[hopeunlimited]

LITHIUM HELPS BIPOLAR BRAIN GROW GRAY MATTER
filed under Bipolar Disorder Biology
UCLA professors Carrie Bearden and Paul Thompson have demonstrated that lithium increases the amount of gray matter in the brains of patients suffering from bipolar disorder.

When the UCLA neuroimaging researchers compared the brains of bipolar patients on lithium with those of people without the disorder and those of bipolar patients not on lithium, they discovered that the volume of gray matter in the brains of those patients who were taking lithium was as much as 15 percent greater in areas that are critical for attention and controlling emotions. This discovery may explain why lithium is of value to people who suffer from bipolar disorder.

The research is published in the journal Biological Psychiatry.

[silvercloud]

'Lithium' is an excellent mood stabilizer ,but 'beware' ,long-term use can lead to kidney issues ... hav found there is 'no' single 'pharma' that effectively moderates 'both' mania/depression ... usually ,maintaining longterm therapy ,'2' drugs required to control the 'parameters' ... w/o MMJ ,the mind never gets a 'vacation' ,or arest ... like all chronic maladies ,it's up to the patient's reponsibility to tweak:smile2:finetune for ultimate reception/transmission ... that is all .....

[Scheize]

You know anything about Depakote? (regarding bi-polar)

[hopeunlimited]

Department of Biochemical Pathology, Assaf Harofeh Medical Center, Sackler Faculty of Medicine, University of Tel-Aviv, Zerifin, Israel.
(1) Valproic acid is an anticonvulsant agent widely used in the management of various forms of epilepsy, including absence, myoclonic and tonic-clonic seizures. (2) It also has anticonvulsant potency in a wide variety of animal models of epilepsy. (3) This action is generally thought to be exerted through modulation of the activity of the endogenous inhibitory neurotransmitter, gamma-aminobutyric acid. (4) Evidence that valproic acid interacts with the gamma-aminobutyric acid system is presented. (5) Interactions of valproic acid with other neurotransmitters, i.e. aspartate, glutamate, taurine, serotonin, as well as with cyclic nucleotides and hormones are also considered. (6) Direct effects of valproic acid on excitable membranes and its relationships with analgesia are outlined.

The study also suggests that lithium and valproic acid work by restoring the balance of these neurotransmitters in the brain.

Valproate (U.S.A.: "Depakote")

If you are not familiar with Depakote, I recommend you have a look at my patient education handout first.

(If you are a woman between the ages of 12 and 50, unfortunately you should probably take this medication off your list of options, for two reasons. First, there may be a risk for women due to a possible shift in reproductive hormone regulation. For a discussion of the latest data on this risk, read about Depakote and PCOS. Secondly, this medication can cause abnormalities in developing children, so very effective precautions against becoming pregnant must be used for women who could become pregnant while taking it.)

Remember, the goal is 100% symptom control, with 0% side effects. In general, with slow-release valproate (Depakote), there are very few side effect problems. About 1 person in every 10 will have some nausea when starting, reduced if the medication is taken with meals. About 1 in 30 (in my experience) will have severe nausea. Even these folks can get used to the medication if the smallest size (125mg "sprinkles") are used and increased by one pill per week or so. Other than nausea, however, other side effects are very uncommon -- except weight gain, discussed in detail below.

The basics-of-Depakote handout shows my current start-up strategies, including using the new "ER" (extended release) formula. Since we can start a person on his/her entire dose in 24 hours, when we're in a hurry, we know it's safe to start really fast. Going slower may help prevent the most frequent problem with this medication: an appetite increase that leads to increased weight. Weight gain obviously carries health risks.

Many male patients can take 1500 or even 2000mg of valproate and not gain weight. Fewer women can, though, and many patients seem to hit a "weight gain threshold" somewhere around 1000mg. This threshold seems clearly to be higher when the new ER version is used; it looks like more patients can reach solid doses like 1500 mg with the new form. In my experience, more than 50% of women will gain weight at 1250mg or above (1500 or above with the ER version). Is this an appetite increase, as patients almost all experience when gaining weight? Or is there some metabolic shift, such as "metabolic syndrome"? The basis for this problem is still unknown. Some psychiatrists have tried using low doses of topiramate, another anti-seizure medication that tends to decrease appetite but has its own side effect problems, as an "antidote" to Depakote’s appetite effects.

Fortunately, the appetite increase shows when this problem is going to occur. I have seen few patients gain weight who did not experience the appetite increase. When people lower their dose, they can tell when their appetite returns to normal, and they do not seem to gain weight. So, I tell patients that if they get an abnormal appetite, they should lower their dose until their appetite returns to normal. The "threshold" seems to lie between 1000 mg and 1500 mg per day for most patients (if using the "ER" version). I don’t think I’ve seen a patient who experienced weight gain at 500 mg per day (there probably is one somewhere).

Depakote at 500mg/day is not generally enough for symptom control, but when combined with low-dose lithium, it can be a very effective medication. And, not all patients will experience the weight gain problem. Hair loss is also common when people hit the weight gain range, but the dose decreases required for appetite control generally take people out of the "hair loss range" as well. For a bit more on this issue, read Depakote and hair loss.
Depakote is the most commonly prescribed treatment alternative to lithium, and should be considered.

Depakote (divalproex sodium) - Valproic Acid

Brand and Generic Names

Depakene®(Valproic acid) – Immediate release
– Syrup: 250 mg/5mL (there is 250 mg in one teaspoonful)

– Capsules: 250 mg

Depakote®/Depakote® ER (both Divalproex sodium) – both are enteric-coated and slow release; Depakote® ER releases more slowly than Depakote®.
– Tablets: 125 mg, 250 mg, 500 mg

– Sprinkle capsules: 125 mg

– Slow-release tablets: 250 mg, 500 mg

Depacon®(Valproate sodium) – Intravenous (IV) formulation
– 100 mg/mL

Note: Even though valproic acid is available in different names, strengths and formulations, all provide the same active medicine. (See below for what you need to know about the different forms)

What is valproic acid and what does it treat?

Valproic acid is a prescription medication that has been proven effective in the treatment of epilepsy, and manic episodes associated with bipolar disorder, also known as manic depression. A manic episode, or mania, is when a person experiences several of the following symptoms at the same time: "high" or irritable mood, very high self esteem, decreased need for sleep, pressure to keep talking, racing thoughts, being easily distracted, frequently involved in activities with a large risk for bad consequences (for example, excessive buying sprees). A depressive episode, or depression, is when a person experiences several of the following symptoms at the same time: "low" or depressed mood (for example, sad, empty, tearful), decreased interest in most or all activities, changes in appetite (usually decreased), changes in sleep (usually poor sleep), loss of energy, feeling worthless/guilty/ hopeless/ helpless, difficulty concentrating, thoughts of death (suicidal thinking).

Bipolar disorder is a brain disorder (mental illness) which exposes people to these mood changes over the course of time. Bipolar disorder affects more than two million Americans each year, but patients with this disorder can lead fulfilling lives when they receive proper treatment. Unfortunately, many of those with this illness don’t receive treatment.

Medication is an essential part of successful treatment for bipolar disorder, and valproic acid is among the most well studied medications approved to treat mania. With the proper dosage, valproic acid can reduce manic symptoms, shorten hospitalizations, help prevent future manic episodes, and make it possible for an individual to live productively in the community.

What is the most important information I should know about valproic acid?

Since bipolar disorder is a long–term illness, duration of treatment with mood stabilizers like valproic acid may also be long-term. It is very important to take valproic acid regularly and exactly as prescribed by your doctor. Not taking valproic acid on a daily basis not only increases your risk for a relapse in your mood symptoms, it may also increase the possibilities of troublesome side effects such as seizures.

Valproic acid may be prescribed by itself or along with other medications to manage your mood symptoms.
There are many different ways for valproic acid to be dosed. Higher starting doses (also known as "loading doses") have been shown to be as effective as slower dose increases, and may result in a faster therapeutic response in many individuals.
Valproic acid is available in many different forms. It is important that you know which form you are taking. It is also important that you not interchange or mix these forms, since they are not always equal in strength. For example, Depakote®500 mg tablets is NOT equal to Depakote®ER 500 mg tablets.
The amount of valproic acid in the blood can be measured. Studies have shown that blood levels between 50 – 125 (micrograms/mL) give patients the best chance of response to valproic acid. In the beginning of treatment, your doctor may check your blood once or twice a week. Once your symptoms are controlled well, blood samples are drawn less frequently.
Valproic acid can be associated with many side effects (see side effects section), but most can be minimized with regular monitoring. Blood tests are done in order to check for liver, pancreas, and platelet abnormalities, which are rare.
There is some evidence to suggest that valproic acid may have advantages for subtypes of bipolar illness-such as rapid cycling and mixed states. Be sure to assess with your doctor the type of bipolar illness so you may better match your interventions to it.

What should I discuss with my healthcare provider before taking Depakene®, Depakote®, Depakote® ER?

Symptoms that are most bothersome to you about your condition
If you have thoughts of suicide
If you have a seizure disorder and are taking any other anticonvulsant medications
Any other chronic medical conditions that you may have (especially with your liver or pancreas, and if you have ever had bleeding problems)
Medications you have taken in the past to treat bipolar disorder
Medications that you are currently taking for other conditions
Side effects that you may have experienced with medications (e.g., stomach pain, vomiting, diarrhea, weight gain)
If you are pregnant, plan to become pregnant, or are breast-feeding
If you smoke, drink alcohol, or use illegal drugs
How should I take Depakote®?

Valproic acid is available in many different forms (for example, liquid, sprinkle capsules, “long–acting”). The recommended starting dose is between 750 and 1500 mg daily taken in divided doses. (The starting dose should be lower in elderly patients.) Dosages are adjusted based on response and blood level. One person may need a higher dose to get a therapeutic blood level compared to another individual. The usual effective dose range is between 1000 and 2000 mg daily, although lower or higher doses are needed in some cases.

Take valproic acid with food to minimize stomach cramping, nausea, and vomiting
Always take valproic acid at the same time every day
Use a pillbox or a calendar as a reminder to take your medications. If needed, have a family member or friend check-in with you to help you take your medications.
If you are currently taking valproic acid multiple times a day and find it difficult to remember to take it regularly, ask your health-care provider if a once-a-day tablet form of Depakote® is right for you.
What differences should I know about the different forms of valproic acid?

Although all forms of valproic acid deliver the same active medication, there are some differences between each form. Different forms are available for this medication for several reasons: 1) for easier swallowing, 2) for fewer side effects, and 3) for taking this medicine fewer times each day.

Differences in formulation
– Liquid: Always take it with food; otherwise it may cause stomach cramping and diarrhea. Do not mix in soda or any other carbonated drinks because it can upset your stomach. Take it 2 – 4 times daily as per your doctor’s instructions.

– Tablets: Swallow the tablets whole. Chewing the tablets gives an unpleasant taste and can be irritating to the mouth and throat. Take it 2 – 4 times daily as per your doctor’s instructions.

– Sprinkle capsules: May be swallowed whole or opened and sprinkled onto food like applesauce or pudding. Sprinkle capsules should not be chewed. Take 2 – 3 times daily as per your doctor’s instructions.

– Long acting tablets (Depakote®, and Depakote extended–release): These two are NOT equal to each other. Always check the color of the tablets to make sure it is what your doctor prescribed. Depakote® tablets may be taken 1 – 3 times a day. Depakote® extended-release tablets can be taken just once a da

[Scheize]

So it sounds like Lithium is a much better choice for a 19 year old girl?

[xian2]

what is "gray matter" in the brain?

[hopeunlimited]

Definition of Gray matter

Gray matter: The cortex of the brain which contains nerve cell bodies. The gray matter is in contrast to the white matter, the part of the brain that contains myelinated nerve fibers. The gray matter is so named because it in fact appears gray. The white matter is white because that is the color of myelin, the insulation covering the nerve fibers. In "The Mysterious Affair at Styles" (1920), Agatha Christie first quoted the fictional Belgian detective Hercule Poirot in regard to his gray matter: "'This affair must be unravelled from within.' He tapped his forehead. 'These little grey cells. It is "up to them"-as you say over here.'"

Grey matter (or gray matter) is a major component of the central nervous system, consisting of nerve cell bodies (neurons), glial cells (astroglia and oligodendrocytes), capillaries, and short nerve cell extensions/processes (axons and dendrites).

Brain tissue is made up of cell bodies ("gray matter") and the filaments that extend from the cell bodies ("white matter").
The density of cells (volume of gray matter) in a particular region of the brain appears to correlate positively with various abilities and skills.
The density of cells is determined by both genes and environmental factors, such as experience.
The speed with which we can process information is governed by the white matter.


Brain tissue is divided into two types: gray matter and white matter. These names derive very simply from their appearance to the naked eye. Gray matter is made up of the cell bodies of nerve cells. White matter is made up of the long filaments that extend from the cell bodies - the "telephone wires" of the neuronal network, transmitting the electrical signals that carry the messages between neurons.
The volume of gray matter tissue - a measure you will see cited in various reports - is a measure of the density of brain cells in a particular region.
Recently, the most comprehensive structural brain-scan study of intelligence to date has supported an association between general intelligence and the volume of gray matter tissue in specific regions of the brain (you can see a picture of these areas here). These structures are the same ones implicated in memory, attention and language.
Previous research has shown the regional distribution of gray matter in humans is highly heritable. But it also clearly has a strong environmental influence. Recent studies have found:
an increased volume of gray matter in Broca's area of professional musicians, apparently reflecting, at least in part, the number of years devoted to musical training
an increased volume of gray matter in the anterior hippocampus of experienced London taxi drivers (a brain region involved in spatial navigation), with volume correlated with length of taxi-driving experience
an increase in the development of new brain cells in older adults who underwent an aerobic training program compared with those who did not
The brain-scan study also found age differences: in middle age, more of the frontal and parietal lobes were related to IQ; less frontal and more temporal areas were related to IQ in the younger adults.
Age differences have already been found to exist in gray matter volume and distribution.
Mapping of the progressive maturation of the human brain in childhood and adolescence has found an initial overproduction of synapses in the gray matter after birth, which is followed, for the most part just before puberty, with their systematic pruning. This process occurs in different regions at different times, with gray matter loss beginning first in the motor and sensory parts of the brain, and then slowly spreading downwards and forwards, to areas involved in spatial orientation, speech and language development, and attention (upper and lower parietal lobes), then to the areas involved in executive functioning, attention or motor coordination (frontal lobes), and finally to the areas that integrate these functions (temporal lobe). The sequence appears to agree with regionally relevant milestones in cognitive development.
Various learning and memory problems have been associated with decreased gray matter in particular regions of the brain:
children with selective problems in short term phonological memory and others diagnosed with specific language impairment had less gray matter in both sides of the cerebellum compared to controls
adolescents had less gray matter in an area in the left parietal lobe if they had a deficit in calculation ability, compared to those who had no such deficit
Gray matter is not the sole arbiter of ability and knowledge, of course. The number of neurons is clearly important, but so is the connectivity of the neuronal network. Interestingly, although gray matter declines steadily from adolescence, white matter keeps growing until our late forties. This is consistent with a large-scale study of mental abilities in adults, that found that mental faculties were unchanged until the mid-40s, when a marked decline began and continued at a constant rate. Accuracy did not seem to be affected, only speed. White matter governs the speed with which signals travel in the brain.