Bipolar Patient Gets Parkinson's Diease


Asked by Marlene

Bipolar Patient Gets Parkinson's Diease

I have had Bipolar1 for the past 24 years and have recently been diagnosed with Parkinson's disease. Is it possible to find the correct medication for the treatment of both or should I consider operations; parkinson's patch or stem cell therapy ??? .. at present I've had no luck with my psychiatrist and neurologist and am in a clinic with a manic episode . Off all the parkinson's medication until the psycosis has been managed. Any information would be helpful


Hi, Mariene. It's not our place to give advice on the fine points of your treatment, especially one involving such a complex and probably unique issue (we are all unique).

But here's a general observation I got from viewing a video lecture by Stanford brain scientist Robert Sapolsky PhD, winner of a McArthur genius grant and other prestigious scientific honors:

Dr Sapolsky was talking about the dopamine system in the brain. Dopamine helps mediate pleasure and reward and arousal, is essential in cognitive processing, plus regulates certain muscle movements.

A number of things can happen when our dopamine is out of whack. At one end, we lose certain muscular control. Not enough dopamine. Hence Parkinsons. Thus, Parkinsons is treated with l-dopa and other dopamine-boosters.

At the other end, we lose mental control. Too much dopamine. Hence psychosis. Thus, psychosis is treated with antipsychotics, which block dopamine.

Dr Sapolsky pointed out that a side effect of l-dopa may be psychotic symptoms. Conversely, a side effect of antipsychotics may be Parkinsonian symptoms (referred to as EPS and tardive dyskinesia). Often, these side effects can be eliminated or controlled by lowering the doses.

So here you are, Marlene, technically with two different diagnoses. But it might pay to look at yourself as having a "dopamine dysregulation" disease (something I made up).

Obviously, your psychiatric team needs to get the psychosis under control. But in the short-term, the treatment may involve exacerbating the Parkinsons.

Obviously, your neurology team needs to get the Parkinsons under control, but not at the risk of flipping you into mania.

Obviously, your neurology team and your psychiatry team need to be talking to each other. The two may come from different specialities, but they both need to be working together to sort out your "dopamine dysregulation" situation.

Keep in mind that although Dr Sapolsky is a brilliant brain scientist, he was oversimplifying things for the purposes of making a point. And I have oversimplified his over-simplification. Your respective treatment teams have a lot of complex issues to work through, and you are an important part of that conversation.

But also keep in mind that each treatment team will be tweaking your dopamine from their perspective ends. You are the one living inside the big picture, and you need to be constantly reminding them of the big picture. They will see you as your diagnosis - either Parkinsons or bipolar. You need to see yourself as more than your diagnosis - as a unique individual with a dopamine dysregulation problem. They may be the experts, but you have a better broad perspective than they do - so don't be afraid to let them know it.

Hope this helps ...

Answered by John McManamy