Better quality research is required

I have just received an email magazine where this headline is presented as if it is a new one, “BIPOLAR DISORDER ‘SHRINKS BRAIN’

Typing this into Google this turns out to be a small study from 2007 http://news.bbc.co.uk/1/hi/health/6907050.stm

that seems to have been dragged up, perhaps by someone somewhere hoping the public will see it as new and worth re-reading?

This idea alarmed and worried people at the time, but then seemed to be untrue having only involved a small number of people and possibly not taken into account a lot of lifestyle issues, such as drug intake that may have influenced the results more than the diagnosis. Here is one of the places it was discussed at the time. You will see some people were upset by being told their brain would shrink faster.

http://psychcentral.com/blog/archives/2007/07/29/bipolar-disorder-shrinks-the-brain/

Professor Goodwin was reported as saying, “It supports the idea that cognitive function is impaired in bipolar patients in middle age” By saying this in this way, makes it sound as if this is a well documented fact. Where does this idea of impaired thinking come from? Those who so readily point out that Winston Churchill and Sir Isaac Newton were probably manic depressives do not seem to believe that mood disorders caused ‘cognitive impairment’ in the days before antipsychotics.

Through my work I meet hundreds of people with the bipolar diagnosis. In my experience those who take antipsychotics gradually have impaired thinking whilst those who do not take drugs continue to have ‘sharp thinking’. Now, clearly the people I meet are a particular sample and a lot of other things are going on in their lives. It is just that they talk to me about the drugs they take and over the years I have seen deterioration in brain function in those who take antipsychotics for long periods. Good brain functioning seems to return for those who can safely, gradually come off the drugs.

The results from this old study might still be useful, if enough data was collected to view them in a different way. What if records exist for how much of the various brain-wasting drugs were taken by each person prior to their first scan and in the four years between the two scans?

It is known that anti-psychotics cause brain shrinkage. How much drug was taken by the bipolar group and how much by the control group? Also alcohol is associated with changes in the brain. Research has shown many people with mood disorders drink more than average amounts of alcohol. Did the researchers record alcohol consumption?

It would be interesting to hear from the 2007 team and see the data they collected and how they came to the conclusion that a diagnosis was causing brains to shrink rather than any environmental factors.

If it turns out that the un-diagnosed group was taking similar drugs prior to the study and during the study then my thoughts are about diet, as people with the bipolar diagnoses can tend to give up hope and turn to less nutritious high calorie low vitamin content foods that may be associated with changes in brain structure.  If not diet, stress hormone (perhaps cortisol) levels may be seen to vary between the groups as we know mental health diagnosis increases stigma and that could in turn increase stress levels.

Do any readers know of brain scan research that has looked at a fuller range of possibilities rather than starting out to prove that a diagnosis can directly shrink brains?

I do not doubt that those of us who were diagnosed have ended up with brain shrinkage. I am just keen to know which factors are causing the loss of brain cells… is it the antipsychotics, the illegal drugs, the alcohol, poor nutrition, higher stress levels or any number of other possibilities such as poor sleep or smoking more?

Let us have more research that includes brain scans – just that a future team could include me, as an experienced researcher with chemistry and pharmaceutical background having had the bipolar diagnosis. This would of course require the rest of the team to accept that the diagnosis has not already shrunk my brain too much. I can say upfront that the amount of medication I took is likely to have destroyed 10% of my brain. There again it is not how much brain we all have – it is how we use it that matters.

Lithium in moderation

Many people have been told, “You will need to take lithium tablets for the rest of your life.”

It is a strange thing for psychiatrists to be saying when first prescribing this mineral. We know that for something like half the people who take lithium as prescribed it just does not do what it is supposed to do.

Could it be that lithium simply works in a similar way to all the other essential minerals like iron, calcium, magnesium, copper, zinc, selenium, with supplements only improving our health if we happened to be suffering a deficiency?

From a nutritionist’s point of view this makes perfect sense. If you have enough of a mineral and you are given more than you will feel worse. Most likely you will become more anxious or depressed. If you really are not getting enough dietary lithium then a lithium supplement will most likely help you to feel less depressed and anxious.

Here is an article I wrote about lithium being a mineral that most people can get from a balanced diet: Lithium for everyone

As always I need to stress that if you have taken lithium tablets then it can be extremely dangerous to suddenly stop taking the tablets. The correct way to come off lithium medication is to first talk to your doctor about ‘titrating down’ very slowly with appropriate monitoring. Would anyone like me to post details of how I reduced my lithium intake when I became concerned about side-effects?

Coming off psychiatric medication

Coming off medication can be risky. At time of diagnosis and prescription there needs be a plan for how withdrawal can be achieved. Without such a plan patients may believe they have to take the medication for the rest of their lives even when doctors are not thinking this way. Patients need to know what is realistically possible by way of recovery and coming off medication.

Withdrawal tends to work with tiny steps. It helps to find a doctor who knows about the medication, the likely withdrawal side-effects, believes you can do it and has time to work with you. It can take a lot of looking to find such a doctor in your neighbourhood.

 

When a diagnosis rate doubles…

When a diagnosis rate doubles, health professionals get concerned.

After a talk I gave on ‘recovery from mood disorders’ a psychiatrist asked my opinion on the bipolar diagnosis rate reaching a new alarming high for young women in their city .

I remembered this conversation when I read “…the number of disabled mentally ill in the United states tripled over the past two decades…”

No one knows for sure why rates for diagnosing bipolar are increasing in so many countries.

Could the answer to far higher diagnosis of young women than the young men (in that city in 2010) be linked to medication? The young men certainly had alcohol as their drug of choice while the young women were more likely to tell their doctor about their troubles and be given antidepressants. Both drugs can make bipolar diagnosis more likely just that the more powerful drugs may take people to this place quicker?

Controversial?

Have you read…

Whitaker, Robert, Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America. 2010, Crown (Random House). ISBN 978-0-307-45241-2.

Diagnosis plus medication is not ideal

Here is a second quote from Robert Whitaker’s book.

“…before medication, 15 to 20 percent of bipolar patients became chronically ill. Half remained symptom-free in long-term studies after a first hospitalization for mania or depression. Seventy-five to 90 percent worked, and showed no signs of cognitive decline.”

I would have been one of the 75-90% who stayed well without medication having no significant mood swings for 17 years and no talk of bipolar disorder until I was persuaded to take an antidepressant.

This is not about everyone giving up medication – some people need to stay on their meds. I am wondering how many others would have stayed relatively well if they had not taken that first tablet?

Whitaker, Robert, Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America. 2010, Crown (Random House). ISBN 978-0-307-45241-2.

When bipolar follows on from antidepressant meds

“Today, one percent of all American children have it, and more than 65 percent of them developed bipolar after being treated with a stimulant or anti-depressant” Whitaker

Most people I know and work with who have a bipolar diagnosis say that they took an anti-depressant shortly before they were diagnosed.

Health professionals need to think carefully before giving antidepressants to people who show any signs of bipolar disorder.

Whitaker, Robert, Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America. 2010, Crown (Random House). ISBN 978-0-307-45241-2.

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