Essentials: The Science & Treatment of Bipolar Disorder

**Andrew Huberman** (0:00)
Welcome to Huberman Lab Essentials, where we revisit past episodes for the most potent and actionable science-based tools for mental health, physical health and performance.
I'm Andrew Huberman, and I'm a professor of neurobiology and ophthalmology at Stanford School of Medicine. Today, we are going to be discussing bipolar disorder, often called bipolar depression.
Bipolar depression is a condition in which people undergo massive shifts in their energy, their perception and their mood. However, it is very important to note that these shifts in mood, energy and perception are all maladaptive. They can often cause tremendous damage to the person suffering from bipolar disorder and tremendous damage to the people in their lives. In fact, people suffering from bipolar disorder are at 20 to 30 times greater risk of suicide. So today is a serious discussion, and it's certainly one in which people who are suffering from manic bipolar disorder or who know people that are suffering from manic bipolar disorder can benefit from. So bipolar disorder impacts about 1% of people. That might seem like a small percentage. If you think about a room of 100 people, that means that at least one of them is very likely to have bipolar disorder. The typical age of onset is anywhere from 20 to 25 years old, although it can be much earlier. There are basically two kinds of bipolar disorder, referred to as bipolar 1 and bipolar 2 Bipolar 1 is characterized by a fairly extended period of mania. What is mania? Mania is a period of very elevated mood, energy, distractibility, impulsivity, and some other symptomology that we'll talk about going forward. But this manic episode is extreme. One of the key clinical criteria or diagnostic criteria of bipolar 1 is that a person suffer from these manic episodes or display these manic episodes for seven days or more. Typically, a person will be brought into a clinic or a person would bring themselves to a clinic or meet with a psychiatrist. And the psychiatrist is going to start to evaluate for a couple of different things. But first of all, what they're going to try and figure out is whether or not the person has at least three of the following symptoms. The first symptom is distractibility. People who are in a manic episode will be talking about a pen and then they'll be talking about something they saw the other day and then something they want to purchase and then a place they're going to travel to, et cetera. But they are also very prone to any stimulus within the room. So highly distractible, highly impulsive. Impulsivity relates to actions. So the person might be fidgeting with something and then they might try and leave the room. The other is grandiosity. People who have manic bipolar disorder, who are in a manic episode, will often display words of or actions of grandiosity. These are actual beliefs that the person comes to have about their grandiose position in the world or grandiose opportunities or potential in the world. Flight of ideas are also typical of manic episodes. So this is a little bit like distractibility, but this would be people talking extensively about one thing and then switching and talking extensively about something else. The other aspect of manic bipolar disorder that often presents itself in the manic episodes is agitation, people feeling extremely physically agitated. So a lot of shaking and moving about.
This can venture into the realm of paranoia, but a lot of agitation, a difficulty sitting down and being still, a difficulty and just looking, feeling and acting calm.
And then another condition is no sleep. And when I say no sleep, I mean no sleep or very minimal sleep. As incredible as it sounds, people who are in a manic episode can often go seven days or more with zero sleep. And a key feature of this zero sleep is that they're not troubled by it. Can only imagine how pulled apart most of us would feel under those conditions. And yet they are just going and going and going with no sleep up all hours, shopping, talking, running, doing all sorts of different things in the categories of other symptoms that we talked about before. And it doesn't bother them that they're not sleeping. And then the last sort of category of symptoms that the psychiatrist is evaluating for and seeing if they present is rapid pressured speech. It's coming at you, coming at you, coming at you. And there's really no room for conversation. So we've got distractibility, impulsivity, grandiosity, flight of ideas, agitation, no sleep and rapid pressured speech. For someone to be diagnosed as in a manic episode, they do not have to be engaging in or displaying all of those symptoms. They do however, need to present at least three of those symptoms. And then in order to meet the condition of bipolar one, they have to be presenting those three symptoms for at least seven days. It could be longer, but at least seven days. Now bipolar one disorder means they're having these extended manic episodes, seven days or more, but it does not necessarily mean that they are dropping into a depressive episode as well. This is a common misconception about bipolar disorder because as it's often called, bipolar disorder is referred to as bipolar depression. And yet many people with bipolar disorder don't necessarily experience the deep depressive episodes. The second category of bipolar disorder is bipolar two. So BP2 or bipolar disorder two is somewhat different than bipolar disorder one. First of all, it's characterized most often by the presence of both manic episodes, mania and depressive episodes or what's referred to as hypomania. Bipolar two is often diagnosed on the basis of the presence of manic episodes that are lasting four days or even less. So someone with BP2 might have four days of this increased energy, goal-directed activity. They're irritable, they're euphoric, they're not sleeping, et cetera, but it's only lasting for about four days. Or they could be having longer extended periods of mania, but they are hypomanic episodes. They're not quite as intense. So the pressured speech isn't quite as pressured. The impulsivity isn't quite as severe, et cetera, et cetera. The other aspect of bipolar two is one that I mentioned briefly a moment ago, which is that it's often associated with the drops into the depressive episodes. One person might go from very high highs that last seven days or more to very low lows, to the outs of depression, major depression, that could last two weeks or more. Other people are rapid cycling by way of three days manic, three days normal, three days manic, and then dropping into three days depression. So you want to erase that picture in your mind that manic bipolar disorder is this sine wave, this cycling up and down between mania and depression. It can take a lot of different forms.