The History and Treatment of a Bipolar Patient
Diagnosed with Borna Disease Virus Infection
Case report
The identity of the author is known to the Editor.
A description of Bipolar Disorder and its
As the patient moves into mania life becomes more chaotic, judgment is impaired. They may engage in outrageous and risky behavior.
Spending money they don’t have and engaging Borna Disease Virus (BDV) may play a role.
in promiscuous sexual activity. Speech and flight of ideas may become rapid and incoherent. It is not uncommon for the Manic to resort to alcohol and other drugs in an attempt to self medicate.
Denial that anything is wrong is commonand the patient will generally express irritability INTRODUCTION
at any one who suggests that they have a The primary symptoms of Bipolar Disorder are significant changes in sleep/wake/activity Once into the Manic phase it is very difficult to convince the patient to accept treatment.
productivity,affect, mental function, and verbal They become grandiose and arrogant, going for days without sleep and in some cases become 75% of bipolar patients report being hospitalized psychotic and paranoid. Hospitalization may be at least once. It has a high relapse rate and required. The manic phase of Bipolar Disorder a mortality rate _20 times the general population.
can be extremely destructive to the patient’s It is the sixth most debilitating disorder professional and social life as well as society at worldwide for ages 15–44 and represents 10% of mental illnesses. A life-long disorder, it is In general it is not until after the ‘‘crash’’ into difficult to manage and is the most expensive depression that the patient becomes willing, and mental illness to treat. Approximately $10 able, to accept help. Such depressions may be Billion per year is spent the U.S. for inpatient long, painful, and debilitating. After the biological aspects clear up, with the help of Most Bipolar patients cycle through phases medication, there follows a sometimes even more of normalcy, hypomania, mania, and depression.
painful phase of recovery and life reconstruction.
The periods and amplitudes of thiscycle vary tremendously between patients and within a single patient over time. Activity, sleep, My first major depression came at the age of 20 after a moderate manic period. It was like significantly different in each of these phases.
beinghit on the back of the head with a large Hypomania is a euphoric state of high energy, little sleep and can be extremely productive and creative. Most observers would not see an illness having no idea what was wrong––filled with and the patient would most certainly deny that guilt and failure. During the next winter my anything was wrong. Life is wonderful.
as Bipolar and started on Lithium, which I tookfor 10 days, declared I did not like it and quit.
SPECT findings
By the next summer I was severely depressed Study shows decreased activity in a wide area again and more than willing to take Lithium.
involving the left frontal lobe, left temporal lobe, For seven years while taking lithium I had parietal lobe, and a portion of the left basal periods of functionality which lasted a few years each, but when life got good I got busy The remainder of the brain had normal activity. life would become unmanageable and I would These findings would have to be correlated stop taking lithium and then the inevitable with appropriate studies such as MRI and CT. depression– months laying on my parents couch.
The findings are certainly not specific for I spent two years at college and quit at the point they were ready to throw me out. Two The large area involved which is contiguous is jobs I had, as a scientific technician, lasted for somewhat unusual for Lyme disease rather than several years each. Each period of stability and scattered defects which are more commonly seen functionality ended in chaos, failure and The consensus of a number of other radiologists My last manic episode was the most severe.
Setting out on my own, with grandiose ideas, I abnormal but not typical of Lyme disease––they quit my job and escalated into a desperate, and had no explanation for it. Even so, this doctor chaotic life. Following the subsequent crash into diagnosed me as having chronic neurological depression I managed to stay on Lithium and Lyme disease and prescribed long term treatment have had few mild hypo-manic periods but no with the anti-biotic tetracycline, which I terminated after 2 months due to side affects.
Marijuana consumption increased and my functionality and quality of life decreased. A Since then a number of blood tests for Lyme councilor managed to convince me that I had to have been negative and my conclusion was that address my alcoholism. I have been sober since At the age of 49 another infectious disease At 40 years old, still plagued with chronic reoccurringdepressions, my psychiatrist tried a pathogens. All tests were negative except for number of anti-depressant medications. We Cito Megilal virus, which she was not concerned settled on Zoloft (a serotonin reuptake inhibitor).
about. The Bartinella test was now negative He and my therapist seemed to think it was somewhat helpful, but it was certainly not acure. My therapist estimated that I was still BORNA DISEASE VIRUS
I had found some information about Borna Viruson a web site in the late 1990’s, but had not At some point I started to feel as if the nature been able to interest any of my doctors in it.
of my depressions had changed and wondered On my own initiative I had Borna titer done if I had some sort of infectious disease. I suffered by Specialty Labs in CA. It showed positive for from ‘‘flue like’’ symptoms, which my therapist antibodies. Unable to find any U.S. doctors who first documented in my early 40-ies. After a had even heard of Borna Virus I contacted Dr.
minor heart attack at age 46 I had a mild ‘‘fever Hanns Ludwig, in Berlin, who had co-authored of unknown origin’’ while in Mass General Microbiology Reviews (3). He requested a blood pathogens including Lyme disease with no sample and his tests indicated that I had a mild, active BDV infection, which had been present gastrointestinal discomfort, which including a feeling of nausea I visited an ear-nose-throat specialist and gastroenterologist. A complete A note from my psychiatrist 15-Jan-08 I attended this patient from 2003 until 2006 I then went to an infectious disease specialist when I closed my practice. His clinical history reflects a complex, mixed mood disorder in the Bipolar Spectrum, with onset in his late teens. Manifesting with intermittent symptoms across Bartinella and Lyme. The Bartinella test was the spectrum, including sleep deregulation, and that, given his long history of difficulties, it attention problems, physical and emotional is most unlikely that his recovery was just a symptoms of depression, anxiety, phases of spontaneous and natural euthymic cycle. I am euthymia, brief phases of hypomania, obsessions somewhat skeptical that the Amantadine was the and compulsions and substance abuse (in sole cause of his remission as I have seen remarkable results from Cymbalta in otherwise flu-like symptoms, executive dysfunction and social difficulties. His level of function was usually poor, with only brief periods of CONCLUSION
productivity and social activity, typically lasting Though I feel that the elimination of the Borna hours or days. At his first visit he presented with Virus is primarily responsible for my current mild mixed symptoms,but subjectively depressed; his psychotropic medication at that time were: Lexapro, Lithobid, Neurontin and Ritalin. however, in line with 2 ‘‘open’’ studies on BDV Changes to his psychotropic medication regime infected patients treated with Amantadine (1, were rather frequent, but rarely was more thanone change made at a time. There were no clear 2), and 1 double-blind, placebo controlled study responses to any medication trial, with the exceptionof Abilify, which repeatedly resulted in There is a pressing need for large scale double sig-nificant improvement in clarity and flexibility blind studies to validate the efficacy of treating of thought process, and a noticeable reduction in perseveration (having a hard time changing topics). Effect on mood was equivocal. Other laboratory experiments are most compelling. medications tried while I was attending him Assuming such validation it would be important to establish laboratory testing world wide.
Provigil, Zoloft, Ambien, Risperdal, Wellbutrin,Depakote ER, Strattera, Testosterone, Diazapam, Ritalin and Neurontin. None of these At this writing I have been off Cymbalta for 2 abated his depressions or anxiety, which lasted months with no depression. If my depression does not return in the next 4 months I will From 20-Jan-06 to 17-Apr-06 (3-months) he conclude that the BDV was responsible for my took 300 mg of Amantadine in divided daily depressions and that Amantadine was the cure.
doses as recommended by Dr. Ludwig. During this trial his mood varied from irritable to REFERENCES
1. Dietrich DE, Bode L, Spannhuth CW, Lau T, At the conclusion of the Amantadine trial Huber TJ, Brodhun B, Ludwig H, Emrich HM.
and negative Borna tests by Dr. Ludwig, he had Amantadine in depressive patients with Borna disease virus (BDV) infection: an open trial. Bipolar His depression worsened over the next month, to the point of suicidal ideation. On 10-May-06 2. Ferszt R, Kƒhl K-P, Bode L, Severus WE, Winzer he began taking Cymbalta, with no noticeable B, Bergh„fer A, Beelitz G, Brodhun B, Mƒller- Oerlinghausen B, Ludwig H. Amantadine revisited: for 6 weeks at which point his depression an open trial of amantadine sulfate treatment lifted (an appropriate response time for in chronically depressed patients with Bornadisease virus infection. Pharmacopsychiatry Cymbalta). Since 4-Jul-06, he’s been doing quite well in all respects. This has been the longest 3. Unpublished study outlined in Bode L, Ludwig period of sustained wellness and productivity H. Borna Disease Virus Infection, a Human he’s had in many decades. His current Mental-Health Risk. Clinical Microbiology Reviews; medication regime is as follows: Abilify, Cymbalta, Lithobid, Ritalin, and Diazapam.
There are numerous confounding variableswhich may have contributed to his recovery. Itcould be that the Amantadine’s effects manifestthemselves in a delayed fashion or that Cymbaltawas a very effective antidepressant. It could alsobe that the combination of these agents was thekey to his wellness. The only clear statement onecan make is that he is clearly significantly better


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