Sex and Bipolar: The Conversation Continues

John McManamy Health Guide
  • This is the second installment in our conversation about sex and bipolar. As I noted in my opening piece, a lot has been written on sex and a lot on bipolar but virtually nothing on the two together. Let’s see if we can change that, starting with how the sex drive affects our capacity to make decisions.

    One thing the brain science is emphasizing loud and clear is that our reason guides us far less than we think. This is not necessarily a bad thing. What we are learning is that the cortical (thinking) areas of our brain need input from the limbic (emotional) areas of the brain in order to figure things out. When the chips are down, we choose what “feels good” to us and are repelled by what “feels bad.”

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    At the risk of vastly over-simplifying, it appears that once the ventral tegmental area (VTA) - the dopamine-sensitive region in the midbrain that mediates pleasure and reward - is activated, the thinking parts of the brain are in a losing battle to assert dominion. If you doubt this, ask yourself about some of your recent purchases.

    Again, this is not necessarily bad. The cortex can be flooded with too much information and easily tricked into making bad choices. Some of my most deliberative efforts have resulted in disaster. On the other hand, my pure-impulse buy of an iPhone two years ago amounted to one of the wisest decisions of my life.

    Jonah’s Leher’s 2009 “How We Decide” brilliantly lays this out, and is well-worth reading cover-to-cover.


    So - how does sex enter into it? Back in 2004, I heard Rutgers anthropologist Helen Fisher discuss a 2002 study of hers that involved scanning the brains of young people in love. When the subjects looked at photos of their sweethearts, the right VTA lit up like a Christmas tree. At the same time - the amygdala - fear central - went silent.

    “Hey, Jude, don’t be afraid. You were meant to go and get her.” In evolutionary terms our genetic future is too important to entrust to the thinking parts of the brain.

    According to Dr Fisher, there are three separate (but overlapping) phases to the process of boy-meet-girl, involving different (but inter-related brain systems). First, we have lust (the craving for sexual gratification), driven by androgens and estrogens). Then there is attraction, what we call romantic love, characterized by euphoria when things are going well and terrible mood swings when they are not, plus obsessive thinking, intense craving, and focussed attention. Dopamine is surging and serotonin ebbs. Finally, things settle down to the sense of calm and stability that one feels with a long-term partner. The feel-good hormones oxytocin and vasopressin come into play.

    As I heard Dr Fisher explain it: “I think the sex drive evolved to get you out there to get looking for anything at all." Romantic love developed to focus one’s mating energy on just one individual, while attachment works to tolerate this individual long enough to raise children as a team.


    But the tendency of brain systems to talk to one another raises enormous complications. Androgens such as testosterone may kickstart dopamine while an orgasm may elevate the attachment hormones. "Don’t copulate with people you don’t want to fall in love with," Dr Fisher jokes, "because indeed you may do just that."

  • This hardly means romantic love is not real. It’s just that brain science is validating centuries of song and poetry. When we go “crazy for you,” this is no exaggeration. We are guided by our emotions. Even the chronically normal get swept away. In the words of the immortal bard:

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      In things right true my heart and eyes have erred,
       And to this false plague are they now transferred.

    But our bipolar adds an additional complication. As Chris reports, in response to my opening piece:

    Recently I was in relationship with a man who I fell madly in love with. He was charming, fun-loving, giving, passionate. We connected to each other in so many ways and talked about sharing a life together and marriage, but in time our relationship started to change. He would be irritable, angry toward me. Every month he wanted to break off our relationship because he was confused with his life ...

    Sadly, we know the story all too well.

    Much more to come ...

Published On: December 05, 2011