New Insights into Bipolar Disorder: Understanding Emotional Extremes and Effective Therapies

𝐇𝐚𝐯𝐞 𝐲𝐨𝐮 𝐛𝐞𝐞𝐧 𝐝𝐢𝐚𝐠𝐧𝐨𝐬𝐞𝐝 𝐰𝐢𝐭𝐡 𝐛𝐢𝐩𝐨𝐥𝐚𝐫 𝐝𝐢𝐬𝐨𝐫𝐝𝐞𝐫?

Sadly, more and more people are receiving this diagnosis, finding themselves fluctuating between extreme highs and very low lows, and then back up again. It can feel like a continuous struggle—almost as if you're wrestling with life itself.

𝘈𝘯𝘥 𝘺𝘦𝘵, 𝘯𝘰 𝘰𝘯𝘦 𝘴𝘦𝘦𝘮𝘴 𝘵𝘰 𝘩𝘢𝘷𝘦 𝘵𝘩𝘦 𝘱𝘦𝘳𝘧𝘦𝘤𝘵 𝘢𝘯𝘴𝘸𝘦𝘳 𝘵𝘰 𝘩𝘦𝘭𝘱.

The mainstream mental health field often presents this illness as having no definite cause, and while we do our best to help with the therapies and approaches that offer some relief, it’s often just a small piece of the puzzle.

𝐁𝐮𝐭 𝐰𝐡𝐚𝐭 𝐢𝐟 𝐈 𝐭𝐨𝐥𝐝 𝐲𝐨𝐮 𝐭𝐡𝐚𝐭, 𝐰𝐢𝐭𝐡 𝐚 𝐬𝐥𝐢𝐠𝐡𝐭 𝐬𝐡𝐢𝐟𝐭 𝐢𝐧 𝐩𝐞𝐫𝐬𝐩𝐞𝐜𝐭𝐢𝐯𝐞, 𝐭𝐡𝐢𝐬 𝐝𝐢𝐬𝐨𝐫𝐝𝐞𝐫 𝐜𝐨𝐮𝐥𝐝 𝐚𝐜𝐭𝐮𝐚𝐥𝐥𝐲 𝐬𝐭𝐚𝐫𝐭 𝐭𝐨 𝐦𝐚𝐤𝐞 𝐦𝐨𝐫𝐞 𝐬𝐞𝐧𝐬𝐞?

The key is to organise its three different components in a specific order, rather than mixing them all together.

𝐖𝐡𝐞𝐧 𝐈 𝐝𝐢𝐝 𝐭𝐡𝐢𝐬, 𝐭𝐡𝐞 𝐫𝐞𝐬𝐮𝐥𝐭 𝐰𝐚𝐬 𝐢𝐧𝐜𝐫𝐞𝐝𝐢𝐛𝐥𝐞—𝐬𝐢𝐦𝐩𝐥𝐞 𝐚𝐧𝐝 𝐥𝐨𝐠𝐢𝐜𝐚𝐥!

So, what exactly did I do? I arranged the components as follows: emotions, thoughts, behaviours—the classic order in emotional trauma.

The brain’s primary goals are:

1. Survival

2. Safety

3. Seeking pleasure

When the brain receives information about existing emotional wounds, it operates with these fundamental goals in mind, guiding its responses and strategies.

Heart-Brain-Body Axis: The Cycle of Emotional Pain, Chemical Responses, and Behavioural Adaptations in Bipolar Disorder

Bipolar disorder is a complex mental and emotional health condition characterised by extreme mood swings that include emotional highs (mania or hypomania) and lows (depression). These mood shifts significantly affect a person’s thoughts and behaviours, making it crucial to understand the nuances of this condition for effective diagnosis and treatment.

Stressful life events, trauma, or significant changes (such as the loss of a loved one or a major life transition) can trigger the onset of bipolar disorder or exacerbate existing symptoms caused by emotionally painful childhood experiences.

1. Initial State: Emotional Pain/Trauma

• Pre-existing Emotional Pain: The heart holds one or many emotionally painful memories that continually broadcast distress to the brain through the vagus nerve. This ongoing transmission of pain prompts the brain to create chemicals that induce sensations of discomfort, sadness, or despair in the body.

2. Brain's Creation of Chemicals and Adoption of Behaviours

• Creation of Chemicals to Feel Pain: In response to the emotional distress, the brain produces chemicals such as cortisol and pro-inflammatory cytokines. These chemicals have the role of creating the sensation of emotional pain within the body, reflecting the emotionally traumatic memory recorded within the heart.

  • Associated Behaviours: As a result of these chemicals, the individual may exhibit behaviours like withdrawal from social interactions, reduced physical activity, or avoidance of previously enjoyable activities. These behaviours are driven by the body’s heightened awareness of emotional pain, which the brain reinforces through chemical signals.

3. Counter-Balancing Behaviours and Chemical Responses

• Brain's Strategy to Counteract Pain: To counteract the prolonged presence of pain-inducing chemicals, the brain identifies and prompts behaviours that will create counter-balancing chemicals. These behaviours are intended to shift the body away from the sensations of pain and towards a more energized or elevated state.

  • Adoption of Manic Behaviours: The brain instructs the individual to engage in behaviours that are likely to produce chemicals associated with heightened energy and mood. This includes activities like taking on numerous projects, excessive socialising, impulsive spending, or engaging in risky behaviours. These behaviours are the brain’s attempt to generate dopamine, norepinephrine, and glutamate, which counteract the depressive chemicals and create a sense of euphoria or heightened energy.

• Creation of Manic Chemicals: As the individual adopts these behaviours, the brain produces an increased amount of dopamine and norepinephrine. These chemicals inform the body that it is in a state of heightened external engagement, attempting to distract or elevate the individual from the persistent emotional pain originating from the heart.

4. Overcompensation and Brain's Intervention

• Overproduction of Manic Chemicals: When the brain's strategy of creating counter-balancing chemicals goes too far, the body experiences an overabundance of dopamine and norepinephrine. This overcompensation leads to the extreme behaviours characteristic of mania, such as reckless decision-making, sleeplessness, or an inflated sense of capability.

  • Brain's Corrective Action: Recognising the imbalance, the brain intervenes to prevent the manic chemicals from causing harm. It begins to downregulate these chemicals, attempting to restore a sense of normalcy. However, this intervention can lead to a crash, where the individual transitions from a manic state back to a depressive state, as the brain tries to re-establish equilibrium.

5. The Cyclical Nature of Emotional Pain and Chemical Responses

• Continuous Broadcast of Emotional Pain: Throughout this cycle, the heart continues to broadcast emotional pain to the brain, keeping the process in motion. The brain’s efforts to counteract the pain, create balance, and manage the resulting chemicals and behaviours lead to the cyclical nature of bipolar disorder.

  • Associated Cyclical Behaviours: The individual’s behaviours oscillate between the withdrawal and inactivity of depressive states and the hyperactivity and impulsivity of manic states. The brain’s continuous adjustment to the heart’s broadcasted pain results in these alternating behaviours as it attempts to maintain balance.

Conclusion: Understanding the Heart-Brain-Body Axis

This understanding of the heart-brain-body axis highlights that the heart's continuous broadcast of emotional pain drives the brain to produce chemicals that induce sensations of pain in the body, leading to specific behaviours. To counteract these sensations, the brain directs the individual to engage in behaviours that produce counter-balancing chemicals, often leading to manic episodes. When these manic chemicals become excessive, the brain intervenes to restore balance, though the emotional pain from the heart (recorded in the Intracardiac Nervous System) remains a constant force.

The body’s experience throughout this cycle reflects the brain’s attempts to manage and regulate the ongoing emotional pain. By understanding this axis, new treatment approaches should focus on addressing the underlying emotional pain transmitted by the unprocessed painful memories recorded in the heart, aiming to break the cycle of distress, overcompensation, and imbalance.

Current Treatment Options

Currently, bipolar disorder is considered to be a lifelong condition.

The below is the classic treatment aimed at managing the symptoms, but not treating them. The primary treatments include:

• Medication- to counteract the chemicals created by the brain:

  • Mood Stabilisers (e.g., lithium) help regulate mood swings.

  • Antipsychotics (e.g., quetiapine) are often used during manic episodes.

  • Antidepressants may be prescribed during depressive episodes, though they are usually combined with mood stabilizers to prevent triggering mania.

• Psychotherapy

  o Cognitive Behavioural Therapy (CBT) helps individuals identify and change negative thought patterns adopted following the painful emotional reality.

  • Psychoeducation provides patients and families with information about the disorder, improving adherence to treatment.

• Lifestyle Changes:

  • Regular Exercise: Can help regulate mood.

  • Healthy Sleep Patterns: Maintaining a consistent sleep schedule is crucial.

  • Stress Management Techniques: Such as mindfulness or relaxation exercises.

My proposed treatment:

• Emotional Trauma Therapy: To access and resolve the initial emotional trauma that is contributing to depressive episodes. This therapy focuses on identifying, processing, and integrating emotionally painful memories. This and other trauma-specific therapies can be used to close and heal these unresolved traumas, thereby eliminating their ongoing impact.

• Lifestyle Changes: A thorough examination of the person’s current life experiences to identify sources of ongoing emotional distress and implement improvements. This may involve strategies such as stress management, setting healthy boundaries, improving work-life balance, and fostering supportive relationships to minimise emotional strain.

• Somatic Therapy: To facilitate the release of existing and newly created stress chemicals stored in the body. This includes:

  • Regular Exercise: Engaging in physical activity helps to "burn off" the chemicals that were created to translate emotional pain into bodily sensations. Through exercise, these chemicals are safely released, alleviating the emotional burden on the body.

  • Deep Breathing and Meditation: These practices promote emotional circulation within the body. Extended exhalations during deep breathing help to release stagnant emotions, clearing them from the body and reducing the brain's workload in translating and "solving" these old emotions.

  • Yoga: Integrating physical postures, breathing exercises, and meditation, yoga aids in both releasing stored emotional stress and achieving physical and emotional balance.

  • Healthier Diet: Nutritional adjustments support brain function and mood regulation by providing essential nutrients and stabilising blood sugar levels, contributing to overall emotional well-being.

  • Healthier Sleep Patterns: Quality sleep is vital as the brain uses this time to process and "solve" the emotions accumulated throughout the day. Ensuring sufficient and restorative sleep helps the brain manage and integrate emotional experiences, enhancing overall emotional health.

Incorporating these approaches can effectively address emotional pain, support the body's natural healing processes, and improve overall well-being.

Understanding Bipolar Disorder: Emotions-Thought Patterns – Coping Behaviours

As mentioned above, bipolar disorder is a complex mental health condition characterized by extreme mood swings that include emotional highs (mania or hypomania) and lows (depression). These mood shifts can significantly affect a person’s thoughts and behaviours, making it crucial to understand the nuances of this condition for effective diagnosis and treatment.

1. Emotional Symptoms

The emotional aspect of bipolar disorder is marked by severe fluctuations between two distinct states: mania (or hypomania) and depression.

• Manic/Hypomanic Emotions:

  • Euphoria: An exaggerated sense of happiness or elation.

  • Irritability: Increased sensitivity, quick to anger.

  • Agitation: Heightened restlessness and an inability to relax.

• Depressive Emotions:

  • Sadness: Deep and persistent feelings of sorrow.

  • Hopelessness: A pervasive sense of despair and a belief that nothing will improve.

  • Anxiety: Excessive worry or fear, often without a clear reason.

During these episodes, the brain’s neurotransmitters, particularly serotonin, dopamine, and norepinephrine, are imbalanced. In manic states, there is often an excess of dopamine, which can contribute to the heightened energy and euphoria. In contrast, depressive episodes are associated with lower levels of serotonin and norepinephrine, contributing to feelings of sadness and lethargy.

During depressive episodes, in addition to diminished serotonin and norepinephrine levels, there are other neurochemical and hormonal changes that occur, some of which involve increased production of certain chemicals. Here are a few key ones:

1. Cortisol:

   • Increased Levels: Cortisol, often referred to as the "stress hormone," is typically elevated during depressive episodes. Chronic stress and depression are associated with prolonged activation of the hypothalamic-pituitary-adrenal (HPA) axis, leading to increased cortisol production. Elevated cortisol levels can negatively impact mood, energy levels, and cognitive function.

2. Glutamate:

   • Increased Levels: Glutamate is an excitatory neurotransmitter that has been found to be elevated in individuals with depression. Excessive glutamate activity is linked to neurotoxicity, which can contribute to the symptoms of depression, such as cognitive deficits and mood disturbances.

3. Pro-inflammatory Cytokines:

   • Increased Levels: Depression is associated with a heightened inflammatory response, which leads to the increased production of pro-inflammatory cytokines, such as interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-alpha). These cytokines can affect brain function and contribute to the development and persistence of depressive symptoms.

These biochemical changes highlight the complex nature of depressive episodes in bipolar disorder, where not only are certain neurotransmitters reduced, but there is also an increase in chemicals that contribute to stress, inflammation, and excitatory neurotransmission, further exacerbating the depressive state.

2. Thoughts and Thought Patterns

Bipolar disorder can profoundly influence a person’s cognitive processes, leading to distinct thought patterns during manic and depressive episodes.

• Manic/Hypomanic Thoughts:

  • Racing Thoughts: Rapidly moving from one idea to another, often with little coherence.

  • Grandiosity: An inflated sense of self-importance or ability, sometimes bordering on delusion.

  • Distractibility: Difficulty maintaining focus due to constant stimulation by new thoughts and ideas.

• Depressive Thoughts:

  • Pessimism: A negative outlook on life, expecting the worst outcomes.

  • Worthlessness: Feelings of inadequacy and low self-esteem.

  • Suicidal Ideation: Persistent thoughts about death, dying, or ending one’s life.

These thought patterns are influenced by the same neurotransmitter imbalances that affect emotions. For example, excessive dopamine during mania can lead to delusional thinking, while low serotonin during depression can cause pervasive negative thinking.

3. Behavioural Symptoms

Behavioural changes in individuals with bipolar disorder are a direct result of their emotional and cognitive states, leading to noticeable shifts in actions and decision-making.

• Manic/Hypomanic Behaviours:

  • Impulsivity: Engaging in risky activities, such as spending sprees, reckless driving, or unprotected sex, without considering the consequences.

  • Increased Activity: Taking on numerous projects or tasks simultaneously, often without completing them.

  • Decreased Need for Sleep: Feeling rested after only a few hours of sleep, or staying awake for long periods without fatigue.

• Depressive Behaviours:

  • Social Withdrawal: Avoiding interactions with others, isolating oneself from friends and family.

  • Fatigue: A lack of energy that leads to difficulty in completing everyday tasks.

  • Changes in Appetite: Either a significant increase or decrease in eating, leading to weight gain or loss.

Chemical Reactions in the Body

During bipolar episodes, the brain’s neurochemistry is significantly affected:

• Manic Episodes: Increased dopamine levels can lead to heightened pleasure and reward-seeking behaviours. Elevated norepinephrine levels can contribute to increased arousal and alertness.

• Depressive Episodes: Low levels of serotonin and norepinephrine are common, leading to mood disturbances, lack of energy, and increased anxiety.

Understanding Bipolar Disorder as a Pattern of Chemical Behaviour: The Brain's Attempt to Escape Emotional Pain During Depressive Episodes

The brain is actively trying to help the body escape emotional pain during depressive episodes. As such, we can outline a pattern of chemical behaviour that reflects the brain's adaptive or compensatory mechanisms. These neurochemical changes, though they may seem maladaptive, are actually the brain's attempts to restore balance and protect itself from prolonged emotional distress.

1. Initial State: Depressive Episode

• Low Serotonin and Norepinephrine: The depressive state is characterised by reduced levels of serotonin and norepinephrine, crucial neurotransmitters for regulating mood, energy, and alertness. This deficiency directly contributes to the symptoms of sadness, low energy, and hopelessness.

2. Brain's Response to Emotional Pain

• Increased Cortisol Production: In response to emotional pain, the brain activates the hypothalamic-pituitary-adrenal (HPA) axis, leading to increased cortisol production. The rise in cortisol is the brain’s effort to mobilise energy reserves and enhance alertness, attempting to "push" through the depressive state.

• Inflammatory Response: The brain increases the production of pro-inflammatory cytokines as part of an emergency response to stress. This inflammation serves as a protective signal, preparing the body to fight off stressors. However, in depression, this response becomes prolonged, leading to neuroinflammation that exacerbates depressive symptoms.

3. Compensatory Mechanisms in the Brain

• Increased Glutamate: The brain increases glutamate levels to boost cognitive function and energy. Glutamate, being an excitatory neurotransmitter, enhances brain activity to counteract the sluggishness of depression. However, if not properly regulated, this increase leads to excitotoxicity, contributing to cognitive symptoms and further mood disturbances.

• Dopamine Dysregulation: To counter the low motivation and reward sensitivity in depression, the brain upregulates dopamine in specific pathways. This explains why some individuals experience moments of agitation or irritability within a depressive episode, as the brain oscillates between states of hypo- and hyper-dopaminergic activity in its attempt to find balance.

4. Transition to Mania as an Overcorrection

• Overcompensation: The brain’s compensatory mechanisms can overshoot, triggering a manic episode. When the brain's attempt to increase dopamine or glutamate goes too far, it leads to the hyperactivity, euphoria, and impulsive behaviours characteristic of mania.

• Increased Dopamine and Norepinephrine: In transitioning to mania, the brain experiences an upsurge in dopamine and norepinephrine, which counteracts the depressive lethargy. However, this overcorrection results in the extreme highs of mania, which are just as destabilizing as the lows of depression.

5. Cyclical Nature and the Brain's Feedback Mechanisms

• Feedback Loops: The brain utilises feedback mechanisms to modulate these extremes, which explains the cyclical nature of bipolar disorder. When neurotransmitter levels become too high during mania, the brain downregulates them, inadvertently triggering a depressive episode, and vice versa.

Conclusion: Adaptive Mechanism

In this view, the brain's chemical behaviour during depressive episodes is a deliberate attempt to escape emotional pain, employing various strategies to restore balance. These mechanisms, though well-intentioned, can become overcompensatory, leading to the cyclical nature of bipolar disorder.

The brain's efforts to "self-correct" from the depressive state involve ramping up neurotransmitters and stress responses in a way that is intended to help, but can sometimes push the individual into mania or exacerbate depressive symptoms. Understanding this adaptive yet flawed mechanism could influence how we approach treatment, focusing on reducing the need for these compensatory processes rather than just targeting the symptoms of each phase.

Psychotherapist Ana Maria Stoica

Emotional Trauma Clinics

The Palms Health and Wellbeing Centre

Gorey, Co. Wexford, Ireland

Y25 V6P6

www.emotionaltraumaclinics.com

ana@emotionaltraumaclinics.com