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More, more, more...

Dopamine is on trend. People often talk about “dopamine hits”, those little hits of pleasure in the brain from a like of your Instagram post, winning a bet or eating a slice of cake. It's the feel good, reward molecule.

But Lieberman and Long in 'the Molecule of More’ show how this isn't the whole picture. They say the best way to understand dopamine is not as the molecule of pleasure, but the molecule of more. Dopamine makes people strive more, want more and do more. It can push people to achieve great things. But it can also push people into self destructive behaviours, such as overwork, drug or alcohol addiction.

Those with bipolar might be aware of the role of dopamine imbalances in a hypomanic or manic episode. In such a state, where dopamine levels are high, they may feel extreme self belief and that they can achieve anything. This can lead to taking on more projects than they can ever hope to complete and taking bold, sometimes risky action. Those who use drugs such as cocaine or amphetamines can show similar symptoms. As the authors put it: “Cocaine intoxication is so similar to mania that doctors have difficulty telling them apart.”

We often think of bipolar disorder as being an either/or condition - either you have it or you don't. But the authors talk about people’s temperaments as a spectrum. For example, there are people who are “hyperthymic”- who have a “hyper” personality. They are “upbeat, exuberant, jocular, overoptimistic, overconfident, boastful, and full of energy and plans, ”but this never tips over into hypomania or mania. There is even a level below this of people who don't experience abnormal symptoms, but do have elevated dopamine levels. They might show “enhanced motivation, creativity, a tendency toward bold action and risk-taking.”

The authors have a theory that immigrant populations show higher than average dopamine levels. As nineteenth-century industrialist Andrew Carnegie put it “the contented do not brave the waves of the stormy Atlantic, but sit helplessly at home.” The authors believe this is true of the US, a nation with a lot of immigration in its history. They say high dopamine levels show up in American national characteristics, such as the bold ambition of “the American Dream.” When I read this I thought of the musical ‘Hamilton’ about ‘Founding Father, Alexander Hamilton. Hamilton is someone who is “never satisfied”, “reads every treatise on the shelf” and vows “there’s a million things I haven't done, but just you wait.” He is always seeking more.

The authors then looked at rates of bipolar in the US which are higher, and diagnosed younger, than in counties like Japan. They speculate that this has been passed down from previous high- dopamine immigrant generations. I wasn't sure how strong this point was - for example, do more Americans have bipolar, or is it just that their health service is different and they make more diagnoses?

While not a book exclusively about bipolar, this was an engaging read, and helped me understand the highs of the condition better. For further reading, I would recommend ‘Dopamine Nation’ by Anna Lembke which looks at the effects of too much dopamine stimulation in modern life.