Essentials: The Science & Treatment of Bipolar Disorder

Andrew Huberman, a professor of neurobiology and ophthalmology at Stanford School of Medicine, opens this Huberman Lab Essentials episode by framing bipolar disorder, which he notes is often called bipolar depression, as a condition in which people go through massive shifts in energy, perception and mood. He stresses that these shifts are not neutral swings in temperament. In his telling, they can cause tremendous damage both to the person with the disorder and to the people in their life. He backs the seriousness of the topic with one figure: people with bipolar disorder are at 20 to 30 times greater risk of suicide. He presents the discussion as relevant to people who have manic bipolar disorder and to those who know someone who does.

it is very important to note that these shifts in mood, energy, and perception are all maladaptive.

Huberman says bipolar disorder affects about 1% of people. He admits this might sound small, then puts it in concrete terms: in a room of 100 people, at least one is very likely to have it. He gives the typical age of onset as 20 to 25 years old, while noting that onset can be much earlier. He divides the condition into two kinds, Bipolar I and Bipolar II. Bipolar I is marked by a fairly extended period of mania, which he defines as very elevated mood, energy, distractibility and impulsivity, along with other symptoms he goes on to describe. He calls the manic episode in Bipolar I extreme, and he names duration as a key diagnostic criterion: the manic episodes have to last seven days or more. He describes the usual clinical setting as a person being brought to a clinic, or coming on their own to meet a psychiatrist, who then evaluates them for several things.

According to Huberman, the psychiatrist's first question is whether the person shows at least three symptoms from a defined set. He goes through them with brief illustrations. Distractibility shows up as talk that jumps from a pen to something seen the other day, to something the person wants to buy, to a place they plan to travel, along with high sensitivity to any stimulus in the room. He separates impulsivity from this by tying it to actions, such as fidgeting with an object and then trying to leave the room. Grandiosity appears in words or actions, and he emphasizes that it reflects real beliefs the person comes to hold about their grandiose position, opportunities or potential in the world.

He describes flight of ideas as related to distractibility but different in form: the person talks at length about one thing and then switches to talking at length about something else. Agitation means feeling extremely physically agitated, with a lot of shaking and moving around, trouble sitting still, and trouble looking, feeling or acting calm. He adds that agitation can venture into paranoia. The next symptom is no sleep, which he clarifies means no sleep or very minimal sleep. He says people in a manic episode can often go seven days or more with zero sleep, and that the defining feature is their lack of distress about it.

And a key feature of this zero sleep is that they're not troubled by it.

He contrasts this with how pulled apart most people would feel under the same conditions. The person keeps going with no sleep, up at all hours, shopping, talking, running and acting across the other symptom categories, without being bothered. The last symptom is rapid, pressured speech, which he describes as relentless and leaving no room for conversation.

The symptoms Huberman lists for a manic episode: distractibility; impulsivity; grandiosity; flight of ideas; agitation; no sleep (or very minimal sleep); rapid, pressured speech.