Thursday, May 28, 2015

Bipolar, the Brain and Energy - Part Three

Okay, so you're suffering from bipolar depressive phase fatigue. Which is defined by an all encompassing mental and physical fatigue which is often completely debilitating and which can last for months and even years, so we're not just talking about feeling all pooped out following a tough week or feeling a bit run down occasionally like most people think of when they hear the world fatigue.

Since originally writing this series a year ago (May 2014), however, I have learned that this debilitating fatigue will be associated with many kinds of psychiatric disorders for similar reasons as to why those with bipolar or major depressive disorder suffer from it. There is therefore much to learn here for anyone who's long suffered long term poor mental health, "brain fog" and chronically low and/or debilitating low levels of energy. 

So let's understand this a bit more (I'll get to in a moment why it's so important to understand this very clearly).

Now we've established in  Part One 
and Part Two of this series that mitochondrial dysfunction is very probably at the root of the fatigue (although there remains other factors that I'll get to) and that there are four probable reasons and factors involved in causing this dysfunction. To review, they are as follows:

A) - a literal exhaustion of cellular energy supplies due to chronic overuse during manic episodes (in the brain, this is just as in any over-taxed cell that simply shuts down due to overuse). While the exact pathology is different, this is true in both bipolar and uni-polar depression. 

B) - build up of toxic cellular waste products as a result of lack of sleep during manic episodes (or the chronic insomnia that often accompanies depression and anxiety and other disorders) and other cumulative damage that results from cellular structures not getting the down time necessary that comes with sleep. Mania has its way of depriving a person of sleep but this is going to be seen in any case that involves sleep deprivation 

C) - grave, long term damage due to chronically elevated levels of glucocorticoids due to chronically activated stress response system. This is the biggest factor in most chronic mental health disorders, something I'm going to be getting to in a lot more detail in future chapters.

D) - oxidative stress damage (which may in part be due to what we see in B)

And because I know you're still not convinced and because I know (and this is from my teaching days) that people need to hear a new concept multiple times from a variety of angles for it to start to "take firm root" (and the study of how brains assimilate new knowledge will bear this out as well), I'll just re-affirm what's going on with neuronal functioning and the role of mitochondria within that. 

To reiterate the importance of mitochondrial functionality in neurons and in intra and inter-neuronal communication, I'll give you this from Jon Lieff's superb neuroscience blog, Searching for the Mind

"Mitochondria are essential energy producers for many of the key functions of the neuron, including the movement and recycling of the vesicles that carry neurotransmitters, the assembly and movement of the structural tubules, the generation of the electric charge in axons and dendrites, and the maintenance of synaptic plasticity. They are needed throughout the neuron to provide fuel. It is not widely appreciated that they are, also, critical for the metabolism of amino acids, lipids, and steroids. They regulate the calcium levels in the cell which trigger the axon signal firing. They also produce free radicals and regulate the process known as apoptosis, whereby a cell is systematically dismantled without forming scars." [bold all mine - BGE]

As someone who has a very high understanding of how brains work, I cannot even begin to tell you how vitally important all those roles are in how well neurons function. Just two massively important parts of inter-neuronal communication - neurotransmitters and electrical charges in axons and dendrites (the latter is what triggers the release of a neurotransmitter discharge in the synaptic cleft and thus a communicative leap from one neuron to others) - depend almost entirely on mitochondria doing its job. 

And just to make it clear how important optimal neuronal functioning is to 
everything you think and do, let's review neurons for just a moment. 

For every single thought, for every single movement of every single minuscule muscle in your entire body, there is a group of neurons that control that. We'll leave aside for now how all these individual regions work in concert to produce, for example, a golf swing that hits a little white ball two hundred yards to within several feet of its intended target (and does that consistently, not by fluke) and all the other dazzling physical feats humans are uniquely capable of or how the collective efforts of your hundred billion or so neurons produce what you experience as "consciousness", let's just focus on the roles of neurons in simple daily functions. 

Every single solitary or unified mental or physical function you do is controlled by a specialized group of neurons. This is not theory, this is known via study into brain injuries, strokes and brain surgeries to remove brain regions. A bit of shrapnel takes out a tiny little brain region in the back upper right part of your neocortex and poof, there goes your ability to recognize faces (even your own). Remove this little bit of brain region (the hippocampus), and poof, there goes your ability to form new memories (which makes what Bill Murray experienced in the movie 
Groundhog Day look like a picnic). Suffer a stroke in this or that region (in which that entire region will suffer total neuronal death due to oxygen starvation), and poof, there goes all kinds of muscular functionality. And so on and so on and so on for every function we have, either physical, mental (as in higher cognitive functions) or emotional.  

So every single thing you think or do is going to require specific brain regions made up of tens of thousands to millions of neurons to fire up and furthermore, the energy needed for those regions to communicate with other relevant brain regions and wider brain networks. Just move your pinky on your left hand a smidgen. There, that fired up several thousand neurons. The conscious effort to absorb my instructions and for areas in your frontal lobes to send that message to that tiny region that controls your pinky necessitated firing up many other brain regions and thus hundreds of thousands of neurons.  

Just attempting to digest what I'm telling you here is requiring brain-wide firing of all kinds of regions, all of which require high activation of specific neurons, ALL of which will require energy. Furthermore, the same energy process is necessary for your brain to communicate with your entire body - all your muscles, all your organs, all of which is going to function sub-optimally due to mitochondrial damage. 

And to take this even further, every single one of your five senses is bringing in a constant barrage of "sensory data" - the vast majority of it below your conscious awareness - and all of 
THAT has to be processed by those overtaxed neurons, brain systems and brain networks. Everything you see, everything you hear, everything you smell, everything you touch, everything you taste. All of it requires some level of neuronal processing and filing (though most particularly sight and sound). 

Plain and simple - and this is super basic neuroscience - everything you do, think and sense depends on neurons firing in a specific region and for neurons to fire and communicate with other regions, they require energy within the neurons themselves and brain wide to facilitate broader system communication and ALL that energy relies on mitochondria (as outlined in the excerpt above), and again, this is just very basic neuroscience (though too often overlooked in our rush to pin mental issues on other factors).

By now you should better understand why your brain consumes a whopping twenty percent of all your energy!

So to expect yourself to function optimally or even normally on any level - physically, cognitively or emotionally - for any sustained period without a healthy "fuel system" in your neurons, without properly functioning mitochondria, is simply not realistic. It's akin to expecting the engine in your car to function without a carburetor system to convert gasoline into a combustible vapour and then expect your car to run without a functioning motor. You may have fuel (gasoline), but if you cannot convert that fuel into energy, then you have no functioning automobile.

And that's just the mitochondria in your neurons in your brain. Healthily and optimally functioning mitochondria are required for every single cell in your body from all the muscle groups to every organ to all throughout your digestive tract. While mitochondrial dysfunction particularly affects brain function, it affects all functions throughout your body (and this can all vary to some degree in each individual depending on a wide range of other factors). 

So why do I go into such great detail and on at such length about all this? For a couple of reasons. 

Let me return for a moment to my personal story. 

I've lived with bipolar and depression almost all my life with it becoming more and more difficult starting in my late twenties, very difficult through my thirties (somewhat not bad during my forties) and becoming extremely difficult in the last six years (that's a run of twenty-six years for those who don't know). The depressive phases have always been very, very difficult for me. And I never, ever understood them. 

They had gotten progressively worse over the years and the fatigue has been steadily worsening the last five years or so (it was spring of 2010 that I really began to notice it and my ability to work as I had all my life began to be seriously impacted). In a man who's been a proud working man since he was fourteen and in a highly driven individual, this fatigue, this being floored and utterly unable to "answer the bell" to go to work for days, then weeks, then months, and now stretching on into years, has been exceptionally difficult on me. 

With the worst of the depression pounding me anyways, with the fatigue there was all the more reason for the already brutal self-flagellation inflicted on me. Because I couldn't work, or had great difficulty working (it's been since the end of 2011 that I've been able to work more than a few days in a row and more than a year since I've been able to work more than a few hours at a time ... or do 
anything for more than a few hours at a time), I used to beat myself up unmercifully on account of this. I mean I tied myself to the whipping post and flogged the absolute living shit out of myself with language that would peel paint off a battleship. 

The fatigue and inability to work caused, I now know, the worst of the suicidal hopelessness. A lot of the hopelessness I struggled with was due to the "brain fog" and related cognitive difficulties and we can see now that a great deal of this brain fog and cognitive difficulty is due to mitochondrial dysfunction and its effect on neuronal function and inter-neuronal communication. 

And why? All because of simple ignorance. Plain and simple ignorance. I beat myself almost literally to death because I simply didn't know why or what was going on in my body and brain (which just reaffirms what useless gits psychiatrists are - nineteen of them in three and half years and 
none of them told me anything about this. Just "take these pills and see me in a month"). 

For years I've had to put up with people telling me flat out that I was "just lazy", "to just push through it", "everybody gets tired" and endless amounts of other bullshit that drove my already hammered mental states lower still. And this goes on to this day. People see a "healthy looking" individual and wonder why I can't work, why I can't function normally. And then all the innuendo about laziness and "just digging down for it like the rest of us do when we're tired" starts. It's inescapable.  

So I vow that no one will go through that or continue to go through that if I can help it. If I can help just one single person avoid all the suffering I had to go through on account of ignorance, that suffering will have been worth it. 

This is what drives me to scour the four corners of the earth and the most bleeding edge science I can find - so that others don't have to suffer in ignorance. 

So if you're suffering through the crippling (and I can think of no better word for it when it's at its worse) fatigue of bipolar depression or major depressive disorder or chronic fatigue of any kind, you can now better understand why. It's not because you are "weak" or "wimpy" or a "drama queen" or "lazy" or "just making excuses" and all that other bullshit you may be getting told, it's because of very serious damage right down to the cellular level, damage that there's 
nothing you can do about by just "bucking up and getting over it". This is a serious medical problem. 

So many of the problems we suffer during the down or depressive cycle of bipolar or in any case of chronic and serious depression or anxiety are to do with the energy engines of our brains simply not being able to manufacture the energy for proper cognitive functionality. It is important for you to understand this. So many of the problems anyone with a long term psychiatric disorder will be for the same reason. 

It's not "you", it's a fundamental brain and body energy problem. Memory problems, focus problems, simply not being able to think, reduced cognitive abilities (not being able to perform mental functions you did well in the past, if at all). This is not because there is something wrong with "you", it is malfunctioning on the cellular level. 

Now while you can't just get over it by attitude alone, there 
ARE things you can do about it. 

The other reason is that I really want - and need - you to truly understand what's going on (on at least a basic level) so that you'll understand what you need to do and, more importantly, believe what you need to do.

I've done enormous amounts of research into how best to cope with mitochondrial dysfunction and the fatigue, most of which comes down to understanding, dealing with and coping with stress and basic lifestyle changes. Some of the basics of which I outline in my Positive Difference Making Fundamentals and others I'll be getting to in more detail when we start learning about stress, what it is, where it comes from and why and how it affects your entire body and brain. 

In the meantime, you can start today, right now, practicing more self-compassion with yourself. Your fatigue and mental fog is NOT your fault.

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Friday, May 22, 2015

Bipolar Disorder in Focus - The Mother of All Manic-Depressive Cycles

The Mother of All
Manic Depressive Cycles

I'm not certain I've talked about this before explicitly but I'm sure I've referred to it often enough here and there. At any rate, I'm pretty sure I've never clearly outlined my last twenty-nine months (has it really been that long??). I would prefer not to talk about my own case too much but on the other hand, I do know it's a textbook case of advanced bipolar disorder and therefore there is much for readers here to learn from it.

I'm afraid most people still don't know what is meant by “bipolar disorder”. Most think one case is equal to another, something which could not be further from the truth. Aside from the basic guidelines I outlined in this post, how it manifests itself in any one person is going to depend a great deal on their age, gender, the amount of family and friend support they get, socioeconomic status and – most importantly – how often they've cycled through manic and depressive episodes, the length of those episodes, how intense and severe those episodes were, how long they've lived with it without being aware and receiving some sort of treatment, whether they have rapid cycled or not and whether or not they've had mixed episodes.

Like most terms tossed around about mental “illness” (one day I'll explain when that term can be used and when it should be in quotation marks), the term “bipolar” means almost nothing to me when people use it. I probably know more about the condition than most people alive and I don't know what the fuck is meant when people tell me they're “bipolar”. There are a number of reasons for this, mostly the fact that the diagnostic criteria for it have been expanded so much in the last several decades that practically any behaviour involving “mood swings” can be considered “bipolar”. What's considered “mania” has been greatly expanded and there's no shortage of people who get a “bipolar” diagnosis as a way of explaining away (and excusing away) what's really just asshole, cantankerous and irresponsible behaviour and inconsistent mental states (grumpy here, cheerful there). It's kind of become the sexy diagnosis de jour among the Hollywood/artist/musician set.

These – and diagnostic criteria in general – are something I hope to explore further in future posts.

I've wrestled with manic depressive cycles for many years. I won't recount all that here now and instead focus on the last seven years and especially the last twenty-nine months.

I mentioned that I was dying in a previous post. Which … well, we all die a little bit each day (and one day we don't wake up). But I'd like to explain that a little more.

I've often said I've got the worst form of bipolar and I'd like to clarify that a little more as well (and why my case is such a textbook example of an advanced and severe case).

On the night of December 28, 2012 I had a very bad psychotic episode, by far the worst of about a dozen that I'd had in the previous thirty months. Psychosis itself can mean a lot of things but for me they meant very powerful commands to harm myself (and sometimes others) along with very, very graphic and gory visions as to what it would all look like. They were always accompanied by a sort of “trial” first in which all my worst transgressions (and I'd accumulated more than a few) were “played” for me in movie like fashion and the voices telling me how terrible I was and how much I deserved what was coming.

If you have not experienced anything like this then there is no way for you to comprehend or imagine what it's like. This is the kind of psychosis you hear about in murder trials where the accused (usually schizophrenic) describes having been driven by inner voices and forces to commit the murder(s). Mine were just like that except generally the only victim was to be me. Horrific and terrifying stuff, I can assure you. That December night was by far the worst one as I was instructed to kill my then wife and my daughter and then myself and it became almost impossible to resist the forces that were taking over my mind and body.

But resist it I did (there was a tiny, sort of instinctive part of my mind that told me if I so much as put a foot to the floor, my body would just follow the commands so that tiny part of me just refused to move and I kept stock still on the bed for the whole four hours the episode lasted. I knew this because the one psychotic episode I had in which I was already up and moving my body just automatically went along with the commands).

It ended as suddenly and mysteriously as it began and when the forces left my mind I entered this state of incredible clarity. I began thinking through the previous thirty months under the care of the psychiatric profession and on psychiatric medications and my now sort of semi-famous favourite question “why?” popped into my head – why was this happening to me and why was I getting worse under the care of doctors and medications?

My mind began working very, very, very fast and with enormous clarity and insight. And it would not stop for the next five weeks. It was an enormous manic episode and it would be exactly thirty-five days to the day that it would finally end when I collapsed in utter exhaustion on a ski slope on a day of skiing with my daughter.

I can't even begin to tell you how much I read in that time. Hundreds and hundreds of websites. Dozens and dozens of science articles. Books upon books. And the variety of material! Anything and everything to do with psychiatry, psychiatric medications, psychiatric disorders, their history, everything you could possibly imagine about suicide, substance abuse, homelessness, you name it. The vast, vast majority of what I learned that would go into this blog I learned in that five weeks.

And writing! I began with a series of emails on my findings. That turned into a book with my story and everything I'd learned about the mental health care system. I wrote close to 150,000 words.

All in five weeks.

And during that whole thirty-five days, I hardly slept at all. Maybe an hour a day and that would only be a quick cat nap. I knew I should sleep and I tried (I had become very good at meditating myself to sleep at that point) but after forty-five minutes to an hour, my mind would flash awake with more ideas about what to search for or what to write or what to do and I'd be utterly seized by a driving force to keep working. It was like an all night cram session that lasted thirty-five twenty-four hour periods. That is a staggering 864 straight hours with virtually no sleep. And virtually all of that time was filled with runaway manic energy.

Then on that day on the ski slope it just ended. I just collapsed. Somehow I got home and my mind settled down a little bit. Or at least I started sleeping more. But my mind kept going. I slowed down but only a little. I just couldn't stop. I really only just dropped from full blown mania into “hypomania” (“mania lite”).

By that time I'd already started studying neuroscience. Virtually everything I know about neuroscience I learned in a three month period spanning about late February of 2013 to early May of that same year. My mind just … I can't describe it, it's beyond description. My mind just did it. Within months I could debate neuroscientists on certain points – and win. I was consulted on certain academic papers by a neuroscientist acquaintance of mine (and mentor) because, as he told me, I “saw things that no one else saw”. I was hailed a genius by two different people in the neuroscience community. All within months.

After that I started reading all kinds of other materials and writing about that. I started other blogs. I started heavily writing in Taming the Polar Bears again (following a long hiatus after creating it in 2010).

In the May of that year I started to break down. I began getting hammered by horrifically dark suicidal episodes. However, I'd learned a great deal about mind control by this time and got over them quickly.

Meanwhile I could not find a job and I had no money. I finally had to tell my wife I had no more money to pay rent and for her and my daughter to go their own way.

It was shortly after that that I had a wildly terrible break-down. I managed to call 911 (because of intense suicide safety plan training I'd undergone it was almost automatic for me to dial the number and follow the directions given). Half a dozen cops and a SWAT team answered the call and I was hauled off to the psyche ward in the back of a cop car.

Yet my mind still wouldn't stop. I had several bags of books and some note pads brought to me in the hospital and I continued studying and writing. Some of my best blog posts for several of my blogs were conceived of and written while I was in the hospital or in the transition house following my release from the hospital.

In that time I was set up for social assistance. It was pitiably small but it was something. I found a room to rent in my hometown. I reconnected with old friends. I was determined to rebuild my life.

I continued to get hammered by the suicidally dark states, however. They'd just come out of the blue and just pummel me. Nothing mattered during these suicidal episodes except how to do it. It just completely took over my mind. But somehow I'd right the ship after a few days and the darkness would just pass. Then I'd carefully analyze the episode to understand why (and this led to some of my more brilliant posts of insight).

Then in September of that year the energy just stopped. I was trying to do some minor home repair and renovation work for a friend. Prior to getting sick, this would have been easy, easy work for me but I just couldn't do it. I could “work” for maybe an hour or so then my mind would just go blank and freeze and I had to just sit down for several hours before I could go on again. My cognitive functions began to fail. Days could go by where I couldn't think of a thing. Simple painting tasks were almost beyond me and I'd be struck mid brush stroke and feel I had no idea where to put the brush next.

Somewhere in there I wrote my very popular Positive Difference Making Fundamentals post (because I came to see that practicing these things were the only things that could make a difference to my states, symptoms and episodes).

Over the years I've played thousand and thousands of solitaire games on my computer and was very, very good at the few different kinds I played. All during my illness they became my go-to for a distraction when my mind was spinning out of control. But when I tried to play during this period there were often times I would stare at the cards and have no idea what to do. I spent hours and hours being able to do nothing more than just stare out the window.

Meanwhile during this time, I had an ugly altercation with a woman at the place I was doing the light renovation work. My mind just snapped. I fell into kind of a catatonic stupor and felt that I just had to go somewhere so I started walking home (about a four kilometer walk). My route took me by some train tracks and without even knowing how I got there I just ended up there waiting for train to come along. Just as calm as could be I was going to step in front of the next train (they passed by every ten minutes on average).

But I waited and waited and after about forty minutes no train had come (by some miracle). During that time my mind began to wander, I thought of some of my old hometown friends, I began to think how much they'd be upset by having to come by and ID my body (during my research into suicide I saw no shortage of police photos of what trains did to a human body) and slowly my mind began to reconsider. Finally I got up, walked back up to the road and continued walking home. Minutes later a train went by.

This period of on and off mental fog lasted all of that fall. But the fog was interspersed by flashes of brilliance still. I started my neuroscience blog then. I was still writing to scientists around the world looking for answers and, miracle of miracles, some of them wrote back and engaged me in great discussions (Steven Pinker, Jon Lieff among them, both of whom answered me with very useful information). I watched online lectures on neuroscience, gained more great insight and wrote great pieces on that.

Then it'd all go blank again and I'd spend days just staring out the window.

I literally had no idea what my mind was going to be capable of on a given day during that fall. Brilliant? Catatonic? Suicidally obsessed? In rollicking good humour?

I described that period to friends as my mind being like the apartment of a blind person and every day you move the furniture on them and so each day the blind person has to find their way around the new lay out and get used to it. That's exactly how my mind was then – every morning I'd have to feel my way around my mind and learn what it was going to be like that day.

At some point in early December of that year I entered the dreaded “mixed episode”. This is when the bipolar mind is in the grips of dark, dark thoughts and thinking and suicidal obsession, all the sort of things associated with depression, ALONG WITH the high powered energy of mania. It is lethal combination. My mind got more wildly and wildly dark and obsessed. I went two weeks without sleeping. All my mind did was plan my final days, method of death and final preparations. At some point I wrote my Visions for the Future of Mental Health Care post, the basis for which I wanted to leave behind as my legacy.

Somehow friends and family were made aware and notified and again I went into the psyche ward. And that's where I closed out a very wild 2013.

Altogether in 2013 I wrote somewhere around 400,000 words in various blogs, book manuscripts and hundreds pages of notes of all kinds, not to mention dozens and dozens of long emails sent to god knows how many recipients. Meanwhile, I read – I estimated once – somewhere close to two million words of highly advanced neuroscience, papers on psychiatric disorders and drugs, dozens of books on science, essays of all kinds – all of it on subjects I'd never thought about or read about in my life.

January through March of 2014 were the worst in many ways. My mind was really shot by this time, now fully being hammered by the effects of an entire year of mania, hypomania, rapid cycling and a horrendous mixed episode. I couldn't read, I couldn't think, I couldn't write, I couldn't move, I couldn't do anything. Day after day after day I just stared out the window or laid in bed. Sometimes I went for walks. Sometimes friends would come to visit.

I have virtually no memory of anything during those three months. It's almost as if it didn't exist, as if I was in a coma. I remember a few certain things. Some friends gave me a very sweet and moving birthday party. Actually, that's the only event I can remember. I tried, as well as I could, to practice something from my Positive Difference Making Fundamentals each day. I listened to a LOT of music. That I can remember. I'm pretty sure I'd be dead if it weren't for Vivaldi, Mozart, Glenn Gould, Miles Davis, Dave Brubeck, John Coltrane and Bill Evans. I can recall starting work on mindfulness cognitive behaviour therapy.

Somewhere in that three month stretch to start 2014 I ended up planning suicide again. It was just unbearable to me. During the previous six years I'd lost everything I'd ever created in my life (all life savings, ownership of my condo, family, friends, the ability to work and earn money). But I felt I still had my mind. I had the ability to write. But then I lost my mind as well. It simply didn't function anymore. And with it my ability to write or do the reading necessary for my studies. I was down to nothing. Somehow, however, I ended up in an email exchange about what I was going through with a bipolar researcher in Australia (I was investigating an online program he'd developed for bipolar patients). He contacted an associate of his at UBC in Vancouver and she contacted me and she talked me through it (we've remained in contact to this day).

It was a time where taking care of myself became virtually impossible, making any decisions about myself became beyond my scope and ability. It was only through the “team” that I'd managed to assemble (consisting of my twin brother, his partner and a married couple who'd been life long friends, all of whom agreed to be my special support team) that I was able to get anything done at all as they took responsibility for my life. I deferred all decisions to them. At one point I felt it would be necessary to sign over legal guardianship of myself to someone else. I was that incapable of thinking through anything. I needed help with everything.

Sometime in April my mind started coming back. In May I started researching mitochondria (after a tip on its implications in bipolar from Jon Lieff of Searching for the Mind) and I wrote my widely and highly acclaimed series on bipolar, the brain, energy and mitochondrial dysfunction.

That effort burned me out again, however, and back into the pits of darkness I fell again.

Now knowing why this was happening to my brain – the mitochondrial dysfunction – I then created and did my Mental Health Boot camp. I spent four weeks in a strict very simple daily routine that I carefully designed for myself. It was based on something similar to what I knew the routines would be in Buddhist monasteries in Asia (to where people there in severe mental and life distress often turn). I gave myself simple domestic chores to do daily, meditation, yoga/tai chi like exercises, gentle walks, I adhered to a strict all natural diet. Every task I did very mindfully. I allowed no other thoughts.

And once more my mind began to come back. I was able to write again and my reading levels began to return.

Then I received a hammer blow. I was told I had to move out of the apartment I'd been renting, the place where I'd worked so hard to build and achieve stability in my mind and life. My therapy cat Mrs Bean had come into my life by then and she meant everything in the world to me. I'd been given a deep discount on the monthly rent and had still struggled with the confines of my small pension. I knew it'd be virtually impossible to find a living arrangement that would suit me and my mind and that would take Mrs Bean and which would fit into my budget.

By the end of July I was homeless.

From August of 2014 to early March 2015 I couch surfed, lived out of a barn (eating in and using the bathroom of the attached apartment suite my friend lived in) and then out of a camper van provided to me by family members. I spent the Canadian winter living out of doors. The story of that will have to wait for another day but the upshot was that while I put great effort into making the best of it and I did a lot of spiritual healing during that time, the efforts of surviving a Canadian winter outdoors burned me right out again (this too I'll address in future posts on natural stressors and how our bodies respond to them).

In early March of 2015 a chance encounter led to a new living arrangement and I again found a home for me and Mrs Bean. I was given a small mobile home that I could call home. I could move my things in and be comfortable again (though still without heat).

But the previous eight months of homelessness and the stress of that caught up to me all in a rush and the all encompassing fatigue and brain fog returned.

This time, however, I was ready. I knew what was happening. I knew what to expect. I knew why it was happening. I could avoid the terrifying panic of losing one's mind. It still remains a tremendous struggle, however. There is little I can do in any given day. I get perhaps an hour or two of truly productive physical and/or mental energy a day. The rest of the time I have to take it easy.

I have no idea how much longer this will last. I have no idea how much longer I can take living like this. Scarcely a day goes by where at some point The Inevitable  doesn't enter my mind. I struggle every day to find reasons to keep going.

But I also try to remind myself what I've been through in the last six and a half years. 2007 is the last year where I had any kind of good mental health at all though even then, I can now see, the seeds for what was to come were being sown. 2006 is the last year I had full working capacity, a good stable life, a loving family and was completely depression or mania free.

From the end of 2007 I have either been in manic, hypomanic or depressive phases. From 2008 on I've battled episodes or instances of severe anxiety disorders, major depressive disorders, nearly a dozen psychotic episodes, numerous total mental breakdowns requiring hospitalizations, severe top of the chart suicidal danger (there are rating scales for that), the effects of Borderline Personality Disorder, at times being penny-less and homeless and all of the cognitive and mood disorders that come with all of that.

That's over six years – with the only exception being a few month stretch during the fall and winter of 2008-2009 – without what would be considered remission from psychiatric symptoms.

Most people with severe psychiatric disorder don't survive that. Most mentally healthy people don't survive that. 

For those reading along trying to understand psychiatric disorders, the prior twenty-nine months would be an absolute textbook case of classic manic-depressive cycle – weeks of full on mania with no sleep, months more of hypomania, several months of cycling between hypomanic periods of energy and mental clarity and brain fog depression and then finally a months and months long episode of classic depression. There is a rule of thumb about bipolar that says for every week of mania there will be about two months of depressive states. I can see now why that is (and some of the main reasons for this is what I outline in brain energy and mitochondrial dysfunction).

So sometimes I have to remind myself of all that, to remind myself that no wonder every cell in my body is burned out and to give myself permission to recover. I have to remind myself that I am still technically in the depressive cycle. Though I am able to control most of the mental symptoms that would normally accompany the depressive phase of a manic depressive cycle, the biological basis of the fatigue I cannot. I can only do my best to not make it worse and to allow it to recover naturally. 

I do this without medications or psychiatric care of any kind (the reasons for which I really must get to soon). I also need to get to in more detail what I do do (in addition to my positive difference making fundamentals, that is).

I also must daily deeply feel gratitude for what I do have. I have – despite everything – been incredibly blessed. There are countless people who in psychiatric terms have been put through something similar to me (the more difficult cases of schizophrenia, bipolar and major depressive or anxiety disorder) who are not so blessed. They end up on the streets, viewed as little more than human garbage. Many descend into substance abuse to numb their pain. Thousands take their lives.

Yet others – with little or no family support or understanding – slip into eternal hopelessness, living out their lives not living, not reaching, not dreaming, not understanding that they have greater potential, that there's more. They don't know that there could be hope, there could be ways to improve their mental states and lives.

I have seen them, talked to them and have heard from them when they come across this blog.

And it is for them that I continue, to fight to find a way.

Meanwhile, I do all that I can to ride out this depressive phase of this mother of all manic-depressive cycles. Twenty-nine months. That's a long time. On top of thirty months immediately prior to that of mental madness. And prior to that two and a half years of instability between mania, hypomania and depression. Mild episodes of psychosis had started in the summer of 2008. That's a staggering ninety months or so without remission. The worst of those ninety months, by the way, were the thirty months I spent on medications. About the only thing the mental health care system did was help make me aware that I had serious problems. They did virtually nothing to solve them (the only exception being a few days of group therapy that I found very useful, something I'll address when I explore the benefits of psychological therapies).

During the time since I had what would by my last psychotic episode (at the end of 2012) when I took full control of and responsibility for my own mental health and well being (and doing all the research that would lead to the creation of this blog), however, I did learn how to keep under control the worst of the symptoms. What I am left with is the inevitable burnout of the previous six and and a half years. The horrible fatigue, I can see now looking back, started in the spring of 2010 and has been worsening ever since.

It is very hard most days to believe that there is an end in sight, that I can look forward to a life with normal energy again. Five years of “data” - all indicators pointing to worsening and perhaps now incurable fatigue - makes it very hard to believe anything else is possible. It becomes very hard to believe that one can be something approaching normal again, that I can be productive again. 

Back to stating that I am dying. 

Many times it feels exactly like that for it feels like the very essence of my life has been sucked out of me. There is nothing there. It feels like I can barely even draw a breath. Days upon days of a blank mind with only dark thoughts fighting to get in. It feels for all the world impossible to survive another hour, yet alone another day, let alone another month, let alone life itself.

So daily I must manufacture hope out of nothing.

And it is so often my dear readers and followers who give me the will to do so.

Wednesday, May 13, 2015

Bipolar, the Brain and Energy - Part Two

Okay, in this follow up to the Part One of Bipolar, the Brain and Energy, let's look a little more about what's going in the brain, the body and what we experience as energy. 

While I initially researched this series specifically regarding bipolar disorder, I want to say that what we will learn here does not only apply to bipolar disorder. Bipolar is particularly bad for burning out the brain and body at the micro cellular level, but since originally researching for and writing this piece in the spring of 2014, I've since seen and learned that people who are suffering from or have recently suffered a severe psychiatric episode, such as severe depression, anxiety and panic attacks accompanied by unusually long periods of sleep deprivation also very often suffer from debilitating fatigue. So there is lots to be learned here for anyone, I believe.

First off, let's understand what an energy consumer the brain is to begin with. Though it represents less than 2% of our body weight, our brain will consume twenty percent of all your body's total energy. Yes, you heard that right - twenty percent. That's approximately twenty percent of the oxygen that your lungs put into your bloodstream and about twenty percent of the nutritional energy that enters your bloodstream through the foods you eat (we'll get to this another time, but trust me, you want to pay a whole lot more attention to what you put into your body as food). All to that little three pound organ between your ears. 

Now that's in a 
normally operating brain. Bipolar brains, however, are far from "normal", which is not in any way to sound disparaging, but it's just a fact (albeit not a widely known or precisely understood fact); bipolar brains operate differently than that of the general population. 

Bipolar brains tend to activate far more brain regions much more intensely when manic than non-bipolar brains. While I can personally attest to this, enormous amounts of research bear this out. This isn't a great brain scan but it serves well enough here to illustrate the point. 

At the top is a normal control subject, the middle a hypomanic brain and the bottom depressed. The brighter yellow or red the region is, the more activated it is. 

It is hard to understate just how active a manic or hypomanic brain is (I'll leave distinguishing between those two for another time, but briefly, hypomania is "mania lite", a much milder form of a manic episode). And again, without having experienced it, it is utterly beyond what anyone with a 'normal' brain can fathom. It really does feel like your brain is lit up like a blast furnace. Your brain feels like, and 
is running on all eight cylinders (usually, as we'll see, the brain actually limits the number of "cylinders" running at any one time). Massive amounts of neuronal real estate is fired up, regions that would not normally operate all at once (not all of this "fired up neuronal activity" is for the good, but again, for another time). 

Now note the brain wide lack of activity recorded in depressive brains. This will make much more sense when we learn more about the role mitochondria plays in all cell functions but particularly in brain cell functions (which we will look at in more detail in Part Three). 

Not only is the brain more fired up, but it won't shut off. In the manic episode I experienced at the start of 2013 and which led to the state I now find myself in, I went thirty-five straight days with virtually no sleep. That's five straight weeks of maybe an hour's nap per day. I've read reports of even longer manic episodes. Long periods of very little or no sleep is a hallmark of mania or hypomania (this, it must be clear, is 
not the same as insomnia and restless inability to sleep). Thoughts and ideas during this time are going to be happening at a breathtaking pace (though not all necessarily for the good).

All of this means not only way above average numbers of neurons, neuronal regions and various circuitry are activated, but for much longer durations than nature ever intended. In just a 
single thought there is an enormous amount of activity and energy requirements so one can well imagine how much demand there is being put on energy during manic phases.

And here's the thing with brains: they evolved to be highly efficient in energy conservation. Generally, a brain will only "bring on board" a limited amount of regions at any one time (other than for perhaps for brief bursts) for the simple reason of conserving energy. In times of acute crisis, for example, it will shut down parts of the frontal cortex (where all kinds of higher human functions such as emotional regulation, judgment, risk evaluation among others usually take place) and fire up other regions (or put them on higher alert). It does this to make the most efficient and conservative use of available energy not only for the brain, but throughout the body. 

In other words, it simply has not evolved to run at the energy outputs seen during manic/hypomanic phases for that long. 

I have long considered bipolar disorder to be largely a disorder of brain energy allocation. I wrote this years ago early in my exploration of what exactly bipolar is: "Whatever mania is, and I am scouring the earth looking for the neuroscience to this, it is energy at its core"
so it's nice to see serious researchers coming to the same conclusion:

"Bipolar disorder seems to be a disorder of energy; too little in depression and too much in mania," said professor Michael Berk, who is leading the study. "This suggests that if we can usefully target energy, we might help depression in bipolar disorder"

[Professor Berk is leading the study cited below]

Energy is not in infinite supply. It does not just materialize out of thin air. As we saw in the Part One of this series (albeit very briefly), mitochondria manufactures energy in all the cells in our body and brain. There is considerable evidence for the idea that mitochondria and the neurons' energy are particularly at risk for damage in psychiatric disorders or even perhaps that our mitochondria being prone to damage is the very source or core to may pychiatric disorders

Mitochondria depends on numerous factors to manufacture that energy and when demand is high, those factors are not going to be able to keep up indefinitely. That's just kind of cellular biology 101. 

So just for starters, with high energy demands during a manic phase, those supplies are just simply going to be exhausted (in the literal sense of "running out") at some point. This is easily observable (and likely easier to understand) in muscle cells - put them under demand for too long, and they will burn out and you'll literally not be able to move a muscle. 

So without going into a lot of long scientific explanation, I think we can fairly understand that aspect of the cyclical nature of bipolar - the brain simply, just like a cellular structure such as a muscle, needs recovery time after a high demand period. This would not only go a long ways to explaining the "crash" following a manic episode, but also in explaining the often debilitating fatigue. And while this does not fully explain the long term debilitating fatigue that some bipolar patients (though not all) suffer through, from all my research and using myself and my own case over the past three years, I will argue firmly that it is perhaps the biggest factor. There are other important factors as well that can lead to the post mania crash but those are something I'll have to get to in a separate piece.

Now I have to remind that there is no single one thing going on in bipolar disorder and I don't mean to suggest that energy and mitochondria is the end all to be all in understanding and treating bipolar; it's just one piece of a very complex puzzle. Certainly dopamine is a major factor. We looked at dopamine's roles in moods and behaviours in this neurochemical in focus piece
 and dopamine has long been thought to play a major role in bipolar. Dopamine, just briefly, is greatly involved in what controls our motivations and drives (and also is widely implicated in many addictions, such as compulsive gambling). When manic, our motivations and drives are on hyper-drive and the role of dopamine in this is largely why anti-psychotics are almost always prescribed (anti-psychotics are dopamine blockers at the synaptic level). 

The "wakefulness" neurotransmitter norepinephrine almost certainly plays a large role in manic phases as would high levels of adrenaline and other stress response system neurobiology

These and other factors are part of what gets manic brains so fired up. And these high energy demands are just part of what's going to burn out the cellular energy factories, mitochondria. 

But there's more.

That sleep the brain doesn't get when manic or the insomnia that often comes with depressive and anxiety disorders?
Bad news. I'll not get into this too deeply here but as I've written elsewhere, sleep is also a critical factor in both neuronal and overall proper brain function. Briefly though, it has to do with neurons needing the down time of sleep for basic housekeeping such as "waste disposal". This is more cellular biology 101 - cells take in substances to produce energy, that process produces waste byproducts that have to be removed. Those waste products are toxic when build-up occurs. There is much research to suggest that neurons (along with all other cells in your body for that matter) need the sleeping state in which to perform this waste disposal and rid neurons of hazardous waste build up (I bet you never thought of it that way before, did you?). 

But there's more yet and the news gets worse.

Mitochondria and Stress: 

There is massive amounts of literature on the relation between stress and neuropsychiatric disorders so I can only hope to summarize this very briefly for now. There are also great bodies of literature on stress and cellular damage throughout the body, perhaps best summarized for laypeople and clinicians alike by Robert Sapolsky lectures and books. While the stress response system is a complicated piece of business (and what isn't in the brain?), the triggering of symptoms and the microscopic neurological damage found in psychiatric disorders more or less boils down to the effects the stress hormone glucocorticoid has on various brain systems and components. 

Chronic stress - which essentially means chronically elevated levels of glucocorticoids - is really bad news for all of your health. While what particular part of your bodily systems it effects will be determined by genetics (a rather large subject in itself that we'll leave for perhaps another day) and other individual differences, in the brain it's going to cause DNA to be changed this way or that, cellular damage, compromised immune systems, neuronal death (particularly in the hippocampus - hello, impaired memory) and, to get to today's topic, damage to mitochondria. 

To get a bit of an understanding of the role of GCs (glucocorticoids) and mitochondria, we'll look at this excerpt from one of the papers I came across when researching for this series

Such work suggests that, under physiological conditions, GCs enhance (my emphasis - BGE) mitochondrial functions to provide cells with more energy for coping and adapting to acute challenges.

So far, so good. This is what all the literature on GCs will show - short term gains in times of, as they put it, "acute challenges". Which in evolutionary historical terms (IE: what our brains and bodies are most evolved/adapted for), means escaping a tiger attack or vigorously hunting for food. These are short term crisis situations though. 

Further now from the excerpt:

However, chronic stress may lead to chronically elevated levels of GCs, which in turn may reduce cell functioning via the interaction between GRs/Bcl-2 and mitochondria. The decrease in proper cell function may contribute to the pathophysiology of several stress related mental health disorders, including major depression.  

Sapolsky has done an enormous amount of work on glucocorticoids that very firmly establishes that not only will chronic stress loads lead to chronically elevated levels of GCs but also his work (and that of many others) documents the cascading amounts of damage they will have in neuronal circuitry and neurons.

So what that latter excerpt is saying, in layman's language, is that chronic exposure to GCs will go past the short term energy boost and instead greatly damage and impair mitochondria's mechanisms for converting various substances into energy, which again is what we're going to see manifested as the physical and mental lethargy and fatigue of the bipolar depressive cycle. And as I stated at the top of this piece, I can now see and have come across enormous amounts of supporting evidence that this mitochondrial damage will be present following many severe depressive and/or anxiety episodes. 

How bad this damage may be and how repairable it may or may not be are matters of ongoing research and study. For now though, I think we can draw some strong inferences. We can take take "subject A", the clinically well observed (and experienced by myself) 
chronic and debilitating fatigue of bipolar depression, add that to our now deeper understanding of mitochondria's vital role in producing the mental and physical energy we need to properly function day to day, and then add these two to what appears to be growing evidence for mitochondrial function being damaged or compromised by both being over taxed during manic phases and/or periods of severe sleep deprivation and chronically elevated levels of GCs and make a conclusion that damaged mitochondria are in large part responsible for the fatigue suffered by many people with bipolar depression and major depressive disorder (and, some literature suggests, schizophrenia). 

There are other factors in the lethargy and lack of motivation experienced during depressive phases - and I 
will get to those in other posts - but for understanding the worst of the fatigue, I do think we have our smoking gun. 

But I always like to include multiple sources, so there's more. The role of mitochondria dysfunction is becoming more widely known and is the subject of more and more research. A reader of this blog brought the following research to my attention. This is from a university group in Australia and New Zealand (led by the above mentioned Professor Berk). The nature of this research is to test a special cocktail of nutrients meant to boost mitochondrial function

What I found of interest is support for the theory that stress is the source of damage to mitochondrial functioning and furthermore, this is the basis for bipolar fatigue. 

There is a growing body of evidence supporting the presence of oxidative stress states in bipolar disorder. With high levels of oxidative stress comes mitochondrial dysfunction. 

Oxidative stress is outside my body of reading so I'll leave an understanding of that to what appears to be a well written and sourced entry in Wikipedia. (I don't like relying on Wikipedia for a source but often it really does summarize various bodies of research as well as anywhere). While I cannot claim an understanding of the exact mechanisms of oxidative stress (gads, yet more reading for my 'to-read' list), it does appear to me that oxidative stress damage (and the world of anti-oxidants to combat it) is different than GC stress damage. 

So to summarize, mitochondria are responsible for all cellular energy generation in the body and brain. Their functionality comes under attack in bipolar, it would appear, via four possible means:

- plain exhaustion (again, in the literal sense of supplies running out) due to chronic overuse during manic phases (in the brain, this is just as in any over-taxed cell that simply shuts down due to overuse).

- build up of toxic cellular waste products as a result of lack of sleep during manic phases

- grave, long term damage due to chronically elevated levels of glucocorticoids which comes from chronic stress (which will arise from a wide variety of sources both within the brain of a bipolar person and from external stressors)

- oxidative stress damage 

Stress and Bipolar Disorder and other Neuropsychiatric Disorders:

So what does stress have to do with bipolar disorder and other neuropsychiatric disorders? Well, almost everything. And in better understanding what stress is and how it affects brain components, we can better understand not only what triggers bipolar and other psychiatric disorder episodes, but more importantly, what to do about it.

And in better understanding the role of stress - or the stress response system - we'll better understand why some people get hammered more by the down cycles of bipolar and why some develop the debilitating chronic fatigue well documented to plague many people who are bipolar (and is the main reason, IMO, it IS a disorder for many). As well, we'll see what a major role chronic and acute stress plays in many psychiatric disorders and why recovery is so difficult. 

The roles of the stress response system has long been a major focus of my research and reading and I'll be getting to that in a series that I hope to have completed soon. 

Please continue to Part Three of the series

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