Neuroimaging Shows Increased Activity in Bipolar Mania

In a recent study looking at the difference in neural activity between persons with bipolar I disorder who were experiencing mania, those with bipolar I disorder who were experiencing euthymia or a normal, non-depressed mood, and persons who did not have any psychiatric disorders and were considered “healthy controls,” researchers found some significant differences in two brain networks.

The first was in the Dorsal Attention Network (DAN), which is a group of regions in the brain that plays a large role in our internally motivated goals using our visual attention and short-term memory processes. In other studies, increased activity is evident in the DAN after the presentation of cues indicating where, when, or to what participants should direct their attention.

In this study, those individuals who were manic had significantly higher levels of activity in their DAN compared to the euthymic group and the healthy control group, possibly explaining the often apparent hyperattention, arousal and emotional response of those experiencing mania to external stimuli.

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This figure shows the increase of connectivity in mania (A) versus euthymia (B)

The second brain area assessed was the Default Mode Network (DMN), which is a group of brain regions that shows a lower level of activity when we are working on a particular mental task like paying attention, but higher levels of activity when we are doing more generic thinking tasks such as daydreaming, recalling memories, guessing about the future, monitoring the environment, speculating on the intentions of others – just thinking without any task-oriented goal in mind. Recent research has begun to find connections between the DMN and mental illnesses like anxiety and depression. Also, meditation is thought to be related to the DMN, which may be why its influence in well-being is significant.

Of particular note in this study, was the fact that those with bipolar disorder in a euthymic state showed hypo-connectivity in the dorsal nodes of their DMN compared to the mania group and healthy control group. The mania and healthy control groups showed the same connectivity.

Does this mean that the euthymic group was more relaxed, less worried about the past and future, less concerned about their surroundings and the behaviors of others than the other groups? Even the “healthy” group? I don’t know. The researchers didn’t comment on what this particular finding suggested other than the fact that this dorsal node is the exact location that corresponds to the target for transcranial magnetic stimulation (TMS) for the treatment of depression, even though they made sure to reiterate the fact that the euthymic group was not depressed.

The researchers pointed out the fact that their study’s results contribute to a body of growing evidence that points to bipolar mania as a behavioral pathology due not to circuit disruption but rather increased coherence (connectivity).

As far as the hypo-connectivity of the dorsal nodes of the DMN in the euthymic group goes, the researchers were not sure if this was due to a compensatory mechanism of the disorder trying to right itself or if it was in fact still part of the diseased state.

Of note:
– Diagnosis was determined using the Structured Clinical Interview for the DSM-IV (SCID)
– Limitations of the study included a small sample size of 23 manic, 24 euthymic, and 23 healthy controls.
– There were no significant differences in participant age, sex, and medications

Resources:

Differential brain network activity across mood states in bipolar disorder
Dorsal Attention Network
Dorsal and Ventral Attention Systems
Know Your Brain: Default mode network

Light Deprivation to Decrease Mania in Bipolar Disorder

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Bright light therapy has been used for years to treat seasonal affective disorder and depressed patients in general. Patients sit in front of a special lamp which has similar effects on their circadian rhythms or wake cycle as the sun would, thus increasing their energy and lifting their moods. I had great success with my light therapy box during a particularly trying depressive episode several years ago.

Researchers are now speculating that light DEPRIVATION therapy, the opposite of bright light therapy, may be a viable treatment for bipolar mania. Light deprivation therapy can be achieved by limiting exposure to sunlight or by wearing specialized glasses.

There are only a few studies testing this theory, however, and while results of these studies are positive, sample sizes are too small to be generalized. Hopefully, they will continue to look into this further because if it works, it would be a safe, non-invasive option for treating bipolar mania.

Impulsive Decision Making in Bipolar Disorder

block-party-pacific-beach-bike-jumping_w725_h544I try to make healthy decisions regarding my lifestyle. Things like eat well, take my meds, get proper sleep, limit caffeine, don’t drink or smoke. Some things are harder than others.

Today, I threw away my only pack of cigarettes with a new resolve to quit once again. I had plans to download a quit-smoking app to keep track of my days quit and to get active on the online smoking cessation forums which were a great support to me in the past. A half hour later I was retrieving the pack out of the trash and lighting one up.

Yesterday, I decided to start counting calories. My goal is to lose ten pounds. I lost more than this last year and have kept it off, so I know I can do it again, but by last night I was baking, and then eating way too many, chocolate chip cookies. My calories were blown for the day.

Impulsivity is running rampant in my life lately, and quite uncomfortably I might add. Initiating too many impromptu social visits is leaving me stressed and fatigued, but I can’t seem to curbed the impulse to do so. Shopping sprees are rampant under the guise of procuring Christmas presents.

Following these impulsive acts comes guilt and shame, plummeting self-esteem, and the beginnings of self-hatred. Up then down. Up then down. The wonderful life of bipolar disorder.

It helps to remind myself, however, that this cycle is not my fault. It is not a character flaw, a punishment, a sin, or a weakness. It is a biological, chemical, brain disease of which impulsivity is but a symptom.

I found a recent study where researchers looked at euthymic patients with bipolar disorder who were not taking antipsychotic medication and 20 case-matched controls performing a roulette task during functional magnetic resonance imaging. The controls showed higher brain activity during safe reward prospects while the bipolar patients showed higher brain activity during risky reward prospects!

The bottom line is impulsivity is part of bipolar disorder. Accepting this is what we have to do. It does no good to beat ourselves up over something we can’t control. Does this mean I am going to give up trying to quit smoking and losing weight? Absolutely not!

We must never give up trying to get better. We have to keep fighting our symptoms whether it be through medication management, lifestyle changes or both, all the while remembering that they are just that – symptoms, not who we are as a person, but just symptoms of a horrible disease that we didn’t ask for and don’t deserve. A disease that we do have and will continue to deal with the best that we can.

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How to S.T.O.P. Anxiety

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When I have a stressful event coming up, such as a holiday, a trip, or out-of-town company coming to visit, I usually spend the days leading up to it preparing myself physically and mentally by scheduling very light, easy days. I make sure not to book any doctor’s appointments or other trips too far away from home. I make sure to get plenty of rest, and may even get a massage. I leave plenty of time to clean my house, pack, or prepare meals for the event, or whatever may need to be done; always asking for help from others, and always doing a little each day and not all at one time or at the last-minute.

Well, this weekend we are going out-of-town for a stressful social event, and due to circumstances out of my control and to prior commitments made I have major plans every day this week, leaving me not one day to rest my body and mind in preparation for our trip. Because of this my anxiety level is through the roof!

I fear I may not be able handle this weekend very well because I will not have had the proper time to prepare mentally and physically for it.

My anxiety plays out in funny ways. It makes me a bit hypomanic. I can’t sleep. I become obsessed with cleaning and organizing my environment, as if by making my surroundings perfect I will somehow feel more put together on the inside, too. I become irritable and agitated; I start eating poorly, and I get headaches.

I suppose I could go through the rest of the week like this OR I could S.T.O.P.

Sit still.
Take a deep breath.
Observe my feelings.
Permit them to be.

I tend to “run away” from uncomfortable feelings like fear. I used to run from them by abusing alcohol. Now, I become too busy cleaning or shopping or doing things for the kids to pay attention to my feelings, and become just as sick as when I used to drink, only you could call it an “emotional hangover” instead of a physical one.

I find that when I am able to take a conscious moment to be quiet, breathe, acknowledge what I am feeling, and allow myself to feel it, the feelings lessen, if not dissipate all together. It is when I ignore them, run away from them, or fight them that they become more intense, and sometimes unbearable.

It is now time for me to S.T.O.P.

How about you?