Is bipolar disorder a form of epilepsy?

A lot of the medications used to treat bipolar disorder are also used in the treatment of epilepsy, notably sodium valproate, lamictal and carbamazepine (anticonvulsants).

There is some discussion in the medical community that bipolar is a form of temporal lobe epilepsy, and that the extreme mood states are in fact a form of seizure.

Here is a short study of thirteen patients with bipolar I disorder and epilepsy. There are overlaps- mood swings for a start, although it has been shown that manic episodes of bipolar I are more severe than those witnessed in temporal lobe epilepsy.

It was suggested when I was seventeen that I suffered from Temporal Lobe Epilepsy as I was experiencing psychosis. If you ever think it’s easy to be diagnosed with a mental illness, you’re wrong, it’s extremely difficult. After running through the gamut of being called an attention seeker, doctors will try to rule out other causes. For example, physical illnesses such as Multiple Sclerosis can present symptoms that need psychiatric treatment. But my symptoms overlapped with TLE. It was eventually ruled out, but you can see why they tested me.

If you look at the symptoms of TLE, they do correspond with symptoms of bipolar I disorder:

Simple partial seizures:

Simple Partial Seizures (SPS) involve small areas of the temporal lobe and do not affect consciousness. These are seizures which primarily cause sensations. These sensations may be mnestic such as déjà vu (a feeling of familiarity), jamais vu (a feeling of unfamiliarity), a specific single or set of memories, or amnesia. The sensations may be auditory such as a sound or tune, or gustatory such as a taste, or olfactory such as a smell that is not truly present. Sensations can also be visual or involve feelings on the skin or in the internal organs. The latter feelings may seem to move over the body. Dysphoric or euphoric feelings, fear, anger, and other sensations can also occur during SPS. Often, it is hard for persons with SPS of TLE to describe the feeling. SPS are often called “auras,” and are sometimes thought to be preludes to actual seizures. The latter is incorrect. SPS are seizures.

The experiences in simple partial seizures are similar to those experienced in mania- for example, hallucinations, dysphoria and euphoria, fear and anger.

Of course, do look further than wikipedia, I’m merely using that page as a summary. I have read further but wiki is good for summing things up. The page for the seizure touches on something interesting:

*amnesia around the seizure event and sometimes events which occurred before the seizure

Something rarely discussed is the cognitive impact of bipolar disorder, such as problems with memory. I experience this, and over years of episodes, my ability to recall events (especially when it comes to things that have been said) and to think clearly has been corroded. I also experience memory blanks when in episodes. I can’t clearly remember any of my manic episodes and with rapid-cycling, short manic or depressive episodes yield blanks for me.

Then there is complex partial seizures which touches on something very interesting:

Signs may include motionless staring, automatic movements of the hands or mouth, inability to respond to others, unusual speech, or unusual behaviors.

Doesn’t that sound like severe catatonic depression and the negative symptoms of schizophrenia?

The similarities end at the point of tonic-clonic seizures.

Remember that bipolar disorder I is not just experiencing severe mood swings. There is a whole host of physical and cognitive symptoms. Mania and depression both involve physical tics such as restlessness, twitching and repetive movement for mania to lack of response in depression. The brain processes things at different speeds in different mood states- too fast in mania, too slow in depression. Memory is impaired, the ability to concentrate is destroyed and at both ends of the rainbow there is psychosis.

There is also some discussion that temporal lobe epilepsy can result in hyperreligiousity, which is also a feature of mania.

Don’t overlook that these are extremely generalised symptoms, though.

So why are bipolar disorder and TLE often treated with the same medications? Something massively overlooked by those who don’t believe in mental illness is that in a lot of cases, the medication works. There is some biological basis to bipolar disorder, or else medication would have no effect. ECT would be rendered useless.

It isn’t a case of simply numbing the person. I take a combination of medication because I have just been diagnosed but my situation isn’t at all representative. Quite a lot of people take one drug- a mood stabiliser or an antipsychotic, and many people take two (those with bipolar II generally take an antidepressant and a mood stabiliser). I started at one- Lithium for mania. My secondary problem, because I experience mania often, is psychosis, so an antipsychotic was added. Then an antidepressant for depression, which was then taken away and Depakote was added for rapid-cycling. All my medications seek to stabilise me. Antidepressants can help depression. Antipsychotics can help psychosis. Antimanics can help mania.

It’s keeping a balance rather than seeking to destroy the feelings and functions of the patient. A lot of people manage to function normally on medications whereas they weren’t able to before. Some people don’t, and some people do not take medication for their illness, either out of unwillingness or because they have a mild form of bipolar disorder. However, there is always the risk that mild will become full blown. Is it behavioural or is it biological? Why does it become worse unmedicated?

The thing is, nobody knows why bipolar medication works. Lithium, one of the oldest drugs for bipolar mania, was discovered by accident and doctors still have no idea how it works. So it’s pretty obvious as to why people won’t take medication. Do you really want to put a drug in your body when you have no idea how it works? There’s more concrete evidence on the mechanics of heroin than on the mechanics of psychiatric medication.

They may be treated with similar drugs because they present similiar symptoms. However, the overlaps in no way mean that they are similiar illnesses. The symptoms of mental illness displayed in TLE are not the whole story.

However, it were proven that bipolar (and possibly even schizophrenia) were forms of epilepsy then it would revolutionise the way they are treated. Physical illnesses garner more sympathy and understanding than mental illnesses. The psychiatric symptoms of physical illnesses are unfortunate side effects of the illness, whereas when the symptoms are the unfortunate illness, the view is quite different.

For example, take the criticism people like me who write about our mental illnesses receive (just cast your eyes over the comments and I could share e-mails I get). I am told often that my illness isn’t real and that I am, as a person, flawed for having this illness. It is unlikely that if I wrote about these symptoms- and symptoms is what they are- while suffering from a physical illness that encompassed these symptoms it would be different. Because physical illnesses are provable, whereas mental illnesses are not. Therefore the physical illness will always be more credible than the mental illness.

If mental illnesses were provable and partially attributed to a biological cause like epilepsy, then the treatment of mental illness and those who have it would change drastically. People who have epilepsy aren’t viewed as burdens to society. People would finally understand that we mean it when we say that we don’t do this to ourselves. The suffering caused by it to ourselves and loved ones isn’t something we embrace and encourage. The opinion of diagnosis of mental illness as a societal tool for cataloguing and catergorising behavioural problems would be dismissed as physical illnesses do present the same symptoms. It would be nice not to be seen as psychos and fuck ups to be seen as people who have an illness that needs treatment as any other.