Episodes cause damage over time

My pdoc always told me that each episode causes damage to the brain. Here is an interview answer that expalins why.

How do the symptoms progress as time goes on?

Dr. Post:

I partially alluded to that already, but if the illness is not treated, these episodes can come right after another, more rapidly and more automatically, and that's why we want to try to intervene as early as possible and stop someone from having a lot of these disastrous depressions and manias.

We also now know that every episode of either depression or mania that somebody has, that seems to be a problem for some of our brain cells. What I mean by that is, there are factors that keep cells alive in the brain. They're called neurotrophic factors. And there's this thing called brain derived neurotrophic factor (BDNF), and it goes down in people's serum with every episode they have, according to how severe it is. In addition there are increases in oxidative stress with every episode, and that can damage the brain.

So there's more potential for hurting brain cells and hurting brain function with every episode because there are increases in these toxic factors, and there's a loss of these brain-protective factors like BDNF. So that's why we think the illness can progress and get more severe over time because the pathways for getting ill are actually getting grooved, if you will. They're getting more automatic.

And that's where treatment comes in, because most of our treatments actually counter all those things I talked about. They can prevent stress from decreasing BDNF. They can increase this brain-protective factor, BDNF, all by themselves. And if they prevent episodes, they're really going to be protecting the brain. So it's a whole new way of looking at this illness. We used to think that the treatments just had side effects, but now we know they have brain-protective effects as well.

Artista,

Thank you for this very helpful explanation.

This explanation helps understand how and why it is dangerous to have another depression or Mania episode.

This explanation shows us why not taking our medication is a bad option, even if weight gain or sluggishness tempt us to stop medicating ourselves.

Protecting the brain, I agree, is a good idea. That is why I wear a helmet when I ride my motorcycle.

Protecting the brain from damaging itself is an infinitely more complex challenge. But it is a challenge that we must face, unless we want to live with the consequences of brain damage.



When I was a child, I knew that something was wrong with me, with my thinking and my feelings and even evidently my behavior.

I begged my mother to take me to a psychiatrist for help, but she had a lot of practical reasons why getting help for me was Impractical. And so I never was treated by a psychiatrist regularly until I was 23 years old.

Even then, I resisted and refused taking medication even as I cycled in and out of mixed episodes for another 6 years. So, in some of my adult life, I have to take responsibility for subjecting my brain to unnecessary accidents.

I knew that I went through periodic bouts of insanity that caused deep anguish and during which I was a danger to myself and others, but I thought that medication would only hurt me, not help me.

I was still living in the paradigm that my mother gave me, to avoid Psychiatry like the plague.

The illness did progress until I had no alternative but to seek medication. When I did seek medication, it gave me a lot of relief.

Just for one example, I lost my driver's license for a Time because I had been driving 100 miles an hour on the highway. Since I did not pay the ticket, I lost my driver's license and a warrant was issued for my arrest. So I simply avoided that state, that jurisdiction, until I had resolved the problem.

Once I began taking Trazodone, I found that I was magically able to drive at the speed limit. Thoughts in my head that caused pain no longer translated automatically into pushing down the Gas Pedal. That is just one example of how medication has helped me.

Unfortunately, trazodone is not available in the Dominican Republic and so I still engage in dangerous Behavior sometimes. But I have other medications that help keep this under control. They are not as effective as Trazodone, but they do a good job, except in acute episodes.

Hi Persistence,

I followed a path where I did not get help until my early forties. I went through psychosis, was a danger to self and others—the whole nine yards. My husband and I thought it was a learned behavior (from my dad) and that was that. Psychiatry was for insane people, and drugs were out of the question.

I behaved badly at times for about 28 years!!! I would chase down people in my car if they cut me off, and wait till they were at a stop when I would get out and threaten violence. I threatened my husband that I would cut his throat in his sleep. If I had a gun I would have likely used it on myself, at work, in my bosses office. Let him clean the brains off the wall if he thinks I don’t show “good judgement.” To think bipolar illness is not dangerous is a fallacy in my opinion. All this bad thinking and behavior is not the real me at all.

Of courses I had plenty of great hypomanic episodes that I truly enjoyed. And, I was pretty fun to be around. But as I got older, I only experienced dysphoric mania. No more “fun” times.

I finally got help when I could no longer put a sentence together. I too was a lawyer so that pretty much disabled me for a time. After I was zombified with medication, I worked for another six years before I left my career forever. Now I try to make it as an artist.

I am grateful for medication and am very compliant. But because I was older when I was diagnosed I will likely never fully recover on meds. That’s ok. Aren’t artist types creative/crazy anyway!? Ha ha :).

Artista, I doubt any of us will "fully recover" and become permanently asymptomatic on meds, regardless of how early we started taking meds.

I'm feeling well at the moment, doing little besides writing (which is something) and social media and television news.

Yesterday, I changed the sheets in my bed, washed all of my clothes and repositioned three lights on my motorcycle.

Mostly my medication cocktail makes me feel inclined to laze around, casually enjoying myself on social media.

And lately, it has helped me ride my motorcycle slower and see nature's beauty around me. How much more should I expect or require?

Artista, I remember joining a free school with self-government, by parents, teachers and students, when I was eight years old.

I remember attending a school organizational meeting (which kids did not usually attend) and manically raising my hand and volunteering for every task I could possibly help with, while offering creative ideas for every challenge presented.

Once, I sold 800 dollars in raffle tickets with my friends, at one dollar each.

I recall going with my mother to her college campus and racing around walking faster than anyone else, as if I had something very important and urgent to do.

I *wanted* something very important and urgent to do, so people began to search me out for political campaigns and such, when I was only ten years old.

I remember being contemporaneously aware that it was kind of strange to want to walk so fast around campus as if something crucial depended on it.

By the time I was 18, I believed and *wanted* to believe that I would be recognized for my great contributions and was *responsible for saving the world*.

I think you are right in what we can expect. I have a similar life pattern as you, and would be very pleased with myself to get as much done in a day as you just did. I also have ADD so organization is a joke for me! It only adds stress that can lead to an episode. Seems like I hardly ever feel “baseline,” for more than three weeks.

I try by best to focus my efforts on my art work. That takes me to a good place, usually. If I’m not well, then it becomes impossible. Impossible to paint, draw or even read about it. But I live for it nevertheless. Ever since I gave up my legal career, I label myself as “fine artist” on LinkedIn. It was either that or closing my account. But I like to keep tabs on coworkers out of morbid curiosity. I know most of them were a tad jealous when I “retired.” I bet you know how the legal profession can be a total grind, especially if mentally unwell.

I gave up driving fast after getting to a point where I could lose my license with one more violation. I have not been manic enough to loose sight of things like that. But if in an episode, I could certainly be arrested for road rage. That I cannot seem to contain.

I do know another lawyer on lithium only that really claims to have no episodes. Maybe they are in denial! But she started meds in her twenties and is now in her fifties. I do think people can recover on meds—you just don’t find them on forums. I know if I’m feeling well, I usually don’t look at it at all.

Artista, not practicing law was, for me, a very traumatic, emotional, ego-dystonic and identity changing decision for me. It was just too hard to manage the profession while my insanity became increasingly apparent to me and to my colleagues.

I had a company car and my boss observed that I was particularly accident-prone, as well as generally "fragile" emotionally. The truth was, I would just as soon crash a car as not crash it.

I lost my driver's license in one state and a warrant was issued for my arrest there. Fortunately, I resolved that long before I was admitted to the Bar.

For the same reasons listed above, riding my motorcycle is still dangerous for me, but at least I don't have the fear of hurting someone else because my motorcycle's smaller and weighs 15% of a car.

As for a "baseline", I don't think I have one. I have various modes and I am surprised myself when I suddenly have the energy to do something in spite of medications whose purpose is to make me less likely to decide to do something dramatic.

Where I live, almost no one wears motorcycle helmets. I wear wear one because my greatest asset is my brain and banging one's head 8s something we should all generally avoid. Logic.

Now, however, I am applying LED lights to my motorcycle helmet that will make it flash like a Christmas tree because, in addition to wanting to be safer, I also have a great big histrionic streak in my personality.

So, even as I have spent most of the last two weeks in bed, feeling well and unpreoccupied, calm and even contented with my life, I write this as I take a break from putting five flashing LED lights on my motorcycle helmet, a project f9r which I bought the supplies a week ago and only found the ★impetus* to implement today.

Since I was seven years old, it was apparent to me and others that I was different from other children, partly by being precocious and unusually diligent (sp?), but also because of bouts of depression that lasted weeks or months, during which I stayed in the house and hid from other people, feeling unworthy of associating with other human beings.

Hope you got your helmet rigged up with lights. I’m curious, did you also experience euphoria as a child? I sure did. As an adult, I long thought that was happiness. Now I know it was more than that.

I did experience euphoria as a child, but noth8ng )ike whatbI felt when Ibsaw my helmet light up and rode around to show it off.

I might not know, but I think I 3xperience a lot more depression than euphoria.

something really extraordinary has to happen, like swimming in a cave on the French Mediterranean.

I have been feeling much happier lately. During the full day when I worked on the helmet, I ate absolutely nothing until I put my motorcycle back together and was able to leave the house for the variety store.

When I was fourteen to eighteen, I frequently spent 24-36 hours in a row working on a car or some other project, eating no food, but just swigging orange juice.

It was "normal" for me to be awake at 3:00 AM with a circular saw in my hand. Neighbors called the police once. I was awake when everyone else, including my twin brother, were asleep.