Over a century ago, Dr Emile Kraepelin suggested that depressive episodes of manic depressive disorder were due to metabolic disturbance. This is the reason, he thought, for the changes to the behaviours of sleep, feeding and mental status.
In chapter 3 of Manic-Depressive Insanity, he describes the physical signs of bipolar depressive episodes. He studied thousands of these patients over his decades-long career. No medicine was available then so he was able to carefully chart the natural history of this syndrome. He was able to chart its remitting/relapsing course [see chapter one of his study of manic depressive insanity]..
Kraepelin noted abnormal vital signs and most tellingly, abnormal breathing rates in his manic depressive patients; too slow in states of depressive insanity at rest and too fast in the same patients in mania.
Too slow breathing rates at rest are bad, this suggests a broken respiratory motor pump, unable to increase easily [at rest] when illness causes a rise in bodily acids.
Too slow breathing rates [with healthy normal lungs] in young adults sets the stage for attacks of alveolar hypoventilation and retention of carbon dioxide in the blood and abnormal pH. This was the reason patients could not eat or sleep or even think properly.
This is what Kraepeplin was suggesting. This is what no one wanted to accept. And he hoped that the perfection of the development of arterial blood gases would point to abnormal PCO2 as the cause of the altered motor and mental status in bipolar depression, as well as explaining the sympathetic autonomic nervous system arousal causing a rise in blood pressure and heart rate and disturbances of heart function. All this are consequences of too slow and fixed breathing rates at rest. A happy additional consequence of too slow breathing seems to be peripheral vasoconstriction and the lowering of normal body temperature. This seems to be protective for the organs, particularly the brain.
I think that everyone has forgotten what Kraepelin figured out, by carefully and methodically examining and recording the pattern of vital signs in his manic depressive patients. Vital signs are important for a reason, and are key to the function of the brain, the nervous system, the motor system and the mind.
Paula is a modern patient with the pattern of vital signs Kraepelin described.. She would fit right in with Kraepelin’s cohort. And I had the privilege to help her, using Kraepelin’s studies as my guide. I am not a doctor, I am a psychologist, with training in basic first aid-which was the key.
Paula has fixed much too slow breathing at rest and during major respiratory challenges due to physical illness, has many of the depressive symptoms described by Kraepelin, including the suffocating sensation of major anguish, which she now thinks is the sensation of Dyspnea [difficult breathing] which was a common symptom in the Polio era. It is the sensation which overcomes a person when their ventilation is no longer sufficient to eliminate the products of cellular metabolism.
We think that Kraepelin’s hypothesis is easy to test scientifically today, in seriously ill depressed patients [unmedicated]. It only takes one minute and a stopwatch to measure breathing rate [which is unconscious, as it is set by the brain stem, allowing for responses of the rest of the vital signs [Blood Pressure, Heart Rate and Function, and Body Temperature] to compensate for hidden [from our eyes] mechanical injury to the vulnerable motor respiratory pump muscle system of the body.
There are non invasive, innovative medical supportive treatments in the 21st century to improve the quality of life for those with mechanical injuries involving the muscles, nerve fibres, bones, and cartilages of the muscle pump system. They will not know what is wrong with them, they will think it normal to breathe as they do- it isn’t.
Measurement will unmask these kinds of problems and bring new insight regarding the importance of being able to move air in and out of the body and its relevance to chronic states of quiet, mixed, and wild [including manic] delirium affecting the ability to eat, sleep and think properly.
It is time to bring psychiatric practice into modern medical and scientific practice. Kraepelin expected this to be obvious to future doctors. It is obvious, if you investigate the problem in a practical way.