More on Sex and Bipolar: The Dopamine (Dis)Connection

Patient Expert

This is the third article in our conversation on sex and bipolar. As I mentioned in my two earlier pieces, there has been a lot written about sex and a lot written about bipolar, but virtually nothing on the two together. As I noted in my previous piece, sexual attraction guides us in our choice of a partner in a loving relationship. Even the chronically normal enter a "crazy for you" phase in boy-meets-girl, but how does bipolar affect this?

Let's start with the proposition that brain science has discovered a connection between feelings of love and surges in the neurotransmitter dopamine. Note that I am not equating love to dopamine, nor am I saying that a very complex state of mind can be reduced to a single molecule, but where you find love you will find dopamine.

Five or six years ago, when I was researching a piece on dopamine for my mcmanweb  site, I came across an internet vendor hawking a greeting card with a dopamine molecule superimposed over a heart. The inside of the card read:

"Sweetheart, you make my dopamine levels soar"

If Elizabeth Barrett Browning had known about dopamine, she could have saved herself no end of time and effort "counting the ways. In a humorous piece on mcmanweb, where I pretend to be a wise elder, I observe that:

If you think you are experiencing God - it's probably dopamine.

If you think you are experiencing love - it's probably dopamine.

That doesn't mean God or love is not real ...

... but we know dopamine is.

Here's the deal: We need our emotions to guide us. Surprisingly, over-thinking our options can result in a host of bad decisions. Yes, we need to think things through, but we also need to pay attention to what "feels right" or "feels wrong" to us. So here is dopamine on the scene, a neurotransmitter that is vital to mental alertness, cognition, motivation, not to mention feelings of pleasure, high energy, anticipation, and gratification. In short, on dopamine we feel alive.

But crank up the dopamine and we get anxious, paranoid, manic, over-energetic, and addictive. We make bad - often catastrophic - decisions. Tamp down the levels and we are depressed, lethargic, and indifferent. Again, we make terrible decisions, or we fail to make decisions.

Bipolar is a very complex illness, but no matter what the actual cause and effect, we know, on some level somewhere - upstream or downstream - in some part of the brain one or more dopamine neural networks are over-active or under-active. Below is a rendering of the brain that shows increased signaling between two different regions displayed by episode-free individuals with bipolar I in response to images of facial expressions. The control subjects also displayed increased signaling, but to a far lesser extent.


This image from a 2009 study is representative of a number of brain scan studies on individuals with bipolar showing exaggerated response to emotion-inducing stimuli. Mary Phillips of the University of Pittsburgh is pioneering much of this research. No doubt, as researchers come up with more of this kind of evidence, they will feel confident in speculating in how our illness adds an extra layer of complexity related to matters of the heart. In the meantime, though, no one is stopping us from engaging in our own hypothesizing. So ...

Perhaps we engage in sex with greater intensity than others. Perhaps not. But what seems plausible is that we experience greater subjective feelings of intensity. Whatever is going on, our brains are reacting like photo-sensitive paper to light. This intensity carries over to feelings of attachment. At once, we are euphoric and obsessed and anxious - the kind of feelings "normal" people have when they are in love. But can we truly trust our own feelings? Are we really in love, or is it our brains simply running away on us?

Are we about to make a catastrophic decision - again?

I like to joke that I wish they would come up with an iPhone app that could read women's minds. But what I really need is an iPhone app that can read my own mind. I certainly can't. But even if I could, would I be able to stop myself?

Questions, questions ...

Ultimately, the best authorities on this topic are you - patients and loved ones. Please feel free to contribute to this ongoing discussion. Comments below ...