Is bipolar disorder a sentence, or is it perhaps a challenge we must face every day, or maybe it is an opportunity to improve our lives, serving as an important motivator?
In this article, I will present how medications aim to help us and how we can avoid hindering them. On the other hand, I will explain how to minimize their negative (side) effects and how to deal with other complications of bipolar disorder. You will learn how dopamine works and why its regulation is important in a state of hypomania, as well as when we feel it is approaching. Above all, I hope this article will guide you on how to take control (even if just a little) and encourage you to explore the literature I refer to. Education about one’s illness, especially Bipolar Disorder (BD), is key to better management and ultimately a better life with the illness.
ADHD and Dopamine
There is a reason I begin with another disorder, ADHD. According to an article in Medical News Today (2022), one of the co-occurring factors with ADHD is low dopamine levels. Therefore, the medications prescribed for this condition often work by inhibiting dopamine reuptake.
Dopamine reuptake inhibition prevents the “return” of the neurotransmitter to the presynaptic neuron, thereby increasing its amount in the synaptic spaces. This works similarly to antidepressants that inhibit serotonin reuptake.
A natural way to increase dopamine in the brain includes exercise, diet, mindfulness, frequent changes of surroundings, and experiencing new things—living a varied life daily (reducing routine, boring and monotonous activities).
Dopamine
Dopamine is an important neurotransmitter responsible for many essential functions such as motivation, planning, problem-solving, creativity, information processing, and working memory, according to The Dopamine Brain (2024). Dopamine is also responsible for the feeling of pleasure, helping us better remember what caused that pleasure and motivating us to seek it out. Engaging in specific activities is aimed at obtaining a reward in the form of this pleasure and satisfaction, which accompanies dopamine release.
This can motivate both healthy and unhealthy behaviors. Healthy ones include physical activity, planning, traveling, and other constructive actions that result in well-being (dopamine release and reward) and are also aligned with deeper values (health, self-development, or exploration). Unhealthy habits include drinking large amounts of alcohol, using drugs, smoking, gambling, shopping, binge-watching, or scrolling through social media reels. These behaviors often share a tendency to engage easily, trigger dopamine release, and bring harmful consequences. Such behaviors are often compulsive and cause significant discomfort if the urge to engage in them isn’t satisfied. Frequent engagement leads to dopamine tolerance, meaning one needs to increase the quantity or intensity of these actions to feel pleasure again, while more ordinary activities like a walk become indifferent.
BD and Dopamine
In bipolar disorder, antipsychotic medications are used to prevent hypomanic and manic states. These medications often work by blocking dopamine receptors, thereby reducing its amount in synaptic spaces. Medications such as Olanzapine and Haloperidol are two examples (National Library of Medicine, 2023).
However, unlike ADHD, individuals with BD do not exhibit dysfunction of these neurotransmitters. However, this does not exclude the negative effects of dopamine release, as described in the scientific article Bipolar Disorder, 2015. This article provides a detailed diagnosis, treatment, and characterization of bipolar disorder, is frequently cited and clarify the matter.
Dopamine Control
Since individuals with ADHD can increase dopamine levels in a healthy way, those with BD can decrease their dopamine levels through appropriate actions. The first step is to replace destructive behaviors with constructive ones. In The Dopamine Brain (2024), the author highlights which activities trigger “good” versus “bad” dopamine and carefully describes how to replace “vain” pleasures with behaviors aligned with our values.
The book is worth noting because, who among those affected by BD hasn’t experienced periods of hypomania where they made enormous purchases of things they later realized they didn’t need? Another example might be compulsive sex or suddenly having more opportunities to drink, or even buying airline tickets and then regretting it, leading to another loss of money. Or compulsively making important decisions. All these behaviors are destructive and significantly increase dopamine levels, counteracting the therapeutic effect of Olanzapine. The author emphasizes the importance of being aware of our values and replacing destructive behaviors with new ones that align with those values, which, though they also trigger dopamine release, do not carry harmful consequences.
The book also highlights the vital role of mindfulness in dealing with bad habits because it helps manage the painful discomfort when resisting compulsive behaviors. This technique is also widely used in depressive and bipolar disorders. I will discuss it in more detail in the next post, specifically in relation to BD. Through mindfulness, we can better handle the intense urge to do something at a given moment, such as shopping, scrolling social media, planning, or overwhelming ourselves with a multitude of tasks.
The hypomanic (and manic) state usually comes with a lot of energy, but that doesn’t mean that using it will get rid of it and bring relief. Unfortunately, it often leads to ramping up. An experienced person with BD knows how to find the right balance between how much “jumping” they can do and when to set a boundary. It’s not realistic to force oneself into a “normal” mode during elevated states, but one can navigate through this storm skillfully.
If we can’t resist even behaviors that support our values, such as planning, task accomplishment leading to a goal, or, for example, exercise, which may still be compulsive, we can replace them with actions supporting the value of “mental health.” This value is certainly important for people with bipolar disorder. Behaviors supporting this value include those that have a calming effect in themselves, such as knitting, reading calm books, painting by numbers, making bracelets, or other activities requiring repetitive, monotonous tasks yet leading to a goal. These can also be relaxing activities, such as a bath, but also ones that result in something meaningful, like a bracelet for a friend or a sweater for a husband. These activities must bring positive effects and cannot be an easy source of dopamine.
This is easy to say, but I know all too well how hard it is to resist buying, overtraining, or spontaneous traveling when in hypomania. There’s this conviction that it’s the only right path, that fulfilling these desires is necessary, that it must happen, and that not doing it means catastrophe, disappointment, sadness, and lack of satisfaction—a painful discomfort.
This is a very difficult task to carry out. Because if we want to reduce dopamine levels, or at least not increase them, we must find alternatives to behaviors that seem obvious in hypomania, relate to increased energy, and are compulsive. The more of these behaviors we engage in, the more we ramp up, the dopamine levels keep rising, and medications like Olanzapine will no longer be enough to stop this machinery. Often, increasing the medication unfortunately doesn’t keep up with the increase in symptoms, and one can quickly slip into mania. Therefore, it’s essential to support our medications so they can reduce dopamine levels, prevent mania, or even hypomania, and ultimately restore the baseline, neutral state.
It’s best, when in a good mood, euthemic state, to explore which activities are engaging, relaxing, and at the same time provide a meaningful effect, practice them, and observe how they affect us. Are we satisfied afterward, are they enjoyable, are they not too boring, do we get easily distracted, are they interesting, and how stimulating are they? While keeping in mind the value of mental health, as well as our family and relationships, we can turn to these activities in hypomanic states. With the deep belief that excessive shopping, absurd physical activity, or drinking alcohol are not pillars of these values, we will focus on what actually brings us closer to them.
Complete abstinence from utilizing our limitless energy in hypomanic states is impossible; therefore, some activities (healthy ones like exercise or travel) can be kept in moderation. The rest can be replaced with our calming activities. Exercise is the key. Dopamine regulation is something that can be learned over many years, but eventually, it will be possible and will bringing us closer to controlling the illness.
Biomarkers of BD
What about other aspects of bipolar disorder, such as physical disturbances? In the scientific article Candidate Biomarkers in Psychiatric Disorders: State of the Field (2023), the authors highlight certain visible (based on research) links between brain changes and mood disorders such as BD. However, no specific biomarkers for this disorder are identified, meaning it cannot be diagnosed based on any tests. This is a disease partly associated with the presence of specific genes, it is hereditary, but this is not a sufficient condition for its “activation.” Environmental factors also play a role, such as trauma, chronic depression, or stress.
Brain imaging studies have shown that the effects of central nervous system stress go hand in hand with mood disorders. This is related to the reduction of areas responsible for stress management, such as the hippocampus and frontal lobe. MRS (Magnetic Resonance Spectroscopy) studies have shown that individuals with BD have reduced secretion of GABA and glutamate, the main brain neurotransmitters. The first one inhibits activity and has a calming effect, while the second one has stimulating effects. The proper activity and quantity of these neurotransmitters allow for regulation of tension and relaxation.
Both neurotransmitters can be stimulated through physical exercise, yoga, breathing exercises (meditation), cryotherapy (warm, cold showers), and periodic deliberate stimulation and calming. Consuming glutamate in the diet has the opposite effect (Genius Food).
Additionally, a significant decrease in BDNF (brain-derived neurotrophic factor) has been observed in mood disorders. BDNF stimulates the creation of new neurons in the part of the brain responsible for memory, but also has protective properties for existing brain cells. However, BDNF levels can be increased through physical exercise and a diet rich in omega-3 acids (Genius Food).
In deceased individuals who had bipolar disorder, the loss of dendritic spines was discovered, which leads to synaptic dysfunction, memory issues, and learning problems. Similar difficulties are also seen in individuals affected by Alzheimer’s disease. Unfortunately, there is currently no treatment to stop this process, and there is no suggestion that physical exercise or diet could change this according to the article Remodeling dendritic spines for treatment of traumatic brain injury, 2019. Research on treatment is ongoing.
However, most of the aforementioned disorders related to brain function can be regulated through diet and physical activity, as demonstrated by research (Genius Food).
Side effects of medications
Medications used to treat bipolar disorder cause a range of side effects depending on the drug. An example is Olanzapine, which can cause serious metabolic syndrome, a set of symptoms such as obesity, increased triglyceride levels, high HDL-C cholesterol, elevated blood pressure, or high fasting glucose levels, according to the article Metabolic Syndrome Update, 2016.
The article, however, provides methods for treating metabolic syndrome through lifestyle changes, especially physical activity and diet. An appropriate body mass (fat mass) is a clear indicator of how well we take care of ourselves. Consuming low-carbohydrate, high-fiber foods, engaging in intense physical exercise, or even winter cold baths can positively contribute to improving metabolic processes (Genius Food).
Summary
It is overwhelming how many conditions and disorders are associated with bipolar disorder, whether as side effects of medication or a result of the illness itself. However, the comforting thought is that there is immense potential to improve this situation on one’s own, every day. Healthy nutrition (I recommend the books Genius Food and Food Pharmacy) and moderate activity can mitigate existing and potential problems. Furthermore, mental exercises, such as learning to search for and engage in activities that support our values instead of pursuing easy pleasures (dopamine regulation, The Dopamine Brain), can potentially stop hypomania or prevent its development. Mindfulness exercises will help regain control. We have these opportunities and tools. They are supplements to medication, a psychiatrist, and a behavioral psychologist but can make a visible difference, improve our situation, and replace a sense of helplessness with real influence over the situation.
– Agnieszka
*The information and comments in this post do not constitute medical advice. The author takes no responsibility for any use of them.