Bipolar depression and mania are serious illnesses that may be caused by acid base disorders due to respiratory pump failure.
Arterial blood gas tests and measurement of respiratory rates and depth and minute ventilation are the ways to check out this hypothesis.
Disturbed mood, mental status and locomotor activity can occur when ventilation [the motor part of breathing] is broken and cannot accommodate normally to rising C02.
This what Dr Emile Kraepelin hypothesized when he measured his patients ventilatory rate and other vital signs. Depressed and/or irregular ventilation are serious signs that the patient is having difficulty moving air in and out and that they are feeling tired, worn out, and out of sorts to the point of mental impairment as a result. Patients can report how alveolar hypoventilation and/or respiratory acidosis makes them feel [it will feel awful] but they cannot report this key chemical imbalance.
Following Kraepelin’s example is an easy and non invasive to look for the possibility of alveolar hypoventilation from hidden and unknown issues with the respiratory motor pump.
How many patients with major depression and/or bipolar depression have respiratory pump failure and alveolar hypoventilation and C02 retention in the blood?
Sadly, no one knows.
Sadly no one is interested in whether psychiatric patients have normal functioning physiology. Unlike COPD, no one has studied the effects of insufficient and ineffective ventilation in ambulatory people. And even COPD is undiagnosed.
When patients can only report how their syndrome makes them feel, there is a big possibility that the diagnosis will be missed and go untreated or result in the wrong treatment.
Paula knows; her serious “control of breathing” issues were not even a little responsive to the psychotherapy she received.
Paula’s deterioration of her motor ventilation, her weakness, her mental confusion, her inability to talk or swallow, and her anguish [sign of ventilatory failure] got the most superficial of attention and no serious medical workup at all.
Without carefully counting respirations at rest, [which is not part of a typical medical workup], no one will hypothesize ineffective ventilation or respiratory pump failure or alveolar hypoventilation or endogenous carbon dioxide retention or possible respiratory acidosis.
And, no one really wants to know, I think, because this is a serious condition, even when chronic and long-lasting .
Yet it is important to study acid base conditions, especially when they become chronic because parts of the body break down and begin to function poorly.
to be continued………………
Of Sound Mind 