These are my notes from The Huberman Lab Podcast episode #82 + some of my own research. I am a BIG fan of Dr. Huberman and his podcast.

This episode was great! Andrew describes:

• what Bipolar Disorder is and its two types
• how to identify it and diagnose it (although it should be done by a psychiatrist)
• the consequences of having Bipolar Disorder
• the most effective ways and therapies to treat it

Let’s go for it.

Bipolar Disorder/Depression (BPD)

Bipolar disorder/depression (which will be used indistinctively) is a condition in which people undergo massive shifts in energy, perception, and mood.

These shifts are maladaptive and can cause tremendous damage to the people suffering it and to the people surrounding them.

Statistics

Bipolar disorder impacts 1% of people.

Someone with BPD has a 20–30% greater chance of suicide than the general population.

The typical age of onset is 20 to 25 years old. The earlier the onset of a bipolar episode, the higher likelihood that the bipolar disorder will be a stable feature in that person

Two Types of Bipolar Disorder

Bipolar Disorder 1

BPD 1 is characterized by an extended period of mania (elevated mood, energy, distractibility, and impulsivity).

This manic episode is extreme. The symptoms are very noticeable to the outside people, but not always to the person suffering it.

Diagnostic Criteria

A person displays these manic episodes for 7 days or more. The psychiatrist evaluates 7 symptoms:

1. Distractability: can they focus?
2. Impulsivity.
3. Grandiosity.
4. Flight of ideas: having lots of thoughts on lots of topics at the same time.
5. Agitation.
6. No sleep (or very minimal) — and some weird feature is that they are not worried about not sleeping, unlike people with insomnia.
7. Rapid pressure speech — they don’t offer any opportunity for conversation.

To be diagnosed with bipolar disorder 1, the patient needs to suffer from at least 3 symptoms for seven consecutive days.

However, there are other things that can make you have manic episodes (brain damage, seizures, drugs, steroids). So even if you suffer 7 days in a row, you may still not be diagnosed with bipolar disorder

BPD 1 does not mean that the patient is also dropping into a depressive episode.

Bipolar Disorder 2

BPD 2 is characterized by manic episodes and depressive episodes (hypomania).

Hypomania: somewhat depressed level of mania. Manic episodes can be of low duration or low intensity.

Diagnostic Criteria

Criteria to diagnose: the presence of manic episodes that are lasting 4 days, or even less.

Another distinctive aspect of BPD 2 is depressive episodes. This is the key difference between the two types.

Study:

People with BPD 1 spend 50% of their time symptom-free. Depressed state about 32% of the time. Manic state about 15% of the time.

People with BPD 2 spend 50% of their time in a depressed state (serious depression). Symptom-free 45% of the time. Hipomaniac state 5% of the time.

Negative Consequences of Bipolar Disorder

Global burden measure: years lost in normal life due to some disability.

The global burden of BPD is massive. Particularly, having BPD1 is extremely debilitating.

Heritability

If one identical twin has a major depressive disorder, there’s a 20–45% chance that the other has it as well. So, it’s not all about genes.

If one identical twin has Bipolar depression, there’s a 40–70% likelihood that the other has it.The genetic component is much higher in BPD than in depression.

The genetic contribution to bipolar disorder is as high as 85%.

People with BPD very likely have a set of genes that create a susceptibility for bipolar disorder to emerge.

However, 85% is not 100%. There’s always an environmental factor that could be improved to not trigger the BPD gene.

Borderline Personality Disorder (BLPD)

BLPD can indeed present itself in ways that resemble BPD.

How do they differ?

The key distinction is that BLPD often has an environmental trigger for that episode.

On the other hand, people with BPD have these episodes without any trigger.

People with BLPD go from loving and absolutely adoring someone, to feeling attacked by that person and feeling very angry and disappointed.

Treatments for Bipolar Disorder

Lithium

How was lithium discovered for BPD Treatment?

Australian psychiatrist who became a prisoner of war from 1942 to 1945. He observed his fellows suffering manic episodes. He hypothesized that people had a chemical building up in their brains that made them maniacs.

He took urine from people with mania and people without and studied it injecting them into guinea pigs. He found that when he gave them the urine from people who suffered maniac episodes, the guinea pigs suffered as well.

He used lithium to dilute uric acid, and when he did that, he discovered that he could calm the guinea pigs that were suffering maniac episodes by injecting that compound.

Lithium has a profound effect on reducing symptoms of mania.

You need to do a lot of blood tests in the first months of using lithium.

Why does it work?

• Lithium increases Brain-derived neurotrophic factor — BDNF(is permissive for neuroplasticity).
• Is a potent anti-inflammatory.
• Is neuro-protective: it can prevent neurons from dying under certain conditions (hyperactivity can kill many neurons).

Two Modes of Perception: Enteroception and Exteroception

People with BPD have very diminished levels of enteroception, so they don’t notice their manic episodes.

Hyperactivity leads to the atrophy of the neural circuits that allow enteroception, and lithium protects the body from this neurotoxicity

Two main neural circuits

Study — Connectomics (analysis of connections of neural circuits in the brain).

Results: people who have a BPD have deficits in the connectivity between parietal brain regions and the limbic system.

The limbic system is responsible for shifting the overall state that you are in (i.e. from relaxed to alert).

The parietal lobe is not able to suppress the limbic system in people with BPD.

Insula region disrupted. The insula allows enteroception.

Key Concept: Homeostatic Plasticity

Homeostatic plasticity is a form of neuroplasticity in which overall circuits can become more (less) active by the addition (removal) of more receptors in the postsynaptic neuron.

If a neural circuit is overactive, there are changes that lead to a homeostatic regulation (a sort of balancing), so that this circuit is no longer overactive.

Whether or not a neural circuit become more (or less) active in the context of homeostatic plasticity depends on this one mechanism.

Lithium and Ketamine exert their action through effects on homeostatic plasticity.

Lithium

When neurons are exposed to lithium there is a reduction in the excitability in the postsynaptic neuron.

Ketamine

Ketamine does the opposite. It increases excitability by making circuits more active. Ketamine is used for depression. While its effects are very potent, they are transient… so it has to be done repetitively.

Other Therapies

Drug therapies are going to be more effective when done with talk therapies.

But talk therapy on its own is rarely (if ever) effective for BPD.

Still, talk therapies can support drug therapies.

1- Cognitive Behavioral Therapy

Progressive exposure of the patient to some of the triggers that would exacerbate BPD. Even though BPD does not require triggers… IF there are any triggers, the situation can get even worse.

2- Family-Focused Therapy

Family members can be excellent windows into whether or not someone is doing well or not (suffering maniac episodes)

3- Interpersonal Social Rhythm Therapy

It is an expansion on family therapy. Focuses on how people are relating to others.

4- Electroconvulsive Therapy (ECT)

It induces a seizure in the patient’s brain.

It’s an effective treatment for major depression. It stimulates the massive release of neuromodulators as well as BDNF.

The problem with ECT is that it only treats depression, not mania.

ECT is also quite invasive, it’s very costly, requires anesthesia, and there’s often some memory loss.

5- Transcranial Magnetized Stimulation

It is a tool that reduces the amount of activity in particular neural circuits.

Positive: It’s not invasive.

However, it is still a very early technique.

6- Psilocybin

It’s a psychedelic

It’s being explored in human patients to treat OCD, depression, and other things.

There are no studies on psilocybin for the treatment of manic episodes.

7- Cannabis

Does not seem to be effective for the maniac episodes.

The only thing it could help with is Sleep, which would act directly in improving the patient’s health, but it does not improve the symptoms of BPD.

8- Lifestyle

Getting better sleep, exercise, nutrition, social relationships, sunlight… they are indirectly shifting the likelihood of an episode

9- Nutrition

Two substances: Inositol & Omega 3 fatty acids.

Inositol: is a compound that reduces anxiety and enhances sleep. It can enhance the membrane fluidity (how readily things can flow around in cells)

Omega 3 fatty acids: also enhance membrane fluidity. Supplementing with omega 3s can deteriorate the symptoms of BPD. However, other study shows that high doses can be beneficial.

Creativity & Occupations

There is some association between creativity and psychiatric disorders.

Those in the military, professional athletes, and natural and social sciences have a very low percentage of mania or depression.

At the opposite extreme (poets, fiction writers, artists): as many as 90% had either depression or mania. 75% of highly accomplished poets had depression.

I hope you found these notes useful, but I still highly recommend watching the entire episode.

I post these notes for every Huberman Lab episode. If you liked it, please feel free to check out the ones that are already published as well.

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