What is Bipolar Disorder?

Jul 28

Bipolar disorder, historically referred to as manic-depressive disorder, is a mental health condition in which an individual will have poor regulation or uncontrolled shifts in mood, energy, and activity levels.

There are 3 different types of bipolar disorder (1). All three types demonstrate clear changes in mood, energy and activity levels. These moods will be on a spectrum from extreme highs to extreme lows. “Highs” include elation, irritable or energized behavior and it may include a small or significant period with a lack of sleep. “Lows” include sadness, being indifferent, hopelessness or depression.

How Common is Bipolar Disorder?

Bipolar disorder is a fairly common disorder, affecting about 2.8% of the United States population. This disorder is known to affect males and females equally, and 83% of the diagnosed cases are considered to be severe (2). It can occur at any age, although it usually develops during late teens to early twenties and is diagnosed most frequently during this time frame. Pregnancy and childbirth may also be times of onset of the disorder in women.

What Causes Bipolar Disorder?

Currently, there is no known definitive cause of bipolar disorder. The two causes with the most evidentiary support are currently physical structural differences in the brain and genetics. Studies have demonstrated structural differences in the white matter of the prefrontal cortex of those living with bipolar disorder. It is theorized this is a contributing factor to the behavioral differences in those struggling with the condition. People who have a first-degree relative with the condition are also more likely to suffer from the disorder [3].

What are Symptoms of Bipolar Disorder?

Symptoms of this disorder are characterized as unusually intense emotions, changes in activity level, and changes in sleep patterns. These also partner with unusual actions and uncharacteristic behaviors. These behaviors are often harmful to the individual, however they are unable to recognize these behaviors as problematic at the time.

There are periods of time where there may be high energy, a sensation of feeling elated, jumpy or “wired.” They may have a decreased need for sleep or food and their decision-making follows illogical thought patterns. These periods are considered “manic” episodes.

There are also periods of “depressive” episodes which include feeling down, slow, hopeless, or restless. They have difficulty concentrating, talk more slowly, have little interest in almost all activities, have a decreased or absent sex drive, increased sleep and appetite, among other depressive symptoms. These periods of time are considered mood episodes and can last for days to weeks. Depending on the type of disorder they have, they may fluctuate through depressive and manic episodes in the same day. Symptoms may also vary over time.

The three different types of Bipolar Disorder are as follows (1):

Bipolar I Disorder - manic episodes lasting at least 7 days or manic symptoms that are of the severity that they require hospitalization. Depressive episodes often last at least 2 weeks. Depressive and manic symptoms may also coexist.

Bipolar II Disorder - a pattern of depressive and hypomanic (less severe) episodes, but not the severity of symptoms seen in Bipolar I Disorder.
Cyclothymic Disorder (aka Cyclothymia) - defined by periods of hypomania and depressive symptoms that last for at least 2 years in adults, or 1 year in children. The symptoms are not severe enough to meet requirements of the previous 2 disorders.

What are the Consequences of Bipolar Disorder?

People living with Bipolar Disorder can see a significant, negative effect on their working relationships, attendance and functionality. Chronic absences from work or short-term disability creates a significant loss of wages for the individual (8). They typically have higher healthcare costs compared to individuals without a mental disorder. Individuals with severe symptoms may cause self-harm during manic or depressive episodes, requiring admittance to psychiatric hospitals. They may suffer from other disorders such as substance abuse and eating disorders.

What Happens to the Brain in Bipolar Disorder?

Bipolar disorder deals with fluctuating symptoms as a result of unstable neurotransmission in the brain. Neurotransmitters are signals sent from one brain cell (neuron) to another. Depending on the neurotransmitter, some are responsible for excitation of the next neuron and some for inhibition. During a manic state, specific regions of the brain are hyper-activated (activated too much) while other regions of the brain that are normally responsible for inhibition of this activity are not functioning properly. Manic patients demonstrate hyperactivity of a few neurotransmitter projections, namely serotonin, norepinephrine and dopamine to the amygdala, ventromedial prefrontal cortex (VMPFC), orbitofrontal cortex (OFC), dorsolateral prefrontal cortex (DLPFC) and nucleus accumbens. Each of these areas result in the different types of manic symptoms (9).

When they experience their elevated and irritable moods, there is hyperactivity of the amygdala, VMPFC and OFC. Grandiosity and illogical ideas arise from excessive activity of the nucleus accumbens. Poor impulse control or increased risk taking is due to hyper activation of the VMPFC again, as well as the DLPFC. DLPFC hyperactivity is also associated with distractibility and poor concentration.

Other subcortical areas, such as the thalamus, hypothalamus and basal forebrain are over excited when there is a decreased need for sleep. Other systems, such as the OFC, should be able to inhibit some of these circuits, however there is too much activity for it to function properly. Therefore, BD is a result of excessive excitatory neurotransmitter production, excessive receptor site response, dysfunction of the inhibitory systems and glutamate excitotoxicity.

Excitotoxicity is a significant consequence of bipolar disorder. Too much activity leads to production of chemical substances that, when combined, become extremely harmful to neurons and eventually lead to neuronal death. Death of neurons eventually leads to degeneration of entire anatomical regions and structures of the brain. This could present as cognitive changes outside of a manic episode or worsening severity and frequency of manic episodes over time (10, 11). Therefore, it is important that manic episodes be managed and, ideally, prevented.

How is Bipolar Disorder Usually Treated?

Bipolar disorder is most often treated through the use of medications, psychotherapy (2), and sometimes Electroconvulsive Therapy (ECT) [6]. Medications are targeted toward treating either the main symptoms of mania or the main symptoms of depression when they occur. Transcranial Magnetic Stimulation (TMS) is a newer therapy being utilized to treat bipolar Disorder (7). Its greatest efficacy has been demonstrated for treatment of bipolar depression, both during acute symptoms and as a maintenance therapy. Treatment of bipolar disorder is usually lifelong. There is also literature demonstrating the efficacy of small doses of lithium orotate supplementation for BD (9).

How is the NeuroRescue Program Different?

One of the main things your brain does, and maybe even the primary thing, is help you determine where you are in the world. Your brain uses inputs from your inner ear to figure out where your head is in relation to gravity and how it is moving. It uses inputs from your muscles and joints to figure out where your body is in relation to your head and what your body is doing. It uses inputs from your eyes to figure out where your body is in relation to the visual environment.

Your brain needs to put all of that together to make sense of where the world is, and where you are in relation to the world. It needs to be able to localize you effectively in the environment, in order for you to be able to respond to the environment properly.

In patients with bipolar disorder, we regularly see degeneration or dysfunction in pathways that involve the eyes, the inner ear, and muscles and joints. This is because pathways utilize the same regions of your brain and brainstem that are affected by BD. In most cases of BD, at a foundational level a failure of regulatory systems has occurred, allowing for other circuits to get out of control.

Many of the neurotransmitters involved in BD are produced in regions of the brainstem known as the pons and the midbrain. These areas are also involved in a host of other neurological functions, including eye movements, inner ear vestibular reflexes, regulating heart rate and blood pressure, balance and coordination, and maintenance of gait patterns, among many others.

In cases of Bipolar Disorder, we regularly see dysfunction along many or all of these domains. A number of specific classes of eye movements have been shown to be impaired in BD (11-13). Balance and vestibular function have been shown to be impaired in BD, with findings shifting between mood phases (14). Deficits in motor coordination, sensory integration, and sequencing of complex motor tasks have all been shown to be present in BD (15).

This is why many patients fail to fully manage their BD with medication, psychotherapy or alternative therapies, even if all of their therapies are performed at the same time. While all of these therapies can help with problems in the individual systems, none of them take the comprehensive NeuroRescue Program approach to address all of the systems involved in anxiety disorders and their ability to work together in harmony.

How Does the NeuroRescue Program Work?

We design your unique NeuroRescue Program to be among the most comprehensive diagnostic and therapeutic protocols available today. We create individual NeuroRescue Programs based on a comprehensive analysis of every relevant neurological system and pathway, using gold-standard, cutting edge neurodiagnostic technologies and examination procedures and state-of-the-art therapies.

We begin with your Discovery Day, wherein we perform a comprehensive history of not only your condition, but your life on a timeline. This allows us to dive deeply into your case and see all of the factors that led to where you are now. It helps us uncover hidden problems and associated conditions that may be making it difficult for you to move your recovery forward.

Our examination allows us to identify the areas and pathways of your brain that have been impacted by your bipolar disorder. We begin by precisely quantifying the function of your visual, vestibular, and proprioceptive systems through computerized analysis of your eye movements, your inner ear reflexes, and your balance in a host of different sensory conditions.

We employ technologies including Videooculography and Saccadometry to measure several classes of eye movements. We use Video Head Impulse Testing to measure the function of your inner ear, and Computerized Dynamic Posturography to assess your balance under varying circumstances.

We use NeuroSensoryMotor Integration testing to evaluate hand-eye coordination and cognition, and Virtualis testing to assess dynamic eye tracking and perception of vertical in a virtual reality environment.

We combine all of this with a comprehensive physical and neurological examination of your sensory, motor, autonomic, and cognitive systems. We review any relevant laboratory testing, radiological imaging, and prior neurodiagnostic testing, and integrate that information with our findings.

We use this information to identify which parts of your brain are working properly, which systems are struggling, and the precise point at which your systems fatigue.

We can then design a NeuroRescue Program that is unique and specific to your brain, and yours alone. Your NeuroRescue Program works to rejuvenate and reintegrate the damaged neurons and pathways in your brain. It works to improve energy, endurance, and functional capacity within your fragile systems. We can also employ supplement protocols to protect the neurons you have and support them to prevent further neurodegeneration and prevent future episodes.

Our therapies may involve specific eye exercises designed to target the deficient areas of your brain [16]. They may include vestibular rehabilitation to address balance deficits (17), or specific electrical stimulation to enhance mood stability (18). It may include transcranial magnetic stimulation to reduce depression (19) and improve cognition (20). It may involve laser and LED photobiomodulation to help with mood regulation (21). It may even include exercises conducted in a virtual reality environment (22). In every case, the exercises and types of stimulation we recommend are chosen for you based solely on your diagnostic testing data and examination findings. No two NeuroRescue protocols are alike.

We use our technologies and procedures to not only see what we need to address, but also when it is time to stop and let you rest. We address your impaired neurological function from multiple angles of therapy, and provide metabolic support to improve neurological recovery.

While we cannot bring back neurons that have been lost, your NeuroRescue Program allows us to take the pathways that remain and maximize their efficiency and endurance. And by focusing on the integration of systems, we can do more than just get pathways working better, we can get them working together again. This gives us our best opportunity to stabilize your emotions, improve your cognition, and return you to living a healthy, vibrant, and fulfilling life.

Your Next Best Step:

Living with bipolar disorder can be extremely challenging, but there is hope for recovery and remission. To see if the NeuroRescue Program is right for you, contact one of our patient care coordinators to schedule your Discovery Day.

And remember, it’s never too late to start getting better.

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