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Q: AD's & "Holes in the Brain" & Dementia
There is a woman posting on a manic depression board who keeps insisting that
her husband - after treatment with antidepressants has since developed
what she refers to as "holes in the brain". Saying that her husband has since
developed dementia after being on the meds for 6 years. Is there such a thing??
She is beginning to scare me. I am Bipolar II and have been getting treated for
8yrs. Is dementia really something I am going to have to worry about? I already
have real problems with memory and had to drop out of college because of it. Any
info you can provide would be greatly appreciated. Thank you so much for your
time.
Dear Melissa --
Well, let’s see. First, how old is her husband? If he’s over 60 or so, then
first we’d have to wonder if he might have developed a condition associated with
aging, which he might have gotten even if he hadn’t been taking
antidepressants.
Then we can wonder if the condition for which he was being treated
with antidepressants might be responsible for those “holes in the brain” –
because depression has very clearly been associated, fairly recently, with
decreases in brain size (particularly in the region associated with memory,
called the hippocampus. This may be – but not for certain yet – why
severe depression seems, especially in my practice, so commonly associated with
terrible problems with memory. I hear that one all the time. We’re always
having to wonder if it could be coming from the medications we’re using, which
in some cases could also be true; but after we fool around with med’s to try to
improve that problem, if the mood problem persists, so usually does the memory
problem, and then when people finally get better in terms of mood, so does their
memory in many cases. There’s even recent evidence that the hippocampus can
generate new brain cells, which was thought to be impossible until this
recent work; and maybe – but not for certain yet – this is why people’s
memory seems to be able to recover when their mood does.)
Now, what are these “holes in the brain, anyway? That could be “lacunar
infarcts”, meaning, basically, a bunch of little holes (from the Latin word
lacune, which means lake: a bunch of little lakes of fluid where there are
supposed to be cells). I suspect that’s what she’s talking about. It might
mean a bunch of “white matter hyperintensities”, which have been found
frequently in bipolar disorder and appear in recent research to be associated
with damage due to too little blood flow - - which is the same problem that
causes lacunar infarcts also.
Beyond that, I’m not sure what these “holes in the
brain” could be. Lacunes have definitely been associated with a dementia that
is often very difficult to distinguish from Alzheimer’s.
Anyway, the point here would be to wonder whether antidepressants have ever
been associated with lacunar infarcts or white matter hyperintensities, or with
anything else that produces something like “holes in the brain” – right?
Okay, let’s look at that. The simple answer is “no”. The longer answer
would acknowledge that one psychiatrist has written about “brain damage” caused
by antidepressants. Dr. Glenmullen has made himself quite famous with this
(e.g. search Google for “Glenmullen depression” and you’ll see a lot of
quoting… Here’s a
blurb on his book; interestingly, his own website,
www.glenmullen.com, is no longer on the web; I wonder
what that means). I’ve read his book and found it unfortunately quite
overstated in places, including on this issue (unfortunately, because otherwise
I think there are some appropriate concerns raised in it). Here’s the
response of the National Mental Health association to
Glenmullen, for a bit more balance on this issue.
So, the bottom line here is “no”, you don’t have to worry about dementia any
more than anybody else, based on your diagnosis or current symptoms (there is a
tiny bit of evidence, mostly clinical experience, I haven’t searched this one
today, that severe bipolar disorder might be associated with a higher risk of
developing something that looks like dementia when one is quite old, if the
bipolar symptoms remain untreated for years. If your treatment is controlling
your symptoms reasonably well, then I think this little bit of evidence is not
relevant to you.) Your memory issue may be related to the stuff I was talking
about above.
Dr. Phelps
Published June, 2003
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