living with bipolar disorder

 

 

What’s it like living with bipolar disorder? Learning to ride the bipolar roller coaster 

by Tina Phillips, MSW

What is bipolar disorder?

Bipolar disorder is a psychiatric condition which causes intense mood swings, often between depression, or low mood, and mania, high mood. Most of us are familiar with depression, but may not be as familiar with mania.

Mania can cause different kinds of behavior including grandiosity or inflated self-esteem, pressured speech or talking fast, racing thoughts or flights of ideas, impulsivity or taking risks that put one in danger, and decreased need for sleep, among some other symptoms.

Some people with bipolar disorder experience paranoia, hallucinations, and delusions, among other psychotic symptoms. Not every person will experience all of these symptoms, but to be diagnosed with bipolar disorder a person must experience at least three of the diagnostic criteria. There are varying symptoms and it can be hard to recognize if one is not aware of how it manifests. It is important to be aware of what bipolar disorder looks like so one can seek diagnosis and treatment or help a loved one in need.

There are several subtypes of bipolar disorder and some consider bipolar disorder to be a spectrum disorder. Bipolar disorder is largely considered a serious psychiatric disorder and around 2.8 percent of the population has it. Bipolar disorder is considered one of the more stigmatized forms of mental illness, making it particularly hard for those who have it to recognize, acknowledge, seek treatment for it, and stick with treatment the rest of their lives in order to manage it. 

 

Types of bipolar disorder

 

Bipolar I

Bipolar I disorder is a mental illness comprising episodes of mania. Many have both episodes of mania and depression. To receive a Bipolar I diagnosis a person must have a mania last at least a week or be so profound that it requires hospitalization.

 

Bipolar II

Bipolar II disorder is a type of bipolar disorder where a person experiences depression with episodes of hypomania, which is not a full blown version of mania, but shares some features.

 

Cyclothymic disorder or cyclothymia

Cyclothymic disorder or cyclothymia encompasses a period of unstable mood in which a person experiences both hypomania and mild depression. This must last for at least two years to meet the criteria and sometimes one can experience leveling off periods of normal mood, but this usually lasts less than eight weeks.

 

Bipolar disorder, “other specified” and “unspecified”

Bipolar disorder, “other specified” or “unspecified” is when a person doesn’t meet the criteria for bipolar I, II, or cyclothymia, but does experience periods of abnormally elevated mood.

 

What causes bipolar disorder?

Scientists are still studying the cause of bipolar disorder, and it appears there are several complex factors at play. These include genetics, brain structure and chemical makeup, and stress/triggers. While each of these plays a part, there isn’t one reason scientists can pinpoint or say every person with bipolar disorder developed it because of something specific. Bipolar disorder is known to run in families, but there is no one gene responsible, and there is no direct connection between one family member to the next. There is some evidence that disruptions in a protein called Akt can lead to brain changes that can contribute to developing bipolar disorder. Also stressful events in our lives can sometimes be a trigger for an underlying condition to express itself. It is most common to see bipolar disorder develop in one’s late teens or early 20s. However, some people don’t get diagnosed until later years, and unfortunately many experience misdiagnosis, leading to many years of suffering without proper treatment.

 

What’s it like living with bipolar disorder?

I can speak from my own experience of living with bipolar disorder. Diagnosed at age 14, I have lived with bipolar disorder for a little over 25 years, more than half my life. I have Bipolar I, which means I have the most severe type of bipolar disorder. For me this includes manic episodes with psychotic features, such as hallucinations, delusions, paranoia, and complete black outs, in addition to most of the symptoms from the basic diagnostic criteria list.

It always starts out as feeling good, and ends with feeling bad. I develop a lot of energy and creative ideas, I come up with grand projects, I start to believe I have special powers, I start talking fast, I have a decreased need for food and sleep, I talk to complete strangers and become flirty, my inhibitions go away, but then my behavior becomes stranger as time goes on. I end up becoming so irritating to those around me, and I cannot believe it when they say there is something wrong with me. To me I am more than fine, I am great. It adds to my stress when others don’t believe what I am saying. My paranoia picks up and then the darkness takes over. 

In the early part of my life I had been on and off several different medications trying to find the right medication for me, working with different psychiatrists. I experienced three major manic episodes, and was hospitalized in a psychiatric ward twice. I stabilized on Carbamazepine in my early 20s and have been on it ever since. However I suffer from traumatic memories of those manic episodes even now. I also recently had an aggravation of my symptoms due to life stressors and had to add medication to treat bipolar depression. 

Although I am medicated I also experience some depression and a lot of anxiety, which I only recently learned is often a large part of bipolar disorder. Even after this long I am still discovering things about the disorder and how it manifests for me. It’s very complex, not every person experiences the exact same symptoms, and it can also shift throughout time. I am starting to look at my emotional patterns and seeing how my mood swings despite being on medication, which is frustrating, but part of the reality with living with bipolar disorder. 

I am still learning about what my triggers are, how to manage my bipolar disorder, and what about me is because of my bipolar disorder. Some of the things other people dislike about me are because of my bipolar disorder, and they aren’t things that can be medicated away. Things like my sensitivity, intense emotions such as anger, how fast and dramatically my mood can change, my anxiety, my loudness, my sleep schedule/being a night owl, my bluntness, and my bossiness. I have to remind myself that I don’t have control over what others think of me, and I need to learn to love myself, even the challenging parts of me.

Many people with bipolar disorder experience isolation and many lose family, friends, jobs, and romantic partners in part due to their bipolar disorder. This can make people feel ashamed for having it and it can lead to further depression. Despite the challenges and heart breaks bipolar disorder can bring to our lives, it’s not something we should be ashamed of. There is nothing we did to deserve having it, and there’s only so much we can do about it. It takes a lot of work to manage our moods and all the parts of life impacted by our disorder.

Sometimes bipolar disorder is like riding a roller coaster we cannot get off, but that doesn’t mean there is nothing we can do to improve the quality of our lives, learn to cope, and find treatments that work for us. There are many other experiences of bipolar disorder, and no two stories are exactly alike. 

 

Bipolar emotions: Intense and sensitive 

Many people with bipolar disorder are accused of being overly “intense” or “sensitive.” In fact, these are common traits and there’s not much one can do about this, as this is the person they are. Medications can stabilize moods to some degree, but some traits cannot be medicated away. People need to try to adjust to their loved ones, friends, or co-workers who display sensitivity and emotionality. When people in a persons’ life don’t try to accept their differences, it can leave a person with bipolar disorder feeling isolated, depressed, anxious, and misunderstood. Often stresses in life and mistreatment can lead to trauma and other disorders.

There are several common co-occurring disorders with bipolar disorder. These include ADHD, OCD, substance abuse disorders, anxiety, and eating disorders. Some of these may come along the same genetic line as bipolar disorder, but also could be triggered by stress in a person’s life. Some people use substances to self-medicate, and eating disorders are often a way for people gain control when they feel their lives are out of their control. In addition, suicide attempts and completed suicides are more common in people with bipolar disorder. In fact, “up to 20% of (mostly untreated) bipolar disorder subjects end their life by suicide, and 20–60% of them attempt suicide at least one in their lifetime.” Given such alarming rates, it’s vitally important we take a look at what can prevent people with bipolar disorder from attempting to take their own lives. Important factors in reducing suicide attempts include early diagnosis, effective treatment, and clinical interventions. 

 

Treatment for bipolar disorder

 

Medication

psychiatry

One of the main treatments for bipolar disorder is psychiatric medication. Medication can be very effective in helping to manage symptoms. There are a range of medications that treat mood disorders, mania, psychotic symptoms, anxiety, and depression. Many people with bipolar disorder see a psychiatrist regularly to help manage medications and make adjustments as needed. Some people require multiple medications to effectively manage their symptoms.

Many people with bipolar disorder struggle to take their medications or do not stay on their medications. Reasons behind this vary. Many experience side effects that become intolerable or they don’t like how the medication dulls their personality. Some people like the way mania makes them feel and are used to living life with mania, and go off of their medication to gain back what they feel like they lost. Some people start to feel better on their medications, and think they no longer need their medication. However, it’s often the medication that is making them feel better and once off the medication they can backslide.

Some people feel the pressure of the stigma of being dependent on medications, or worry about what other people think of them and cave to pressure of wanting to appear “normal.” This is ironic because medication actually stabilizes mood and can help people manage their condition, making them more functional. Some people worry being on medication for life will affect their long-term physical health or even shorten their lifespan.

It’s important not to judge people for their decision not to take medications because we don’t walk in their shoes. Respecting the self-determination of people with mental illness is key. We should work towards research that will develop new therapies that have less side effects. People with bipolar disorder should work closely with their healthcare team to address any concerns and adjust medications as needed. 

 

Therapy

Psychotherapy can also help people manage moods, learn their triggers, develop and practice coping skills, and find creative ways to regulate their mood. Several types of therapy have been shown effective in treating bipolar disorder including Cognitive Behavioral Therapy, Dialectical Behavioral Therapy, Family Focused Therapy, Interpersonal and Social Rhythm Therapy, and Group Psychoeducation. Group therapy also helps some people as they can talk with peers experiencing similar struggles, feel validation, and share social support.

Learning coping skills and having a wellness action recovery plan can really help people navigate the bipolar journey. Different techniques work for different people and so it’s important to be open to trying various tools and strategies to find which ones fit best for you. Some people also use apps to manage their symptoms or keep track of their moods. 

 

Finding balance: ways to manage bipolar disorder

There are many ways to manage bipolar disorder outside of traditional methods. These include exercise and other coping mechanisms such as art, journaling, and mindfulness/meditation, among other activities. Other important factors are proper nutrition, getting enough sleep, keeping a schedule/routine, and avoiding drugs and alcohol. Disruptions in these key factors can lead to mood destabilization or lead to medications being less effective. 

Furthermore, managing stress and triggers, relaxation and rest, and having social support are very important in managing bipolar disorder. Having places to go and community that is inclusive decreases stigma, gives people hope, and builds skills that help people recover. One such place is a clubhouse for those with mental illness. Putting together the right plan for each individual to successfully manage bipolar disorder may take some trial and error, but it’s worth the journey of exploration. It takes a lot of adjustment and readjustment throughout the lifespan to learn to ride the waves of bipolar disorder. It is not an easy life, but it is a life that can be worth living. Seeking help to manage the mood swings and creating a good quality of life through various coping skills and strategies is how we thrive through the ups and downs of life. 

 

Further resources and recommended reading

 

https://www.bphope.com/

https://www.dbsalliance.org/

https://www.dbsalliance.org/support/chapters-and-support-groups/find-a-support-group/

https://www.verywellmind.com/best-online-bipolar-disorder-support-groups-4802211

https://www.nami.org/

https://www.mayoclinic.org/diseases-conditions/bipolar-disorder/diagnosis-treatment/drc-20355961

https://www.nimh.nih.gov/health/statistics/bipolar-disorder.shtml

https://www.psychiatry.org/patients-families/bipolar-disorders/what-are-bipolar-disorders

https://www.rethink.org/advice-and-information/about-mental-illness/learn-more-about-conditions/bipolar-disorder/

https://www.psycom.net/what-i-wish-people-knew-about-bipolar-one-disorder

https://www.helpguide.org/articles/bipolar-disorder/living-with-bipolar-disorder.htm

https://www.helpguide.org/articles/bipolar-disorder/bipolar-disorder-treatment.htm

https://www.helpguide.org/articles/bipolar-disorder/helping-someone-with-bipolar-disorder.HTML

 

volunteer at an animal shelter

 

10 fun things to do if you’re depressed

 

The past year has driven most of us to live like angry tigers pacing tiny cages. Isolation isn’t natural and has serious side effects, but one can also cultivate a healthy solitude. Knowing yourself isn’t an easy process and it’s easy to get intimidated by the outside world and its standards and materialistic focus.

This article is for anyone. Even if you have a partner, invest in yourself. Trying new things alone is key to keeping your independence and understanding emotions as they pop up in your life. We learn through new experiences, and this helps to keep our brain young and happy. Living with purpose and open-mindedness makes life a lot more interesting than following someone else’s lead. 

If your’re depressed, try dating yourself. Dating yourself is fun. There’s no compromising – you get to choose what you do. It’s healthy for people in relationships too. Being in the constant company of your partner can be overwhelming and creates a dependence that’s bad for your mental health. 

Before I got married, I spent a lot of time by myself. I made continual efforts to entertain myself and explore who I am. I still date myself. Covid-19 changed my normal patterns. I try to visit a new place alone a few times a year. I haven’t been anywhere this year, and I’ve got a bad case of cabin fever.

 

traveling alone

 

While I’m eager to explore places like Romania and Greece, we have to be careful because the crisis isn’t over yet. A few of these suggestions require a little investment but rediscovering and reconnecting with yourself is worth every cent.

 

Go to the movies alone

This seems like a no–brainer. People watch television by themselves all the time but taking a weekday trip to the movies is fun. Most people don’t show up for the first showing of any film. Some theaters won’t care if you slip into a second movie if you buy concessions. I’ve spent entire days lost watching movies. 

go to the movies alone

 

Learn how to bake

I have mixed feelings about baking because it is technical. The quality of your tools, like measuring cups, scales, and other items will determine how well your efforts turn out. I’ve made some real stinkers because I wasn’t precise with the measurements.

A few years ago, I tried to make Red Velvet Cup Cakes, but I was sloppy with the chemistry and they turned out as dense as baseballs. My poor husband ate one with a smile on his face. That’s true love.

learn to bake

 

Meet a new city alone

I must admit traveling alone is my favorite thing in the whole world. You may want to wait a little while as the pandemic finally comes to an end but exploring a new place – even the next town closest to you might have something unexpected to find. The United States is an enormous place with people as different as Europe. It takes an estimated 40 hours of driving to get from one coast to the other. The drive is scenic particularly if you skip the big highways and take the smaller roads. Don’t freak out if you get lost. That is part of the adventure.

visit a city on your own

 

Check out your local cemetary

I’m from Lexington, Kentucky and our city cemetery is the most beautiful part of the entire city. There are mean ducks that might try to run you off if you get too close to the water or forget to bring grapes or other types of fruit. Bread is bad for ducks and other wildlife. I love cemeteries and I make visiting these monuments to past generations a priority when I visit a new city.

 

Volunteer 

There are endless opportunities to help others. The United States has a serious issue with homeless cats and dogs. Thousands are put to sleep every week because they aren’t enough homes for them all. Digging in and helping an animal rescue will make you feel good about yourself and you will be helping creatures that could die without you.

If helping animals isn’t your thing, then volunteer at a homeless shelter or any number of organizations that desperately need your help. From spending quality time with kids to digging in and helping feed those who sleep on the streets, there are endless opportunities to help out and you get a big dose of serotonin for your efforts.

 

Take yourself out to dinner

You might have to sit at the bar if the restaurant is full, but most bartenders are excellent listeners and offer advice and understanding. Alternatively, bringing a novel to dig your teeth into as you try a flight of beer or wines is a great way to spend an evening. You end up making new friends or at the very least hear some juicy details about someone else and their experience. You might feel a little uncomfortable at first but try to embrace the discomfort and watch and adventure unfold as you try something new.

 

Go to an aquarium

You must check out the ratings for any animal attraction. Don’t spend your hard-earned money on places that mistreat any creature. Ethical animal attractions might cost more than their less reputable counterparts, but do you want to see dolphins in tiny takes living like prisoners? No. Do your research before visiting any animal attraction.

 

Learn to grow veggies from table scraps

As the climate crisis rages forward it is crucial to embrace a circular economy. Green onions, potatoes, leeks, and herbs are foods you can grow on a window ledge. All you need to do for potatoes has cut them in half after they have grown a few eyes. Cut them in half and deposit them in deep soil. You will have potatoes by winter!

This is easy and quick to do, but if you have more time on your hands, you can start a larger veggie garden. Gardening reduces stress and negative emotions, it gives you a sense of responsibility and you get to nurture something and see it grow and thrive.

gardening with table scraps

 

Treat yourself to a spa day (or organize one at home)

A spa day is a luxury and if you do a little internet digging you might be able to grab a deal that makes the treatment more affordable. Or you could plan a spa day at home. A bath bomb, essential oil, bath salts, and a few candles and a pumice stone can change your bathroom from an ordinary experience into something truly relaxing, and you can add a face mask or even mix brown sugar and coconut oil for a more natural approach to getting a glow to your skin.

Take your time and pay attention to your feet. A proper foot rub is an easy way to improve your health and help you sleep. Magnesium flakes also can offer an extra element making bedtime a breeze. Magnesium is best absorbed through the skin which means if you have a deficiency, this is a great way to resolve the issue.

Get naked, paint your toenails, do yoga. Go crazy taking care of yourself. A full day dedicated to relaxation is a great way to get in touch with yourself and renew your mind and body.

 

 

Go to a show or a musical performance

Did you know you are more likely to make new friends and acquaintances when you’re all by yourself? Don’t be afraid to push to the front of the crowd and dance your pants off. This is another exhilarating situation, particularly if you are passionate about the music or play you are watching!

take yourself out

 

Bonus tip! Take a long walk!

Self reflection should shadow selfies. Understanding yourself and your emotions can be a complex issue to tackle and take hours or days to process. Being human is hard! Taking time to  breathe and think. If people made it common practice to be careful with their words and intentions even when speaking to themselves is becoming a focus throughout many health and wellness experts. 

Compassion for others is important, but compassion for yourself is more crucial than anything you can do for others because if you’re bullying yourself, then you need to readjust and pull that focus of care on you’re on well-being.

take a walk

  

 

 

how to stay healthy in the pandemic

 

How to be happy during the pandemic

By Lea

 

How can we stay mentally healthy during the pandemic? Better yet, how can we stay healthy with terrible pandemic management?

The healthiest thing I’ve done is stop watching the news, because it’s just bad news and viral boredom.

If there’s a good thing to be found in the pandemic, it’s that it’s exposing the insanity of our human society.

As technology advances, humanity regresses.

It seems that rather than stopping the pandemic, they want to keep it around, with vaccine shortages and spoiled vaccines. Here in Portugal, there are restrictions that don’t make sense and don’t seem to work, but they keep them in place anyways.

Why? Well… the measures don’t stop the virus, but they do kill small businesses. They don’t stop the virus, but end up causing more diseases. 

This is because health is not only physical, it is also economic, social, emotional, relational, spiritual, creative, and psychological. It is the balance of all these aspects of a human being.

This apparent disorganized handling of the pandemic makes me think of what Muadmar Gaddafi said in his 2009 speech at the UN:

Capitalist companies produce viruses so that they can generate and sell vaccinations. That is very shameful and poor ethics. Vaccinations and medicine should not be sold.”

Does anyone really win here? Yes, billionaires have added trillions of dollars to their pockets, however finding a “winner” now is like finding a winner in wars. Everyone is harmed, just some more than others.

We can find different theories to explain what is behind the virus, because although it has long ceased to seem like it, humans are rational beings. We simply cannot go against our nature, we need to give explanations, whether they are correct or not.

Below are some tips – based on what I’ve personally learned in my life – for how to be happy during the pandemic.

First, I want to emphasize that we cannot speak of our mind as something separate; it is linked to a physical, emotional, and social body. Therefore, if we want to speak of mental health, we must speak of health in all these areas.

We could say that our emotions have gone through an earthquake. Yes, the floor has moved, and now we have to relocate internally and externally.

A sense of humor

how to stay happy during a pandemic

Despite this upheaval, if we want to preserve our mental health, a sense of humor is an antidote to losing it. How can we maintain a sense of humor? By not letting ourselves be bombarded by the news, for one.

Create

By the way,  how is it possible that the same three or four news items pass through the 24 hour news cycle on repeat?

The world has eight billion people, and we are by nature creative. Are we losing our nature? If so, what are we, or what are we becoming?

Break some rules

Another antidote is to join the circus breaking some – just some – of the rules to survive. Because if you’re wondering if mental health is possible in over a year of confinement, the answer is no, of course it’s not! Humans are social beings. Contact with others is a necessity even for the least sociable among us. If we lose it, our balance falters.

 

Exercise

Another tip for emotional health, valid at any time, is physical exercise, and this is much better outdoors. I say this from experience, and it’s scientifically proven.

Eat more fruits and vegetables

Another good piece of advice – which no one has asked me but I’m sure you’ll gladly accept if you try it out – is a good diet. By this I mean less flour and sugar and more fruits and vegetables. Where else can you get vitamins and minerals? It’s the fuel for this vehicle called the body.
If you put the best fuel in your car, please remember to do it with your physical body; your emotional and mental body will also thank you.

Start practicing meditation

how to be happy in a pandemicIt’s a good time to practice meditation. We have time, since most of us don’t have to commute to work right now. You don’t need that much time, anyways. At first five minutes a day will be more than enough, and as you advance in the practice, you’ll be able to add minutes. (By this I mean: take advantage of starting to do it now, since many of us don’t know what to do with so much time at home. But don’t stop doing it when the pandemic ends.)

This is something that helps our psychic health, because it’s an important activity for our internal or spiritual world, which we have long forgotten, at least in the West.

Learn something new

Is there anything that you’ve thought about for a long time but never found out how to do? The internet can help you in that search, especially in the pandemic, since we spend so much time at home.

Think positively

Another tip to fight the pandemic and get away with it is to be attentive to our thoughts.

Careful! Depression begins with a sustained use of inappropriate or negative thoughts. Those thoughts are like opening a window in the daytime and seeing only darkness. So, also take care of the thoughts that feed your being. Thoughts can allow or give rise to certain sensations and feelings, this is another reason to choose them consciously.

Get into nature, and nurture your imagination

What happens when we stay indoors without giving ourselves the opportunity to be in open spaces, such as the mountains, the countryside, or the beach?

This absence of distant horizons leads us -if we are not aware- to the absence of distant goals. We stop dreaming, and dreaming is what gives us life or at least, the desire to live and continue.

So what we cannot do physically, let’s at least close our eyes and make it real in our imagination, because everything we do has to pass through our mind beforehand. Even what we say “arises”; it arose because you were open for that to arise.

 

 

 

mdma as a cure for ptsd

 

MDMA-assisted psychotherapy & PTSD: Revising our pasts

MDMA, or ecstasy, is what you take before you go clubbing, right? Or, during your therapy session – which it looks like we may all need after Covid. And by then MDMA-assisted psychotherapy may actually be available.

MDMA isn’t a classic psychedelic like LSD. It doesn’t exactly alter your reality (though it might be able to change your past). The drug, which makes you feel happier, confident, and more empathetic, was synthesized in 1912, but wasn’t used until the 1970s, when it enjoyed a brief therapeutic career. In the 1980s it was sold on the street as a party drug, and was swiftly criminalized in 1985.

On the street, ecstasy is seldom pure MDMA; it’s usually cut with other drugs like amphetamine. It’s true that it’s not as harmless as classic psychedelics like LSD or psilocybin, and overdose or heavy, long-term use can have serious consequences. Its use at raves have earned it a negative reputation in the press, but pure MDMA – when used sparingly – is relatively safe, and less addictive than most illicit drugs.

Anyways, now that psychedelics are becoming more acceptable, the media is changing its mind and shedding light on MDMA’s seemingly magical powers to alleviate – if not cure – PTSD. And these days, there’s more trauma than ever.

The more we talk about PTSD, the more it shows up. One could even say we live in a traumatized society. Around 10% of people in the US are estimated to have PTSD at some point in their lives, and about 3.5% of the population in any given year. But those are the official estimates.

PTSD as a diagnosis was created to describe the symptoms of Vietnam War veterans. However we’re now learning that not only war, but everything from bullying, to living in poverty, to racism, to having Covid can cause PTSD. It’s also common in first responders like paramedics, who have to witness traumatic events on a daily basis. Whether or not we catch the “disease” depends less on the objective event as it does on the person, how they experience it, and the support they receive immediately afterwards.

Oppressed groups such as racial minorities and people in poverty are more likely to experience long-term stress and traumatic events. And those who don’t know they have PTSD are at greater risk of being retraumatized. This can lead to its new, stronger variant, C-PTSD (trauma is also mutating).

The only currently approved treatments for PTSD are SSRIs and psychotherapy, in particular exposure therapy. In exposure therapy, the patient recalls the traumatic event(s) in safe contexts over time. This is supposed to promote “fear extinction”, or an unlearning of the fear response. It turns out patients don’t tend to like remembering their traumas over and over again, and it has high dropout rates. Neither antidepressants nor exposure therapy are very effective in treating PTSD, with only around half of patients responding.

MAPS, an organization founded in 1986 to promote the research of psychedelics, has been at the forefront of MDMA research. MAPS decided early on to focus on MDMA because it’s the drug that best lends itself to therapy, and it had the potential to treat PTSD, which has no strong treatment alternatives. They’ve been trying to conduct research with veterans since 1990, with no luck because of the stigma, despite the huge need; over one million veterans are on disability for PTSD.

“The real motivation, why I’ve kept going for so long, is that humanity as a whole is, I would say, massively mentally ill,” said MAPS founder Rick Doblin in an interview.

 

Towards an understanding of PTSD

More people with anxiety, depression, and even addictions are realizing that these problems are often rooted in trauma. This was the approach of early psychoanalysts, that psychological problems sprang from childhood trauma (though people like Freud created weird theories around it, like “this person is anal retentive because they experienced a trauma during the very scientific phase of potty training”).

Behavioral psychology and medical explanations have dominated since the mid-20th century, because it’s more profitable to treat human beings like lab rats than traumatized subjects. Acknowledging the sources of trauma would also mean addressing the deep inequities in our society. However the popularity of people like the doctor Gabor Maté, who says that all addiction is rooted in trauma, has helped bring trauma theory back.

And now that we now know a lot more about the brain, there’s some biological understanding of how PTSD works (and MDMA, too).

PTSD changes our brain structure. As we revisit the memory or it’s cued in our environment by a “trigger”, our bodies secrete stress hormones like adrenaline and cortisol to respond to the threat, and our bodies reactivate the fight, flight, freeze, or fawn response. Our hippocampus measures and regulates cortisol, but too much wears it down, and so it shrinks. Meanwhile, cortisol continues to signal the fear center of the brain, the amygdala, which grows as we maintain a state of hypervigilance. The pre-frontal cortex, which is responsible for thinking and can rationally tell your amygdala to calm down, also shrinks as the amygdala grows. So people with PTSD have a smaller pre-frontal cortex and hippocampus, which translates to deficits in thinking, learning, and memory, and a larger amygdala, making them more sensitive to fear. 

Of course this hypervigilant state was meant to respond to real threats in our environment, but PTSD is usually maladaptive, playing traumatic memories or their reminders and fear responses on loop.

It’s worth noting that memories aren’t only visual. As a study of traumatic experience notes:

“Episodic memory can present itself in parts… [it] might appear as an inner vision, a sound, or just a hint – a brief sensation in the belly or a strong pain in the chest.”

 

MDMA-assisted therapy offers hope

“We know from brain scans of PTSD patients that PTSD changes people’s brains, and MDMA can change it back in almost the exact same way,” said Doblin. 

“So, where PTSD increases activity in the amygdala (the fear processing part of the brain), MDMA decreases activity in the amygdala. PTSD decreases activity in the prefrontal cortex (where we think logically), MDMA increases activity in the prefrontal cortex. PTSD makes people feel isolated, alone, mistrustful, but MDMA builds trust and connection.”

MDMA increases the availability of the neurotransmitters serotonin, norepinephrine, and dopamine, while releasing hormones including oxytocin, cortisol, prolactin, and vasopressin.

This neurobiological cocktail puts subjects in an ideal therapeutic state. It provokes a sense of peace and safety, makes them more introspective and open, and more trusting in their relationship with their therapists.

And in combination with psychotherapy, it appears that MDMA heals trauma in about two-thirds of cases.

It wasn’t with veterans, but MAPS was finally able to conduct their first study in 2008. It was such a success that the FDA granted MDMA-assisted psychotherapy Breakthrough Therapy Designation in 2017, fast-tracking the research. 

In 2020, MAPS aggregated the follow-up data for six phase 2 trials of MDMA-assisted psychotherapy. All of the trials were conducted similarly, with participants undergoing eight psychotherapy sessions, two of which lasted eight hours and involved MDMA. 

At treatment exit, 56% of participants no longer met the criteria for PTSD. However in the one year follow-up this number had increased, and 67% of participants no longer met the criteria, while over 90% had a clinically significant reduction in symptoms. These are magical numbers. A follow up of an older study is even more promising, suggesting that the benefits of MDMA treatment for PTSD canlast at least 3.5 years.

MDMA-assisted psychotherapy for PTSD is now in phase 3 trials, which are expected to be completed in 2022, and the therapy could be approved by the FDA as soon as 2023.

In case the government wasn’t sold on the benefits, MAPS produced a separate study estimating that making MDMA-assisted psychotherapy available to just 1,000 patients with PTSD would reduce general and mental health care costs by $103.2 million over 30 years. So for a million veterans, it would save $103.2 billion.

 

Positively changing our memories

MDMA & PTSD

MDMA-assisted psychotherapy is thought to treat PTSD through memory reconsolidation. It increases the connectivity between the hippocampus and amygdala, which may indicate a heightened capacity to emotionally process fear-related memories.

It turns out that when we recall memories, they become malleable. There’s a small window in which they “reconsolidate”, and we can modify and update them. The events themselves may not change, but the way we remember them, and especially the feelings we have associated with them, do.

We do this all the time. For example if you once looked back on a fun experience with a partner fondly, but then found out that partner cheated on you, you might remember that same experience differently – perhaps with sadness, anger, or a sense of betrayal.

When we recall trauma memories and our adrenal receptors in the amygdala are activated, those memories are reinforced from a place of fear. Continually recalling the same memories with the same emotions may be what underlies the long-term nature of PTSD.

MDMA therapy is like the opposite of that. The key is reconsolidating memories in a positive state. First you enter a safe, happy state of mind, and only then do you recall memories with your therapist, process them, and reconsolidate them.

MDMA allows us to visit the ghosts from our pasts from a place of empathy or compassion. Without fear, we can see through them and give them new meanings. We can make peace with them, and lay them to rest.

Can you use MDMA to treat yourself? You can try, but I wouldn’t recommend it. You’ll need the psychotherapy help you to integrate your experience and process your trauma, but to pick up the pieces of your life that trauma has left in its wake.

Doblin says the end goal of the MAPS project is “mass mental health”. If phase 3 trials are successful and MDMA-assisted psychotherapy is approved by the FDA, MAPS will focus on researching group therapy for PTSD, as well as other indications for MDMA.

Because MDMA is thought to stimulate prosocial behavior, MAPS is also studying MDMA-assisted psychotherapy as a treatment for social anxiety in autistic adults. It’s also being investigated for couples therapy and addiction.

 

magnesium for depression, anxiety, and stress

 

How magnesium relieves anxiety, depression, and stress

Magnesium is fundamental to many processes in our bodies; it plays a role in over 300 biochemical reactions necessary for our physical homeostasis. It supports the cardiovascular system, endocrine system, and digestive system. It prevents the hyperexcitability of neurons that results in anxiety, stress, and cell death. For this reason it’s also being investigated as a preventative treatment for neurological diseases such as Alzheimer’s, Parkinson’s, and stroke. Magnesium also reduces the risk of heart disease, lowers blood pressure, and reduces the frequency of migraines.

Magnesium deficiency is extremely common

magnesium for depression, anxiety, and stress

Most people aren’t getting enough magnesium – it’s estimated that about 68% of all adults in the US are deficient in this essential mineral.

Why? Most processed foods are stripped of their natural magnesium. For instance, refined flour contains only 16% of the magnesium found in whole wheat. So much pasta, so little Mg! 

Water treatment facilities also tend to filter magnesium out of our drinking water. Poor diet is strongly linked to magnesium deficiency, and other factors like excessive alcohol intake and stress can also deprive our bodies of much needed magnesium.

Magnesium deficiency can cause anxiety, depression, weight gain, fatigue, insomnia, irritability, muscle cramps, diabetes… the list goes on.

Several studies have established magnesium’s efficacy in treating depression and anxiety. In one recent study, daily use of magnesium significantly reduced symptoms of depression  and anxiety within just two weeks.

Magnesium deficiency, stress, and neural atrophy

So how does magnesium work? Because magnesium is so vital to so many processes, its role in relieving depression is multi-faceted. However one way is by regulating the HPA (hypothalamic-pituitary adrenocortical) axis – our body’s main stress response system, which controls the secretion of our stress hormones. 

A second way magnesium may act to curb anxiety is by preventing glutamate from excessively binding to NMDA receptors. Glutamate is the main excitatory neuro-transmitter in our brains, and anxiety provokes an overactivation of NMDA receptors. Over time, these neural pathways become reinforced, and chronic overactivation of these receptors causes the death or atrophy of complementary neurons, resulting in neurological dysfunction. Long term, the cell death caused by NMDA overactivation causes a loss of neuroplasticity, and even  brain damage.

Don’t freak out – you can reverse this process and grow new brain cells. However, this neuronal death and atrophy causes key areas of the brain to shrink, a core physiological feature of depression. The hippocampus, which is responsible for learning and memory, is 10-20% smaller in patients with stress-related disorders like major depression and PTSD.

Have you ever heard it said that a depressed person has “stopped growing”? Well, this may be more than figurative – the hippocampus is also where all new neurons are born (perhaps thousands a day in healthy adults), so damage to neurons in the hippocampus may also limit our ability to form new neurons. If our ability to create new brain cells is stunted, it can affect our entire brain, literally limiting our ability to learn and grow. The prefrontal cortex, the area of the brain responsible for planning, cognition, creativity, self-expression, and social behavior, also tends to be smaller in people suffering from depression.

Magnesium may also support serotonin production, and increase the availability of GABA, the inhibitory neurotransmitter that relaxes us.

New neurons, neurogenesis and neuroplasticity

In short, magnesium deficiency can lead to excess anxiety and stress, which can in turn cause neurons and areas of the brain to atrophy, a central feature of depression. The good news is that you can reverse a lot of this damage by stimulating the growth of new neurons, which is called neurogenesis. Since all new neurons are born in the hippocampus, learning is a great way to stimulate neurogenesis. Exercise is also a classic way. Sex is said to help, too, by way of relieving stress.

Another experimental class of treatments, psychedelics, increases neuroplasticity and may even stimulate neurogenesis. Psychedelics reverse depression-related neuronal atrophy by stimulating the growth of dendritic spines and synapses in existing neurons. These are the very ends of neurons, where they communicate with other neurons. More and stronger synapses mean new connections and neural pathways, which translates to new ideas, thoughts, creativity, and growth.

Your brain will also need magnesium in order to create nucleic acids, which are essential parts of neurons and all living cells.

What type of magnesium should I take?

As with many supplements, absorption is a factor. Magnesium comes in many forms. Look for supplements with magnesium glycinate or magnesium chloride, which are thought to be among the most easily absorbed by the body.

Of course, mental health is complex; biological mechanisms interact with social,  environmental, and historical factors. However nourishing your mind and body by getting enough magnesium is an excellent place to start to feel better.