can sleep take away a manic episode?

[TheHeartHasAVoice]

Does anyone know if sleep can take away a manic episode without meds?

Just to clarify manic episodes are typically episodes where one becomes abnormally euphoric and can become psychotic and delusional.

 

[TheHeartHasAVoice]

I guess the reason i'm asking is because why don't they use sedatives that induce sleep besides antipsychotics and lithium?

When I was manic they gave me zyprexa and that made me sleep and when I woke up my mania ended I slept for like 12 hours. Zyprexa is totally different to lithium so I was wondering how the theory lithium treats a brain disorder is valid if you have two different medications that work in different ways and achieve the same thing.

 

[HLon99]

Hi,

Although episodes of mania often affect sleeping patterns and the two are connected this realtionship is complex and indirect. Sleep alone did not cure your mania, its the antipsychotic/antimanic effect of the Zyprexa that cured your mania, the sleep was just a (beneficial) side effect.

During my first (unidagnosed) manic episode, I went to my GP and got sleeping pills, for what at the time I told her was insomnia. The sleeping pills did nothing to cure the mania. They would knock me out at night and I would wake up in the morning still manic. This is because the mechanism by which sleeping pills/sedatives/tranquilisers work is totally different from medications known to be able to treat mania.

To get technical, Mania is a very complicated and misunderstood process. From postmortem studies of brains, it has been postulated that there is a dysfunctional protein in the brains of bipolar people, which for some unknown reason suddenly increases at certain intervals and this causes the monoamine system (dopamine, norepinephrenine, seratonin) to go haywire and become extremely hypersensitive. Atypical antipsychotics (e.g. Zyprexa) directly on the monoamine system; by antagonism/partial agonism of Dopamine D-2 receptor and antagonism/partial agonism of certain seratonin 5-HT receptors; in order to bring things back into balance. Lithium has a dual effect, it downregulates the monoamines, by slowing release of Dopamine and Norepinephrine, and, in the maintainance phase, it blocks the dysfuctional protein from triggering manic episodes in the first place. Lithium and most modern atypical antipsychotics have similar rates of success in treating mania, with antipsychotics having a slight edge because they work quicly wheras Lithium takes a few weeks. However, for long term stabilisation Lithium is preferred due to this dual effect. Sedatives such as Valium, Xanax, Ambien worked totally differently. Valium acts by opening up GABA channels, which are responsible for the sedation of your entire central nervous system. However, this effect is temporary and is not the direct mechanism for mania. So, after you wake up you will still be manic.

Sorry for the science lesson, but you asked so there. Bottom line is, sedatives and drugs known to treat mania work in wildly different ways. Valium is occasionally given short term to people with mania to take the edge off if they are feeling extremely anxious, however, using Valium alone to treat mania would be totally ineffective. There is a relationship between mania and sleep, but this relationship is indirect and you can't simply sleep off mania. It doesn't work like that. We are only now starting to understand the mechanisms of mania. The drugs used today were developed before they had any credible theories to explain mania, by trial and error. Lithium by a doctor who tested it on hyperactive rats and found that it sort of calmed them down and antipsychotics because they were known to work on people with Schizophrenia and so they wanted to try it on people with bipolar. No one knows why some antiepileptic drugs such as Valproate/Lamotrigine work, but people who had both epilepsy and bipolar found that these drugs had an effect on reducing not only seizures, but also treating their bipolar.

Hope this answers your question.

 

[HLon99]

P.S. The sedative effect of Zyprexa is not due to its antipsychotic mechanism (D2 and 5-HT antagonism/partial agonism) but due to the fact that it is also a potent antihistamine, similar to certain drowsy allergy medicines such as Benadryl. I am on Abilify (Aripiprazole) which, unlike Zyprexa, has little to no antihistamine effect, not drowsy at all. However, it still works for mania due to its antipsychotic mechanism. It is not at all necissary for a drug to induce drowsiness in order to treat mania.

 

[TheHeartHasAVoice]

P.S. The sedative effect of Zyprexa is not due to its antipsychotic mechanism (D2 and 5-HT antagonism/partial agonism) but due to the fact that it is also a potent antihistamine, similar to certain drowsy allergy medicines such as Benadryl. I am on Abilify (Aripiprazole) which, unlike Zyprexa, has little to no antihistamine effect, not drowsy at all. However, it still works for mania due to its antipsychotic mechanism. It is not at all necissary for a drug to induce drowsiness in order to treat mania.

Thank you for your well informed responses. They were helpful.

 

[HLon99]

Thank you for your well informed responses. They were helpful.

You're welcome! If you have any other questions, please ask.

 

[Galaxy]

Thanks HLon99, I also found your post a very interesting read

 

[Doopadoop]

From personal experience knee deep in my own worst manic episode, I've gone from sleeping 12 or more hours steadily in my depressive episode, to skip hopping to 8, 3, 8, then 15 again though I cranked back up to being paranoid and not many things making sense, extreme sensitivity etc. All its done is give me more time to have very strange dreams and think too much about how weird my thinking is. I'm attempting to come out of it and want to try to go outside, I ate and whatnot but... it depends. I felt very rash and didnt want to react negatively towards my family so i think it helped me control things in a manner but I'm not going to be able to continue staying in bed/sleeping all day I can feel it's not helping. I've been trying to read some articles and that's given me some goals to tend to but being at a standstill isnt a complete solution. Maybe a good pause.

 

[Wishbone]

For anyone interested in anything sleep-related to Bipolar this is a decent read of the various factors that may or may not be involved. HLon has covered some of it, but you also have other factors influencing our brains (and it does seem that ours function, or react to certain things, differently) which all come together to create this thing. And as is so often the case with our bodies, and especially our brains it seems, there are a number of things contributing to create the perfect storm. I guess that's why it wasn't fixed long ago. https://onlinelibrary.wiley.com/doi/full/10.1111/pcn.12688

 

[TheHeartHasAVoice]

For anyone interested in anything sleep-related to Bipolar this is a decent read of the various factors that may or may not be involved. HLon has covered some of it, but you also have other factors influencing our brains (and it does seem that ours function, or react to certain things, differently) which all come together to create this thing. And as is so often the case with our bodies, and especially our brains it seems, there are a number of things contributing to create the perfect storm. I guess that's why it wasn't fixed long ago. https://onlinelibrary.wiley.com/doi/full/10.1111/pcn.12688

I had a quick skim over it and bookmarked the page thanks for that. Sleep seems to be an incredibly sensitive process important for human health. I remember when I took my daughter to the sleep specialist he told me it's being regarded as a pillar of health now. I notice myself when I sleep deep i'm in a better mood.

 

[Wishbone]

Exactly. I've always felt it central to my own moods even long before I was diagnosed. Most people will be grumpy without sleep but I tend to be better when I've had what would be considered less than the ideal of 7 or 8 hours. But the part about depression and having too much sleep is just as important in this whole thing because many people feed their depression by doing this very thing. Depression wants you in the dark.

 

[Ginger Kitten]

Hi,

Although episodes of mania often affect sleeping patterns and the two are connected this realtionship is complex and indirect. Sleep alone did not cure your mania, its the antipsychotic/antimanic effect of the Zyprexa that cured your mania, the sleep was just a (beneficial) side effect.

To get technical, Mania is a very complicated and misunderstood process. From postmortem studies of brains, it has been postulated that there is a dysfunctional protein in the brains of bipolar people, which for some unknown reason suddenly increases at certain intervals and this causes the monoamine system (dopamine, norepinephrenine, seratonin) to go haywire and become extremely hypersensitive. Atypical antipsychotics (e.g. Zyprexa) directly on the monoamine system; by antagonism/partial agonism of Dopamine D-2 receptor and antagonism/partial agonism of certain seratonin 5-HT receptors; in order to bring things back into balance. Lithium has a dual effect, it downregulates the monoamines, by slowing release of Dopamine and Norepinephrine, and, in the maintainance phase, it blocks the dysfuctional protein from triggering manic episodes in the first place. Lithium and most modern atypical antipsychotics have similar rates of success in treating mania, with antipsychotics having a slight edge because they work quicly wheras Lithium takes a few weeks. However, for long term stabilisation Lithium is preferred due to this dual effect. Sedatives such as Valium, Xanax, Ambien worked totally differently. Valium acts by opening up GABA channels, which are responsible for the sedation of your entire central nervous system. However, this effect is temporary and is not the direct mechanism for mania. So, after you wake up you will still be manic.

Sorry for the science lesson, but you asked so there. Bottom line is, sedatives and drugs known to treat mania work in wildly different ways. Valium is occasionally given short term to people with mania to take the edge off if they are feeling extremely anxious, however, using Valium alone to treat mania would be totally ineffective. There is a relationship between mania and sleep, but this relationship is indirect and you can't simply sleep off mania. It doesn't work like that. We are only now starting to understand the mechanisms of mania. The drugs used today were developed before they had any credible theories to explain mania, by trial and error. Lithium by a doctor who tested it on hyperactive rats and found that it sort of calmed them down and antipsychotics because they were known to work on people with Schizophrenia and so they wanted to try it on people with bipolar. No one knows why some antiepileptic drugs such as Valproate/Lamotrigine work, but people who had both epilepsy and bipolar found that these drugs had an effect on reducing not only seizures, but also treating their bipolar.

HLon99, I found that explanation very helpful - and I wonder if you should be taking a science degree, rather than economics! I did know a little something about the biochemical processes of my two drugs, lithium and quetiapine, but I didn't know it in detail. And if I remember nothing else, I will remember the system in the brain responsible for mania, as you explain it: 'the monoamine system (dopamine, norepinephrenine, seratonin'). That will give me some ideas for research (if I ever feel like it - I only got once science A level [Biology] at school, the rest were the arts, French and English, so it would be a struggle!).

I found the science above a bit befuddling (my fault, not yours, you've explained it clearly), but think I did manage to follow (most of) it. I will reply to the OP of this thread now. KR, Ginger.

 

[Ginger Kitten]

Hello, The heart has a voice, the short answer to your question is, 'No'.

The longer answer is that good sleep is vital for people with bipolar. Although sleep can indeed reduce feelings of both mania and depression, lack of sleep is common with both moods. That's the irony about sleep: it will help to reduce the severity of episodes and yet disturbed sleep is a symptom of the illness. So when you need it most to help you recover, that's the time it will become most elusive.

Added to this, it is vital that people with BP maintain regular sleeping, eating, waking habits, in order to regulate 'diurnal rhythms' (or in popular parlance, 'body clock'). So it is not down to sleep alone; everything needs to be regulated, in order to keep you on an even keel emotionally.

So, sleep will not 'take away' a manic episode (and in mania, especially at its upper reaches, sleep will be very hard to come by), but it will reduce the severity of the symptoms. This is why pdocs are so keen to medicate us, before the sleeplessness becomes ingrained and robs us of our sanity.

But there are other things that will also reduce a manic episode (are you in one atm, may I ask?). Any soothing activity you enjoy, whether swimming, walking, listening to music, and consciously slowing down, reducing stimulation: turning down the lights, switching off the phone - and staying off it! - reducing technology use, paced breathing exercises... the list goes on.

If you'd like to know how to reduce manic symptoms, perhaps you could start another thread about that? I find the more info you have at your hands, the better you get at staying euthymic (in a level mood) for longer, or noticing when you are heading towards an episode. This is what mh professionals mean by 'insight' and it's something they strive to help their patients achieve.

Kind regards, Ginger.

 

[HLon99]

HLon99, I found that explanation very helpful - and I wonder if you should be taking a science degree, rather than economics! I did know a little something about the biochemical processes of my two drugs, lithium and quetiapine, but I didn't know it in detail. And if I remember nothing else, I will remember the system in the brain responsible for mania, as you explain it: 'the monoamine system (dopamine, norepinephrenine, seratonin'). That will give me some ideas for research (if I ever feel like it - I only got once science A level [Biology] at school, the rest were the arts, French and English, so it would be a struggle!).

I found the science above a bit befuddling (my fault, not yours, you've explained it clearly), but think I did manage to follow (most of) it. I will reply to the OP of this thread now. KR, Ginger.

I haven't done biology since GCSE and it wasn't my strong suit. However, since I developed my bipolar, I started educating myself about all the ins and outs of the illness and its treatments. I don't want to play amateur psychiatrist, but I want to stay on top of things and be involved in decisions about my care; so its worth doing to a certain extent.

BTW, since you're interested, I'll try to explain my rationale behind my interest in Quetiapine. My current regiment consists of Lamictal, Aripiprazole and Elvanse. Lamictal I have no problems with, but the other two have the potential to interact with one another. Elvanse, like other ADHD meds, is a stimulant. Stimulants work by blocking the reuptake of monoamines (Dopamine, Norepinephrine) in the brain, thereby increasing their levels. Elvanse on its own has the potential to trigger mania in patients who have bipolar and ADHD. However, when balanced with an antimanic mood stabiliser or antipsychotic, to prevent the monoamine levels from getting too high, this risk becomes negligable. My current mood stabiliser/antipsychotic (Aripiprazole) is almost too good at controlling monoamines. Even at the very lowest dose (2mg), it binds to 75% of Dopamine receptors in the brain and since it is extremely long acting (half-life 72-96hrs), these levels remain consistant throughout the day. Quetiapine has a unique mechanism, whereby it binds to Dopamine receptors at a much lower level and very transiently. Even at its peak, Quetiapine (XR, 400mg) only binds to 40% of receptors. It also has a short half life (8-12hrs) meaning that this number drops to 25-30% after 12 hours. This leave much more free Dopamine receptors open for the Stimulant to do its work. Despite this 'light touch' approach, Quetiapine is as effective at mood stabilisation as Aripiprazole. No one really knows why, but they suspect it is something to do with its effect on Seratonin receptors. Clozapine also works in a similar way, but comes with a bunch of nasty side effects.

Unfortunately, I have not been able to find any comprehensive study comparing various combinations of drugs in the treatment of comorbid Bipolar and ADHD cases. However, documented case studies and anecdotal reports have shown that people have more luck with Quetiapine + Stimulant as oppose to Aripiprazole + Stimulant. Also the stimulant, when working properly, can ward of some of the sedation and weight gain caused by Quetiapine.

 

[TheHeartHasAVoice]

Hello, The heart has a voice, the short answer to your question is, 'No'.

The longer answer is that good sleep is vital for people with bipolar. Although sleep can indeed reduce feelings of both mania and depression, lack of sleep is common with both moods. That's the irony about sleep: it will help to reduce the severity of episodes and yet disturbed sleep is a symptom of the illness. So when you need it most to help you recover, that's the time it will become most elusive.

Added to this, it is vital that people with BP maintain regular sleeping, eating, waking habits, in order to regulate 'diurnal rhythms' (or in popular parlance, 'body clock'). So it is not down to sleep alone; everything needs to be regulated, in order to keep you on an even keel emotionally.

So, sleep will not 'take away' a manic episode (and in mania, especially at its upper reaches, sleep will be very hard to come by), but it will reduce the severity of the symptoms. This is why pdocs are so keen to medicate us, before the sleeplessness becomes ingrained and robs us of our sanity.

But there are other things that will also reduce a manic episode (are you in one atm, may I ask?). Any soothing activity you enjoy, whether swimming, walking, listening to music, and consciously slowing down, reducing stimulation: turning down the lights, switching off the phone - and staying off it! - reducing technology use, paced breathing exercises... the list goes on.

If you'd like to know how to reduce manic symptoms, perhaps you could start another thread about that? I find the more info you have at your hands, the better you get at staying euthymic (in a level mood) for longer, or noticing when you are heading towards an episode. This is what mh professionals mean by 'insight' and it's something they strive to help their patients achieve.

Kind regards, Ginger.

Hi thanks for your long and helpful response it was interesting. I'm not in a manic episode. The reason why I started this thread is because I'm an independent researcher and I remember my last manic episode in 2014. I was really sleep deprived and they gave me a Zyprexa tablet which made me sleep for like 12 hours and I was taken out of my manic episode. I'm just skeptical that only antimanics and antipsychotics are the only drugs to take one out of a manic episode. I study critical Psychiatry and if I remember correctly it's not truly known how these drugs work and that they are just simply sedatives. They would affect a Bipolar person just like a non-bipolar person. So I was curious as to whether it's the sleep the Zyprexa gave me that took me out of my manic episode and if so then why don't they develop safer drugs instead of ones that destroy the liver and kidneys. it hasn't changed much in roughly 50 years.

I wish they would do some experiments with safer drugs and deliberately inducing sleep because the biochemical imbalance is just a theory and is assumed ie has never been found. In other words, these "illnesses" can't be detected anywhere in the body. The moment they do they go outside of Psychiatry. You can get mania from hormone imbalances which the Psychiatrist doesn't deal with. You can get schizophrenic symptoms from infections which are killed with antibiotics etc.

The guy who invented lithium was Dr John Cade from Victoria Australia. He was convinced that Manic Depression (Bipolar Disorder) was a biological (physical) disorder not a psychological one. Lithium's benefits were discovered after he injected lithium carbonate into guinea pigs and noticed after about 2 hours the animals although full conscious became extremely lethargic and unresponsive to stimuli for a while. Lithium was then administered to people with mania with similar results. (Francis A Mondimoore, 2014. Bipolar a guide for patients and families 3rd edition)

In my opinion all it's doing is tranquilizing you/sedating you. This might be good in the short term as it can save your life but long term can be problematic.

That's why I started this thread because I believe it was the sedation that saved me and not the treating of a "diseased disturbed molecule" in my brain by a drug. This is important to me as someone who has decided to dedicate his life to research mental illness because i'm not convinced ailments like Schizophrenia and Bipolar Disorder are the hopeless life long ailment they are portrayed as. Not in every case that is. These ailments have a rich history with modern Psychiatry only dominating the management of them in recent history.