The History and Treatment of a Bipolar Patient
Diagnosed with Borna Disease Virus Infection
PRESENTED BY AN ANONYMOUS AMERICAN PATIENT*
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
The prevalence of various psychiatric
engage in outrageous and risky behavior.
disorders in the United States in which
Spending money they don't have and engaging
Borna Disease Virus (BDV) may play a role.
in promiscuous sexual activity. Speech and flight
My personal history of Bipolar Disorder
of ideas may become rapid and incoherent. It is
not uncommon for the Manic to resort to alcohol
diagnoses and treatment of Borna Disease
and other drugs in an attempt to self medicate.
Denial that anything is wrong is commonand the patient will generally express irritability
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
patterns, mood, energy, socialization,
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
hospital costs alone.
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
and regularity of circadian rhythms are
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
I spent the summer in bed in great pain
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.
abated my mood rose. I was diagnosed
as Bipolar and started on Lithium, which I tookfor 10 days, declared I did not like it and quit.
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.
I consulted was that the SPECT scan was
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
manic episodes. My use of Alcohol and
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
I did not have Lyme disease.
the age of 35.
At the age of 49 another infectious disease
At 40 years old, still plagued with chronic
specialist at MGH tested me for numerous
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
(which puzzles me).
somewhat helpful, but it was certainly not acure. My therapist estimated that I was still
BORNA DISEASE VIRUS
depressed 50% of the time.
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
a comprehensive paper on BDV in Clinical
Hospital. They tested me for a number of
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
After a period of having sinus and
for some time. He recommended a 12 week
gastrointestinal discomfort, which including a
course of Amantadine treatment.
feeling of nausea I visited an ear-nose-throat specialist and gastroenterologist. A complete
A note from my psychiatrist 15-Jan-08
battery of tests showed nothing.
I attended this patient from 2003 until 2006
I then went to an infectious disease specialist
when I closed my practice. His clinical history
who ordered a Single Positron Emission
reflects a complex, mixed mood disorder in the
Bipolar Spectrum, with onset in his late teens.
Tomography (SPECT) scan and tests for
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
remission since 1987),
remarkable results from Cymbalta in otherwise
flu-like symptoms, executive dysfunction and
treatment resistant depressions.
social difficulties. His level of function was usually poor, with only brief periods of
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;
well being, the scientific evidence is
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
humans with Amantadine. The preliminary
perseveration (having a hard time changing
data collected from humans, animals and
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
from weeks up to 4-months.
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
depressed to euthymic.
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
been depressed for 12 days.
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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