AD's & "Holes in the Brain" & Dementia
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Q:  AD's & "Holes in the Brain" & Dementia

There is a woman posting on a manic depression board who keeps insisting that her husband - after  treatment with antidepressants has since developed what she refers to as "holes in the brain". Saying that her husband has since developed dementia after being on the meds for 6 years. Is there such a thing?? She is beginning to scare me. I am Bipolar II and have been getting treated for 8yrs. Is dementia really something I am going to have to worry about? I already have real problems with memory and had to drop out of college because of it. Any info you can provide would be greatly appreciated. Thank you so much for your time.

Dear Melissa --
Well, let’s see.  First, how old is her husband?  If he’s over 60 or so, then first we’d have to wonder if he might have developed a condition associated with aging, which he might have gotten even if he hadn’t been taking antidepressants. 

Then we can wonder if the condition for which he was being treated with antidepressants might be responsible for those “holes in the brain” – because depression has very clearly been associated, fairly recently, with decreases in brain size (particularly in the region associated with memory, called the hippocampus.  This may be – but not for certain yet – why severe depression seems, especially in my practice, so commonly associated with terrible problems with memory.  I hear that one all the time.  We’re always having to wonder if it could be coming from the medications we’re using, which in some cases could also be true; but after we fool around with med’s to try to improve that problem, if the mood problem persists, so usually does the memory problem, and then when people finally get better in terms of mood, so does their memory in many cases.  There’s even recent evidence that the hippocampus can generate new brain cells, which was thought to be impossible until this recent work; and maybe – but not for certain yet – this is why people’s memory seems to be able to recover when their mood does.)

Now, what are these “holes in the brain, anyway?  That could be “lacunar infarcts”, meaning, basically, a bunch of little holes (from the Latin word lacune, which means lake: a bunch of little lakes of fluid where there are supposed to be cells).  I suspect that’s what she’s talking about.  It might mean a bunch of “white matter hyperintensities”, which have been found frequently in bipolar disorder and appear in recent research to be associated with damage due to too little blood flow - - which is the same problem that causes lacunar infarcts also. 

Beyond that, I’m not sure what these “holes in the brain” could be.  Lacunes have definitely been associated with a dementia that is often very difficult to distinguish from Alzheimer’s. 

Anyway, the point here would be to wonder whether antidepressants have ever been associated with lacunar infarcts or white matter hyperintensities, or with anything else that produces something like “holes in the brain” – right?

Okay, let’s look at that.  The simple answer is “no”.  The longer answer would acknowledge that one psychiatrist has written about “brain damage” caused by antidepressants.  Dr. Glenmullen has made himself quite famous with this (e.g. search Google for “Glenmullen depression” and you’ll see a lot of quoting…  Here’s a blurb on his book; interestingly, his own website,, is no longer on the web; I wonder what that means).  I’ve read his book and found it unfortunately quite overstated in places, including on this issue (unfortunately, because otherwise I think there are some appropriate concerns raised in it).  Here’s the response of the National Mental Health association to Glenmullen, for a bit more balance on this issue. 

So, the bottom line here is “no”, you don’t have to worry about dementia any more than anybody else, based on your diagnosis or current symptoms (there is a tiny bit of evidence, mostly clinical experience, I haven’t searched this one today, that severe bipolar disorder might be associated with a higher risk of developing something that looks like dementia when one is quite old, if the bipolar symptoms remain untreated for years.  If your treatment is controlling your symptoms reasonably well, then I think this little bit of evidence is not relevant to you.)  Your memory issue may be related to the stuff I was talking about above. 

 Dr. Phelps

Published June, 2003


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