Sarah Troy writes:
I am not a doctor. I have bipolar disorder. My responses are based on my own experience, reading and research.
QUESTION: “I know bipolars begin to experience cognitive damage with each untreated manic episode but do BPs on medication also experience this cognitive damage?”
Yes. Bipolar is a progressive, organic brain disease.
Bipolar is a major mental disease (or disorder). Research on the major mental disorders, such a bipolar, schizophrenia, major depression, and Alzheimer’s disease, shows: A) Deterioration of the brain occurs slowly over the lifespan in each of these disorders. B.) This deterioration is both structural and functional. C) There are differences between how the brain looks in each of these disorders. In other words, the brain of a bipolar has structural and functional deterioration that is different from the brain of a major depressive disorder. D) In each of these disorders, we know that active phases of the disease, or “episodes,” accelerates brain deterioration.
In bipolar, the “episode” used as the marker for brain deterioration is the hypomanic or manic episode. So, one thing observed in bipolars is that as they age (due to the underlying organic deterioration) “episodes” of hypomania or mania gradually become more intense and frequent, with a fewer number of years between episodes. This pattern of deterioration occurs in all bipolars, whether they are un-medicated, under-medicated, or medicated.
There is simply no “cure” for bipolar.
Does medication slow the progressive nature of the disease? Yes, because effective treatments (medications) for bipolar decrease the intensity or frequency of hypomania or mania, or increase the number of years between episodes.
Therefore, a bipolar who is effectively (adequately) medicated will experience less brain deterioration over time than a bipolar who is under-medicated or un-medicated.
Do we know more about lithium than other bipolar meds? Yes. Because lithium has been studied the longest, we know more about it than any other bipolar medication. Research shows effective treatment with lithium can, in some people, help the brain to heal the damage done by “episodes.” Can other bipolar meds do this? We just don’t know. More research is needed.
How much of a difference is there between the brains of effectively (adequately) medicated bipolars and the brains of un-medicated or under-medicated bipolars? A lot. It has been established for a while that the brains of untreated Schizophrenics deteriorate similarly to the brains of Alzheimer patients over time. Now, the newer research is showing that the brains of untreated bipolars deteriorate like the brains of untreated schizophrenics over time. Hence, the brains of untreated bipolars have been compared to the brains of Alzheimer’s patients over time.
http://www.bipolar-lives.com/ bipolar-brain-imaging.html – Accelerated shrinking of grey matter of brain
http://www.pendulum.org/ disease.htm#enlargedventricles - Disease process of Bipolar and Schizophrenia
http://www.amenclinics.com/ brain-science/spect-image-gallery/spect-atlas/images-of- bipolar-disorder-and- schizophrenia/ – Images of Bipolar disorder and Schizophrenia
http://www.loni.ucla.edu/ ~thompson/projects.html – Current neuroscience projects