Issues in Bipolar: Problems Thinking

Patient Expert

How does thinking enter into the bipolar equation?

We all have our "lost the car keys" moments. For the most part, this is normal. But then, considering the brains you and I were born with, we have reason to wonder. As Donna observed:

Before my own "crash" I had an absolutely spectacular memory (had people telling me I was the smartest person they had ever known), made almost straight A's in college, could easily accomplish anything I set my mind to.   After the crash, I couldn't remember how to do math so my long-time job as an office administrator and accountant went down the tubes and I couldn't even remember how to use a calculator to add two numbers

Donna was responding to my Question of the Week: Losing Time and Absent-Mindedness. Donna wasn't the only one. Karen wrote:

I used tohave a mind like a steel trap, almost perfect memory, and be articulate. I have to facilitate meetings at my job, but can't talk sometimes. It creates a lot of stress. I do not have confidence in myself anymore and don't feel on top of things. I try to write thingsdown, but it would take 2 hours to write down all I have to do. I have a Master's but probably could not pass the fourth grade now.

Similarly, with Charlotte:

My job is part-time in retail.I used to be an MD before "the crash", as I like to call it.When I started in retail, it was amazingly hard to pick up things at work and it took me forever to learn to use the cash register.

What is going on? In early June, I attended the Ninth International Conference on Bipolar Disorder, held in Pittsburgh. One session was given over to the things that go wrong in our thinking. Over the past decade, considerable research has been directed to the issue.

Naturally, when our moods are way up or way down, our thinking is going to be distorted, but this runs deeper. Even when euthymic, it seems, we have a lot to contend with. Lest we jump to conclusions, we are not talking about some form of dementia or of schizophrenia. What seems to be happening is differences in the way our brains process information. This is neither all-good nor all-bad. On the credit side of the ledger is what I like to call our sense of hyper-realism. It's as if our brains were running on rocket fuel. On the debit side, however, we have those moments when our brains seem to run on molasses.

Naturally, it's much easier to research all the things that go wrong with our brains, which tends to yield a distorted picture. Yet, distorted or not, the brain science is beginning to yield answers to that enduring question: What is wrong with me?

At the Bipolar Conference, Stephen Strakowski of the University of Cincinnati offered up his version of an owner's manual. Instead of viewing bipolar as an illness involving a glitch or two in a specific region of the brain, Dr Strakowski asks us to be more holistic, to conceptualize instead entire brain networks being compromised.

Thus, in a 2004 brain scan study, euthymic (symptom-free) bipolar patients performed as well on a simple cognitive task as the healthy controls, but here was the catch - more brain regions were involved. The brain scans revealed that the amygdala, which mediates fight or flight, was fully activated, a sure sign of stress. To compensate, the bipolar subjects recruited one of the thinking parts of the brain, the ventral medial prefrontal cortex (VMPFC). So even in routine situations, a lot of us with bipolar have to work our brains a lot harder.

In a more complex task, involving the ability to think and react quickly, the controls were more successful in slowing down their reaction times, which allowed them to bring the thinking parts of their brains online precious micro-seconds more quickly. These areas were involved in impulse control, which allowed them to make the necessary course corrections to come up with the correct answers in real time. The bipolars, by contrast, kept plowing ahead, which resulted in lots of wrong answers.

Similarly, in another study, when push came to shove, bipolars found difficulty in recruiting the VMPFC to suppress over-activity in the amygdala.

Can you detect a pattern to these studies? One part of the brain over-reacts. We get stressed. Another part of the brain fails to control the over-reaction. Various intermediate networks fail to compensate. We get overloaded. We can't think. Our emotions are in charge. We lose control.

And this is only a small part of the picture. What about all those situations where the brain simply refuses to turn over, like a car with a dead battery? What about all those situations where our memory fails us? On and on and on it goes.

Then we have our meds to consider. As Donna notes: "I was always an excellent speller until I stated taking an antipsychotic. ... I don't remember having memory problems before the antipsychotics, but maybe I just don't remember them!"

Our meds are good at slowing down our brains, but at what expense? Patients have been telling their doctors for years that they don't want to feel like zombies. Our doctors seem to think we are addicted to our highs.

I, for one, certainly do not take a fully operational brain for granted. Every second I feel the reception coming in loud and clear is a gift from God. My life is organized at squeezing every micro-unit of productive output from these precious moments.

Obviously, we have a lot more to contend with than just mood. If only, it were just mood ...