Andrew Huberman· PhD
So the very circuits that atrophy that start to wane and disappear in people with bipolar disorder are the circuits for interoception, for understanding of what's going on in one's own body.
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The evidence is convergent. Multiple independent sources reach the same conclusion, the underlying mechanism is well-characterized, and even the field's most cautious voices treat it as worth doing.
So the very circuits that atrophy that start to wane and disappear in people with bipolar disorder are the circuits for interoception, for understanding of what's going on in one's own body.
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The reality is that people with bipolar depression very likely have a hyperactivity, that is an increased level of activity in certain circuits within the brain early in the expression of their disease. And that typically, as I mentioned earlier, sets in around the early 20s, although sometimes that can be even earlier, in the teens and so forth. But that hyperactivity, we think, leads to a toxicity and excitotoxicity of certain elements of the neural circuits that are responsible for interoception.
Their lack of internal awareness is reduced, and that turns out to be, by way of neural structures, like the insula which is a brain region that is connected in a very direct way to our somatosensory cortex, so the part of our cortex that registers how we feel, literally, sense of touch and internal state. So those circuits, excuse me, for those for those of you listening I just bumped the microphone, excuse me. Those circuits are disrupted in people with bipolar and the top down control, that kind of accelerator and break on our overall levels of energy are also disrupted.
There are circuits that are present in people with bipolar disorder and in people that do not suffer from bipolar disorder, both of those circuits do the same thing in both sets of individuals, and yet in people with bipolar disorder, there seems to be an atrophy or a removal of certain neural connections over time that leads to a situation in which people with bipolar disorder become very poor at registering their own internal state, in particular, their emotional states and their somatic states.
This atrophy of neural circuits for interoception is starting to emerge as one of the defining neural circuit characteristics or underpinnings of bipolar.
So it appears that lithium is exerting its positive effects on bipolar depression treatment, at least in part by preventing the loss of certain neural circuits, namely the neural circuits for interoception and the top down control over the limbic system.
So we are always existing in a balance between exteroception and interoception, but as it turns out, people with bipolar disorder over time, and especially into the second and third decade of having bipolar disorder seem to have progressively diminished levels of interoception.