4 symptoms & 5 rules for Bipolar Disorder

Several research studies have shown that the left amygdala plays a key role in bipolar disorder. By the time teenagers are developing bipolar disorder, there appears to some loss of volume in the left amygdala, which is shown in MRI images of the brain. (Dickstein DP, Milham MP, Nugent AC, Drevets WC, Charney DS, Pine DS, Leibenluft E. Frontotemporal alterations in pediatric bipolar disorder: results of a voxel-based morphometry study. Arch Gen Psychiatry. 2005 Jul;62(7):734-41). There also appears to be greater activation in the left amygdala of teenagers with bipolar disorder when they process facial expression, which has been shown in functional MRI images. (Rich BA, Vinton DT, Roberson-Nay R, Hommer RE, Berghorst LH, McClure EB, Fromm SJ, Pine DS, Leibenluft E. Limbic hyperactivation during processing of neutral facial expressions in children with bipolar disorder. Proc Natl Acad Sci U S A. 2006 Jun 6;103(23):8900-5.) Functional MRI's show the specific areas of the brain that are active from the increased blood flow to an active area.

The image above shows the amygdala in red. (Image is from Anatomography maintained by Life Science Databases (LSDB), Japan.)  Although the amygdala is not much bigger than an almond, it has many functions. It appears to have a major role in the processing of emotions, particularly fear and anger. It plays an essential role in learning from stress. A popular term, "amygdala hijack," refers to a strong emotional reaction that briefly takes over reasonable thinking.

The research shows that the left amygdala has slightly less volume and a significantly greater signal output in people with bipolar disorder. If the amygdala functions as a "volume control" on the emotions, then it is possible that the changes in bipolar disorder cause the volume control to be set at a higher intensity than is needed. People with bipolar disorder tell me that the experience this effect, when they are happy, they are too happy. When sad, they are too sad. When angry, they are too angry. When worried, they are too worried. The emotions that they experience are more intense than the situation calls for.

Although excessive emotions is part of bipolar disorder, it is not enough to diagnose bipolar disorder, or even be considered a definite early sign of this condition., It is important to try to identify children or teenagers who are on the way to developing bipolar disorder early, because with treatment, it is possible to avoid many of the problems, and sometimes even prevent the development of the full disorder.  The best way to determine the beginnings of bipolar disorder is to watch for definite manic episodes of high mood with rapid speech and decreased sleep alternating with depressed episodes of depressed mood with lower energy. The manic and depressed episodes lasts for days, and there can be times of relatively normal moods, energy, and sleep.

Many times, it is difficult to observe definite manic and depressed episodes that lasts for days. In my work with teenagers who were developing bipolar disorder, and adults who had bipolar disorder, I have found that there are four early symptoms, and having three of them appear to predict the development of bipolar disorder. The four symptoms are, (1) bouts of rapid thinking, (2) violent videos, (3) arguing in the mind, and (4) annoying sexual thinking.  The bouts of rapid thinking last 20 minutes to much longer, with the thoughts so rapid that reasoning or school work is not possible. Violent videos are highly graphic with blood and injury, generally occur during times of anger, but do not mean that the person will act out the violence. Arguing in the mind seems as though two people are intensely arguing in the thoughts, but it is not a hallucination.

I ask those who have or are developing bipolar disorder to follow five rules:

1. Manage rages
2. Avoid drama.
3. Don't trust your feelings.
4. Take medication.
5. Don't use drugs or alcohol.

Managing rages involves learning where the "switch" is, and to be able to avoid "flipping the switch" into an angry rage that dominates reason. Reducing anger can be done with an activity that uses the parietal lobe of the brain, which are visual activities or music. Avoiding drama means avoiding people and situations that brings unnecessary stress. Don't trust your feelings for making decisions, because the feelings are too intense or even out of control. Make decisions based on reasoning, logic, and good advise. The last two rules are easy to understand, take medication that is prescribed, and avoid alcohol as well illegal and unprescribed drugs, which can destabilize the mood.

Copyright 2010, Henry A. Doenlen, M.D. All rights reserved.