Brain Damage and Bipolar

Hello Everyone, I hope I'm finding you in good spirits! Today I wanted to explore the possibility of bipolar disorder causing brain damage. I know personally I can't recall much of my college courses. There are gaps in my memory. My case manager form the local mental health authority told me she's pretty sure manic episodes cause permanent damage in the brain. That's why the doctors try to keep us level on meds. Since she didn't seem too sure I decided to do some looking myself. Here's what I found:

Bipolar disorder does in fact cause damage to the brain. A study by researchers at the San Francisco VA Medical Center indicates that people with bipolar disorder may suffer progressive brain damage. 

“For the first time, our study supports the idea that there may be on-going damage to certain regions of the brain as the illness progresses,” said the study’s lead author Raymond Deicken, MD. Deicken is the medical director of the Psychiatric Partial Hospital Program at the San Francisco VA Medical Center and UCSF associate professor of psychiatry."

The study appears in the May issue of the American Journal of Psychiatry.

"Researchers determined chemical signatures of different brain structures in these two groups using proton magnetic resonance spectroscopy. One finding focused on the level of an amino acid called N-acetylaspartate, or NAA, in the hippocampus, which is made up of a right and left half and is part of a complex of neural circuits in the brain that regulate emotion and memory.
 
The study found significantly lower concentrations of NAA in the right hippocampus of males with bipolar disorder when compared to the control group. They also found that for the right hippocampus, bipolar patients who had the disease the longest had the lowest levels of the amino acid. This association between length of illness and NAA appears to be confined to certain brain regions since it was not found in previous studies that involved the frontal lobe and thalamus.

NAA is the second most abundant amino acid-next to glutamate-present in brain tissue. It is a biochemical indicator of the presence of neurons and axons, plays an important role in the synthesis of neuronal proteins, and is a precursor of myelin, which acts as insulation around neurons in the brain.

“Low NAA is an indication that the integrity of neurons and/or axons has been compromised in some way, either by damage, loss or dysfunction,” Deicken said. The decrease of hippocampal NAA over time in the test subjects indicates a progressive nature of this disease. Decreasing levels of NAA are also seen in neurodegenerative diseases like Alzheimer’s disease, Parkinson’s disease, and multiple sclerosis.

According to Deicken, the findings also confirm the important role of the hippocampus in bipolar disorder. Brain imaging studies of patients suffering from major depression have demonstrated smaller hippocampi. Given that bipolar disorder also affects mood and emotion, it is not surprising that this study provides evidence for hippocampal damage or dysfunction in the disorder.  The hippocampus is also important from a therapeutic standpoint since it is one of two brain regions where new neuronal growth, or neurogenesis, can occur, offering hope for reversal of damage.
NAA measurements may also help us to understand how medications work in bipolar disorder.

Additional authors of the study include Robert Feiwell, MD, UCSF assistant clinical professor of radiology; Brain Soher, PhD, SFVAMC Magnetic Resonance Unit; Mary P. Pegues, MSW, and Susan Anzalone, BA, research associates, SFVAMC Psychiatry Service. Deicken’s research was supported by the National Institute of Mental Health and a Stanley Foundation Research Award from the National Alliance for the Mentally Ill." Source



Stephen M. Stahl, M.D., Ph.D. suggests neurons may be damaged by the very process of ferrying angry, malfunctioning chemical and electrical events. As symptoms are shipped about the brain, they may leave behind weakened or sinking neurons due to the triggering of neuronal death by apoptosis or necrosis. Some symptoms may be associated with the fading away of neurons by a quiet process of designer cell death called apoptosis. Other symptoms may be associated with excitotoxic neuronal explosions due to chemical failure and, ultimately, messy necrosis. He too suggests staying on medication to prevent future damage. Source


"A lengthy review article by Carrie Bearden PhD et al of the University of Pennsylvania published in Bipolar Disorders cites "findings of persistent neuropsychological deficits" in long-term bipolar patients, even when tested in symptom-free states. The relationship between these deficits and length of illness led the authors to suggest that "episodes of depression and mania may exact damage to learning and memory systems." An article by FC Murphy PhD and BJ Sahakian PhD of Cambridge University in the British Journal of Psychiatry draws a similar conclusion: "The balance of evidence ... supports a hypothesis of residual cognitive impairments."

Father Time appears to be a major factor. Dr Bearden et al cite a study that found that chronic, multiple-episode patients exhibited more severe cognitive impairment than younger patients or patients who remit, and that these impairments were not restricted to their affective episodes. The same study found 40 percent of the patients were rapid-cyclers. Another study found that of 25 patients initially hospitalized with mania with no signs of cognitive impairment, one third showed significant cognitive impairment five to seven years later.

Also, it appears that our current bipolar medications actually repair and protect brain cells, which is one of the better arguments for staying compliant. Further research in this area may produce new drugs with enhanced neuroprotective properties." Source


Here are some more useful links with study abstracts:
Increased excitotoxicity and neuroinflammatory markers in postmortem frontal cortex from bipolar disorder patients

Acute mania is accompanied by elevated glutamate/glutamine levels within the left dorsolateral prefrontal cortex.

Frontal lobe function in bipolar disorder: A multichannel near-infrared spectroscopy study


It looks like we do have some damage occuring after all. Just one more reason to stay on our meds instead of seeking that manic high. What are your thoughts?