4 Min Read

Last Updated: 12.06.23

The Science & Treatment of Bipolar Disorder

Huberman explains bipolar disorder, its biology, symptoms, causes, and types. Discusses neuroplasticity, mood regulation, and contrasts with bipolar biology. Outlines brain mechanisms, treatments (lithium, ketamine, therapies, ECT, TMS, nutraceuticals). Relevant for those with bipolar disorder and those interested in brain function.

Key Takeaways

High level takeaways from the episode.

The prominent markers of bipolar disorder include:

Manic episodes
Displaying elevated mood and expansive thoughts all day, every day
Distractibility and trouble holding attention
Impulsivity

The prominent markers of bipolar disorder include:

Grandiosity (i.e., delusions of grandeur)
Agitation, that is difficulty staying still or sitting down
Lack of sleep, either little or none, often going a week or more with limited sleep
Fast speech, with no opportunity for conversation or rapport
Hopelessness and a lack of optimism for the future

Bipolar disorder (BD), often called bipolar depression, is a severe psychological condition that consists of two components, Bipolar 1 (BP‑I) and Bipolar 2 (BP-II). The leading theory underpinning the condition is that an individual inherits a susceptibility to BD, which then becomes triggered by environmental factors.

Bipolar disorder can be difficult to detect and often goes undiagnosed, as other conditions can cause similar bouts of manic state, and in some cases, can present identical symptoms. These include, for example, traumatic brain injury, seizure, prescription drugs, illicit drugs such as amphetamine and cocaine, and corticosteroids that are often prescribed for immune conditions.

For someone to be diagnosed they must meet these criteria:

Present at least three symptoms for a minimum of seven days
The symptoms must not be better explained by something else going on in a person’s life or their immediate medical history

Bipolar disorder’s inheritability is 85%, meaning that certain individuals have a gene or a set of genes that create a susceptibility for the condition to present itself.

Usually begins to display itself when an individual reaches their early twenties. The earlier the onset on the condition, the higher likelihood that it will become a stable feature of that individual’s psychology.

There is no single gene or identified gene cluster that determines where this susceptibility is inherited from. The disorder is predominantly triggered by environmental factors.

Bipolar Disorder‑1

Bipolar Disorder 1 (BP‑I) is characterised by:
- extended period of mania
- elevated mood and energy
- distractibility
BP‑I is very noticeable and very extreme. An individual experiencing it may not recognize it, but it’s highly recognizable to others.

BP‑1 vs BP‑2

It is a common misconception that BD is always accompanied by severe depression. In fact, people with BP‑I do not suffer from such deep depressive states in comparison to those with BP-II.

BP‑1, on average

~50% of life symptom-free
~32% of life suffering from major depression / severe challenges
~15% of life in a manic state

BP‑2, on average

~45% of life symptom-free
~50% of life suffering from major depression / severe challenges
~4–5% of life in a manic state

People with BP-II experience four days or less of mania or hypomania, compared to a minimum of seven days in BP‑I individuals.

People with bipolar disorder have hyperactivity — an increased level of certain circuits in the brain. This generally manifests in their early twenties, but can be earlier.

The overuse of certain circuits can lead to a diminishing or even death of those brain circuits. This hyperactivity then leads to hypoactivity, after the death of neural circuits. This makes bipolar disorder an extremely complex condition to treat.

People suffering from bipolar disorder have progressively diminished levels of interoception. This atrophy of neural circuits for interoception is emerging as one of the defining of neural circuit characteristics of bipolar disorder, explaining symptoms such as rapid speech and a lack of sleep or appetite.

Bipolar disorder is a time sensitive condition and once it has been properly diagnosed, it is important to begin treatments as early as possible to prevent some of the longer lasting changes in brain circuitry.

It is highly recommended that sufferers implement a protocol that combines drug treatments, talk therapy, lifestyle interventions and supplements.

Bipolar Disorder

Affects 1% of the population
Higher risk of suicide (20–30% greater incidence)
Typical age of onset: 20–25 years old
Two types: Bipolar I and Bipolar II

Bipolar 1

Characterized by extended periods of mania (elevated mood, energy, distractibility, impulsivity)
Manic episodes last for 7 days or more

Bipolar 1

Diagnosis requires at least three of the following symptoms:
- Distractibility
- Impulsivity
- Grandiosity
- Flight of ideas (rapid, disorganized thoughts)
- Increased goal-directed activity
- Decreased need for sleep
- Excessive involvement in pleasurable activities with potential for negative consequences

Manic episodes: grandiosity, flight of ideas, agitation, no sleep, rapid pressured speech

To be diagnosed with a manic episode, at least three symptoms must be present for at least seven days

Bipolar II

Characterized by the presence of both manic episodes (mania) and depressive episodes
Often diagnosed on the basis of manic episodes lasting four days or less
Associated with drops into depressive episodes
Hypomania: a somewhat suppressed level of mania, can be due to the duration or intensity of mania

Bipolar disorder can vary tremendously between individuals

Some may experience very high highs and very low lows, while others may rapidly cycle between mania and depression
It is important to erase the idea that manic bipolar disorder is a simple sine wave, cycling up and down between mania and depression
Bipolar 1: manic episodes lasting 7 days or more
Bipolar 2: hypomanic episodes lasting 4 days or less

Bipolar 1:

50% of time symptom-free
32% of time depressed
15% of time in manic or mixed manic state

Bipolar 2:

50% of time in a depressed state
45% of time symptom-free
4–5% of time in hypomanic state

Bipolar disorder is one of the highest risk factors for global burden (years lost in engaging in normal life due to disability)

Proper treatment is crucial to reduce the impact of bipolar disorder on life trajectory

Heritability of bipolar disorder is 85%

Higher genetic component than major depression
No single gene or gene cluster identified for bipolar disorder
Genetic susceptibility to environmental influences can trigger bipolar disorder

If a family member has bipolar disorder, be on the lookout for symptoms in yourself and other family members

Lithium treatment for Bipolar

Still used with success in many patients with bipolar disorder
Requires careful monitoring of blood levels due to toxicity
Not all patients respond to lithium treatment
Possibility for better treatments with fewer side effects

Urgent need for new and better treatments for bipolar disorder. Understanding lithium’s mechanisms can lead to new discoveries:

Increases BDNF (brain-derived neurotrophic factor)
Potent anti-inflammatory
- Suppresses inflammation in neural tissues and the brain
Neuroprotective
- Prevents neurons from dying under certain conditions
- Protects against excitotoxicity (hyperactivity of certain brain areas killing off neurons)

People with bipolar disorder have atrophy or removal of certain neural connections over time

Leads to diminished interoception (registering one’s own internal state)

Hyperactivity of certain neural circuits early in the disease

Leads to excitotoxicity and atrophy of circuits responsible for interoception

People with bipolar disorder have reduced internal awareness due to disrupted neural structures like the insula

Top-down control over limbic system is also disrupted in bipolar disorder

Homeostatic Plasticity

A form of neuroplasticity that balances neural circuit activity
If a neural circuit is overactive, changes occur at the cellular level to reduce activity
If a neural circuit is underactive, changes occur to increase activity
Involves the addition or removal of receptors in the postsynaptic neuron

Lithium and ketamine seem to exert their actions through effects on homeostatic neuroplasticity

Lithium reduces excitability of neurons over time, making them less excitable
Ketamine increases the number of receptors in postsynaptic neurons, leading to greater excitability and electrical activity within neural circuits

Ketamine: effective treatment for major depression and depressive episodes in bipolar disorder

Effects are potent but transient, requiring repeated treatments

Lithium: reduces manic episodes and intensity of manic symptoms in bipolar disorder

Protects neural circuits from dying away due to overactivity and excitotoxicity
Reduces the number of receptors in certain elements within circuits, leading to less excitability and preventing excitotoxicity

Drug therapies are most effective when combined with talk therapies

Talk therapy alone is rarely effective for bipolar disorder

Cognitive Behavioral Therapy (CBT) is the most popular and effective talk therapy for bipolar disorder

Progressive exposure to triggers or conditions that exacerbate bipolar disorder in a controlled clinical setting

Family Focused Therapy

Involves family members in the treatment process, helping patients navigate and predict conditions that can trigger bipolar episodes

Interpersonal and Social Rhythm Therapy

Focuses on establishing and maintaining regular daily routines and social rhythms to stabilize mood and prevent relapse

Repetitive Transcranial Magnetic Stimulation (rTMS)

Non-invasive technique to reduce activity in specific neural circuits
Effective in increasing neuroplasticity and reducing depressive episodes
Early technique with limited availability

Ketamine Therapy

Primarily targets depressive aspects of bipolar disorder

Cannabis is not effective for treating manic or depressive phases of bipolar disorder

Sleep, exercise, nutrition, social interactions, and sunlight can support the nervous system and psyche of someone with bipolar disorder

These factors have a modulatory effect, indirectly shifting the likelihood or intensity of an episode
However, most people with bipolar disorder will still need drug therapy intervention

Inositol and omega‑3 fatty acids have shown potential in adjusting symptoms of bipolar disorder

People with bipolar disorder should consider a combination of drug treatments, talk therapy, lifestyle interventions, and supplement-based treatments (such as omega‑3 supplementation) to manage their illness

Certain aspects of mania are associated with creativity

Occupations with higher incidence of bipolar depression: poetry, fiction writing, art, nonfiction writing, music composition, theater
Important to distinguish between emotional states and full-blown bipolar disorder
Be cautious when labeling people as “bipolar” or “OCD” without understanding the severity of these psychiatric conditions

Protocols

Science-based tools and supplements that push the needle.

Drug Therapies + Talk Therapies for Bipolar

1/3

In general, most psychiatrists state that talk therapies on their own are ineffective, but if used in conjunction with drug therapies, they can be extremely useful.

2/3

Occasionally, drug treatments may fail to work or side effects may be too strong. Talk Therapies ******are a good use of support and may help with potential side effects, even allowing for the consumption of a lower dosage.

3/3

SSRIs for Bipolar

1/2

Drug therapies are the most common form of treatment of BD with Selective Serotonin Re-uptake Inhibitors (SSRI’s), such as Prozac and Zoloft, changing the availability of neurotransmitters in the synapse. This allows for more serotonin to sit within the synapse for longer, preventing the re-uptake by the presynaptic neuron and allowing for a greater impact.

2/2

Monoamine Oxidase Inhibitors (MAO Inhibitors) for Bipolar

1/2

A class of drugs used to treat depression. They work by inhibiting the enzyme to prevent the breakdown of neurotransmitters and allow for more to be available in the synapse.

2/2

Cognitive Behavioral Therapy for Bipolar

1/3

The most popular, effective, and most explored therapy strategy. It includes the progressive exposure of the patient in a clinical, controlled setting to analyze the triggers of what exasperates someone with bipolar disorder.

2/3

This is beneficial because someone with BD can have exaggerated symptoms, should life conditions become more stressful. Direct exposure to anxiety-provoking elements of life helps adjust the responses to otherwise triggering events.

3/3

Electroconvulsive Therapy (ECT) for Bipolar

1/4

Induces either a low-level or grand mal seizure in the patient’s brain and nervous system.

2/4

It can be considered barbaric, but has shown to be a very effective treatment for major depression, specifically treatment-resistant depression in patients that show no ongoing positive response to drug therapies, which can be a key component of bipolar disorder.

3/4

It can help control the release of a variety of neuromodulators such as serotonin, dopamine and acetylcholine and allows neuroplasticity to take place. However, it has no impact upon the manic aspects of bipolar disorder and can cause memory loss in some cases, as well as not being very cost-effective.

4/4

Repetitive Transcranial Magnetic Stimulation (rTMS/TMS) for Bipolar

1/5

A tool that allows researchers and clinicians to reduce the amount of activity in specific neural circuits in the brain by using targeted magnetic fields via a coil placed on the outside of the skull.

2/5

This method is minimally invasive, while still being effective at increasing neuroplasticity and in some cases, reducing depression and the intensity of manic episodes in bipolar disorder.

3/5

In addition, it can also activate certain perennial inputs which can help to control the limbic system, the part of the brain involved in behavioral and emotional responses.

4/5

However, this technique is still in the very early stages and therefore, is not widely available. Any individuals that wish to pursue this method should proceed with caution and do their own research beforehand.

5/5

Lithium for Bipolar

1/8

Naturally occurring and can be synthesised. Showing great potential and application in many patients, while still being used significantly and successfully in many cases to this day.

2/8

Several things have happened throughout history to prevent lithium from reaching patients:

As it is a natural element, no person or institution owns the patent to lithium in its purest form. Meaning that it could not be monetized — therefore, drug companies do not consider it to be a worthwhile investment
The use of lithium can also coincide with significant side effects such as toxicity, meaning that blood levels need to be monitored vigorously, especially in the first three months of treatment

3/8

Animal and human studies show that lithium can increase brain-derived neurotrophic factor (BDNF) to calm people down and reduce their manic episodes.

4/8

BDNF is often discussed in the context of neuroplasticity, which describes the ability of the brain and nervous system to change/adapt in response to experience.

5/8

Ingesting lithium increases BDNF, which helps the neurons, the nerve cells, and their connections in the brain to be more likely to change in the proper environmental conditions.

6/8

This is extremely beneficial as bipolar disorder and other psychiatric conditions share the same hyperactivity of certain brain areas that start to kill off neurons if they’re too active for too long.

7/8

The chemicals associated with neuroactivity, such as calcium and neurotransmitters like glutamine, can kill the neurons that are active. However, lithium is a potent anti-inflammatory which can suppress inflammation in neural tissues within the brain, making it neuroprotective. Therefore, under the correct conditions, it can increase an individual’s chemical or physical resiliency and prevent this process.

8/8

Psilocybin for Bipolar

1/4

A naturally occurring psychedelic which is currently illegal in the United States.

2/4

There is a lot of excitement surrounding its potential uses; it is currently being explored as a clinical therapy in human patients for the treatment of major depression, obsessive compulsive disorder and eating disorders.

3/4

Results were impressive for the major depressive episodes, however, there has been no controlled clinical trials and therefore no data for the manic component of bipolar disorder.

4/4

Myo-Inositol for Bipolar

1/4

Inositol or Myo-Inositol, is related to second messenger pathways, which help to improve the mechanisms within brain cells by stimulating changes and improving membrane fluidity.

2/4

Myo-Inositol, ******if taken at a dosage of 900mg every third night, has been shown to improve the depth and quality of sleep, as well as the ability to fall back to sleep.

3/4

It also has a potent anti-anxiety effect during the following day. It has been used at higher dosages of 10–18g to reduce symptoms of other psychological disorders, in this case OCD, but showed gastric side effects and limited efficacy.

4/4

Omega‑3 Fatty Acids for Bipolar

1/4

Omega‑3 fatty acid supplementation has shown impressive results.

2/4

When ingested, it can be readily incorporated into neural pathways or directly into the cell membranes, carrying information throughout the human body, thereby positively changing their functionality. This can help to offset bouts of mania and depression in people that suffer with bipolar disorder.

3/4

In 1999, a mixed gender study consisting of 30 participants, aged 18–64 years old, consumed 9.6 g of fish oil per day for 4 months. Results showed that such supplementation greatly reduced symptoms of bipolar depression and in some cases, mania. However, this is a high dosage to be consuming daily and should not be the only form of treatment. Conversely, Murphy et al. (2012) found that 4 g per day of omega‑3 fatty acid supplementation during the manic phase of bipolar disorder worsened symptoms of mania over a period of 16 weeks.

4/4

Ketamine for Bipolar

1/5

The use of ketamine as a treatment for BD has been widely explored but is predominantly targeted towards the depressive aspects of manic depression, being less effective for individuals without such symptoms.

2/5

Studies show that if neurons are exposed to lithium for a period, there is a reduction in the excitability of the post synaptic neuron.

3/5

However, ketamine does the opposite and increases the number of receptors, creating greater levels of excitability and electrical activity.

4/5

This effect only lasts for a short time and therefore must be used repeatedly, the dosage and duration vary on a case-to-case basis and must be discussed with a psychiatrist.

5/5

Full Notes

Bipolar Disorder and Depression

Bipolar disorder: massive shifts in energy, perception, and mood
- Maladaptive and can cause damage to the individual and those around them
People with bipolar disorder are at 20–30 times greater risk of suicide
Discussion also relevant for those with major depression
- Up to 20% of people will suffer from major depression at some point in their life

GLP‑1 and Appetite Suppression

Glucagon-like peptide‑1 (GLP‑1): peptide that can suppress appetite
- Released in the gut and acts on intestinofugal enteric neurons
- Causes gut distension, making people feel full
- Activates neural pathways within the brain that trigger satiety
Yerba mate: tea that promotes the release of GLP‑1
- Can provide mild appetite suppression and caffeine
- Avoid smoked varieties due to potential carcinogenic effects
New prescription drugs for diabetes and obesity stimulate GLP‑1 release or are synthetic versions of GLP‑1

Parallel Pathways

Parallel pathways: independent pathways that operate together to accomplish a common goal
- Example: GLP‑1 acting on the gut and brain for appetite suppression
- Example: Activation of epinephrine/adrenaline in response to stress or excitement
Communication between brain and body is often bidirectional
Important theme in understanding biological organization
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Bipolar Disorder

Affects 1% of the population
Higher risk of suicide (20–30% greater incidence)
Typical age of onset: 20–25 years old
Two types: Bipolar I and Bipolar II

Bipolar I

Characterized by extended periods of mania (elevated mood, energy, distractibility, impulsivity)
Manic episodes last for 7 days or more
Can be mistaken for other conditions (e.g., traumatic brain injury, drug use)
Diagnosis requires at least three of the following symptoms:
Distractibility
Impulsivity
Grandiosity
Flight of ideas (rapid, disorganized thoughts)
Increased goal-directed activity
Decreased need for sleep
Excessive involvement in pleasurable activities with potential for negative consequences
Manic Bipolar Disorder
Manic episodes: grandiosity, flight of ideas, agitation, no sleep, rapid pressured speech
To be diagnosed with a manic episode, at least three symptoms must be present for at least seven days
Psychiatrists must determine that these manic episodes are not due to something other than bipolar disorder (e.g., traumatic brain injury, seizures, medications, etc.)

Bipolar Disorder Types

Bipolar I

Extended manic episodes (seven days or more)
May or may not experience depressive episodes
Can be diagnosed accurately even if only experiencing manic episodes and then dropping down to baseline

Bipolar II

Characterized by the presence of both manic episodes (mania) and depressive episodes (hypomania)
Hypomania: a somewhat suppressed level of mania, can be due to the duration or intensity of mania
Often diagnosed on the basis of manic episodes lasting four days or less
Associated with drops into depressive episodes
People with bipolar I can also go from manic episodes to severe major depression

Variability in Presentation

Bipolar disorder can vary tremendously between individuals
Some may experience very high highs and very low lows, while others may rapidly cycle between mania and depression
It is important to erase the idea that manic bipolar disorder is a simple sine wave, cycling up and down between mania and depression
Bipolar Depression
Bipolar disorder can be challenging to diagnose due to its varying forms
Bipolar 1: manic episodes lasting 7 days or more
Bipolar 2: hypomanic episodes lasting 4 days or less
Manic episodes are the defining criteria of bipolar disorder

Bipolar 1 vs Bipolar 2

Bipolar 1:
50% of time symptom-free
32% of time depressed
15% of time in manic or mixed manic state
Bipolar 2:
50% of time in a depressed state
45% of time symptom-free
4–5% of time in hypomanic state

Global Burden of Bipolar Disorder

Bipolar disorder is one of the highest risk factors for global burden (years lost in engaging in normal life due to disability)
Proper treatment is crucial to reduce the impact of bipolar disorder on life trajectory

Heritability of Bipolar Disorder

Interaction between genes and environment
Identical twins: if one has major depression, there’s a 20–45% chance the other will also have major depressive disorder
This indicates that genes play a role, but environmental factors also contribute to the development of bipolar disorder
Genetics of Bipolar Disorder
Heritability of bipolar disorder is 85%
- Higher genetic component than major depression
- No single gene or gene cluster identified for bipolar disorder
- Genetic susceptibility to environmental influences can trigger bipolar disorder
If a family member has bipolar disorder, be on the lookout for symptoms in yourself and other family members

Distinguishing Bipolar Disorder from Borderline Personality Disorder

Borderline Personality Disorder (BPD) can resemble bipolar disorder
- Key distinction: BPD episodes often have an environmental trigger, while bipolar disorder episodes can occur without a trigger
- BPD is characterized by “splitting” — sudden emotional shifts in response to external factors
- BPD is also a serious disorder, causing suffering for the individual and those around them

Treatments for Bipolar Disorder

Lithium is a successful treatment for many patients with bipolar disorder
- Discovered as a treatment before understanding the underlying biology of the disorder
- Naturally occurring substance, arrived on Earth through stardust
- For more information on the origins of lithium, refer to the linked YouTube talk in the show notes
  Lithium and Bipolar Disorder
Discovery of lithium as a treatment for bipolar disorder
- Australian physician John Cade
- Observed mood vacillations in fellow prisoners of war during WWII
- Hypothesized a buildup of a chemical in the brain causing mania, which was then urinated out
Cade’s experiments
- Collected urine from manic and non-manic patients
- Injected urine into guinea pigs
- Observed that urine from manic patients seemed more toxic
- Separated urea and uric acid, found urea was not the cause
- Used lithium to dilute uric acid, creating lithium urate
- Found lithium urate calmed guinea pigs and had a calming effect
- Tested lithium alone and found it also had a calming effect
Cade’s paper: “Lithium Salts in the Treatment of Psychotic Excitement”
- Published in the Medical Journal of Australia in 1949
- Described case studies of patients with bipolar disorder treated with lithium
Lithium treatment today
- Still used with success in many patients with bipolar disorder
- Requires careful monitoring of blood levels due to toxicity
- Not patentable, as it is a naturally occurring element
- FDA approved for use in the United States in 1970
Importance of understanding lithium’s mechanism
- Not all patients respond to lithium treatment
- Possibility for better treatments with fewer side effects
- Urgent need for new and better treatments for bipolar disorder
  Lithium and Bipolar Disorder
Lithium: understanding its mechanisms can lead to new discoveries
Thousands of scientific studies on lithium’s actions and mechanisms
- Increases BDNF (brain-derived neurotrophic factor)
  - BDNF is permissive for neuroplasticity
  - Allows neurons to change if proper environmental conditions are met
- Potent anti-inflammatory
  - Suppresses inflammation in neural tissues and the brain
- Neuroprotective
  - Prevents neurons from dying under certain conditions
  - Protects against excitotoxicity (hyperactivity of certain brain areas killing off neurons)

Neural Circuits in Bipolar Disorder

People with bipolar disorder have atrophy or removal of certain neural connections over time
- Leads to diminished interoception (registering one’s own internal state)
Hyperactivity of certain neural circuits early in the disease
- Leads to excitotoxicity and atrophy of circuits responsible for interoception
Lithium protects against atrophy of interoception circuits
- Through its anti-inflammatory, neuroprotective effects, and ability to increase BDNF

Treatment Challenges in Bipolar Disorder

Different treatments or combinations of treatments for manic and depressive episodes
Complexity of oscillations in mood and atrophy of interoception circuits
Accurate understanding of bipolar disorder often depends on reports from people around the patient, not the patient themselves

Neural Circuits in Manic States

Interoception is diminished in people with bipolar disorder
Further research needed to understand the neural circuits that lead to manic states
Neural Circuits in Bipolar Disorder
Recent study: Longitudinal Changes in Structural Connectivity in Young People at High Genetic Risk for Bipolar Disorder
Analyzed neural circuit connections (conectomics) in people with bipolar disorder
Found deficits in connectivity between parietal brain regions and the limbic system
- Limbic system: collection of brain structures responsible for shifting overall states (e.g., calmness, alertness)
- Parietal lobe: exerts top-down control over the limbic system
People with bipolar disorder have reduced internal awareness due to disrupted neural structures like the insula
Top-down control over limbic system is also disrupted in bipolar disorder

Homeostatic Plasticity

A form of neuroplasticity that balances neural circuit activity
If a neural circuit is overactive, changes occur at the cellular level to reduce activity
If a neural circuit is underactive, changes occur to increase activity
Involves the addition or removal of receptors in the postsynaptic neuron
Discovered in the visual system by Gina Turrigiano at Brandeis University
Important for understanding the treatment of psychiatric conditions, including bipolar disorder
Homeostatic Neuroplasticity in Bipolar Disorder
Lithium and ketamine seem to exert their actions through effects on homeostatic neuroplasticity
Lithium reduces excitability of neurons over time, making them less excitable
Ketamine increases the number of receptors in postsynaptic neurons, leading to greater excitability and electrical activity within neural circuits

Ketamine and Lithium in Bipolar Disorder

Ketamine: effective treatment for major depression and depressive episodes in bipolar disorder
- Effects are potent but transient, requiring repeated treatments
Lithium: reduces manic episodes and intensity of manic symptoms in bipolar disorder
- Protects neural circuits from dying away due to overactivity and excitotoxicity
- Reduces the number of receptors in certain elements within circuits, leading to less excitability and preventing excitotoxicity

Talk Therapies in Bipolar Disorder

Drug therapies are most effective when combined with talk therapies
Talk therapy alone is rarely effective for bipolar disorder
Cognitive Behavioral Therapy (CBT) is the most popular and effective talk therapy for bipolar disorder
- Progressive exposure to triggers or conditions that exacerbate bipolar disorder in a controlled clinical setting
Family Focused Therapy
- Involves family members in the treatment process, helping patients navigate and predict conditions that can trigger bipolar episodes
Interpersonal and Social Rhythm Therapy
- Focuses on establishing and maintaining regular daily routines and social rhythms to stabilize mood and prevent relapse
  Interpersonal and Social Rhythm Therapy
Expansion on family-focused therapy
Incorporates social and interpersonal aspects
Recognizes the impact of relationships and financial situations on bipolar disorder

Electric Shock Therapy (ECT)

Effective treatment for major depression
Used for treatment-resistant depression
Stimulates the release of serotonin, dopamine, acetylcholine, and BDNF
Invasive, high cost, requires anesthesia, and may cause memory loss

Repetitive Transcranial Magnetic Stimulation (rTMS)

Non-invasive technique to reduce activity in specific neural circuits
Effective in increasing neuroplasticity and reducing depressive episodes
Early technique with limited availability

Ketamine Therapy

Primarily targets depressive aspects of bipolar disorder

Psilocybin

Shows promise for treating major depression, OCD, and eating disorders
No controlled clinical trials for treating mania in bipolar disorder

Cannabis

Not effective for treating manic or depressive phases of bipolar disorder
May help with sleep in some cases

Naturopathic Approaches

Not recommended as the sole treatment for bipolar disorder
Should be combined with appropriate prescription drug approaches from a board-certified psychiatrist

Lifestyle Interventions

Can support people with bipolar disorder alongside medical treatments
Lifestyle Factors and Bipolar Disorder
Sleep, exercise, nutrition, social interactions, and sunlight can support the nervous system and psyche of someone with bipolar disorder
- These factors have a modulatory effect, indirectly shifting the likelihood or intensity of an episode
- However, most people with bipolar disorder will still need drug therapy intervention
Lifestyle interventions alone are unlikely to prevent extreme forms of mania and depression in bipolar disorder

Inositol and Omega‑3 Fatty Acids

Inositol and omega‑3 fatty acids have shown potential in adjusting symptoms of bipolar disorder
Inositol:
- Related to second messenger pathways, which can affect cell membrane fluidity
- Can improve sleep, reduce anxiety, and help with symptoms of OCD
Omega‑3 fatty acids:
- Found in fish oil and can change cell membrane fluidity
- Some studies show improvement in depressive symptoms and manic symptoms in bipolar disorder
- Should not be viewed as the only treatment approach for bipolar disorder

Importance of a Comprehensive Treatment Approach

People with bipolar disorder should consider a combination of drug treatments, talk therapy, lifestyle interventions, and supplement-based treatments (such as omega‑3 supplementation) to manage their illness
Omega‑3 fatty acid supplementation is interesting for its potential effects on brain imaging and neural circuits in people with bipolar disorder, but it should not be relied upon as the sole treatment
Omega‑3 Fatty Acids and Bipolar Disorder
Study published in the American Journal of Psychiatry
Omega‑3 fatty acid treatment and T2 whole brain relaxation times in bipolar disorder
MRI scans show how brain structures and neural activity can be evaluated
Study shows that membranes of neurons in bipolar subjects treated with Omega‑3 fatty acids showed more fluidity and ability to move in and around the membranes
Omega‑3 supplementation not the only intervention, but worth considering and discussing with a doctor

Creativity and Bipolar Disorder

Certain aspects of mania are associated with creativity
Occupations with higher incidence of bipolar depression: poetry, fiction writing, art, nonfiction writing, music composition, theater
Important to distinguish between emotional states and full-blown bipolar disorder
Bipolar disorder is extremely maladaptive and associated with high suicide risk
Be cautious when labeling people as “bipolar” or “OCD” without understanding the severity of these psychiatric conditions

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