Here’s the latest from Practicing Mental Illness:
Bipolar disorder affects more than moods. It is now considered a multi-system condition with serious impact on the immune system.
Co-morbidities, or conditions that frequently occur in people with mood disorders, have long been known to include cardiovascular disease, diabetes, obesity and poor response to pharmacological interventions
The frontier of psychiatric research, however, is the extremely high co-occurrence of auto-immune diseases in people with mood disorders. Some researchers even surmise that bipolar disorder (BP) itself is an autoimmune disorder.
Patients with Guillain-Barre syndrome, Chron’s disease and auto-immune hepatitis have significantly higher rates of BP than the general population. Those with lupus are 6 times more likely to have BP, and people with MS are 30 times more likely to suffer from BP.
Thyroiditis plays a role in BP for many patients. In fact, many physicians check thyroid functioning before diagnosing BP, as inflammation in the thyroid can be the cause of severe mood swings. Like BP, thyroiditis is strongly heritable. The offspring of those with thyroiditis and BP often inherit both conditions.
The old model of diagnosing and treating mood disorders as psychiatric conditions only, responsive to mood-stabilizers and psychotherapy, may be hopelessly out of date. The connections between mood disorders and physical diseases, especially auto-immune disease, is too great to ignore.
Doctors are even finding a small number of patients with Covid-19, patients with no history of mental illness, are having severe psychotic episodes after contracting the coronavirus. The immune response and inflammation in key areas of the brain caused by the virus are the culprits. This isn’t unusual in coronaviruses, as similar psychiatric symptoms were found in patients with SARS, MERS, and even in the 1918 pandemic.
Immunologists, neurologists and other medical specialists should be consulted in every new case of BP, and in every existing and long-term case, as new research makes new discoveries about the relationship between the brain and the autoimmune system.
Such studies show that the addition of anti-inflammatory treatment to mood-stabilizers can significantly reduce the length and severity of depressive episodes. Research is ongoing on these therapies’ impact on mania and mixed states.
Researchers are even investigating how an anti-inflammatory as simple as aspirin may positively impact those with BP. Of course, please don’t throw out your psych meds and start taking aspirin. This research on mood disorders and autoimmune disorders is ongoing. Just be sure your doctor is keeping up-to-date with it.
The most significant physical factor that mood disorders and auto-immune disorders have in common is the body’s reaction to stress. Severe stress often precipitates changes in mood and leads to increases in biochemical contributors to inflammation and decreases in the body’s immune response.
Stress management should be considered a primary, font line therapy for both mood and auto-immune disorders. Meditation, movement and meaningful work can all help a person to reduce and manage negative stress.
As science discovers more about the causes and co-morbidities of mood disorders like BP, psychiatry must keep up. More effort should be put into mind-body medicine, treatments must expand to include immunology, and healthcare providers should adapt to cover physical therapies as well as more traditional psych meds and visits when a mood disorder is diagnosed.
After years of sitting in zazen, still, focused on the breath, I’ve begun to return to the contemplative practices that first got me interested in meditation. I’ve begun to return to prayer and the meditative reading of ancient scripture and poetry. In so many wisdom traditions from all over the world, at the intersection of meditation and prayer is chant. Whether it’s the Muslim call to prayer, the Zen repetition of the Heart Sutra, or the repeated mantra of TM, a focus on the music of unfamiliar words can be extremely effective for developing focused attention and the ability to predict, prevent and manage difficult moods.
Of course, it can be extremely awkward to sit alone chanting in your room while other people in the house turn up the TV or play with the dogs. Chanting feels most natural and effective in a group in a church, temple, mosque or meditation hall. However, chant can be a very impactful point of focus even if you just listen to it. And wow, can it be transcendent. Here’s an example of Cistercian chant. I defy you to not feel better after listening to a little of this.