No one likes what he found. That doesn’t make it any less probable.
I believe that the key to the diagnosis of bipolar illness, especially in the depressive stage is to measure respiratory rate at rest.
Respiratory rate at rest will tell you a lot about metabolism and metabolic dysfunction at rest. The metabolic system at rest is monitored by the brain stem. When something is internally wrong, the stress reaction will immediately kick in. If the underlying problem is not detected and treated it will become chronic.
This stress reaction, as you know, increases breathing rate and volume, and kickstarts the activation of the sympathetic nervous system, increasing heart rate and raising blood pressure.
In some people , with experiencing serious anguish and general slowing down of depression, the breathing rate will not rise, as would be normal, and is abnormally too slow. Retention of PCO2 in the blood is the most likely result.
The patient is not conscious of the too slow breathing even in the face of sympathetic activation. But it does not feel good, it feels very bad. Breathing rates determine the amount of carbon dioxide in the blood. If breathing rate at rest is , in effect, broken, then the result is ventilatory muscle pump failure.
This is an important clue that was observed over a century ago by the famous Dr Emile Kraepelin. Dr Kraepelin documented the disease course of what he called attacks of “Manic Depressive Insanity. Because Dr Kraepelin measured what he called – the bodily signs of the disease- he discovered that thousands of these patients, during their disabling depressive stage of the reversible illness, had too slow breathing.
Dr Kraepelin knew that he was describing a form of respiratory failure and a clear [but hidden- unless unmasked by looking for it] sign of disturbed metabolism of the blood.
No one liked his conclusion then or now. Even though, today we have the tools to support ineffective ventilation systems of the body.
For some reason, it has not been part of clinical medicine to measure the function of the respiratory muscle pump even though it can clearly lead to chronic locomotor stages of delirium [hence the periods of insanity].
Any injury to the neck or torso, at any time- will impair the nerve fibres and the muscles and the attachments to bone of the spine and rib cage in any number of ways, making moving air in and out of the body a little more difficult; and a lot more difficult during physical illness.
This observation is key, I think, in the development of research into reversible attacks of bipolar illness. Respiratory pump failure is not obvious to the eye, it needs to be mindfully looked for.
Paula and I discuss her experience with bipolar depression and her shocking discovery [in a work related first aid class] of her own “broken” breathing-of which she and I were unaware. Paula needed resuscitation and transfusion at birth. [ Paula and I are colleagues and treat college age young adults experiencing stressful life situations].
There are treatments today for respiratory pump failure, but you must first know how to identify it.
I suspect that underlying injury to these important parts of our anatomy will be key to understanding many neurological and neuropsychological diseases.
We discuss how easy it would be to test Dr Kraepelin’s hypothesis and observations in unmedicated serious first episode patients with disabling depression.
So far, no one has taken us up on this challenge.
We are very concerned that this means psychiatric and neurological patients are being neglected and are not offered the many supportive medical treatments available for others who arrive at hospital with more visible wounds and infections.
We think that the whole science of attacks of bipolar illness needs to be rethought….and all it would take would be to introduce regular measurement of respiratory rate [and volume if possible] at rest.
Let us know what you think