By Janet Settle MD
In this post, I’m reporting on the journal article by Adrienne Sprouse MD, et al. Organic Solvent-induced Bipolar Disorder: A Case Report. Advances in Mind/Body Medicine. 2013;27(3):19-23.
Summary: This is the first literature report of new onset type 1 bipolar disorder linked to industrial solvent exposure. This 43 year-old man with a three year history of bipolar disorder, type 1, presented with memory complaints, severe insomnia and auditory hallucinations. On exam: depressed mood and affect, religious delusions, irritability, auditory hallucinations, grandiosity. He was monosyllabic with severely delayed speech so his wife and mother were the primary historians. His symptoms worsened through the week and improved on weekends and vacations. He had no personal or family history of psychiatric illness and had previously been high functioning and productive. His occupation was textile printing using petroleum based dyes and organic solvents. He owned and managed his own printing plant. Meds at intake: lithium carbonate 1650 mg, clonazepam 0.75 mg, Benedryl 25 mg, armour thyroid 90 mg, melatonin 2.5 mg, DHEA 25 mg.
He was found on testing to have an elevated serum mercury level. Although, he received 11 IV chelation treatment until his mercury levels were normal, his symptoms, which are consistent with mercury exposure, did not improve.
He was then found to have the highest serum organic solvent levels that had ever been measured by the lab (Accu-Chem). He was treated with IV nutrients to support his detoxification pathways and with sauna detoxification. He avoided the plant and installed a new ventilation system. At 8 months, his symptoms were improved enough to return to work. At 24 months, his solvent levels were undetectable and he had returned to being happy and successful. His medications were largely discontinued. During the medication taper, he had mild symptom flares when exposed to chemical triggers: ie car exhaust, cleaning products.
Over 13 years of follow up, he had no significant mood symptoms. His maintenance medication regimen was: valproate 250 mg, lithium orotate 30 mg, clonazepam 0.25 mg. The authors conclude that, “A comprehensive program of chemical avoidance, nutritional therapy, and sauna detoxification may be helpful for those bipolar patients who have elevated levels of solvents, pesticides, or other toxic chemicals.”
Some background about toxins and mental health symptoms:
- Chronic organic solvent exposure has been associated with depression, suicide, fatigue, neuropsychiatric symptoms, one case of new onset schizophrenia and now bipolar disorder.
- Bipolar disorder patients have higher levels of serum and urine lead and cadmium levels than controls.
- Pesticides have been associated with depression and suicide risk but not bipolar risk.
- Gasoline exposure and heavy DEET use have been reported to cause transient (2 week) episodes of bipolar disorder symptoms that cleared with toxin removal.
Toxin exposure is ubiquitous. Organic solvents are also found not only in industrial settings but also in the following domestic exposures: dry cleaning fluid, perfumes including any scented product unless it uses only essential oils, nail polish remover, paint thinner, glue, spot remover, degreaser, some detergents, etc.!
Brain damage is seen on fMRI following organic solvent exposure. In this case report, the authors propose that organic solvents may act on the brain through the mechanism of neurologic kindling. “Neurological kindling can be produced by many stressful events including emotional trauma or stress, traumatic injury, alcohol and other drugs, infection, or heavy chemical exposure.”
The take home message is to take an environmental history. One tool is IFM’s Toxin Exposure Questionnaire (TEQ-20). You can find additional resources at the Environmental Working Group website (ewg.org) and at saferchemicals.org.