Nicotine May Help Bipolar Disorder and Schizophrenia
In individuals with bipolar disorder and schizophrenia, smoking is heavily present. The British Journal of Medicine found that approximately 56% of those with bipolar disorder smoke; with psychosis, this number jumps to 70%. The Royal College of Psychiatrists found that almost 90% of those with schizophrenia smoke. This is far higher than the national average which the CDC estimates at around 20-25%. So something must be driving the use of tobacco, and in particular nicotine, in these two disorders.
So what’s going on? Is it being driven by the disease or is it self medication. Well, it appears that there is some evidence for self medication. The associated content referencing Science Magazine reports that one of the roles that nicotine is playing is in the GABA receptors. Nicotine bound in the prefrontal cortex and the hippocampus inhibited the enzyme DNMT1, which breaks down GABA, allowing for more GABA to be produced. The effects of nicotine on GABA is profound. In a study conducted by the American College of Neuropsychopharmacology, they found that GABA rose by 10% in the brain after smoking an inhaler and then, 45 minutes later, continued producing GABA at a four-fold rate compared to a normal brain.
So what is this magical GABA and what does it do to the brain. The Associated Content provides a nice outline of what GABA does in the brain:
“GABA is the communications speed controller, making sure all brain communications are operating at the right speed and with the correct intensity”, writes Joseph M. Carver, Clinical Psychologist. When there is too little GABA, we become overstimulated and engage in excessive and impulsive behavior. When there is too much GABA, we become overly relaxed and sedated. The levels of GABA are low in schizophrenia and bipolar disorder as well as in epilepsy and other seizure disorders.”
So that’s what GABA does in our brains, it acts as an inhibitor in the hippocampus region of our brains and slows down the firing of the neurons.
What does this mean for those with schizophrenia and bipolar disorder. For schizophrenia, the results are good. Ripoll et al. found that a 14mg nicotine patch improved sustained focus in schizophrenic patients while there was no gain in control subjects. It was also found to enhance smooth eye movement. Smooth eye movement is a complex task involving the visual cortex and the motor cortex. The complexity of this task is difficult for those with schizophrenia, indicating that cognitive improvements can be measured by how well movement tracking is performed. In more general terms of cognitive enhancement they found that “attention, sensory gating and eye movements, and more generally in cognitive, sensory and memory disorders” were improved with nicotine. In addition to these findings, there are previous studies showing that schizophrenic symptoms return when nicotine intake is reduced.
So the comorbidity of schizophrenia and smoking appear to be self medicative in a positive way. In addition to that Dépatie et al. found that such improvements with a 14mg nicotine patch were not found in the control groups. This indicates that nicotine use in schizophrenia is not merely a matter of habit or addiction, it is a matter of self medication for symptoms.
Now for bipolar disorder. For similar reasons as above mentioned, the impact of increasing GABA in the brain acts as a mood regulator by sedation. Acting as a neurotransmitter inhibitor, the effects of the nicotine slows down the brain and reduces symptoms like anxiety. But this comes with a double edged sword. According to the Journal of Affective Disorders, non-smokers fared better in the Young Mania Rating Scale than smokers did. Indicating that smoking has some negative impacts on mania. Why is this? Serotonin. Nicotine also stimulates the production of other neurotransmitters, such as dopamine, noradrenaline, GABA and glutamate. Serotonin acts as a type of antidepressant for the brain, the same way that SSRIs do operate. So the influx of more serotonin may actually counter act the inhibition due to GABA. However, when depressed, this may be reversed. So depending on what mood you are currently in, nicotine might be beneficial or detrimental to one’s mental health.
But the short term effects of GABA are what primarily interests me in these studies. The sedating and calming effect of nicotine may well be what is needed for short term relief from manic symptoms. And though it may play a role in prolonging mania with elevated serotonin levels, the short term is positively impacted with sedation. Hence the reason for sometimes needing a cigarette to calm down when agitated is so needed while manic.
More work needs to be done on studying the interplay between mental illness and nicotine. There is very little done in studying the effects of nicotine and bipolar disorder, but there is some literature on it regarding schizophrenia. So from what I can glean, the use of tobacco for the nicotine is not something that is merely an addiction that is difficult to shed by a particular class of mental illness, but instead appears to have therapeutic effects as well.
Hope you enjoyed this bit of research.
http://www.news-medical.net/news/2007/12/10/33328.aspx
http://www.cdc.gov/chronicdisease/resources/publications/AAG/osh.htm
http://www.ncbi.nlm.nih.gov/pubmed/11435266
http://apt.rcpsych.org/content/6/5/327.full
http://www.medscape.com/viewarticle/483888_4
http://www.associatedcontent.com/article/1690861/why_nicotine_calms_the_brain_in_schizophrenia_pg2.html?cat=70
http://www.medwire-news.md/47/76704/Psychiatry/Smoking_interferes_with_treatment_for_bipolar_mania.html
http://www.jad-journal.com/article/S0165-0327(08)00038-4/abstract
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Posted on November 8, 2011, in Bipolar, Mental Health and tagged bipolar, bipolar disorder, health, mania, mental health, mental illness, nicotine, research, smoking. Bookmark the permalink. 13 Comments.
GABA regulates the communication center, huh? I pose a theory. I have bipolar disorder, which would likely indicate the disregulation of GABA in my brain, whether it is higher or lower. This can be postulated by my initial usage of nicotine around the onset of my bipolare disorder.
Here’s the new theory. My son was diagnosed with Pervasive Development Disorder – Not Otherwise Specified. It’s on the egde of higher functioning Autism Spectrum Disorder. The PDD-NOS was diagnosed because my son exhibited a speech delay and sensory integration disorder, but no pervasive qualities (which I thought was core to an ASD diagnosis). My son was very quirky in his toddler years (1-2) but now that he’s 3, I see a sharp increase in receptive and expressive language. He is purposefully engaging other children and plays cooperatively.
With this evidence, it stands to reason that my son has a disregulation in his GABA. First, his development happens in fits and spurts. My son is very emotional and (was) very hyperactive. Sometimes he needs more sensory stimulation and Occupational Therapists have told me that he is “sensory seeking”.
Thoughts?
GABA seems to be low in bipolar, but GABA switches roles in developmental stages, so it’s hard to tell what exactly is going on. With all of this stuff coming up in research, I’m getting tempted to go and get a textbook or two so I can really explain just what is going on in our brains in the language that the scientists speak. Here, I’m just an amateur neurobiologist reading abstracts and conclusions and trying to wade through the studies. I really wish I knew more to speak clearly on how all these neuroreceptors work and what goes wrong with them in mental disorders.
I look forward to seeing what you come up with. You’re my go-to guy when it comes to research. I used to love to do this kind of stuff when I had time. Blah, time. I need more of that. Can I borrow a cup? *Smiles*
Its also the case in the very young that the disorder is still evolving. Some will go on to develop Schizoaffective disorder. Perhaps this may be one possible explanatory variable. A different type of mood disorder more similar to Schizophrenia than Bipolar?
The role of GABA in developmental stages is fascinating. I will have to look more into that. One of my learning goals is to get more into the neurophysiology of different mental illnesses so that I understand them better. If you are into finding more about this – start with going back to basic human bio, cell biology; then your brain anat and physiology – neuro anatomy, then look at the functions of the different centres of the brain – also fascinating; Then go back to cellular neurophysiology and then focus on the brain. The limbic system, frontal and temporal lobes are the main areas to look to to start with then look at the brainstem and then explore! That’s my action map in terms of revision and learning anyway…
Now here is the next question. What are people doing towards acquiring nicotine and GABA without smoking? Because the biggest problem with smoking in terms of cancer is the tar. That cannot be eliminated no matter what form of filter or cigarette/pipe/tobacco (or weed) etc is used.
One of the other things that people tell me they like about smoking is that it gives them something to do. They smoke excessively because they are bored. Does lack of GABA occur natually in all people with Bipolar or does it occur due to lack of whatever else the rest of the population does to produce it? (keeping in mind that candidates for research are likely to have been clients of mental health services and unemployed). Is this true also for findings for Schizophrenia? If they were to test a population sample who were working or studying the majority of the time, would the results be the same? There is my next research question of the study. What was the sampling method? Was it biased toward a chronically unwell population?
see I’ve just done it again. The initial comment was that this was interesting then I just kept thinking.
Completely anecdotal evidence, but most of the people I know who smoke have a different kind of brain chemistry. Smoking isn’t a fashionable thing anymore, so we’ve pretty much eliminated it down to the people who are addicted to the habit. Why do people even start smoking in the first place? Honestly, the first time I tried it, I was disgusted, I nearly coughed a lung up, and I thought I was going to vomit everywhere. And yet, I kept on.
I quit the day I went to be induced with my son. I made it through the initial twenty-four hours. But I was unknowingly tumbling down the hole of post-partum psychosis. I remember I used to take five hits off of a cigarette, put it out, and sit back and enjoy myself for a few minutes. There were the only moments I can remember being happy in the first two months of my post-partum. It was at that point that I rememberred why I continued smoking. Those few minutes of happiness.
Why does smoking seem work in different ways? I can only assume that it’s based on the physiology of the person. It would stand to reason that smoke does produce a calming effect, despite the stimulant evidence. Why does Adderall calm some and hype others? Physiology.
Nicotine delivery without usage is easy. Slap a patch on, put a thing of gum in the mouth, use an inhaler, etc. Nicotine can be delivered without the other harmful agents. It’s commonly done in smoking cessation methods of delivery.
Just in case I decided to consider taking up smoking. . .
I cannot smell an anti-depressant without going wildly manic (pun not intended). I wonder. . . How much nicotine (if any) is absorbed in secondhand smoke, James? Because that could explain a great deal about my mood cycling when I used to hit the bars regularly and take in secondhand smoke more than oxygen, it seemed, versus now when I’m seldom around it.
Hmm. . .
I’m not sure how much is absorbed, but nicotine has an odd quality to it; it ups you at low levels and then sedates you at higher levels. The low levels of nicotine might be upping you quite a bit, especially if it’s giving you a serotonin kick like an antidepressant would.
Very interesting research and findings. Am Bi-Polar II (this month ha) and diagnosed clinically depressed from the age of 14 until the diagnosis of BiPolar in my early 40′s. Am 50 now… and am STILL addicted to nicotine. Gave up ciggies for 10 years but never gave up the Nicorette the entire time. Now switch back and forth.
Am wondering if this is also tied to those of us diagnosed as bi-polar also having a higher addiction rate to Everything than the ‘normal’ populace.
thank you for the info. good post.
Really good post James and a lot of good discussion, here is my two cents worth from a therapist point of view.
1. Nicotine is one of the few drugs that are bi-phasic. In a pure form it is very toxic. When there are low levels in the blood stream it acts like a stimulant. As the dose reaches the high end it becomes more toxic and acts like a depressant. Get the blood level high enough and the consumer dies. This is why a cigarette wakes a smoker up in the morning when level of nicotine in the blood is low and helps calm them down at night when the level is high.
2. More than half of all the cigarettes smoked in America are smoked by someone with a DSM-4 diagnosis. Some writers have suggested that manufactures add ingredients in addition to the nicotine that are attractive to those with neurotransmitter issues.
3. GABA is also linked to alcoholism and alcoholism to depression. Remember there are at least 400 neurotransmitters and even the specialists are not sure how they all work at this point.
4. While tar is an issue all smoking is bad for the lungs. Even people who burn a lot of incense, and firefighters can damage their lungs from the ash in the smoke and the increased temperature.
5. For the lady who asked about PDD. That diagnosis is expected to change in a year or two when the new DSM-5 comes out. Right now we try to separate kids into groups and call them Autistic, Asperger’s and the least affected we use Pervasive Developmental Delay Not Otherwise Specified (PDD-NOS.) With the DSM-5 we will start treating all of this as one long continuum from severe symptoms to those whose peculiarities don’t both them or others so we won’t give them a diagnosis. I kind of like this approach cause if you look at enough kids they all have some peculiarities.
Thanks for the great forum. David Miller, LMFT counselorssoapbox.com
James,
I find this article really interesting. My fiance was a long-time smoker. When he quit in December 2010 – I saw a huge difference in him being able to manage his bipolar disorder. So much, in fact, that sometimes I was tempted to tell him “Pick up a cigarette – please!.” I long wondered about the correlation between him using Chantix to quit smoking and his steadily declining mental well-being. I still think that this may have had a large impact. But – perhaps the smoking itself also had an impact.
I am Bipolar 2…diagnosed 5 years ago. Quit smoking off and on 40 years. For reasons I can’t figure out, I have never had a problem quitting when I do…I don’t get the normal withdrawal most people do..but I always enjoyed it which is why I was sporatic in my usage. NOW I KNOW WHY!!! The GABA information aforementioned is about as sound and makes more sense than any other info I have read…(I am a science dude that does much research). The problem is tar from cigs and the known issues that go with it. Now I use an “E-Cigarette; which is really a personal vaporizer that delivers nicotine and releases water vapor rather than smoke. Much cheaper than patches, mints, gum and is very efficient. Bear in mind that the mental health experts do not know how the brain works, only speculation AND every mental health drug on the market says “The mechanism of this action is unknown”…which means they don’t know why the drugs do what they do so its trial and error until a combination works as well as possible.
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