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

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.

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.

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