Bipolar Thoughts

You’ve Got Something In Your Nose

There have been two very interesting developments in the world of psychotropic pharmacology lately.

The first was a couple months ago, I might have mentioned it, where they are developing a new type of anti-depressant that might be effective in bipolars.

Here is the scoop: there are two types of anti-depressants, MAOIs and SSRIs. MAOIs are very rarely used anymore. They are old and full of nasty side effects, although the efficacy rate was pretty high on that class of drugs. They just aren’t really around, except in special cases. SSRIs (selective serotonin reuptake inhibitors) are the main class of anti-depressants.

The concept is simple: serotonin makes you happy, let’s prevent the serotonin from being absorbed by the brain so it stays out there and keeps you happy. So they designed a drug that inhibits the reuptake of serotonin, get it?

The efficacy rate is getting better on these drugs, but it is still low, like below 30%. But the main thing for me is that they don’t typically prescribe them to bipolars. SSRIs tend to push bipolars into euphoric states or even mania. They are sometimes used in emergency situations, like suicidal depression, but only for a short period of time. And even in an emergency situation, you have to wait upwards of two weeks to feel the effects of the drug. Not great.

So this new type of drug has almost nothing to do with serotonin or dopamine, first of its kind.

What researchers have noticed is that depression may be caused by a lack of proper signals being transferred by the brain. And there is a chemical in your brain that aids in this process. They have found that depressed people are typically lacking this chemical. So, this pill will increase this chemical which makes for more fluid transfer of signals which might make you less depressed. They rodent studies are very promising with extremely high efficacy rates and results are shown as quickly as one day.

And the best part is that bipolars might be able to take this. In fact, it might be a regular treatment for bipolar in its own right as well.

Pretty cool. Amazingly cool! Not only will this type of medication treat depression, it is the first drug that has been developed that treats an actual causal relationship between the brain and depression. SSRIs work because we know how serotonin works, but depressed people don’t have low levels of serotonin typically, so that isn’t a cause. Anyway, I am really excited and hopefully it isn’t much more than five years before these drugs are available.

But there is another cool thing that I just read about last week. Nasal medication.

They have been doing some tests in taking psychotropic medications and delivering them nasally. There are two main nerves that run from your nasal cavity to your brain and these medications would ride this nerve straight into the brain instead of going into the bloodstream first.

There are a few benefits. First, a lot of psychotropic pills make you nauseous. My lithium is killer if I have an empty stomach, many pills I have taken have been this way. Nasal eliminates the stomach portion.

Second, some medications lose efficacy because of the blood to brain loss syndrome. Some chemicals are too big molecularly to go from your bloodstream into your brain, some can only fit some in, and some lose potency from travelling through your body, especially if you ingested them.

Third, you can avoid stress on other organs. Some pills are tough on your kidneys or liver, and going straight to the brain avoids this problem completely because they are metabolized or filtered through the blood.

Fourth, faster symptom relief. Even a fast acting pill like klonopin or ambien can take up to a half hour to kick in. Not nasally, just minutes is all there is between you and relief. This would be a dream in a suicide situation.

There are some questions too, like are some drugs too dangerous to snort? What will this do to your nose? Is it easier to abuse the medication this way?

People like to forget that cocaine used to be consider a psychotropic drug and was administered nasally for direct and immediate impact. That didn’t work out so well, or it worked out perfectly depending on who you ask. So they need to be careful. Rates of drug abuse are much higher among mentally ill people, this is something we always need to be wary of, and a reason MAOIs and Benzodiazepines are less and less part of treatment packages.

This is something I am interested in as I have now twice tested with high liver enzymes that I had to be treated for due to my medications. I want to be mentally healthy, but I don’t want to be physically unhealthy, with a bad liver and kidneys when I am older either. There needs to be a balance. My doctors have always taken the viewpoint that I am young and I need significant psychiatric help now. So they prioritized those needs. But hopefully one day in the near future, you won’t have to compromise.

I’m very excited and curious about where this all goes!