Epilepsy and Bipolar Disorder
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Epilepsy and Bipolar Disorder

Q: Hi Dr. Phelps, I am curious about the correlation between epilepsy and bipolar. From what I have read I believe I have what is called abdominal seizures. I become very nauseated, sweaty and dizzy. Every part of me above the waist must become relaxed or the episode will last longer and then I pass out. I am then out from anywhere between 15 minutes and eleven hours. This has happened only in the evenings on occasion and hasn't happeded on quite some time. Can you give me some enlightenment on this ?

Hello Star -- 

Ah, enlightenment, that would be good.  I may fall short of that.  (    :)   ).  Before turning to your question, the place to start is to worry about these events.  They sure sound like seizures all right.  The sensation you describe could be an "aura", which commonly precedes a seizure.  If they are becoming less frequent, that's good; but even one in a rare while is worrisome.  Obviously -- you've probably worried something like "what happens if I have one of these while I"m driving?"  So the place to start is to see a doc to be evaluated for these probable seizures.  You'll probably get an electroencephalogram (EEG) and unless that was flat "normal" you'll probably be prescribed an anticonvulsant.  

Now, if I have any "enlightenment" to offer, it's this: if you're reading my site you might have some mood symptoms too?  If you think you might have something like bipolar II, just make sure the doc' who treats your probable seizures knows about that too so that she/he might choose a medication that could have mood stabilizing effects as well as anti-seizure effects (i.e. Depakote or carbamazepine, as opposed to Dilantin or Neurontin).  

Jim Phelps, M.D.

Published September, 2000

Does LSD permanently change brain chemistry?

Q: I am familiar with the "self-medicating" drug abuse effects of BP. I was wondering if there is a hypothesis about drug abuse triggering, or even as a cause of, BP disorder. For example, I did LSD several times in my youth, the effects of which can were psychotic-like hallucinations and delusions. Has the chemical effects of LSD been studied in order to see if a similar link exsists for psychotic BP? Does LSD permanently change brain chemistry? thank you for your reply.

Hello Terri --
The general thought a few years ago (and I just did a quick search, finding surprisingly few recent articles, with those from the 80's supporting this general thought) was that people who might be vulnerable, especially genetically, could be triggered into an ongoing mental illness with bipolar or psychotic features, from drug use.  The implication of the theory, of course, is that if you didn't use you wouldn't have gotten sick.  That's not particularly useful, is it?  Perhaps this implication is why there isn't a lot of recent writing on this topic: once you say that, there's not much room to say anything else.  You might as well go back to trying to reduce drug use in the first place -- for this reason perhaps, and for others as well.  One article suggested that if LSD caused psychotic-like experiences, that suggested the individual was one of those "vulnerable" ones. 

But think about it: how would you ever test this hypothesis?  To really know, beyond statistical associations of drug use and subsequent mental illness, you'd have to do a "randomized controlled trial just as is the best standard for "knowing" whether a new medication really works any better than a placebo.  To do this trial you'd have to give some people LSD, others a placebo, then wait to see if the LSD group got more psychosis over time.  Obviously that's one study than ain't going to happen!  So anybody who tries to answer your question is limited to the statistical association of drug use and mental illness: but that doesn't mean the drugs caused the illness!  Maybe something else causes both drug use and the illness symptoms. Or maybe those people who are drifting toward greater symptoms see it coming somehow and start using.  There are quite a few other maybe's possible.  So the bottom line is, yes, it looks like there's an association all right, but what does that mean?  We don't really know and aren't likely to find out soon.  Try searching "LSD bipolar" on Pub Med (instructions/help Dr. Phelps

Published September, 2000

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