The Science & Treatment of Bipolar Disorder | Huberman Lab Podcast #82
Andrew Huberman・116 minutes read
The Huberman Lab Podcast delves into bipolar disorder, discussing its characteristics, treatments like lithium, and the importance of accurate diagnosis due to its severity and high suicide risk. Various treatments, lifestyle interventions, and supplements like omega-3 fatty acids play a role in managing bipolar disorder, emphasizing the need for a comprehensive treatment approach.
Insights
- Bipolar disorder, characterized by significant mood shifts, poses a severe risk of suicide, emphasizing the crucial need for understanding and addressing this condition.
- The podcast delves into the biology of mood shifts, treatments like lithium, and the importance of recognizing and diagnosing bipolar disorders, particularly bipolar 2 which may be overlooked due to its fluctuating nature.
- Lithium, a successful treatment for bipolar disorder, discovered by Cade during World War II, has neuroprotective and anti-inflammatory effects, impacting neural circuits and preventing neurotoxicity.
- Various treatments for bipolar disorder, including lithium and ketamine, can effectively manage both manic and depressive episodes, but caution is advised when considering commercial clinics for treatments like rTMS.
- Lifestyle interventions, omega-3 supplementation, and drug therapy from a board-certified psychiatrist are crucial for managing bipolar disorder's severity and high suicide risk, emphasizing the need for a comprehensive treatment plan.
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Recent questions
What is bipolar disorder?
Bipolar disorder involves extreme mood shifts.
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Summary
00:00
"Bipolar Disorder and Brain Mechanisms Explained"
- The Huberman Lab Podcast discusses science and science-based tools for everyday life, hosted by Andrew Huberman, a professor at Stanford School of Medicine.
- Today's topic is bipolar disorder, characterized by significant shifts in energy, perception, and mood, which can be maladaptive and harmful.
- The podcast delves into the biology behind these mood shifts and explores various treatments, including the historical discovery and effects of lithium.
- Bipolar disorder poses a severe risk of suicide, emphasizing the importance of understanding and addressing this condition.
- Major depression is also a common issue, affecting up to 20% of people, with significant treatment developments discussed.
- The podcast covers basic brain mechanisms like neuroplasticity and how the brain regulates mood, energy, and perception.
- The Huberman Lab Podcast is now partnered with Momentous Supplements, offering high-quality single-ingredient formulations for various benefits like sleep enhancement and focus.
- A recent study in the journal Cell highlights the role of GLP-1, a peptide that suppresses appetite through parallel pathways in the gut and brain.
- GLP-1, stimulated by compounds like yerba mate, can lead to mild gut distension and increased satiety, aiding in weight loss and appetite suppression.
- The podcast also emphasizes the importance of understanding parallel pathways in biology, where brain and body act together through independent or bidirectional mechanisms.
12:20
"ROKA Glasses, Blinkist App, Bipolar Disorder"
- ROKA glasses and sunglasses designed for performance, staying on during physical activities and being lightweight.
- ROKA eyeglasses used for reading and driving at night, sunglasses for bright daytime conditions.
- To try ROKA glasses, visit roka.com and use code Huberman for a 20% discount on the first order.
- Blinkist app offers condensed nonfiction books for quick consumption in 15-minute key takeaways.
- Special offer for Huberman Lab Podcast listeners: free seven-day trial and 20% off a Blinkist premium membership at blinkist.com/huberman.
- Bipolar disorder affects about 1% of the population, with a higher incidence of suicide.
- Typical age of onset for bipolar disorder is 20 to 25 years old.
- Two main types of bipolar disorder: bipolar 1 and bipolar 2.
- Bipolar 1 characterized by extended periods of mania, with specific diagnostic criteria.
- Symptoms of manic episodes include distractibility, impulsivity, grandiosity, flight of ideas, agitation, no sleep, and rapid pressured speech.
24:52
Diagnosing Manic Episodes in Bipolar Disorder
- Manic episodes in bipolar disorder can include symptoms like distractibility, impulsivity, grandiosity, flight of ideas, agitation, no sleep, and rapid pressured speech.
- To be diagnosed with a manic episode, a person needs to exhibit at least three of these symptoms for at least seven days.
- Diagnosis of bipolar 1 requires the presence of these symptoms for at least seven days, ruling out other potential causes like traumatic brain injury, seizures, or medication side effects.
- The challenge for psychiatrists lies in accurately diagnosing manic episodes, as individuals may present differently at different stages.
- Bipolar 1 disorder involves extended manic episodes without necessarily transitioning into depressive episodes.
- Bipolar 2 disorder includes both manic and depressive episodes, with hypomania being a less intense form of mania lasting for shorter durations.
- People with bipolar 2 may spend about half their time in a depressed state, with shorter and less intense manic episodes.
- Individuals with bipolar 1 spend about 50% of their time symptom-free, 32% in major depression, and 15% in manic states.
- Those with bipolar 2 spend about 45% of their time symptom-free, 50% in a depressed state, and only 4-5% in hypomanic states.
- Understanding the percentages of time spent in different states can aid in recognizing and diagnosing bipolar disorders, especially bipolar 2 which may go unnoticed due to its fluctuating nature.
37:52
"Bipolar 2 Disorder: Self-Medication and Burdens"
- People with bipolar 2 disorder may self-medicate with alcohol or substances, leading to changes in behavior that may not always be obvious.
- Hypomanic states in individuals with bipolar disorder may appear normal to others, especially if they were previously in a depressed state.
- Awareness is crucial to identify individuals who may be suffering from bipolar 2 disorder, even if they seem depressed or isolated.
- Bipolar disorder can lead to significant emotional, occupational, and educational burdens, impacting the ability to engage in normal activities.
- The global burden of bipolar disorder is measured by the years lost due to disability, with bipolar disorder ranking high among disabilities.
- Genetic factors play a significant role in bipolar disorder, with a high heritability rate of 85%.
- Studies on genetic concordance show a higher likelihood of bipolar disorder in identical twins compared to major depression.
- Environmental factors can trigger the expression of bipolar disorder in individuals with a genetic susceptibility.
- Borderline personality disorder differs from bipolar disorder in that it often requires an external trigger for mood shifts.
- Understanding the distinctions between bipolar disorder and borderline personality disorder is crucial for accurate diagnosis and treatment.
52:01
Lithium: Treatment for Bipolar Disorder Success
- Bipolar disorder involves extreme highs and lows, impacting individuals negatively.
- The relationship between bipolar disorder and creativity is strong, despite the disorder being challenging.
- Lithium is a successful treatment for bipolar disorder, discovered before understanding its biological basis.
- Lithium, a naturally occurring element, was discovered by an Australian physician, Cade, during World War II.
- Cade hypothesized that uric acid buildup in the brain caused mania, leading to experiments with guinea pigs.
- Injecting lithium urate into guinea pigs calmed them, indicating lithium's calming effect.
- Cade's experiments led to successful treatment of human patients with lithium, reducing manic symptoms.
- Lithium treatment requires careful monitoring due to its toxicity and individual response variations.
- Lithium's lack of patentability delayed its availability for bipolar disorder treatment until 1970 in the US.
- Despite its side effects, lithium remains a successful treatment for many individuals with bipolar disorder.
01:05:51
New Treatments for Bipolar Disorder: Lithium Insights
- The toxicity and issues associated with lithium necessitate the urgent need for new treatments for bipolar disorder.
- Understanding lithium's cellular and neural circuit mechanisms is crucial for discovering new treatments.
- Lithium treatment increases BDNF, a factor linked to neuroplasticity.
- BDNF permits neural changes based on environmental conditions.
- Lithium is anti-inflammatory and can suppress inflammation in neural tissues and the brain.
- Lithium is neuroprotective, preventing neurons from dying under certain conditions.
- Lithium can prevent neurotoxicity caused by hyperactivity in certain brain areas.
- People with bipolar disorder experience atrophy in neural circuits for interoception, affecting their ability to register internal states.
- Lithium's effects on inflammation and neuroprotection can counteract the atrophy of neural circuits in bipolar disorder.
- Studies show deficits in connectivity between brain regions in individuals at high genetic risk for bipolar disorder, emphasizing the importance of understanding neural circuitry in the disorder.
01:19:32
Limbic System: Balancing Alertness and Calmness
- The limbic system is a collection of brain structures responsible for shifting states from relaxed to alert.
- It is linked to the autonomic nervous system, regulating sleep cycles, digestion, hunger, and alertness levels.
- The limbic system acts as a volume control for alertness and calmness levels.
- Disruptions in the limbic system's circuitry are associated with bipolar disorder.
- The parietal lobe interacts bidirectionally with the limbic system in individuals with bipolar disorder.
- Bipolar individuals exhibit deficits in internal awareness and top-down control over energy levels.
- Lithium benefits bipolar depression treatment by preserving neural circuits for interoception and top-down control.
- Homeostatic plasticity is a form of neuroplasticity that balances neural circuit excitability.
- Neurons communicate through neurotransmitters released into synapses, influencing postsynaptic neuron activity.
- Lithium reduces postsynaptic neuron excitability, while ketamine increases it, impacting neural circuit activity.
01:32:26
Bipolar Disorder Treatment: Lithium, Ketamine, and More
- Ketamine is a potent chemical FDA approved for major depression treatment, but its effects are transient.
- Lithium reduces manic episodes in bipolar disorder by protecting neural circuits from excitotoxicity through neuroprotection.
- Lithium diminishes circuit activity by downregulating receptors, preventing neurotoxicity.
- Treatment for bipolar disorder requires addressing both manic and depressive episodes.
- Lithium and ketamine are key treatments, but there are many other drugs available for bipolar disorder.
- Clozapine, an antipsychotic, is used to sedate individuals in manic episodes.
- Drug therapies are most effective when combined with talk therapies for bipolar disorder.
- Cognitive behavioral therapy is the most effective talk therapy for bipolar disorder.
- Family-focused therapy involves family members in the patient's treatment and helps predict triggers.
- Interpersonal and social rhythm therapy focuses on relationships and social interactions in bipolar disorder treatment.
01:46:20
Innovative Treatments for Bipolar Disorder Management
- Repetitive Transcranial Magnetic Stimulation (rTMS) is minimally invasive and has shown effectiveness in increasing neuroplasticity and reducing depressive episodes and manic episodes in bipolar disorder.
- Commercial clinics are starting to advertise rTMS, but caution is advised when approaching these clinics without a strong association with a research institution.
- rTMS is used in university hospitals and clinical settings to reduce limbic circuit activity and manage manic episodes by either reducing excitability or activating neural circuits.
- Ketamine therapies are also used for depressive aspects of bipolar disorder, but may be less effective for those without depression.
- Psilocybin, a psychedelic, is being explored for major depression and eating disorders, showing impressive results, but controlled trials for mania in bipolar disorder are lacking.
- Cannabis is not effective for treating manic or depressive phases of bipolar disorder, with limited potential for aiding sleep in some individuals.
- Lifestyle interventions like proper sleep, exercise, nutrition, social interactions, and sunlight can support individuals with bipolar disorder but are not sufficient on their own for managing the condition.
- Inositol and omega-3 fatty acids are two supplements showing promise in adjusting bipolar disorder symptoms, with inositol affecting second messenger pathways and cell membrane fluidity.
- Inositol can enhance sleep and reduce anxiety, while omega-3 fatty acids found in fish oil can change cell membrane function, particularly in neurons.
- Lifestyle interventions are important but drug therapy from a board-certified psychiatrist is crucial for managing bipolar disorder due to its severity and high suicide risk.
01:59:40
Omega-3 Supplementation in Bipolar Disorder: Effects and Considerations
- Omega-3 supplementation can help offset the effects of mania and depressive episodes in bipolar disorder.
- Studies have shown varied results on the effectiveness of omega-3 supplementation through fish oil, with some finding no effect.
- Fish oil can be taken in capsule or liquid form, with liquid form being more cost-efficient and capsules being more palatable.
- Supplementing with high doses of omega-3 fatty acids, such as four grams per day, may worsen symptoms of mania.
- A study in 1999 found that high-dose supplementation of 9.6 grams of fish oil per day reduced symptoms of bipolar depression significantly.
- High-dose omega-3 supplementation seems beneficial for many with bipolar disorder but should not be the sole treatment approach.
- Omega-3 supplementation can improve depressive and manic symptoms in bipolar disorder, but it should be part of a comprehensive treatment plan.
- Brain imaging studies show that omega-3 fatty acid treatments can impact neural circuits and cell membranes in people with bipolar disorder.
- Certain occupations, like poets and artists, have a higher incidence of depression or mania, suggesting a link between creativity and mood disorders.
- While there is a relationship between mania and creativity, it is essential to consider the maladaptive effects of bipolar disorder and the need for comprehensive treatment approaches.
02:13:40
Differentiating Mental Health Disorders and Treatments
- Distinguishing between sadness, depression, and major depression is crucial, as well as recognizing the difference between being erratic, energized, and having bipolar disorder.
- Obsessive-Compulsive Disorder (OCD) is a severe condition, not to be confused with obsessive-compulsive personality disorder or tendencies that can benefit individuals.
- Bipolar disorder, whether BP-1 or BP-2, is associated with high suicide risk and should not be casually labeled as being "bipolar" without understanding its seriousness.
- A deep dive into bipolar disorder, including its manic and depressive components, various forms, major treatments like lithium, and the neural and chemical basis of treatments such as homeostatic scaling.
- Understanding the importance of neurotransmitters like serotonin, dopamine, and acetylcholine in mental and physical health, as well as the significance of omega-3 fatty acids and drug treatments in maintaining overall well-being.
