I read your Open Apology to the Internet yesterday. You are courageous to talk about it, and my heart goes out to you. Although I don't know exactly what trouble you've gotten yourself into, I know the pain of Bipolar II, because I have it. Or I had it. Words get a bit tricky, and I have written an entire essay on whether someone has a disease or not when they show no symptoms .
I have no symptoms of bipolar and have been completely off of medication since I started my current diet. How I stumbled upon what has been my cure was sort of an accident, but having a strong background in ketogenic diets played a role, and much of my expertise, at least in the beginning, was given to me by you, Lyle.
You probably don't know of me, but of course I know of you. I read your work in the late 90's while playing around with the CKD. Later, in 2002, The Ketogenic Diet was out of print and very hard to get, but Zooko somehow procured me a copy, presenting it to me on the occasion of our second wedding anniversary. I studied it carefully.
Lowering carbs always helped my mood, and there are many plausible reasons to believe that a ketogenic diet might treat bipolar (see below), but a ketogenic diet by itself didn't cure my disease, and didn't prevent it from progressing.
As you say, bipolar progresses. And one thing that may catalyse the progression is antidepressants. From PsychEducation.org, an excellent resource on Bipolar II:
That antidepressants can cause "switching", bringing on a manic or hypomanic phase, is generally accepted, although how often this occurs is still hotly debated (somewhere between 4% and 40% of the time?).
However, antidepressants may pose bigger risks in the long term. Substantial evidence suggests that antidepressants can induce "rapid cycling". Indeed, it is a standard recommendation for the treatment of rapid cycling to gradually withdraw any antidepressant. In addition, more subtle "destabilizing" effects are possible. Antidepressants may make it more difficult to get a good outcome from an otherwise effective mood stabilizer treatment. There is even a concern that antidepressants may permanently alter the course of a person's bipolar illness, through a phenomenon called "kindling".
I feel strongly that my hypomanias were related to my extensive use of antidepressants.
A hijacked brain
You described bipolar as having a hijacked brain. This is exactly my experience.
Last summer I gave a lightning talk at HOPE X on exactly this. (Unfortunately, it was not recorded.) I compared bipolar disorder to having your brain hacked.
I argued that mood states in bipolar act like drugs in state dependent learning. For example, when I had periodic bouts of anger (which increased in frequency as time went on), it was very easy to remember all the things I had been thinking about last time I was angry. It gave the illusion of continuity; that my entire life was one constant stream of things making me angry.
But I had multiple moods, and my beliefs about life in different states were beginning to diverge from each other, based on this contrast in the strength of memory of evidence. I knew this was happening, but it created a dilemma: Do I act on what I think I might believe later, or what I believe now? To whom am I loyal — myself now, or the self I know I will be later?
Specifically, what should I do when in that state in which I know that life is not worth living, because my whole life, it seems then, has been one long stream of futility? I chose to be loyal to a future self, in that case. But there is no doubt that betraying yourself in the now because you lack trust in your own brain is a shitty place to be.
You have a life to recreate, and consequences to bear, but I have faith in you. It is not easy to be creative and highly intelligent in that bipolar way, because you will discover truths that other people can't see, and thus have to deal with the constant criticism of wrong people, sometimes very intelligent wrong people. You have been through this and are obviously strong, even if we couldn't see all that was going on.
Turn your natural abilities and your strength to curing yourself as best you can. What worked for me might work for you! I hope you try it and it does. But if you don't or if it doesn't then I think you will find a way. Study the drugs (many modern bipolar drugs are anti-convulsants, suggesting that what helps epilepsy might help bipolar). Study the physiology. You already know way more than I do. Look at plausible fringe theories (some interesting things to be found on the site I mentioned above). You will find something, and your life will get better.
My own apology
I hope you take this letter as I intend it: as an expression of care, sympathy, and of hope that perhaps what I have learned could help you in some way. Please forgive my boldness to speak to you personally when I don't know you, or all of what you are going through.
Most of all, I just want to say that I admire you for your openness, your willingness to admit to mistakes, and your commitment to change.
With love and encouragement,
Some papers that might be of use:
- The ketogenic diet may have mood-stabilizing properties. El-Mallakh RS, Paskitti ME. Med Hypotheses. 2001 Dec;57(6):724-6.
- The ketogenic diet; fatty acids, fatty acid-activated receptors and neurological disorders. Prostaglandins Leukot Essent Fatty Acids. 2004 Mar;70(3):253-64. Cullingford TE.
- Potential Applications of the Ketogenic Diet in Disorders Other Than Epilepsy Rif S. El-Mallakh Epilepsy and the Ketogenic Diet Nutrition and Health 2004, pp 153-159
- The neuropharmacology of the ketogenic diet. Pediatr Neurol. 2007 May;36(5):281-92. Hartman AL1, Gasior M, Vining EP, Rogawski MA.
- The neuroprotective properties of calorie restriction, the ketogenic diet, and ketone bodies. Brain Res Rev. 2009 Mar;59(2):293-315. doi: 10.1016/j.brainresrev.2008.09.002. Epub 2008 Sep 25. Maalouf M1, Rho JM, Mattson MP.
- Schizophrenia, gluten, and low-carbohydrate, ketogenic diets: a case report and review of the literature Nutr Metab (Lond). 2009; 6: 10. Bryan D Kraft and Eric C Westman
- The ketogenic diet for type II bipolar disorder. Neurocase. 2013;19(5):423-6. doi: 10.1080/13554794.2012.690421. Epub 2012 Oct 3. Phelps JR1, Siemers SV, El-Mallakh RS.