"Bipolar disorder is widely believed to be the result of chemical imbalances in the brain."
As I understand it, the notion of a "chemical imbalance" as the cause of mental and mood disorders is highly dubious and losing support. It may be attractive within the context of a certain kind of reductive psychiatric paradigm and can sometimes sound a lot like New Age woo. What does it mean for neurotransmitters to be "in balance"? What is the cause of imbalances? If there is a cause, then is it really the imbalance that's at issue, or is the imbalance merely a sign of some underlying problem (like having too much bilirubin in the blood can indicate living failure)? Add to this that what are commonly accepted mental disorders are generally descriptive, collections of symptoms, rather than causes, though in common speech we often reify these descriptions into some cohesive cause to which we attribute causal power (this, too, can be appealing because it allows you to feel like the cause has been identified and this can feel comforting if you are suffering).
Of course, I am not claiming that constitutional factors cannot cause or contribute to mental disorders. However, it is also possible to ascribe too much to constitution. We often speak of mental, constitutional, and moral factors as if they were distinct, but each can influence the other. Just as constitutional factors can contribute to mental disorders, so can moral factors. A habit of lying, for example, can contribute to depression and anxiety. Denial of truths that we'd rather not face can become expressed as obsessive-compulsive disorders. A hedonistic lifestyle can negatively impact cognition and lead to monomania. I think ignoring these other angles and searching solely for constitutional factors is a disservice. We are seeing an increase of mental disorders today and the causes are very unlikely to be solely constitutional.
> A habit of lying, for example, can contribute to depression and anxiety. Denial of truths that we'd rather not face can become expressed as obsessive-compulsive disorders. A hedonistic lifestyle can negatively impact cognition and lead to monomania.
I don't really know if any of these are true and I don't understand the correlation of these things. I don't know what correlates lying with depression and anxiety, partially because I know liars who aren't depressed or anxious, liars who are depressed or anxious, and don't know how their lying has a causal factor to anything. This also goes on for hedonistic lifestyles- I've seen depressed dropouts drowning in hedonism and I've seen ultra-wealthy hedonistic celebrities and I don't understand the correlation or causation you're trying to make.
Can you please clarify this point? I genuinely don't understand this because it doesn't match my model of reality, which doesn't show any apparent correlations of generic character flaws (such as lying a lot) with specific mood disorders (like generalized anxiety).
Dude, bipolar disorder can be just about cured in some people by dosing them with ground-up rocks. Lithium is a chemical element. If it isn’t inducing some kind of chemical change, what is it doing?
Inducing some chemical change is so broad as to be meaningless. "Chemical imbalance" is at least a claim, and GP was right to question it before going way off the rails. To address that: major mood disorders are caused by something, and it isn't the decisions of the sufferer. Those can make it better or worse, sure, but to even entertain the idea means you've never encountered this in the wild.
Treating something with a chemical doesn't mean what you were treating is a chemical imbalance. If it's vitamin C and scurvy, yes, if it's ulcers and antibiotics, no.
No one thinks bipolar disorder is caused by a lack of lithium. The theory of chemical imbalance is just a theory, one I don't happen to think has much going for it.
You’re being pedantic. I’m with you that “imbalance” sounds a little new-agey and imprecise, but I’ve talked to a lot of scientific and medical people about BiPD and I haven’t met one yet who didn’t understand what was actually being said: that bipolar disorder has some kind of physical, correctable cause in the brain. Somewhere in there, all those little lithium ions pummel a misfolded protein into shape or clog up an ion channel or something in such a way that the patient experiences relief.
It isn’t precise. But back in the real world, the “chemical imbalance“ explanation serves the very important purpose of explaining to a lot of ordinary people who otherwise wouldn’t understand that bipolar people who are manic or depressed are not in control of what they do. And that’s important, because when they’re manic or depressed, bipolar people often act like bad people.
I'm not being pedantic at all, my best bet is that bipolar disorder arises from brain connectome structure, not chemical imbalance.
The chemical imbalance theory of various disorders is ascendant but it's by no means universally supported for bipolar disorder. These days "depression is when you don't got serotonin" is likely to get you laughed out of the room.
I don't believe anyone including the person you are responding to is suggesting that Lithium works outside of chemical pathways so it looks like you are attacking a strawman.
> Just as constitutional factors can contribute to mental disorders, so can moral factors.
I agreed with you up to here. It seems like you're replacing chemical imbalances with morality. Mental illness does not abide by morality.
For example:
> A habit of lying, for example, can contribute to depression and anxiety.
Sure. People can be anxious about their lies catching up to them.
Yet there are people that compulsively lie even when they've been outed and presented with material evidence to the contrary. It defies all logic and appears compulsive, like...
> Denial of truths that we'd rather not face can become expressed as obsessive-compulsive disorders.
I agree with this too, but two independent statements being True does not imply a causal relationship between them. This behavior is found in Histrionic and Narcissistic personality disorders too (and maybe Borderline?).
It has been suggested that pathological lying is a symptom of OCD. The internet is divided on this, but in my anecdotal observations, this has held true. The worst liars I know all have OCD, but not everyone with OCD is a liar. I don't claim to understand why this overlap exists.
> A hedonistic lifestyle can negatively impact cognition and lead to monomania.
Sure, but what does one "get" from a Hedonistic lifestyle? I would suggest: dopamine surges.
This might seem like an easy-to-reach response to Depression, but consider that monomania/ADHD (a cognitive disorder) is literally treated with...induced dopamine surges (in the form of amphetamines).
So does the subject drown themselves in sex and drugs because they are a Lazy Glutton, because they are Depressed...or because there was something wrong with their ability to regulate dopamine production in the first place?
My pet theory: the biggest shortcoming of modern psychiatry is that we over-extrapolate observations of small groups of people as though their traits universally apply to all humans. That some people thrived during quarantine while others went berserk should attest to how we are more different than we care to admit, but we don't have a non-eugenic way of cataloguing those differences beyond labeling everyone as having some sort of psychiatric disorder because their behavior deviates from arbitrary baselines (which is in itself a problem).
Some people just can't follow orders, some are born leaders, some can't sit at a desk for 8-12 hours a day, some can live happily underground, some are liars and storytellers, some overeat. There's probably a genetic reason why individuals are wired to do each of these things, but our best guesses to date have been ridiculous and seem to be discredited with each new generation. Two cats of the same species won't behave identically either. Is either one flawed, or are both optimized for purposes we don't recognize?
> A habit of lying, for example, can contribute to depression and anxiety. Denial of truths that we'd rather not face can become expressed as obsessive-compulsive disorders. A hedonistic lifestyle can negatively impact cognition and lead to monomania
Is there any evidence of this? Not saying you are wrong but without a cite this just seems hand-wavy conjecture. I could just as easily say lying to yourself about the state of the world leads to happiness and it is the realists that are depressed and anxious.
It is common, but still feels out of place for a psychiatric disorder. 'Understanding', or 'treating' seem like better choices. Like you wouldn't say 'we pledge to fight down's syndrome' - it doesn't work.
> It is common, but still feels out of place for a psychiatric disorder.
Probably a result of there being a couple conflicting ways of looking at them: there's the "it's part of who you are (or I am)" perspective—so, an identity thing—and the "psychiatric diseases are just diseases like any other (so shouldn't be stigmatized any more than a broken arm would be)" perspective.
Adhering to the latter, this kind of phrasing is exactly what's desired—writing about psychiatric diseases the same way we'd write about any other disease. Favoring the former, it could come off as insulting.
I think this language started because healthcare advocacy organizations are trying to draft in the wake of military propaganda. Many governments of countries with active militaries (e.g. the US) spend a lot of money convincing the populace that fighting wars on the government's behalf is a great thing. Why not try to recapture that free advertising for a war on poverty, a war on drugs, or a war on cancer? IMO it's not a particularly healthy analogy but it's what we're steeped in.
There are some genetic factors that contribute - it tends to cluster in families. But genetic pre-disposition is just one factor; just because a person has some genes associated with bipolar doesn't mean they will develop it. Genes associated with bipolar have overlap with genes associated with schizophrenia and autism.
Bipolar is also associated with trauma in a person's life, however some people develop bipolar without any particular trauma.
There is also some evidence that it could be a result of viral infection, similar to MS.
There seem to be some difference in calcium channels in cells among people with bipolar, as well as sodium levels within cells.
Bipolar is associated with difference in blood brain barrier permeability.
Bipolar is associate with increased propensity to get eczema.
There are generally some structural difference in people with bipolar's brains, although it's unclear if those are what cause the disease, if the disease causes them or if treatment causes them. Or all of the above.
Basically, there are tons of potential causes, but most studies are limited by size, length and the population willing to participate in them. Study participants are often in an in-patient setting, which is generally people with a more severe form of the disorder, and is also when the disorder is at its worst, and doesn't allow for tracking the overall course of the disorder. Some long term longitudinal studies would be great
"Cara Altimus of the Center for Strategic Philanthropy will serve as managing director of BD²."
HN may not know who she is, but Dr. Altimus is an accomplished researcher who has worked with Samer Hattar at Johns Hopkins and has done major work on ipRGCs. Very excited!
> Even so, treatment breakthroughs have lagged and the drug often prescribed for the condition, lithium, was first used nearly 75 years ago.
This is false. I don’t know what this author was doing. Even reading Wikipedia would give you a better understanding than that.
Initial treatment for patients presenting with acute mania are antipsychotics like Risperdal or Geodon. After that they might try mood stabilizers like lamotrigine or seroquel, or any number of other things that are much more recent than lithium.
If you want to learn more about the wild world of psychopharmaceuticals, I recommend crazymeds.com, which also tells you a lot about how mentally ill people often view themselves. It’s fascinating even if you’re not crazy.
My experience has been that Lithium is still very widely prescribed for bi-polar disorder as well as BPD (borderline personality disorder).
It's not that there aren't alternatives, but they are much more hit-or-miss in terms of efficacy. Lithium tends to be more predictable in terms of keeping things stable, but the side effects are awful.
Lithium is still the fallback drug of choice with the best track record. In some countries it's as much as 50% of patients.
I was first put on lamotrogine and it's mental side effects were far more debilitating than lithium's physical side effects. Lamotrogine destroyed my working memory to the point I'd consistently leave food on the stove and just forget about it. Lithium also works better for me. It is also dirt cheap compared to alternatives which don't work as well for many people.
Other forms of Lithium also have potential for future treatments, with Lithium Orotate being considered for trials recently (few side effects, safer, crosses blood brain barrier more effectively, but was mischaracterized in the 70s and largely ignored until now).
I was also on lamotrogine for a period of time and the cognitive decline was real. Not only was memory affect I also suffered from severe brain fog. Years later I still feel as if I haven't recovered completely from it.
Lithium works great but it's not a good long term solution as years of use is terrible for the kidneys.
A friend of mine was bipolar and died of lithium toxicity. Bipolar is a challenging disease to treat, and the treatments don't work for everyone. We can't get better treatments and ways to figure out which treatment will work for a given patient soon enough.
I have been through the wringer in the mental health system, and only 3 years ago did I discover the true genesis of my condition.
My parents began shuffling me into therapists when I was about 8 years old. It wasn't really effective because we were all resistant to it: admitting problems, wanting to change, sticking to a course of treatment. So it continued and I was put on SSRIs when I was 21. I loathed that development. I was further hospitalized and put on mood stabilizers a few years later. Needless to say, that was even more detrimental: I still didn't know why I was like this.
Receiving a diagnosis of bipolar disorder was weird; they explained the chemical imbalance fairy tale and the way drugs would help, and they explained how many famous people throughout history had also suffered from this scourge, so I suppose I was supposed to feel like I was in good company. But it was unsatisfying, because if I had a mere mood disorder, why was my life so profoundly messed up? Just because I had a few bouts of sleepless nights?
Fast forward to 3 years ago and I had a series of revelations which indicated significant and enduring childhood trauma and abuse. I landed on a diagnosis which isn't in the DSM and can't be medicated. That has been satisfying, because now I was equipped to both reject the drugs and work on the issues at the root of my profound anguish.
"Bipolar disorder" is a silly catch-all description. It's a collection of behaviors and "symptoms" that can't be clinically tested, it's just a label to slap onto people so that they can be drugged and checkboxes can be ticked in a treatment plan by providers and your insurance (if any).
If they're telling you that you're "bipolar" and they're trying to drug you and you're unsatisfied with that prognosis, then good! I encourage you to dig deeper and explore the root causes. You'll need to trust and commit to good therapists.
For me, my faith in Jesus Christ as savior has made all the difference, and that's actually a gift which my adoptive parents gave me alongside everything else, so thank God for that!
34 comments
[ 3.3 ms ] story [ 80.2 ms ] thread"Bipolar disorder is widely believed to be the result of chemical imbalances in the brain."
As I understand it, the notion of a "chemical imbalance" as the cause of mental and mood disorders is highly dubious and losing support. It may be attractive within the context of a certain kind of reductive psychiatric paradigm and can sometimes sound a lot like New Age woo. What does it mean for neurotransmitters to be "in balance"? What is the cause of imbalances? If there is a cause, then is it really the imbalance that's at issue, or is the imbalance merely a sign of some underlying problem (like having too much bilirubin in the blood can indicate living failure)? Add to this that what are commonly accepted mental disorders are generally descriptive, collections of symptoms, rather than causes, though in common speech we often reify these descriptions into some cohesive cause to which we attribute causal power (this, too, can be appealing because it allows you to feel like the cause has been identified and this can feel comforting if you are suffering).
Of course, I am not claiming that constitutional factors cannot cause or contribute to mental disorders. However, it is also possible to ascribe too much to constitution. We often speak of mental, constitutional, and moral factors as if they were distinct, but each can influence the other. Just as constitutional factors can contribute to mental disorders, so can moral factors. A habit of lying, for example, can contribute to depression and anxiety. Denial of truths that we'd rather not face can become expressed as obsessive-compulsive disorders. A hedonistic lifestyle can negatively impact cognition and lead to monomania. I think ignoring these other angles and searching solely for constitutional factors is a disservice. We are seeing an increase of mental disorders today and the causes are very unlikely to be solely constitutional.
For myself, I am a “moral person” in most regards. There is nothing I can do to stop or prevent my episodes without medication.
For most people it is a severely limiting disability.
I don't really know if any of these are true and I don't understand the correlation of these things. I don't know what correlates lying with depression and anxiety, partially because I know liars who aren't depressed or anxious, liars who are depressed or anxious, and don't know how their lying has a causal factor to anything. This also goes on for hedonistic lifestyles- I've seen depressed dropouts drowning in hedonism and I've seen ultra-wealthy hedonistic celebrities and I don't understand the correlation or causation you're trying to make.
Can you please clarify this point? I genuinely don't understand this because it doesn't match my model of reality, which doesn't show any apparent correlations of generic character flaws (such as lying a lot) with specific mood disorders (like generalized anxiety).
Treating something with a chemical doesn't mean what you were treating is a chemical imbalance. If it's vitamin C and scurvy, yes, if it's ulcers and antibiotics, no.
No one thinks bipolar disorder is caused by a lack of lithium. The theory of chemical imbalance is just a theory, one I don't happen to think has much going for it.
It isn’t precise. But back in the real world, the “chemical imbalance“ explanation serves the very important purpose of explaining to a lot of ordinary people who otherwise wouldn’t understand that bipolar people who are manic or depressed are not in control of what they do. And that’s important, because when they’re manic or depressed, bipolar people often act like bad people.
The chemical imbalance theory of various disorders is ascendant but it's by no means universally supported for bipolar disorder. These days "depression is when you don't got serotonin" is likely to get you laughed out of the room.
I agreed with you up to here. It seems like you're replacing chemical imbalances with morality. Mental illness does not abide by morality.
For example:
> A habit of lying, for example, can contribute to depression and anxiety.
Sure. People can be anxious about their lies catching up to them.
Yet there are people that compulsively lie even when they've been outed and presented with material evidence to the contrary. It defies all logic and appears compulsive, like...
> Denial of truths that we'd rather not face can become expressed as obsessive-compulsive disorders.
I agree with this too, but two independent statements being True does not imply a causal relationship between them. This behavior is found in Histrionic and Narcissistic personality disorders too (and maybe Borderline?).
It has been suggested that pathological lying is a symptom of OCD. The internet is divided on this, but in my anecdotal observations, this has held true. The worst liars I know all have OCD, but not everyone with OCD is a liar. I don't claim to understand why this overlap exists.
> A hedonistic lifestyle can negatively impact cognition and lead to monomania.
Sure, but what does one "get" from a Hedonistic lifestyle? I would suggest: dopamine surges.
This might seem like an easy-to-reach response to Depression, but consider that monomania/ADHD (a cognitive disorder) is literally treated with...induced dopamine surges (in the form of amphetamines).
So does the subject drown themselves in sex and drugs because they are a Lazy Glutton, because they are Depressed...or because there was something wrong with their ability to regulate dopamine production in the first place?
My pet theory: the biggest shortcoming of modern psychiatry is that we over-extrapolate observations of small groups of people as though their traits universally apply to all humans. That some people thrived during quarantine while others went berserk should attest to how we are more different than we care to admit, but we don't have a non-eugenic way of cataloguing those differences beyond labeling everyone as having some sort of psychiatric disorder because their behavior deviates from arbitrary baselines (which is in itself a problem).
Some people just can't follow orders, some are born leaders, some can't sit at a desk for 8-12 hours a day, some can live happily underground, some are liars and storytellers, some overeat. There's probably a genetic reason why individuals are wired to do each of these things, but our best guesses to date have been ridiculous and seem to be discredited with each new generation. Two cats of the same species won't behave identically either. Is either one flawed, or are both optimized for purposes we don't recognize?
Is there any evidence of this? Not saying you are wrong but without a cite this just seems hand-wavy conjecture. I could just as easily say lying to yourself about the state of the world leads to happiness and it is the realists that are depressed and anxious.
Probably a result of there being a couple conflicting ways of looking at them: there's the "it's part of who you are (or I am)" perspective—so, an identity thing—and the "psychiatric diseases are just diseases like any other (so shouldn't be stigmatized any more than a broken arm would be)" perspective.
Adhering to the latter, this kind of phrasing is exactly what's desired—writing about psychiatric diseases the same way we'd write about any other disease. Favoring the former, it could come off as insulting.
Even as a factor, this is about as sophisticated as saying broken legs are caused by downhill skiing.
Bipolar is also associated with trauma in a person's life, however some people develop bipolar without any particular trauma.
There is also some evidence that it could be a result of viral infection, similar to MS.
There seem to be some difference in calcium channels in cells among people with bipolar, as well as sodium levels within cells.
Bipolar is associated with difference in blood brain barrier permeability.
Bipolar is associate with increased propensity to get eczema.
There are generally some structural difference in people with bipolar's brains, although it's unclear if those are what cause the disease, if the disease causes them or if treatment causes them. Or all of the above.
Basically, there are tons of potential causes, but most studies are limited by size, length and the population willing to participate in them. Study participants are often in an in-patient setting, which is generally people with a more severe form of the disorder, and is also when the disorder is at its worst, and doesn't allow for tracking the overall course of the disorder. Some long term longitudinal studies would be great
HN may not know who she is, but Dr. Altimus is an accomplished researcher who has worked with Samer Hattar at Johns Hopkins and has done major work on ipRGCs. Very excited!
This is false. I don’t know what this author was doing. Even reading Wikipedia would give you a better understanding than that.
Initial treatment for patients presenting with acute mania are antipsychotics like Risperdal or Geodon. After that they might try mood stabilizers like lamotrigine or seroquel, or any number of other things that are much more recent than lithium.
If you want to learn more about the wild world of psychopharmaceuticals, I recommend crazymeds.com, which also tells you a lot about how mentally ill people often view themselves. It’s fascinating even if you’re not crazy.
It's not that there aren't alternatives, but they are much more hit-or-miss in terms of efficacy. Lithium tends to be more predictable in terms of keeping things stable, but the side effects are awful.
I was first put on lamotrogine and it's mental side effects were far more debilitating than lithium's physical side effects. Lamotrogine destroyed my working memory to the point I'd consistently leave food on the stove and just forget about it. Lithium also works better for me. It is also dirt cheap compared to alternatives which don't work as well for many people.
Other forms of Lithium also have potential for future treatments, with Lithium Orotate being considered for trials recently (few side effects, safer, crosses blood brain barrier more effectively, but was mischaracterized in the 70s and largely ignored until now).
Lithium works great but it's not a good long term solution as years of use is terrible for the kidneys.
My parents began shuffling me into therapists when I was about 8 years old. It wasn't really effective because we were all resistant to it: admitting problems, wanting to change, sticking to a course of treatment. So it continued and I was put on SSRIs when I was 21. I loathed that development. I was further hospitalized and put on mood stabilizers a few years later. Needless to say, that was even more detrimental: I still didn't know why I was like this.
Receiving a diagnosis of bipolar disorder was weird; they explained the chemical imbalance fairy tale and the way drugs would help, and they explained how many famous people throughout history had also suffered from this scourge, so I suppose I was supposed to feel like I was in good company. But it was unsatisfying, because if I had a mere mood disorder, why was my life so profoundly messed up? Just because I had a few bouts of sleepless nights?
Fast forward to 3 years ago and I had a series of revelations which indicated significant and enduring childhood trauma and abuse. I landed on a diagnosis which isn't in the DSM and can't be medicated. That has been satisfying, because now I was equipped to both reject the drugs and work on the issues at the root of my profound anguish.
"Bipolar disorder" is a silly catch-all description. It's a collection of behaviors and "symptoms" that can't be clinically tested, it's just a label to slap onto people so that they can be drugged and checkboxes can be ticked in a treatment plan by providers and your insurance (if any).
If they're telling you that you're "bipolar" and they're trying to drug you and you're unsatisfied with that prognosis, then good! I encourage you to dig deeper and explore the root causes. You'll need to trust and commit to good therapists.
For me, my faith in Jesus Christ as savior has made all the difference, and that's actually a gift which my adoptive parents gave me alongside everything else, so thank God for that!