Bipolar, depression, ADD and the amygdala

Just finished listening to Frederick M. Jacobsen, MD, a psychiatrist-scientist and clinical professor of psychiatry at George Washington University, give a cool talk last night at the GWU Hospital auditorium on research on the response of people who have bipolar, depression and ADHD/ADD to strong emotional stimuli, a surgical treatment for depression, diagnosing bipolar disorder, the bipolar spectrum and the degenerative nature of mania and depression (e.g. more episodes increases the likelihood of more and worse episodes). Dr. Jacobsen pioneered research into the use of Trazadone, an anti-depressant, as a sleeping medication, and has a special interest in bipolar. He is a researcher, a teacher and treats patients.

Dr. Jacobson discussed research by Helen Mayberg, M.D., a professor at Emory, into the reactions at patients with bipolar, depression and ADHD/ADD have in the amygdala portion of the brain when given stimuli. The amygdala is the region of the brain that governs memory and emotional reactions. Dr. Jacobsen noted that the research ha shown that people with bipolar had greater oxygen flow to the amygdala than control patients or depressed patients, and that patients with ADHD had increased responses, but not as much as those on the bipolar spectrum. The underlying implication is that those with bipolar disorder might have heightened, most intense and more acute observations and responses to emotionally threatening situations, followed by those with ADHD and then trailed by depressed and control patients. Dr. Jacobson also discussed Dr. Mayberg's research on surgical implants to fight depression -- called deep brain stimulation -- saying that it "shows a high rate of response" even though "many surgeons don't want to get anywhere near it." Illustrating the degenerative nature of bipolar disorder without treatment, Dr. Jacobsen discussed recent research that shows that those with unipolar depression and bipolar depression have a 50 percent chance of a reoccurrence of a depressive episode after their first one, a 70 percent chance of reoccurrence after the second episode and a 90 percent chance of reoccurrence after the third episode.

He discussed at the factors believed to contribute to the development of bipolar disorder, including an individual's biological vulnerability coupled with chemical mood regulatory changes, trauma and situational events. Dr. Jacobsen argued, against general medical belief, that mania and hypomania can be diagnosed in those with abuse substances or have general medical conditions, such as lupus, that are known to induce mania. Dr. Jacobsen discussed the definition of bipolar disorder, calling it a spectrum of illnesses. He said that anyone who has had a single manic episode is labeled as Bipolar I, and that Bipolar I is the illness that was once called Manic Depression. He said that those with Bipolar II, Cyclothymia and Recurrent Depression do not fit into the definition of Manic Depression but are on the bipolar spectrum. He said Bipolar I, or Manic Depression, only makes up 10 percent of the bipolar spectrum. At the same time, it makes up the vast majority of the people who seek consistent help. He discussed rapid cycling -- where individuals switch between normal, hypomania, mania and depression in rapid cycles -- and mixed state -- where mania and depression present at the same time with anxiety, agitation and irritability.

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