Hi Reader!!

(If you can't wait for the punchline just scroll to the P.S. I'm pretty sure you can handle a little bit of delayed gratification though. And the good part is actually BEFORE the P.S.!)

Do you know about the bipolar-salt connection? No?!?

I mean there's the salty ocean, the salt on the rim of a margarita (didn't Jimmy Buffett sing about that?), and of course that salty old lady that lives down the way, but that's not what I'm referring to here.

I'm talking about the sodium ion! For anyone who remembers high school cell biology (depending on where you went to school, of course) brain cells are neurons and neurons send electrical signals to get their messages across.

Part of how that impulse conduction happens is with the help of ions! The charge on the inside of the cell is different from the outside membrane and with the right conditions the signal gets sent!

In today's video I spend about 7 minutes briefly talking about one of the known physiologic issues in bipolar disorder: too many sodium ions inside neurons and why that's a bad thing (no salt in this wound, please!)

​

​

If you want to LISTEN instead you can click HERE or for the TRANSCRIPT, click HERE.

And here are your top bites to share:

Regarding the brain processes:

• We don't know the full pathophysiology of Bipolar Disorder but we DO know that ions, especially sodium, calcium, potassium, and hydrogen, play is big part in the problem
• Bipolar disorder might be caused by inflammation, oxidative stress, mitochondrial problems, or a combination of other things we don't know yet
• There's no single "bipolar gene" but many of the abnormal genes in bipolar disorder have to do with building the structures that regulate ion transport
• More sodium = more excitable neurons -> neurons send signals more easily -> manic or hypomanic symptoms show up with increased activity, pressured speech, decreased need for sleep, the brain is "on fire"
• When neurons hit depolarization block they can't signal anymore and that leads to those anhedonic depressive states with psychomotor slowing

The medication bites:

• High sodium inside of the neurons is a target for medications
• Mood stabilizers directly impact the amount of sodium inside the cells: lamotrigine, valproic acid, lithium, carbamazepine, oxcarbazapine, and topiramate are commonly prescribed mood stabilizers
• Antipsychotics can be used for mood stabilization but use an indirect mechanism to decrease the sodium inside cells
• Benzodiazepines can help too, especially with mania, and have an impact on sodium through the GABA system
• Serotonin and dopamine systems don't appear to be dysfunctional in bipolar disorder and SSRIs can make symptoms worse and stabilizing mood harder
• "Best" regimen is a mood stabilizer + an antipsychotic or a mood stabilizer alone

There's a bit more about the medications in the video/etc. but I have enough bullet points for this email! 😂

So what do you think? Super interesting right? We don't know how to "cure" bipolar disorder yet but this is a very specific target and we have medications to "fix" the sodium problem!

(Did you catch the pun there? "Curing" bipolar disorder? Because of too much salt? Ok, yeah, a food joke is kind of weak. I'm working on it.)

Now if only the bipolar patients I treat were as easily swayed to take their meds every day for the rest of their lives. Still working on that one...

Share this with anyone you think could benefit from it! And if you're a neurophysiologist please provide some feedback if I got anything wrong!

Also, for anyone who wants to know more about what it is to live a life with a bipolar diagnosis, I strongly recommend this book! Kay Redfield Jamison is a psychologist who shares a beautifully detailed (and sometimes scary and heartbreaking) story of her bipolar experience. It's a great recommendation for patients too!

​

Cheers to healthy brains,

Dr. B

P.S. Why is there a ring of salt around the rim of a margarita glass?...

To keep the spirits from escaping! 😂 🤦🏻‍♀️

Please forward this to a therapist you know with an excellent sense of humor!