my topic...I think that within our organic brain disorder that once you taste the terror and exhileration, the change of pleasurable pain to terrifying heights, you can't help

[seven]

skimmed, but if I'm gettin' the gist, ...according to current thinking, yes to genetic disposition evolving with stressful environs into full-blown bipolar or more. aka the diathesis stress model.

So, if you react to stress with mania, well, of course it has its unique chemical intracellular picture. If a chain of atomic interactions preceded your actions, can you also say you willed it? i think such circular inquiries are tautological to some degree.

The exercise of volition to assert self, as it feels, is definitely what anyone would do, except we do it with more passion and bravado! So, it backfires sometimes. We are not measuring cups.

7

(had to try it out)

[Unregistered]

ncc, interesting that you mention sodium channels. My pdoc is a researcher and he is curently working on a theory involving cyclical ion concentrations around voltage gated sodium channels. Sounds very impressive. I must remember to ask what he thinks is the mechanism behind the cycling (frankly, I don't care if it's ion concentrations or evil pixies, as long as they get to the bottom of why the bastards cycle...)

[SerraGeorge]

I have no sort of brain medicine degree, and I'm just pondering things. If I'm being a dope, then let me know. Doesn't stress change brain chemistry? Like the adrenaline when you're scared and the "in love" endorphins? If that's true, then couldn't a manic episode be triggered by external stimuli? In that case, the mania would still remain a genuine brain chemistry anomaly, but it could also be said that it was an environmentally triggered response.

Wouldn't it be hysterical if science eventually figured out that it had nothing to do with having screwy brains at all, and our bipolar crap was caused by a gene mutation that caused the appendix to secrete a bizarre substance whenever we stubbed a toe.

[Glen]

ncc, interesting that you mention sodium channels. My pdoc is a researcher and he is curently working on a theory involving cyclical ion concentrations around voltage gated sodium channels. Sounds very impressive. I must remember to ask what he thinks is the mechanism behind the cycling (frankly, I don't care if it's ion concentrations or evil pixies, as long as they get to the bottom of why the bastards cycle...)

<{POST_SNAPBACK}>

You should ask him to look into chloride. Sodium Potassium and calcium are all transport mechanisms which affect intracellular chloride. In fact the NKCC1 co-transporter and intracellular chloride seem to all have links to some very material relationships. Notably PKC, T4, glutamate and gaba. Further to that Lithium valproic acid and lamictal all effect chloride transport. All AFAIK, ncc should be able to spread more light on this.

[groovyone]

Wouldn't it be hysterical if science eventually figured out that it had nothing to do with having screwy brains at all, and our bipolar crap was caused by a gene mutation that caused the appendix to secrete a bizarre substance whenever we stubbed a toe.

<{POST_SNAPBACK}>

This make me laugh! *grin*

Well, they are mapping the human genome so maybe by they time they get around to finding some mysterious "bipolar gene" this may be the answer!  It just might be thwarted by any bipolars that had appendectomies prior to their illnesses being exposed.

Ah, but I'm splitting hairs.  It could be any gland/organ etc...

Karen