Pittsburgh Reflections

It’s almost 5 PM. I should be flying out of Pittsburgh right now, but - wouldn’t you know it? - my plane is not in the gate.

I cut out of my Bipolar Conference early for this?

A few observations on the International Conference on Bipolar Disorder:

I attended my first conference in 2001. Then, the brain science was only mentioned peripherally and speculatively, and the brain science posters strictly concerned size and structure rather than function and connectivity. The meds researchers were the stars of the show, and for very good reason - a lot of what we take for granted now in prescribing meds was emerging knowledge back then.

For instance, Gary Sachs of Harvard spoke about the NIMH-underwritten STEP-BD real world clinical trials that would be getting underway. That study, which yielded a lot of valuable information, wrapped up two or three years ago. Clinical trials results tended to dominate the posters sessions.

On the other hand, some things stay the same. There was a lot of talk back then about the safety and efficacy of using antidepressants to treat bipolar. With a lot more knowledge now, opinion now leans on the side of “No,” but the debate is by no means closed.

(Boarding call. ... I’m back, cruising over western PA, en route to the east coast.)

Significantly, Robert Post, then of the NIMH, disclosed new findings from the Stanley Foundation Bipolar Network that revealed that although mania gets most of the attention in bipolar, our population is depressed three times more than it is manic. Knock me over with a feather. Everyone else in the room, too.

A completely new and controversial topic was child bipolar. One of the presenters acknowledged the issue wouldn’t have even come up two years ago. Barbara Geller of Washington University (St Louis) reported on a study she was about to publish showing that bipolar kids are sicker than bipolar adults. Two major differentiating features from ADHD, she reported, were grandiosity and risk-taking.

Fast forward to 2009. The brain scientists are the stars of the show. Thomas Insel, head of the NIMH, tells the conference in so many words that bipolar research is starting to catch up to other fields. Husseini Manji who now works for Johnson and Johnson and had spoken before at the conference, talks about how things work at the cellular level while Mary Phillips (another return speaker) connects the dots at the systems level and Nick Craddock of Cardiff University reports on a gene that affects calcium channel function in a small segment of the bipolar population.

(Bear with me. We’re approaching Baltimore-Washington. Time to stow my laptop. ... I’m eating diner food in the terminal, waiting for my connecting flight to Hartford. To continue ...)

The brain science posters are starting resemble an illustrated owner’s manual to how our mind actually works (or fails to work). Hardly any industry sponsored drug trials. I spend a good 20 minutes talking with a researcher about the significance of one of the lit up areas from the functional images on display. It’s too soon to draw conclusions, but it looks like we can show the circuitry that makes bipolars over-react to both reward and disappointment. In the same area of the brain? I’m asking. Two opposite effects? Holy crap!

Meanwhile, at other posters, the first results of a longitudinal study tracking 400 bipolar kids are starting to roll in. The study is going to tell us a lot about the course of early onset bipolar, and whether it turns into adult bipolar over the years. Unlike eight years ago, virtually no one here is questioning the diagnosis. Instead, the debate is over achieving a consensus on the diagnostic fine points.

Of course, the more we find out the more we realize how ignorant we are. Moreover, in the real world, patients would be hard-put to point out any personal benefits from new scientific discovery. Quite the contrary, services have significantly deteriorated over the years while the new-generation meds have failed to live up to their promise, which has set off a justifiable reaction.

You’ll have to trust me on this: The difference between my first conference and the one I just attended is night and day. Mind-boggling findings are coming in thick and fast. Perhaps our generation will only achieve a marginal benefit, but be assured - future generations will be spared a lot of our suffering. It was my privilege to be talking to the people who have dedicated their lives to making this happen.

Time to board my flight. This is John McManamy. Over and out ...

Tooting from Pittsburgh II

It's going on 10 PM. I'm just about to get some serious sleep after a full day at the Eighth International Conference on Bipolar Disorder taking place in Pittsburgh. The image comes from a PowerPoint presentation in a morning talk by Husseini Manji on the fine points of BAG-1, a protein which seems to prevent glucocorticoid receptors from migrating to the nucleus of the neuron, if you know what I mean.

Let's put it this way, when glucocorticoid succeeds in its migration bad things happen.

It was heavy duty on the brain science this morning. We're not talking "imbalance of chemicals of the brain," Dr Manji reminded his audience. Instead, think of mood disorders as "impairments of synaptic and neural plasticity."

Don't worry if you don't understand any of this. I'm just giving you a feel for how my day went. Take my word for it, this is brain science 6.0. I'll be better able to break it down for you when I have a clear brain. To bed ...

This is John McManamy, live - well, actually brain dead - from Pittsburgh.

Tooting from Pittsburgh

Got into Pittsburgh late last night. Slept like a log at a hotel near the airport. Miraculously, next morning, at a shop adjoining a gas station, I was able to order a fresh fruit smoothie. My first non-junk food in 24 hours. Maybe it was the placebo effect, but suddenly I'm not feeling like someone who has been subjected to hours of torture by the airlines.

Today I'm in a hotel adjoining the convention center where tomorrow the Eighth International Conference on Bipolar Disorder, hosted by the University of Pittsburgh and the Western Psychiatric Institute, takes place. The room is a far cry from my Priceline specials (you know the type - where the air conditioning and plumbing are loud but unoperational, the guests in the next room and foot traffic outside are even louder, the view is into a parking lot or brick wall, towels the size of face cloths, and the wireless plays dead). I received an award at the previous conference two years ago and the organizers still remember - hence the luxurious (by my standards) hotel room.

(Towels! Big fluffy towels!)

Familiar names at the conference include Kay Jamison (part of a panel on suicide and note she just another expert here rather than a celebrity keynoter), Thomas Insel, head of the NIMH, and David Miklowitz, author of "The Bipolar Disorder Survival Guide." Plus a whole bunch of people who have contributed to my understanding of bipolar over the years, including Nassir Ghaemi, Husseini Manji, Ellen Frank, Michael Thase, and many many more.

Plus I look forward to catching up with numerous people I've met at past conferences.

Today I'm chilling. Had a long nap, got my didgeridoo with me (my lightweight "travel didge," not my new one I've been blogging about), and am about to take a walk. Dinner tonight with a friend of a friend. Tomorrow up early for a 7:45 AM start.

This is John McManamy, tooting from Pittsburgh. More in future blog posts ...

Tooting off to Pittsburgh

Never fly in the summer. Zoo is the wrong term to describe San Diego Airport. Animals are treated far more humanely. They get knocked out at home and wake up at their destination. I demand to be treated like an animal.

It took me 90 minutes to clear check-in, security, and the news shop. I spot one of those horse collar travel pillows. I have a whole closet full of them. Unfortunately, I didn’t bring my closet with me. Another one to my collection.

I was up at five this morning. Not by choice - my brain won’t let me sleep on travel days. Then they route me to Chicago because they can before dumping me off in Pittsburgh late at night and three hours out of my circadian rhythms.

Fortunately, I was wise enough to schedule a rebound day for tomorrow.

I’m plopped into a seat at my boarding gate. Someone with a high-decibel baby plops into the seat right behind me. I am very tolerant - compared to a lot of adults I know, the baby is a model of exemplary behavior.

I whip out my emergency iPod and jam in the earphones. Kiri Te Kanawa is singing Richard Strauss. Sanctuary, asylum. Ahhh!

I will be attending the Eighth International Conference on Bipolar Disorder, hosted by the University of Pittsburgh and Western Psychiatric Institute. Three days of the world’s top bipolar experts, along with leading brain scientists and geneticists. But right now I’m looking across the aisle, where a lady has open Food Network Magazine.

“Best Burgers,” reads the cover. The shot of the cover burger poses more of a temptation than the Victoria’s Secret Catalogue.

It’s always good to be passionate about something in life.

From Pittsburgh, it’s a family visit to CT. I did have a trip scheduled to visit a rehabilitation farm in the Berkshires, but that fell through. So straight home from there. Correction: The airlines are not familiar with the concept of straight.

This is John McManamy, on the road, tooting to Pittsburgh. Stay tuned for more road blogs ...