The Infinite Mind; No. 32; Manic Depression; Part 1

I'm Dr. Fred Goodwin, and this is The Infinite Mind this week on The Infinite Mind, manic depressive illness will reveal a stunning new discovery that could have a profound impact on millions of Americans who feel the highs and lows of this often lethal mood disorder. Could relief be as simple as changing your diet? There's a phenomenally exciting study. And after four months, the results were so striking and dramatic that the Ethics Committee made them quit and give the placebo group the omega three fatty acids. Then Congresswoman Lynn Rivers. For years, mental illness was viewed as a political liability, but she's open about her bipolar disorder and has won the support of her constituents. When I finally got a diagnosis, I've said to people it was the best day of my life, not because I was happy to be sick, but because I was sick. Plus Dysthymia, psycho, thymine, hypomania, bipolar two. What are all these different diagnoses? We'll hear from a top researcher. There are several types of bipolar disorder that we're confident

that are related to one another. All of this and your calls coming up today on The Infinite Mind. I am Dr. Fred Goodwin. I've long been fascinated with manic depressive illness and I've been fortunate to study it for most of my 33 years as a clinical psychiatrist, researcher and later as head of the National Institute of Mental Health. It's a condition that's been described since antiquity. The ancient Greeks named it, in fact, and believed correctly that it resulted from a biological disturbance in brain function. Manic depressive illness today is also called bipolar disorder, a reference to its swings between the two poles of emotion, highs and lows. The illness fascinates researchers because it offers a rich variety of states and transitions to study. There's the intensely euphoric, frantic and often psychotic excitement of mania. Then there's hypomania, literally less than mania, which ranges from a feeling of profound well-being to irritation. And there's the death of the spirit, the short circuiting of the brain that manifests

as depression. Bipolar disorders are often hard to identify. Patients usually don't want to recognize that what they are experiencing is a mental illness, and doctors may not want to see a disorder in that lively, talkative, charming, even seductive patient in their office. Manic depressive illness is perhaps our most dramatic instance of the integration of the biological and the psychological. On the one hand, it is incontrovertibly genetic, perhaps the most genetic illness in psychiatry, yet it is frequently triggered by the environment in the treatment arena. It is the illness that has put the final nail in the coffin of the old argument about the effectiveness of psychotherapy versus drugs, for it is in manic depressive illness. Long the graveyard of psychotherapy that new psychotherapies used in combination with medications are showing perhaps our greatest power two, three, even four fold decreases in relapse rates when talk therapy and medications are used together. Yet another fascination of the illness is its paradox.

It can profoundly devastate lives, marriages and careers. And yet the dark cloud of this terrible illness has silver linings. People with manic depressive illness can be among our most creative, sensitive and productive, from Winston Churchill to Theodore Roosevelt to Ted Turner. I often tell people that this makes the stakes for treatment all the more high. We begin today with a woman who has been living with. Manic depressive illness for 10 years, but only recently sought treatment. ?Donna Hahn? Is 26 and lives in New York's Hudson Valley. I was in my sophomore year of high school and my attention span was just getting erratic and I was getting pretty depressed. That had been building up for about a year. So what I did was I tried to kill myself and from an overdose of psychiatric drugs that were in my house at the time,

my dad was a psychiatrist. So I took these medicines and then I guess I passed out and they brought me to the E.R. of a hospital and pumped my stomach. And from there I began seeing a psychiatrist that my parents chose and the psychiatrist pretty much gave me a diagnosis of bipolar. And this is why I resisted getting treated for so long. But I just couldn't accept that this was ultimately Donna. I was getting conscious after a period of cycles of my mood swings, but I was willing to trade off the depressing periods so that I could have the highs. In a depression, one feels about twice as heavy, if not five times heavier than normal. Their body is just not moving in a way that that feels like you can. You're where I mean, I feel very separate from my body. You know, very uninterested and uninspired to do anything.

The tendency to feel kind of, you know, like life is very monotonous. The brain shuts down. I feel stupid. One just feels like they've turned kind of into Kaleigh. A manic period could last anywhere from for me about two weeks to five months. You feel really great. Your sense of self is heightened, is very, very heightened at times. It's just a great a natural high, a natural mood. I could stay up for a couple of days or get by with very little sleep over a course of a period of time. Nothing is hard. Everything is easy to do anything I can tackle any kind of project and feel. I mean, it's a little bit exaggerated at times because I know, you know, I'm feeling a little too good. I didn't want to to have to suffer the depressing periods.

They were getting worse and worse. In the past few years, they've been getting pretty bad and coming more frequently, coming more intensely and seeing they seem to last longer. I was less and less able, I think, to manage coping with depressing periods just to have the the high period, because the high period is equally destructive. I couldn't keep a job. I've never been able to keep a job for more than ten months. And you do things without thinking very impulsively, very compulsively. And it just seems normal, promiscuous behavior, spending lots of money on things that are not that useful. Not sure where I was going to sleep the next night, sometimes oftentimes taking strew drugs. Well, I was in Europe, I was invited to exhibit my artwork and just got involved with a lot of bad street drugs and in a very manic phase

and found myself back in the States after seven weeks with a lot of my money gone, homeless, jobless. I didn't know what to do. And I met up with my boyfriend and went to the hospital in Port Chester, New York, one day and panicked with the idea of being an inpatient. And then went the next day after calling a crisis team, a long term plan is to go back to school next fall and study to be an art therapist. I have yet to get my undergraduate degree. I have two and a half years of art college, so I want to complete that and help others in the way that I was helped at the hospital. And I feel like I feel very good. I feel like I took a bold step in admitting to myself that I should actually get help for something I was diagnosed with over 10 years ago.

Our first guest is Dr. Joseph Hibbeln, who's a psychiatrist, lipid biologist and chief of the outpatient clinic at the National Institute on Alcoholism and Alcohol Abuse, part of the National Institutes of Health. He's here to tell us about some exciting new research that indicates an astonishing link between diet and mood disorders like manic depression and depression. I understand this study grew out of some epidemiological findings. What can you tell us about it? The primary epidemiological finding, which I think speaks to how powerful this brain nutrient may affect mental illness, is a study of the difference of the prevalence of depression across countries. Hmm. Using the gold standard of epidemiological data, Myrna Weissman published an article showing that the depression across countries varies quite widely. What I did was to compare that prevalence of depression to how much fish people ate among those different countries.

And there was a very profound protective effect. The variance in depression may be fold different. That's not double or times 10, but 60 times, 60 times some high fish to low fish from high fish to low fish diet. What made you think of fish? Why to countries? Well, the biochemical reality that led me to this is the issue that omega three fatty acids are highly concentrated in the brain and they make up the synapses of neurons. That is where the nerve cells communicate with one another. They are the walls of the of the brain and determine its activity. Now, these critical and essential nutrients from the brain are only available through our diet. The body cannot synthesize them. So the composition of the brain is determined by what we eat. And secondarily, these fatty acids also affect the immune system and have other physiological effects in the body. One of the reasons that led me to this idea was that the diets that we eat now in modern Western societies are radically different than

the diets that we evolved on during the two to three million years of evolution. We eat diets that were lower in saturated fats and much higher in omega three fatty acids. That is a polyunsaturated fatty. What are the foods that these fatty acids occur and they occur in leafy green vegetables. They're highly concentrated in fish. And any particular kind of fish or any fish you eat would have more omega three fatty acids than a hamburger. OK, but there is variance among fish. And so cooking get rid of them or cooking does not get rid of them. You will, however, alter the fat balance of foods if you fry it. Foods that you fry with or oils that you fry with are usually corn oil or soybean oils. And they have very few omega three fatty acids and are very rich in in a counterbalancing fatty acid and omega six fatty acid. When we evolved, our diets had very few of these omega six fatty acids because we didn't eat a lot of seed oils, we ate a lot of leafy green vegetables and we ate

animals, which again ate leafy green vegetables. So the ratio of these omega six to omega three fatty acids when we evolved was probably one to one or one to four, omega six to omega three. Now that we have diets based on corn and soybean, the ratio is perhaps 25 to one in 15 to one, which radically alters the composition of our brain cells and of the nutrients that are available for our immune system to operate. In the last hundred years, during this change in dietary fat consumption, we've seen a radical increase in the prevalence of coronary artery disease, and it's well accepted that that organ function can be changed by dietary fat intake. However, to test this hypothesis, I considered well, then again, has depression also increased in the last 100 years? So here's where your psychiatry and your biochemistry are coming together. Absolutely. Absolutely. And although it's not definitive and proving of this hypothesis, it is true that the rates of prevalence of depression have markedly increased

in the last hundred years, not only in this country, but in many other Western countries, and it parallels the increase in coronary artery disease. So it's possible that both of these illnesses can be simultaneously influenced by a low intake of these omega three fatty acids. It's a very exciting hypothesis that it may be linked to the diet. And you know that for many years, 20 or 30 years, we know that people who are more depressed are more likely to die of coronary artery disease. Right. So in a nutshell, what what you found was that the these omega three fatty acids, that one particular class of fatty acids are very high in the diets of people in countries that have very low rates of depression and perhaps even manic depressive illness and conversely, are very low in countries that have higher rates of depression and perhaps manic depressive. Precisely. Absolutely. And you are suggesting that these can be this discrepancy and can be fixed by diet and perhaps

even by directly taking these fatty acids, these omega three fatty acids, through what you can buy in health food stores. Right. I certainly hope that that's the case for depression. There have not been any clinical trials to see if these omega three fatty acids work. So people who are depressed should certainly not abandon their current effective treatments. What about for manic depressive illness, for manic depressive illness? There's a phenomenally exciting study that's been conducted at Harvard by Andrew Stoll at the brilliant Waveland's Harvard. He studied unstable bipolar patients who were just discharged from the hospital. All of them were on two medications, lithium and valproic and not doing really well and not doing real well on it. And that was Depakote, lithium and lithium and Depakote, Depakote, by the way, as a short chain fatty acid. That's right. That's right. The plot thickens. The plot thickens. Exactly. The study was intended to run nine months and after four months, the results were so striking and dramatic that the Ethics Committee made them quit and give

the placebo group the fatty acid. And, of course, placebo group was getting already lithium and Depakote. And the both groups were still getting lithium and Depakote in the active group. One out of 15 people relapsed. And in the placebo group, I think eight out of all the people who were getting their regular treatment, plus these omega three fatty acids had one out of 15. One out of 15 relapses in four months compared to the group that had the routine treatment was right about eight out of 50. Wow. Has there been any further extension? This is brand new research. This is absolutely brand new research. Mm hmm. The other work that Dr. Stoll has done has not really been published, but he's telling me he's getting very good results, even without medication, without other medication, really medications. Right. Part of the underlying reason for this may be the relationship between these fatty acids and levels of a marker of brain serotonin. I believe that there are probably 10 or 15 or 100 different mechanisms whereby these

fatty acids may be affecting the brain. But to think critically, I wanted to first test the relationship with the brain serotonin because of our prior work with low fi via that marker of brain serotonin being associated with depression and violence. We looked at healthy volunteers and we examined their plasma for essential fatty acids, which largely reflects how much they eat. Higher levels of these omega three fatty acids in the plasma predicted higher levels of five HIPAA, that marker of serotonin, higher levels in the cerebral spinal fluid. So presumably people who have these high fish diets, people who live in Japan and the Far East, have higher levels of brain serotonin, which may be something that protects them somewhat from depression. What about suicide? The rates of suicide in Japan are actually striking, have been strikingly lower than they are in the West, although that's been changing in the last 15 to 20 years.

Coincidental to them moving to a Western diet. And as I go to McDonald's. Right, I understand you also have some findings related to postpartum depression. Right. Since these fatty acids can only be taken from our diet, you can imagine that a developing fetal brain would would need a critical and direct supply of these fatty acids to make their brains grow. Well, mothers intuitively know this and women will deplete themselves of their bodily stores of omega three fatty acids for the sake of the developing infant. They will do that during gestation and also while they're breastfeeding infants. So if omega three fatty acid deficiency is associated with depression, this may be a convenient or a reasonable explanation to explain the phenomenon of postpartum depression. So what I did, again, was to rely on the basic tool of epidemiology and compared the prevalence of postpartum depression across 17 countries.

And again, just like major depression, higher levels of fish consumption predict strikingly lower levels of postpartum depression. Now, you mentioned in this one very preliminary way that some of the people in any stoles group were actually finding a manic depressive were, at least in the short term, getting on was just us. But you wouldn't caution people to. That's a very preliminary study that was done on a few subjects. So it makes sense for people to talk to their doctor about maybe supplementing their treatment with omega three fatty acids, but not to substitute it. The FDA recognizes that up to three grams of omega three fatty acids are generally recognized as safe. That is three grams total of the two major fatty acids, EPA and DHEA is that is at the level that was given in these trials. The level that was given the trials was about six grams total of those fatty acids. So the levels were actually much higher. So we don't really know whether a three gram level, an FDA approved

level would would be efficacious. Chances are it would be because we know from the extensive work in cardiovascular disease what the relationship is between dosage intake and plasma levels, three three grams is plenty. Now, if somebody were just trying to do this by diet, how many fish would they have to eat and what kind of fish are they? A real easy dietary prescription to raise your tissue levels of omega three fatty acids is a diet that you would should follow to prevent yourself from getting heart disease. And that is basically following the diet of Crete. Get rid of salad dressings made of corn oil and soybean oil and substitute them with olive oil and try to eat fish every day or every other day. And how should you prepare the fish? Don't fry it. All right. Baking, broiling, poaching. Just once a day. Fish is enough. Once a day, fish will do a very good job of raising your raising. And is there one hand of some kind of fish is better than others. The highest containing food source for omega three fatty acids as caviar,

which is interestingly a highly prized food. Second is actually sardines, which you can readily, readily buy. But many other fish have high levels. Some fish that taste horrible, like mackerel have very high levels. But halibut, what about. Samira Samin is fine. The trick is also that fish that are raised in culture and fed corn or soybean will have lower levels of fish that are far, I guess, three fatty acids. How do you know whether fish has been farmed or not? If it's very expensive, it's caught from the wild. And if it's reasonably priced, it's farmed. Oh, dear. One of the dietary sources of fatty acids that's been eliminated from our diet is the essential fatty acids in formula for babies across the world. Mothers enrich their milk with omega three fatty acids and across the species mammalian species.

Mothers enrich their milk with omega three fatty acids. However, formulas in this country are virtually devoid of omega three fatty acids. Wow. So you work, of course, in the Alcohol Institute now. What's the link between all this and the problems with alcohol? Right. The reason that these studies of fatty acids have been conducted in alcoholism is that alcohol can selectively deplete the brain of these omega three fatty acids. And thus, as we were discussing before, it makes an intriguing hypothesis that this may be why alcoholism increases the severity of so many other major disorders, like depression and manic depression. Right. And we also know that there's a relationship between measures of brain serotonin and alcoholism, right? Absolutely. You said the FDA has a safety limit of three grams. You've suggested that in the trials of cardiovascular, it's gone up as much as six and safely. How much is too much?

I mean, can you get what happens if you get too much? Well, the natural human experiment of too much is the Eskimo's OK. And they have if you eat a diet much, you become an Eskimo. Yeah, that's right. You become very cold. No Eskimos have traditionally eaten diets that are entire almost entirely seafood or whale blubber, which is seafood, very high in fat. And they have no cardiovascular disease, no rheumatoid arthritis, but they do have an increased risk of stroke to eat Japanese levels of fish or traditional Japanese levels of fish. There is a small increase in the risk of stroke, but there's a reduction in overall mortality. That's it. Not a there's no brain problem with having if you took 10 grams instead of three gram. No, no, none. That's no, no, no. Known so far. And it would certainly be closer to the diet that we evolved on. Well, Dr. Hibbeln, this is a fascinating discussion and talk about leading edge stuff. I haven't even seen this in the journals yet. So our listeners have a real advanced peek here. Well, thank you very much.

For more information about the link between omega three fatty acids and mental illness, Dr. Hibbeln suggests the book The Omega Plan by Artemis Simopoulos, published by Harper Collins for easy access to information about omega three fatty acids and manic depression or anything else you hear on the infinite mind. You can visit us at w w w dot the infinite mind dot com named as one of the hot sites on the Internet by USA Today. If you have a comment about this program or would like to be a caller on an upcoming program, call us toll free at one 888 345000 Mind. That's one eight three five oh six four six three upcoming programs will explore issues including obsessive compulsive disorder, romance, grief and human. Our next guest has grappled with the highs and lows of bipolar disorder for more than 20 years. She is Michigan Congresswoman Lynn Rivers from Ann Arbor, who has represented Michigan's 13th district since 1994.

She serves on the House budget and science committees. On weekends, she returns home to Ann Arbor, where she lives with her husband and two daughters. Welcome to The Infinite Mind, Congresswoman. Thank you. Thanks for having me. We're very glad to have you. Why don't you start out by telling our listeners a little bit about how you first came to realize that you were having a kind of mood problem? Well, in retrospect, I probably had had problems all the way through my teen years. But it wasn't until I was married at 18 and my first daughter was born that same year that I began to experience anxiety attacks, a real broad mood swings, and then what became a pattern of a long time pattern of cycling up and down and up and down, having these periods of very active, productive abilities and then going crashing down to depressions that were in many cases so profound that I wouldn't get out of bed for weeks and weeks and weeks. So you were sort of on your way up or down all the time. All the time. Why don't you describe what that nature was like?

What was that depression like for you? It's a deadness more than a sadness. People oftentimes think that depression means that you're saying to me it becomes almost unfeeling. You don't feel anything. There is no happiness. There may be some underlying sadness or sort of lack of hope is a better way to put it than anything else. But just feeling pain all day, feeling without any sort of energy, without any ability to do anything, no interest in anything, no interest in taking care of myself, taking care of by that point to young children. And it would get even worse at certain times. I would become almost agoraphobic. I didn't want to leave the house. I didn't want to answer the phone. I became frightened of everything. It it was being like being a prisoner in my own mind. And I just knew that I couldn't stand to go on the way it was. I felt suicidal. I didn't want to live. I didn't have any interest. I wasn't capable of doing anything.

And then when I would finally begin to cycle up, I would be hyper productive. I would clean my house in an hour, which I got. I wish I could still do that, but of course I can't. I would do everything. I would get all straight A's at college. I would I would be very, very, very productive. How long would these periods last? Several months. But more of the time I was depressed more. The time was depressed. But what would end up happening is as the downslide began, there was a period of humiliation and in in really guilt, because what would happen is all of the promises that I had made during my productive time could not be fulfilled because I was getting sick. And so I spent a lot of time thinking that there was something fundamentally bad about me. Not sick, but bad. Morally bad. Yeah. And that these were this was a character flaw. And when I finally got a diagnosis, I've said to people it was the best day of my life, not because I was happy to be sick, but because I was sick. I wasn't bad.

That's a very important point that people say that all the time. It's kind of like I finally have a name to put on this now. And more importantly, it had a treatment and that was something I couldn't have hoped for. I didn't believe that anything was going to change. I was terrified that this was the way my entire life was, was going to be. Now, how did you get the diagnosis? Who helped you with it? I ended up going to a psychiatrist in Ann Arbor and it was a doctor I could not afford, even though my husband and I were married very, very young. He was seventeen. I was eighteen. We were probably less impoverished by being young parents than we were by what it cost to treat my illness. And there were times he was working two or three jobs. There were times when I was doing better that I would work, you know, to jobs to to pay the cost. And that's one of the reasons. Now, as a member of Congress, the whole issue of parity is so important to me. I mean, their families all over this country that are being impoverished by trying to get medical care for a family member who needs it.

When you first got into politics, did you find that this was something you had to struggle with, whether you were going to talk about it? When I was first diagnosed, I really didn't hide it from anyone. I was willing to talk about it. As a matter of fact, I looked for opportunities to talk about it, particularly with other people who had similar problems, because you try to find out everything you can when you're first diagnosed. But I never tried to hide it. You know, I just talked about it. And there were certainly times when I was forced to share it because I would find I couldn't meet a commitment that I had made or I wasn't able to to do things with my children or whatever. And it was impossible not to give an explanation. It's interesting to me as a as a sideline or as a and as an aside, the number of people who are willing. To let folks think they are alcoholic or addicted to drugs or any other kind of situation to rather than admit that they have a mental illness, tell us about your medication and what happened. One of the things that that's clear to me is that for anyone who's struggling with this disease, compliance with medication is difficult. And I know how hard it is. It took almost 10 years from start to finish to find

the mix. But when we found it, it worked. Since 1991, I have been symptom free. We struggled. It was difficult, but I had to keep taking my pills. And if I had not taken my pills, there's just no way I could have had the stability that I have now, nor could I have achieved the things that I've achieved over the last 20 years. Now that you're in Congress, what are you doing about some of these problems, either with parity or with general issues with managed care? I've been working with my Rock'em on her parity bill, which we're hoping. I don't think it's going to happen in this Congress. We're in the waning days, but I'm hoping that by the next Congress we will have a chance to pass a real parity bill. There's just no reason to say that we will cover the costs of someone who has diabetes and not someone who has schizophrenia. It doesn't make any sense to me. Well, thank you very much. I think you made some points that will be very well appreciated by our audience. And we're very glad to have you up there on the Hill. Great. Thanks so much.

OK, you can write to Congresswoman Lynn Rivers at 106 e Washington. Ann Arbor, Michigan, zip four eight one zero four. You can get free screening for depression by calling the National Depression Screening Hotline at one 800 five seven three four four three three. That number, again, is one 800 five seven three 44 33. More information about depression and manic depression and about support in your community is available through the National Depressive and Manic Depressive Association at one 800 eight two six three six three two. That's eight hundred eight to six. Thirty six. Thirty two. Coming up in our second half hour, new diagnoses that may leave you wondering where you fit on the bipolar spectrum.