of possible interest ... kindling of bipolar episodes

[Guest guest]

The " Kindling " Model in Bipolar Disorder

If a bipolar person goes untreated for a period of years, could he or she

begin to experience rapid cycling, or become treatment-resistant? If

stressors initially set off episodes, in time could episodes appear without

any such triggers? Research says the answer to all these questions is yes,

and the reason may be a process that has been termed " kindling. "

The phenomenon of kindling in epilepsy was first discovered by accident by

researcher Graham Goddard in 1967. Goddard was studying the learning process

in rats, and part of his studies included electrical stimulation of the rats'

brains at a very low intensity, too low to cause any type of convulsing.

What he found was that after a couple of weeks of this treatment, the rats

did experience convulsions when the stimulation was applied. Their brains had

become sensitized to electricity, and even months later, one of these rats

would convulse when stimulated (History, 1998). Goddard and others later

demonstrated that it was possible to induce kindling chemically as well

(Hargreaves, 1996.)

The name " kindling " was chosen because the process was likened to a log fire.

The log itself, while it might be suitable fuel for a fire, is very hard to

set afire in the first place. But surround it by smaller, easy to light

pieces of wood - kindling - and set these blazing, and soon the log itself

will catch fire.

Dr. M. Post of the National Institute of Mental Health (USA) is

credited with first applying the kindling model to bipolar disorder (NARSAD).

Demitri and Janice Papolos, in their excellent book The Bipolar Child,

describe this model as follows:

.... initial periods of cycling may begin with an environmental stressor, but

if the cycles continue or occur unchecked, the brain becomes kindled or

sensitized - pathways inside the central nervous system are reinforced so to

speak - and future episodes of depression, hypomania, or mania will occur by

themselves (independently of an outside stimulus), with greater and greater

frequency.

Thus, to put it simply, brain cells that have been involved in an episode

once are more likely to do so again, and more cells will become sensitized

over time. This theory has been borne out by some research observations. For

example, " there is evidence that the more mood episodes a person has, the

harder it is to treat each subsequent episode... " thus taking the kindling

analogy one step further: that a fire which has spread is harder to put out

(Expert Consensus, 1997).

Thus, many researchers now believe that kindling contributes to both rapid

cycling and treatment-resistant bipolar disorder, and this model also is

consistent with cases where cycling began with definite mood triggers,

stressful or exciting events, and later became spontaneous.

In addition, it has been shown that substances such as cocaine and alcohol

have their own kindling effects which can contribute to bipolar kindling. In

fact, it was the knowledge that cocaine causes seizures that led Dr. Post to

connect kindling in epilepsy with mood disorders, after he had studied the

unexpected effects of cocaine on severely depressed patients (NARSAD). A

study led by Dr. ph Goldberg found that patients diagnosed with both

bipolar disorder and substance abuse were much more likely to respond to

treatment that included an anticonvulsant/mood stabilizer, divalproex

(Depakote) or carbamazepine (Tegretol), with or without Lithium, than

treatment with Lithium alone. At the same time, patients who had bipolar

disorder but no history of substance abuse had similar remission rates with

both types of treatment.

Dr. Goldberg did note that more controlled studies are needed on the role of

anticonvulsants in treating dual diagnosis patients. (Substance Abuse, 2000)

As a result of many studies involving the kindling model, many researchers

now stress the need for early and aggressive treatment of bipolar disorder,

to prevent the brain from becoming more and more sensitized and going into

rapid cycling or treatment resistant manic depression. A 1999 study also

indicated that a significantly higher percentage of dual diagnosis patients

had a history of medication noncompliance - which could suggest that kindling

had more time to take place when no medication was being taken. (Substance

Abuse, 2000)

What does all this mean for the bipolar patient? Take your medications as

prescribed. Stopping treatment now could make your condition actually worsen

and become more difficult to treat in the future.

If you have not been diagnosed but feel you may be manic depressive, seek

treatment, the sooner the better.

Be honest with your prescribing doctor if you have an alcohol or drug

problem, so he or she can evaluate your medication therapy accordingly.

[Guest guest]

Tx to whoever posted this.

I also believe a " kindling " process takes place in the case of

schizophrenia too - and these are probably different manifestations of

the same disease. I have seen someone come off lithium after years of

success and within weeks breakdown, never to get back to where they

were before.

This one of the reasons why I get so angry with the so-called " First

do no harm " pprinciple invoked by ppl to oppose psych meds. Not

medicating is most certainly NOT a no-risk option and there is

absolutely no logical basis for preferring it a priori. The rational

approach to such issues is on a benefit:risk analysis.

P.

> The " Kindling " Model in Bipolar Disorder

>

> If a bipolar person goes untreated for a period of years, could he

or she

> begin to experience rapid cycling, or become treatment-resistant? If

> stressors initially set off episodes, in time could episodes appear

without

> any such triggers? Research says the answer to all these questions

is yes,

> and the reason may be a process that has been termed " kindling. "

>

> The phenomenon of kindling in epilepsy was first discovered by

accident by

> researcher Graham Goddard in 1967. Goddard was studying the learning

process

> in rats, and part of his studies included electrical stimulation of

the rats'

> brains at a very low intensity, too low to cause any type of

convulsing.

>

> What he found was that after a couple of weeks of this treatment,

the rats

> did experience convulsions when the stimulation was applied. Their

brains had

> become sensitized to electricity, and even months later, one of

these rats

> would convulse when stimulated (History, 1998). Goddard and others

later

> demonstrated that it was possible to induce kindling chemically as

well

> (Hargreaves, 1996.)

>

> The name " kindling " was chosen because the process was likened to a

log fire.

> The log itself, while it might be suitable fuel for a fire, is very

hard to

> set afire in the first place. But surround it by smaller, easy to

light

> pieces of wood - kindling - and set these blazing, and soon the log

itself

> will catch fire.

>

> Dr. M. Post of the National Institute of Mental Health (USA)

is

> credited with first applying the kindling model to bipolar disorder

(NARSAD).

> Demitri and Janice Papolos, in their excellent book The Bipolar

Child,

> describe this model as follows:

>

> ... initial periods of cycling may begin with an environmental

stressor, but

> if the cycles continue or occur unchecked, the brain becomes kindled

or

> sensitized - pathways inside the central nervous system are

reinforced so to

> speak - and future episodes of depression, hypomania, or mania will

occur by

> themselves (independently of an outside stimulus), with greater and

greater

> frequency.

>

> Thus, to put it simply, brain cells that have been involved in an

episode

> once are more likely to do so again, and more cells will become

sensitized

> over time. This theory has been borne out by some research

observations. For

> example, " there is evidence that the more mood episodes a person

has, the

> harder it is to treat each subsequent episode... " thus taking the

kindling

> analogy one step further: that a fire which has spread is harder to

put out

> (Expert Consensus, 1997).

>

> Thus, many researchers now believe that kindling contributes to both

rapid

> cycling and treatment-resistant bipolar disorder, and this model

also is

> consistent with cases where cycling began with definite mood

triggers,

> stressful or exciting events, and later became spontaneous.

>

> In addition, it has been shown that substances such as cocaine and

alcohol

> have their own kindling effects which can contribute to bipolar

kindling. In

> fact, it was the knowledge that cocaine causes seizures that led Dr.

Post to

> connect kindling in epilepsy with mood disorders, after he had

studied the

> unexpected effects of cocaine on severely depressed patients

(NARSAD). A

> study led by Dr. ph Goldberg found that patients diagnosed with

both

> bipolar disorder and substance abuse were much more likely to

respond to

> treatment that included an anticonvulsant/mood stabilizer,

divalproex

> (Depakote) or carbamazepine (Tegretol), with or without Lithium,

than

> treatment with Lithium alone. At the same time, patients who had

bipolar

> disorder but no history of substance abuse had similar remission

rates with

> both types of treatment.

>

> Dr. Goldberg did note that more controlled studies are needed on the

role of

> anticonvulsants in treating dual diagnosis patients. (Substance

Abuse, 2000)

>

> As a result of many studies involving the kindling model, many

researchers

> now stress the need for early and aggressive treatment of bipolar

disorder,

> to prevent the brain from becoming more and more sensitized and

going into

> rapid cycling or treatment resistant manic depression. A 1999 study

also

> indicated that a significantly higher percentage of dual diagnosis

patients

> had a history of medication noncompliance - which could suggest that

kindling

> had more time to take place when no medication was being taken.

(Substance

> Abuse, 2000)

>

> What does all this mean for the bipolar patient? Take your

medications as

> prescribed. Stopping treatment now could make your condition

actually worsen

> and become more difficult to treat in the future.

> If you have not been diagnosed but feel you may be manic depressive,

seek

> treatment, the sooner the better.

>

> Be honest with your prescribing doctor if you have an alcohol or

drug

> problem, so he or she can evaluate your medication therapy

accordingly.