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PEM in Bipolar Disorder?

pattismith

Senior Member
Messages
3,926
Increased cerebral blood flow among adolescents with bipolar disorder at rest is reduced following acute aerobic exercise
2016

Highlights


Measured cerebral blood flow (CBF) at baseline and after recumbent cycling.


Baseline frontal CBF was increased in adolescents with bipolar disorder compared to controls.


Acute exercise decreased CBF more dramatically in adolescents with bipolar disorder.


Exercise-related CBF change was associated with feelings of exhaustion.

Abstract
Objective
Cerebral blood flow (CBF) is altered in mood disorders but has not been examined among adolescents with bipolar disorder (BD). Similarly, little is known about the acute neurophysiologic effects of aerobic exercise in BD. We therefore compared CBF between adolescents with and without BD at rest and acutely following a single exercise session.

Methods
Thirty-one adolescents with BD and 20 age and sex-matched controls participated in this study. CBF magnetic resonance images (MRI) were acquired using arterial spin labeling at a baseline as well as 15 and 45 min after a single 20-min session of recumbent cycling. Voxel-based CBF analyses compared groups at baseline and after exercise. Clinical, body mass index (BMI) and exercise-induced feelings inventory (EFI) data were examined for their influence on CBF findings.

Results
Baseline CBF was increased in medial frontal and middle cingulate regions in BD compared to controls. Analysis of the acute CBF changes revealed pronounced exercise-related decreases in CBF in BD. Exercise-related feelings of exhaustion were associated with CBF changes in frontal but not parietal regions.

Discussion
A single bout of moderate-intensity aerobic exercise reduced regional CBF to a greater extent in BD compared to controls; these time dependent CBF responses were associated with exercise-induced feelings of exhaustion.
 

andyguitar

Moderator
Messages
6,581
Location
South east England
Well it's interesting @pattismith but having spent 2.5 years working with a singer who had fairly serious bi-polar I doubt that there is much of a relationship between it and CFS/ME. That persons mother and grandmother both had what we now call bi-polar but none had any fatigue like symptoms. Except when going through a depressive cycle. And even then both the singer and her mum could do much more than those i have known with CFS/ME. But that said they all had migraine so maybe there is a link there...but a distant one. Keep looking though. You are turning up some interesting stuff. :thumbsup:
 

pattismith

Senior Member
Messages
3,926
Well it's interesting @pattismith but having spent 2.5 years working with a singer who had fairly serious bi-polar I doubt that there is much of a relationship between it and CFS/ME. That persons mother and grandmother both had what we now call bi-polar but none had any fatigue like symptoms. Except when going through a depressive cycle. And even then both the singer and her mum could do much more than those i have known with CFS/ME. But that said they all had migraine so maybe there is a link there...but a distant one. Keep looking though. You are turning up some interesting stuff. :thumbsup:


It's a pity that this study was not performed with either a Mania or a depressive episode of BP, but you are right:

"Fatigue is a common, but serious symptom of bipolar disorder that usually arises during depressive episodes. It can also trigger depressive episodes and exacerbate other symptoms, meaning it presents a major challenge to treatment and managing the disorder....
Fatigue is a condition that is difficult to describe to someone who has never experienced it; words like tiredness, exhaustion and lethargy generally describe this condition, but they fail to articulate the lifelessness of fatigue. People with this condition may stay in bed for most of the day or even several days in a row, not because they are lazy, but because they simply lack the strength to rise. In this way, a simple task like doing the laundry can seem so exhausting that it brings someone to tears. Additionally, fatigue is both physically and mentally draining. When this symptom appears, patients may experience muscle weakness, difficulty concentrating, irritability, loss of appetite, headaches, confusion, drowsiness, lack of motivation and energy, apathy and more."

http://www.bipolardisorderscenters.com/bipolar-disorder-and-fatigue/

This may be different to ME, but some patient with these symptoms may think they have CFS/ME, although BD could be an alternative diagnosis.

BD patients are not all like the ones you have met, some of them have very few Manic episodes and a lifelong depressive episode, which makes it sometimes difficult to differenciate from ME or Depression.
 

ljimbo423

Senior Member
Messages
4,705
Location
United States, New Hampshire
This may be different to ME, but some patient with these symptoms may think they have CFS/ME, although BD could be an alternative diagnosis.

They could also have both BD and CFS. There are many people with CFS that also have OCD, ADHD, depression, anxiety and panic attacks, etc.

I think the physical roots of CFS often cause psychological issues. It certainly has in my case.:);)

Jim
 

andyguitar

Moderator
Messages
6,581
Location
South east England
There are certainly some interesting observations here. In the music world I have met, and worked with, many,many people who have had a diagnosis of BD, Depression, OCD, ADHD and just about every other 'Psychiatric' disorder listed. I got to know some of them very well over a period of years. @pattismith is spot on when she says it can be difficult to differentiate between ME And Depression. And as we all know the diagnosis will vary from one Doc to another. What @ljimbo423 says about CFS causing psychological issues is absolutely correct. Any chronic health problem will have an effect on a persons state of mind. But one thing that I have noticed in PWME is that the level of depression they experience is less than I would expect in such a horrible illness. That's not to say they are always happy- who would be- but they are not as bad as other people I have met with different- and less crippling- chronic health probs. This is just an observation I have made over the years and I would'nt apply it to CFS as I have met very few with that.
 

Seven7

Seven
Messages
3,444
Location
USA
PEM in Bipolar Disorder?
There is a known thing called exercise intolerance on POTs for example and other mitochondrial (born) conditions. which is different than PEM., for PEM they would have to get significantly more depressed or more maniactic (manic apisodes, exharsabation of existing symptoms). Vs feeling bad after exercise (exercise intolerance).
 

andyguitar

Moderator
Messages
6,581
Location
South east England
It's all very difficult to work out. But based on my own limited observations of people with BP I dont think the fatigue they get is the same as in ME. It's not as 'total' as in ME. But like I say my observations are limited and small scale so I could be persuaded to change my mind.:cautious:
 

ljimbo423

Senior Member
Messages
4,705
Location
United States, New Hampshire
It's all very difficult to work out. But based on my own limited observations of people with BP I dont think the fatigue they get is the same as in ME. It's not as 'total' as in ME. But like I say my observations are limited and small scale so I could be persuaded to change my mind.:cautious:

Hey Andy-

People with CFS/ME can have different levels of fatigue and PEM that vary dramatically. There are people that are a "0" on the bell scale and cannot get out of bed. There are also people that are an "9" on the bell scale and function almost completely normally.

So there is an extremely broad level of fatigue that comes with CFS/ME, that ranges from vary mild to devastating. I think that the immune activation in CFS/ME and resulting low grade inflammation from that, causes the high numbers of people with OCD, ADHD, depression, anxiety and panic disorder in CFS.

There is mounting research on how inflammation causes depression, every year. I think in time, the connection of chronic low grade inflammation in causing these other disorders will become much clearer.

My own personal experience with treating dysbiosis and leaky gut has almost completely eliminated the severe anxiety attacks I use to get, often. In fact I can't remember the last time I had one!!

I believe that lipopolysaccharides from gram negative bacteria in the gut, get into the bloodstream through a leaky gut. That causes immune system activation, low grade inflammation and caused my anxiety attacks.

Improving my microbiome and leaky gut has all but eliminated them!:D Not only that but my overall health has improved dramatically from treating my gut.

Jim
 

mermaid

Senior Member
Messages
714
Location
UK
Anecdotally re the subject, I have been married to someone now for 45 years who though has never been diagnosed officially with bipolar, shows many of the signs, and his father was hospitalised with it several times. My husband self-diagnosed about 10 years ago having seen the Stephen Fry programmes on the subject and recognised himself and from my own perspective it explained a lot of his odd behaviour over the years.

Certainly I know his father did not show any signs of fatigue that I remember (he died many years ago) except no doubt when in depression.

As for my husband, well he's now 71 and is fitter than most people of his age. He can walk quite happily from our house to the nearest town (40 mins) and then walk back again up a very steep hill, after spending maybe 2 or 3 hours there. He may do this 2 or 3 times a week. He shows no sign of energy loss the next day after doing this.

He does sleep a lot in the winter and does much less physically now than he did in the past, but the fact was that there was never any sign of energy issues in him when younger and as a child he would walk miles with his parents. If we go out together (rarely) he gets fed up with my pace of walking as he's so quick at everything he does and has a very quick mind as well.
 

pattismith

Senior Member
Messages
3,926
@mermaid , if PEM occurs in BP, it would be more logically in the depressive episodes:


A model of the mitochondrial basis of bipolar disorder
2017

Highlights


Bipolar disorder phenomenologically is a biphasic disorder of energy; increased in mania and decreased in depression.


There is evidence of increased mitochondrial respiration and ATP production in bipolar mania contrasting with decreased mitochondrial function in patients in the euthymic or depressive phase of the illness.


Consequently, the central thesis of this paper is that bipolar disorder is due to a phasic dysregulation of mitochondrial biogenergetics.
...
Discussion
There are many potential mediators of mitochondrial function which collectively are implicated in bipolar disorder. Levels of oxidative stress, pro-inflammatory cytokines and intracellular calcium ions are all higher in bipolar mania than in the euthymic and depressive phases of the illness. Increased levels of calcium ions can partly account for increased oxidative phosphorylation via well documented pathways such as the modulation of the F1–FO elements of ATP synthase."
 

andyguitar

Moderator
Messages
6,581
Location
South east England
Yeah I agree with what @ljimbo423 says about inflammation causing a range of problems. And am in broad agreement that gut problems are a significant factor in ME/CFS and many other problems. What @mermaid says about her husband pretty much fits with my observations. There is another point i forgot to make. When those I have known with depression or BI Polar are very, very down they dont get the sesitivities to noise, light and smells that PWME get. But it is possible that there is a link in the sense that the biochemical processes are the same but happen in different areas of the brain. The theory about Mitochondrial dysfunction in BP is one I have heard before. But instead of that being the cause of symptoms in BP (or ME/CFS) in my opinion it is the result of something else. And the something else is causing the inflammation of the mito. As to what the 'something else' is my theory for along time has been it is Hydrogen Peroxide being produced by elevated levels of Serotonin (5-HT). By the way many here believe that Hypobaric Oxygen Treatment (HBO) works. The theory being it kills an infection that causes ME/CFS. Well here is a fact. HBO is used in emergency medicine to treat acute Hydrogen Peroxide poisioning. When they can get the patient to a HBO chamber.