Medicine for emotions

Published April 01 2018

Emotions provide a richness and depth to life that is uniquely human. Compellingly warm emotions envelop me when I view a Mark Rothko painting, attend a Latin Tridentine Mass or dance to a favorite DJ at a club. We realize how precious emotions are when we cannot experience them normally. When there are no emotions, or too much of any emotion, the imbalance interferes with living a healthy and fulfilling life. Emotional dysregulation is a symptom of many psychiatric disorders.

As a patient, I can attest to the havoc of unchecked emotions. I began experiencing symptoms of severe depression and anxiety about 12 years ago, at age 22. At the time, I was a first-year biochemistry Ph.D. student at Harvard Medical School. A few months before starting school, my fiancée had left me for someone else. Everything inside me felt disordered, empty and dark, and it was not going away. I sought help from a psychologist who was a family friend, but a much greater struggle was in store.

Four years later, having withdrawn from Harvard because I didn’t have a thesis lab, I was in an ambulance traveling from a hospital in Marlborough, Massachusetts, to McLean Hospital in Belmont, Massachusetts, about 30 miles away. I was in an overmedicated fog, so the trip is a bit hazy. I think I joked with the paramedics, but I can’t be sure. At McLean, I was unloaded from the ambulance and led to the locked inpatient depression unit.

After about a week in the psychiatric unit at Marlborough, the staff hadn’t known what was wrong with me. My family hoped that McLean, considered the best psychiatric hospital in the world, could figure me out. Thankfully, my intake psychiatrist offered to work with me after I was released from the unit about two weeks later. I was diagnosed with bipolar disorder, though I do not know at what point during my stay, and the next several years involved an arduous recovery.

Bipolar disorder is a psychiatric illness consisting of manic and depressive episodes. Mania is elating and full of grandiose thoughts, whereas depression flattens affect and makes you feel worthless. For me, mania consists of racing thoughts and a reduced need for sleep. Conversely, depression ruins my self-esteem and self-confidence and promotes social isolation. In either case, my emotions run dangerously out of control. As part of my recovery, I use medication and therapy for safety and proper functioning.

I ultimately came to rely on three medications for my mental health: citalopram (Celexa), lamotrigine (Lamictal) and aripiprazole (Abilify). Citalopram is an antidepressant of the specific-serotonin reuptake inhibitor family, which works by blocking a transporter protein that removes serotonin from the synaptic cleft between neurons, thus keeping serotonin in the cleft for prolonged action. Lamotrigine is a sodium channel blocker that initially was used as an anticonvulsant for epileptics but found its way into psychiatric clinics as a great mood stabilizer. Aripiprazole is an atypical antipsychotic that partially activates dopamine signaling in the brain and is used to treat a variety of diseases including bipolar disorder.

It confuses me to think about how these diverse medications are helping balance my brain biochemistry. How do they act in concert with my body to stabilize, and thereby help me truly experience, my emotions? They have such different mechanisms of action, and the brain is so complex, that I do not think a full explanation is possible. What I do know is the emotional and behavioral effect they have on me when used together. I’m able to sleep and eat normally, and the full range of healthy emotions is open to me at appropriate times. I stop withdrawing from other people, and I am able better to identify what bothers me without spiraling into oblivion. These medications don’t calm the storm of life, but they do give me control of my ship.

There is no single cause of bipolar disorder, but genetic and environmental factors are believed to increase risk. This lack of a single cause occasionally agitates me. I wish my psychiatrist could point to a single malfunctioning molecule in my brain to explain what’s wrong with me, but that is impossible. I do take comfort in the fact that the disease definitely has a brain biochemistry component. This is evidenced by the many successful psychiatric medications that have returned the lives of so many patients. I am thankful that such medications exist and that I am able to take them without any side effects. Finding the right regimen for me took years of psychiatric help, but the work was well worth it. I have my life back and the emotions to prove it.

Stefan Lukianov Stefan Lukianov is a Ph.D. candidate at Harvard Medical School and a contributor to ASBMB Today.