March 2nd, 2011
12:24 PM ET

Sheen has us asking: What's bipolar?

Over the last couple days, I have found it interesting how many people have watched the antics and interviews with Charlie Sheen, and immediately diagnosed him as either being on drugs or in the middle of a manic episode. Could be – but who knows, maybe it is all a big ruse. His erratic behavior is not in question, but arriving at a diagnosis based on a TV interview is impossible. In fact, my colleagues in the psychiatry community say it can be challenging even after completing a full assessment.

Bipolar disorder is characterized by the occurrence of at least one manic episode during the patient’s lifetime. Most patients also, at other times, have one or more
depressive episodes. In the intervals between these episodes, most patients return to their normal state of well-being. This is according to the Diagnostic and Statistical Manual of Mental Disorders (DSM). When looking for evidence of mania, doctors often cite symptoms like being overly euphoric, agitated behavior, racing speech and impulsive behavior to name a few. Just reading that gives you an idea of why arriving conclusively at a diagnosis can sometimes be so difficult.

That is why I was so interested in a paper I recently read. Scientists at UCLA took on the goal of peering deep into someone’s brain, while the person was in the middle of a manic episode, to better understand what was happening. Now, as you might imagine, getting someone who is manic to agree to sit still in a functional MRI scanner wasn’t easy, but eventually the researchers recruited 18 patients into the study, nine of whom met the criteria for a manic episode, and nine other patients, who were healthy and served as controls.

What they found was fascinating. When given certain tasks to perform, the manic patients had a decrease in activity in part of the frontal lobe. Think about that - the frontal lobes are sort of your behavioral filter, and the activity there was much lower than in a healthy person. It is the part of the brain that makes you think before you speak or evaluate before you act. If there is low activity, those filters are turned way down, and you may start to see the impulsive, racing behavior associated with a manic episode. Those same patients also had higher than normal activity in the amygdala, which is associated with emotion.

When you look at these brain scans, consider this - you are seeing evidence of what a manic episode really looks like. And, in another study with depressed patients, the findings were very nearly the opposite. The filters were turned way up and the frontal lobe area shined brightly, whereas the emotional part of the brain had lower activity.

For now, patients with true mental illness can get outstanding diagnosis and treatment. This is a glimpse, though, of where the mental health field may be headed. Could we be approaching a day when a person with concerns about mental illness could get a special scan to find out? And, might that information also answer the question about the best treatment options as well? What do you think the pros and cons are, if scans like this became available?

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soundoff (225 Responses)
  1. David

    I agree that you really can't give a definitive diagnosis based on some tv interviews and reports in the media. He would really need to have some diagnostic assessments done in a clinical environment by a trained professional to understand fully what is going on.

    Either way, the media is eating it up.


    April 25, 2011 at 14:44 | Report abuse | Reply
  2. Dr Sam Girgis

    Evaluating psychiatric illness with brain scans is very intriguing, but it seen financially improbable. How often would these patients need head imaging studies? With each manic episode, or once a month as routine screening?

    Dr Sam Girgis

    May 5, 2011 at 22:12 | Report abuse | Reply
  3. Headrush40

    Doctor Gupta, want you start talking about how the FDA lets drug companies sell non-narcotic that can kill you with just one pill. no pill that has any possible side effect that's fatality should never be allowed on the market unless it's for terminal patients and has a chance of curing them. come on america, i have severe arthritis and a broke back, and where i live they are so hard on doctors, they only want to proscribe stuff like celebrex, not sure that is how it's spelled, but the fact is it destroys my stomach. some side effects of it can kill you, what the hell, i just want the pain to go away. i don't want to die.

    June 17, 2011 at 07:58 | Report abuse | Reply
  4. Concerned Mom

    Dr. Sanjay Gupta, This concern of mine is not regarding the behavior of Charlie Sheen, it is for My son and the medication treatment he has been prescribed. My son was diagnosed with ADD / HD at a young age and he was on ritalin at age 4 or 5, then prescribed concerta by age 10 or 11, then I was put on adderall. Then the dosage was increase to the FDA maximun of 40mg by age 16, then I was prescribed Strattera also FDA maximum dose of 85mg to take together for my ADD and Zoloft 100mg. I am concerned of the long term side effects of taking all of these together. He turned 18 this month and has told me that he has had elevated BP for a while since his new medication regimin. . I took his blood Pressure yesterday and it was 140/102 p 104 and he was told because of the ADD Medication. I have Hypertension and I just turned 40 last year and I am medicated for it. I am concerned and upset that it is expected of High BP for people when they get older but he is young and just turned 18. I dont know the side effects of all 3 medications in conjunction with each other and if it is necessarily needed. I also noticed other neurological behaviors also like hands shaky, clammy hands at times, acne, bites on fingernails sometimes and other little things . I cannot get someone to answer this concern of mine. I watch your program all the time and I hope you can help answer this before something happens to him. Is there other safer medications out there? or is this the only medication treatment prescribed for someone who has ADD / HD and drepression? I always told my husband out of the world of Doctors out there, you would be the only one I would trust 100% with my life. Please advise?? Thanks in advance......... 🙂

    July 1, 2011 at 09:23 | Report abuse | Reply
  5. handed

    It’s very interesting that they can use imaging technology to see the frontal lobe’s ability to filter behavior malfunctioning. Hopefully they can eventually use this to improve diagnoses of bipolar disorder. You can read more about bipolar disorder and available complimentary and alternative medicine (CAM) in regards to bipolar disorder at http://www.naturalstandard.com. For example, I learned that there is strong scientific evidence for the use of music therapy, sage and St. John’s wort in treating bipolar disorder. I had heard that St. John’s wort may benefit patients with depression, but it’s really interesting to find out that it may treat other psychiatric illnesses as well.

    July 22, 2011 at 10:01 | Report abuse | Reply
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Get a behind-the-scenes look at the latest stories from CNN Chief Medical Correspondent, Dr. Sanjay Gupta, Senior Medical Correspondent Elizabeth Cohen and the CNN Medical Unit producers. They'll share news and views on health and medical trends - info that will help you take better care of yourself and the people you love.