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5-HTP, St. John’s Wort, DHEA, Fish Oil, and More

SOURCES: Naturalstandard.com: “Bipolar Disorder.” Naturaldatabase.com: “Bipolar.”  U.S. Food and Drug Administration: “Dietary Supplement: Health Education Act of 1994.” Montgomery, P, Richardson, AJ. Omega-3 fatty acids for bipolar disorder. Cochrane Database Syst Rev 2008; CD005169. Kasper, S, Anghelescu, IG, Szegedi, A, et al. Superior Efficacy of St John’s Wort Extract WS 5570 Compared to Placebo in Patients With Major Depression: A Randomized, Double-Blind, Placebo-Controlled, Multi-Center Trial. BMC Med 2006; 4:14.

Stoll AL, Severus WE, Freeman MP, et al. Omega 3 fatty acids in bipolar disorder: A preliminary double-blind, placebo-controlled trial. Arch Gen Psychiatry 1999;56:407-12. Naturaldatabase.com: “Bipolar.”

Su KP, Shen WW, Huang SY. Are omega3 fatty acids beneficial in depression but not mania? Arch Gen Psychiatry 2000;57:716-7.

Naturalstandard.com: “Bipolar Disorder.” https://consumer.naturalstandard.com/index.asp

Pain Free Back by Harris H. McIlwain, MD and Debra Fulghum Bruce, PhD. [New York: Holt, 2004].

Overkill by Kim Thompson, PhD and Debra Fulghum Bruce, PhD. [Rodale: Rodale Books, 2002].

The Unofficial Guide to Alternative Medicine by Debra Fulghum Bruce, PhD. [New York: Macmillan USA, 1998].

Calabrese, JR, Rapport, DJ, Shelton, MD. Fish Oils and Bipolar Disorder: A Promising But Untested Treatment. Arch Gen Psychiatry 1999; 56:413.

Stoll, AL, Severus, WE, Freeman, MP, et al. Omega 3 Fatty Acids in Bipolar Disorder: A Preliminary Double-Blind, Placebo-Controlled Trial. Arch Gen Psychiatry 1999; 56:407.

Montgomery, P, Richardson, AJ. Omega-3 fatty acids for bipolar disorder. Cochrane Database Syst Rev 2008; :CD005169.

Rabkin, JG, McElhiney, MC, Rabkin, R, et al. Placebo-Controlled Trial of Dehydroepiandrosterone (DHEA) for Treatment of Nonmajor Depression in Patients With HIV/AIDS. Am J Psychiatry 2006; 163:59.

Hunt, PJ, Gurnell, EM, Huppert, FA, et al. Improvement in Mood and Fatigue After Dehydroepiandrosterone Replacement in Addison’s Disease in a Randomized, Double Blind Trial. J Clin Endocrinol Metab 2000; 85:4650.

Kasper, S, Anghelescu, IG, Szegedi, A, et al. Superior Efficacy of St John’s Wort Extract WS 5570 Compared to Placebo in Patients With Major Depression: A Randomized, Double-Blind, Placebo-Controlled, Multi-Center Trial [ISRCTN77277298]. BMC Med 2006; 4:14.

Muller, T, Mannel, M, Murck, H, et al. Treatment of Somatoform Disorders With St. John’s Wort: A Randomized, Double-Blind and Placebo-Controlled Trial. Psychosom Med 2004; 66:538.

Kahn, RS, Westenberg, HG. L-5-Hydroxytryptophan in the Treatment of Anxiety Disorders. J Affect Disord 1985; 8:197.

van Praag, HM, van den Burg, W, Bos, ER, et al. 5-Hydroxytryptophan in Combination With Clomipramine in Therapy-Resistant Depression. Psychopharmacologia 1974; 38:267.

U.S. Food and Drug Administration: “Dietary Supplement: Health Education Act of 1994.”

Foods to Avoid and Good Foods to Eat

If you or a loved has bipolar disorder, you know how important it is to manage mood episodes with bipolar medications and healthy lifestyle habits. But did you also know that certain foods and dietary supplements might play a role in helping — or hindering — people with bipolar disorder?

What Is Bipolar Disorder?

Bipolar disorder is a complex disorder that’s defined by dramatic or unusual mood episodes of highs and lows. The episodes of mania and depression can range from very mild to extreme in their intensity and severity. With bipolar disorder, mood episodes can come on gradually over many days or even weeks. Or they can come on suddenly, occurring over the course of just a few days. To count as episodes, symptoms must occur as a constellation of features that affects not only mood but also sleep, energy, thinking, and behavior and must last for at least several days, representing a change from your usual self.

With bipolar disorder, the person may experience episodes of major depression or instead, extreme elation and excessive energy. The elation is called mania. The mood episodes of bipolar disorder are accompanied by disturbances in thinking, distortions of perception, and impairment in social functioning.

Bipolar disorder was once thought to affect about 1% of the population. Some experts now believe it’s higher, perhaps affecting 3% to 4% of the population. There are no laboratory tests to diagnose bipolar disorder, and its symptoms can overlap with other psychiatric disorders. As a result, it’s often misdiagnosed and undertreated.

Is There a Diet for Bipolar Disorder?

There is no specific bipolar diet. Nevertheless, it is important to make wise dietary choices that will help you maintain a healthy weight and stay well. These choices include:

  • Avoiding the “Western” style diet that’s rich in red meats, saturated fats and trans fats, and simple carbohydrates. This eating style is linked to a higher risk for obesity, type 2 diabetes, and heart disease. Eating less saturated fats and simple carbohydrates can help overall health but does not directly affect the symptoms of bipolar disorder.
  • Eating a balance of protective, nutrient-dense foods. These foods include fresh fruits, vegetables, legumes, whole grains, lean meats, cold-water fish, eggs, low-fat dairy, soy products, and nuts and seeds. These foods provide the levels of nutrients necessary to maintain good health and prevent disease, in general.
  • Watching caloric intake and exercising regularly to maintain a healthy weight. Some findings show that those with bipolar disorder may have a greater risk for being overweight or obese. Talk to your doctor about ways to avoid weight gain when taking bipolar medications.

Does Fish Oil Improve Mood With Bipolar Disorder?

The American Heart Association (AHA) recommends eating non-friedfatty fish at least two times a week. Good choices include:

  • Albacore tuna
  • Anchovies
  • Herring
  • Mackerel
  • Salmon
  • Sardines
  • Trout

If you do not like fish, you can take an over the counter fish oil supplement, but it is not known if that will have the same positive effect. 

Fish oil can help keep your heart healthy. But some experts also believe that fish oil might play a role in brain function and behavior. While studies of omega-3 fatty acids for mood symptoms are not conclusive, some experts believe that they may be helpful in some people with bipolar disorder, particularly if they have a higher risk of cardiovascular disease or high triglycerides.

Some research suggests that getting more omega-3 fatty acids found in fish oil is linked to greater volume in areas of the brain. In particular, these areas are related to mood and behavior. In one study of 75 patients, one of the benefits of omega-3 fatty acids was decreasing depression in bipolar disorder.

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Still, the overall evidence for benefit of fish oil in bipolar disorder is inconsistent. More studies are needed before fish oil can be recommended as a proven treatment for bipolar disorder.

If you’re a vegetarian or vegan looking for possible benefits of fish oil, go with nuts. Walnuts, flaxseed, and canola oil contain alpha-linolenic acid (ALA), which is converted to omega-3 fatty acid in the body.

Which Foods Should I Avoid if I Have Bipolar Disorder?

Some general dietary recommendations for treating bipolar disorder include:

  • Getting only moderate amounts of caffeine and not stopping caffeine use abruptly
  • Avoiding high-fat meals to lower the risk for obesity
  • Watching your salt if you have high blood pressure but not skimping on salt if you are being prescribed lithium (low salt intake can cause higher levels of lithium in the blood)
  • Following your doctor’s instructions to stay away from foods that may affect your specific bipolar medication, if any

In addition, you need to be wary of natural dietary supplements that can cause a drug-herb interaction.

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Avoiding too much caffeine may be helpful for getting good sleep, which is especially important for people with bipolar disorder. When someone with bipolar disorder is feeling depressed, extra caffeine may temporarily cause a boost in energy, and possibly mood. The problem is that caffeine can disrupt sleep. Caffeine can also cause nervousness, heart palpitations, and headaches, worsen high blood pressure, or cause irritation in the stomach or esophagus in people that have acid reflux.

In addition to lowering caffeine, it’s important to avoid high-fat meals with some bipolar medications. High-fat meals may delay the time it takes for some bipolar medications to be absorbed into your system. Talk to your doctor about your medications and necessary dietary changes.

If you take MAO inhibitors (a certain class of antidepressant that includes phenelzine (Nardil,) and tranylcypromine (Parnate), it’s important to avoid tyramine-containing foods. These foods can cause severe hypertension in people taking MAO inhibitors. Some foods high in tyramine are:

  • Overly ripe bananas and banana peels
  • Tap beer
  • Fermented cheese
  • Aged meats
  • Some wines, such as Chianti
  • Soy sauce in high quantities
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Your doctor can give you a list of foods to avoid if you take these drugs.

Also, avoid taking natural dietary supplements if you are taking bipolar medications. Supplements such as St. John’s wort and SAM-e are touted to treat moderate depression. A few studies show benefit for some people with depression. But these natural therapies can interact with antidepressants and other bipolar medications. Discuss any natural dietary supplement with your doctor to make sure it is safe.

What About Alcohol and Bipolar Disorder?

Instructions for most psychiatric medications warn users not to drink alcohol, but people with bipolar disorder frequently abuse alcohol and other drugs. The abuse is possibly an attempt to self-medicate or to treat their disturbing mood symptoms, and they may also cause mood symptoms that can mimic those of bipolar disorder.

Alcohol is a depressant. That’s why many people use it as a tranquilizer at the end of a hard day or as an assist for tense social situations. While some patients stop drinking when they are depressed, it is more common that someone with bipolar disorder drinks during low moods. According to the National Institute of Mental Health, people with bipolar disorder are five times more likely to develop alcohol misuse and dependence than the rest of the population.

The link between bipolar disorder and substance abuse is well established. Alcohol is a leading trigger of depressive episodes in many people who are vulnerable to depression or bipolar disorder. Substance use disorders can seriously disrupt efforts to treat bipolar disorder and often may require their own forms of treatment.

Can I Drink Grapefruit Juice While on Bipolar Drugs?

Be careful. Talk to your doctor or pharmacist about eating grapefruit or drinking grapefruit juice with your bipolar medication. Grapefruit juice may increase the blood levels of many psychiatric medications that are used in bipolar disorder. These include some antidepressants – such as fluvoxamine (Luvox) or sertraline (Zoloft), the anti-anxiety drug buspirone (Buspar), certain anticonvulsants – such as carbamazepine (Carbatrol, Epitol, Equetro,Tegretol), some antipsychotics – such as lurasidone (Latuda), quetiapine (Seroquel) or ziprasidone Geodon), stimulants – such as dextroamphetamine (Adderall, Adderall XR, or Dexedrine), and many sedative-hypnotics (benzodiazepines), such as alprazolam (Xanax),clonazepam(Klonopin), diazepam (Valium), and lorazepam (Ativan), which could cause excessive drowsiness, mental impairment and even toxicity.

Should I Take Bipolar Medication With or Without Food?

Each bipolar medication is different. So talk with your doctor or pharmacist before taking the first dose. Some bipolar drugs can be taken with or without food. Others (such as Latuda or Geodon) are better absorbed into your system when taken with food or are less effective if taken with food (such as Saphris). Your doctor or pharmacist can pull the latest recommendations on taking the bipolar medication so you can safely take the medicine and get the full benefit of the drug.

Natural mood stabilizers: What are some healthy ways to enhance your mood?

Some people who suffer from depression prefer to look to natural mood stabilizers like St. John’s Wort or Rhodiola to help them manage symptoms. But before you try one yourself what should you know about these natural remedies? Which ones have been shown to help and which ones lack evidence of effectiveness? Can some of them have harmful side effects?

Natural remedies that can help improve your mood

St. John’s Wort. A 2008 Cochrane review of this herb found that it can work as effectively as some prescription antidepressants but with fewer side effects. However the review mentioned that there are a few factors to consider including varying levels of quality and strength as well as potential interactions with other drugs.

Omega-3 fatty acids. Long-chain fatty acids like eicosapentaenic acid (EPA) and docosahexaenoic acid (DHA) have been shown to reduce inflammation. Since inflammation is considered to be a partial underlying cause of depression and bipolar disorder these acids could be beneficial to many. Taking a fish oil supplement or eating fish that’s high in Omega-3 like salmon can help increase fatty acid levels in the body.

SAMe. SAMe also known as S-Adenosyl-L-methionine has been studied scientifically as a treatment for depression. Several well-designed trials have shown that SAMe often works better than placebo or prescription antidepressants. It was also shown to help people who experienced depression but were resistant to typical antidepressants.

Rhodiola. Rhodiola rosea an herb that grows in arctic Asia and Eastern Europe has been used as a medicine in those areas for many hundreds of years. A 2015 study in Phytomedicine showed that it didn’t work as well as a prescription antidepressant but did produce a “modest” reduction in depression symptoms for people in the trial. The authors reported far fewer side effects indicating that it could be a good choice for people with mild to moderate depression.

Who should consider using natural mood stabilizers?

These natural remedies for mood disorders are generally considered to have fewer side effects than their pharmaceutical counterparts. They can be a good choice for people who have experienced intolerable side effects from their prescription antidepressants.

In addition these stabilizers can also be a good choice for people with milder mood disorders who might only require temporary treatment. Natural remedies provide an alternative to prescription antidepressants in the event that the prescribed medication is ineffective.

What should you know before trying mood-enhancing natural remedies?

Always speak with your doctor before deciding to try a natural mood stabilizer or enhancer. These products can interact with other medications and may cause side effects that could be dangerous depending on your health.

If you have bipolar disorder anything that acts as an antidepressant has the potential to cause a manic episode so be sure to use extra caution and again first check in with your physician before using natural remedies.

It’s also important to research the source of a natural remedy and the purity of a supplement. Do your homework talk to your doctor and enjoy a natural mood enhancer — and potentially greater well-being.

Image source: Flickr

Manic Depression: 6 Natural Treatments for Bipolar Disorder

Do you or someone you know experience extreme mood swings with any type of recurring frequency? I’m talking about things like manic “high” period of increased energy in rotation with very “low” periods of depression. If so, it may a sign of manic depression.

Although many people live with manic depression, also known as bipolar disorder, many are never accurately diagnosed. Experts believe at least 5 million to 6 million people suffer from this condition in the U.S. alone.

While even healthy people experience many changes in their moods throughout the day and over the course of their lifetimes, those with manic depression are prone to much more abrupt and drastic “ups and downs.” The majority of people with manic depression experience so much low (depression) and high (manic) phases that their quality of life is significantly impaired. This greatly affects their ability to live normally, hold relationships, take care of their bodies, work and communicate with others.

Bipolar disorder impacts just about every facet of someone’s life, including that person’s thoughts, bodily sensations, sleep, personality and behaviors. During the high manic periods of manic depression, symptoms usually include restlessness, rage, hallucinations and aggression. On the other hand, during the low episodes symptoms are those common to depression, such as fatigue, despair, loss of motivation and social isolation. Although the exact cause of manic depression isn’t entirely known, some of the factors contributing to its development include genetics, brain chemistry, childhood environment and life events.

Like clinical/major depression and other mental disorders, manic depression is a condition that needs to be controlled carefully throughout someone’s lifetime. Becoming educated on the condition and its early warning signs, getting professional help, and reducing anxiety and depression through a healthy lifestyle and lowering stress can all help manage manic depression. Finding out all you can about how bipolar disorder develops, progresses and is sustained can help you or a family member deal with the symptoms of this sometimes-debilitating condition.


Natural Treatments to Help Manic Depression

Bipolar disorder can be progressive and worsen over time when left undiagnosed. Some people wind up having more drastic mood swings/episodes, and more frequently, as time goes on and symptoms are not treated. Although it cannot be cured entirely in most cases, managing symptoms can prevent frequent mood swings and suicidal, destructive behaviors.

Just like with clinical depression or anxiety, many doctors choose to control bipolar disorder using medications (such as mood stabilizers, antipsychotics, antidepressants and anti-anxiety drugs). (1) However, there are many effective natural treatments that can also help control symptoms of manic or depressive phases, and these have practically zero negative side effects, unlike psychotropic drugs.

Treatment for depression and bipolar disorder has come a long way, and today many individuals are able to receive help that significantly improves their quality of life, relationships, levels of independence and ability to live happy lives. Even when medication is used, these treatment options below can help stabilize the condition and improve recovery.

1. Education and Medical Care

Many experts feel that becoming educated about manic depression — learning about its symptoms and adopting a plan to recognize the early warning signs of a depressive or manic episode — can be one of the best tools. This helps develop problem-solving skills and establishes a plan for what to do when depression or mania starts emerging, such as telling a family member/friend or speaking with a therapist as quickly as possible. Meeting others with bipolar depression, reading online about helpful tips, and enhancing your life with things like physical activity, meditation and creative projects can boost self-esteem and keep up a more peaceful environment.

Cognitive behavioral therapy (CBT) is one type of therapy that has shown promise for naturally managing bipolar disorder episodes. CBT can help you start to recognize underlying thought patterns that trigger mood swings; be attentive to your feelings, body sensations and emotions before they turn into more severe symptoms; and help you to learn to reach out for help when you notice you’re in a difficult frame of mind (such as experiencing more anxiety or losing sleep).

In one Systematic Treatment Enhancement Program for Bipolar Disorder study, researchers compared people in two groups — those undergoing collaborative care therapy versus intensive CBT psychotherapy — over nine months and found those practicing CBT had fewer relapses, lower hospitalization rates and were better able to stick with their treatment plans even one year later. (2)

No matter the type of therapy approach you choose, some of the ways to help improve your therapy sessions and recovery include:

  • being open and honest
  • gaining support from your family (even including them in therapy sessions)
  • creating a daily planner to help manage stress and stay organized
  • keeping a journal of your feelings
  • staying open-minded to suggestions from your therapist
  • taking care of yourself in other ways between therapy sessions that can increase happiness (like eating right and getting enough sleep)
  • joining a support group or group therapy class is another great way to lower stress about manic depression, connect with other people going through the same thing and receive valuable advice from others who have recovered. Many support groups exist around the U.S., are easy and free to join, and can be found on the Depression and Bipolar Support Alliance website.

2. Exercise (Ideally Outdoors)

Exercise is practically a natural depression remedy since it’s a helpful way to lower stress, build confidence, help with getting good sleep, take care of your body, and even connect with other people if you a join a group team or cause. Many therapists who work with patients with depression or anxiety recommend taking a walk outdoors every day, regardless of the weather or time of year, to stay in touch with nature, the seasons and the elements around you.

Exercising outdoors has all the same benefits of exercising inside (it’s good for your heart, immunity, bones and weight, for example), plus it exposes you to uplifting natural light, connects you to what’s going on around you and tends to make you “see the bigger picture” more easily. These help lower anxiety, feelings of isolation, fatigue and hopelessness.

This is supported by research. A 2016 study published in the Journal of Affective Disorders found that “exercise was associated with improved health measures including depressive symptoms, functioning and quality of life.” (3)

3. Eating a Healthy Diet

You might be surprised to know how much altering your diet can change how you feel. Some studies have found that those who eat diets high in processed and fast foods are up to 60 percent more likely to suffer from depression compared to people eating healthier diets. (4) Your diet can greatly affect hormone production, neurotransmitter functions, energy and other processes that influence your overall mood.

As part of an anti-depression diet, it’s best to avoid foods that have lots of sugar, added sodium and artificial ingredients, in addition to greatly cutting back or eliminating caffeine and alcohol. Some of the best foods for fighting anxiety and depression include:

  • Healthy fats — coconut, raw dairy and grass-fed meats (saturated fat supports cellular function and neurological health)
  • Clean, lean protein foods — cage-free eggs, wild fish, grass-fed meat and pasture-raised poultry. Try to have at least four to five ounces of high-quality lean protein at every meal to get a variety amino acids that are important for hormonal balance
  • Wild-caught fish — omega-3 fatty acids found in fish like salmon, halibut, sardines and mackerel are critical to maintain a healthy brain
  • Vegetables and fruit — increase your intake of vital nutrients and antioxidants that support mood
  • High-fiber foods — nuts and seeds, such as flax, chia, hemp and pumpkin seeds, provide essential fiber in addition to omega-3s for brain function and fiber. Fiber is also found in fresh produce, ancient grains and beans/legumes

There are even some case studies that suggest the keto diet could positively impact symptoms of manic depression. Two patients following the diet to remain in a state of ketosis (achieved by drastic carbohydrate reduction and high fat intake) were observed for multiple years. Both reported a stabilization of mood while on the diet they claimed exceeded their medication and resulted in little to no side effects. (5)

 

 

4. Yoga and Meditation

Mindfulness meditation is similar to CBT, as it’s an effective way to recognize when your mood is becoming problematic, you’re getting stuck in ruminating thought patterns, and external situations are causing you to feel stressed, angry or vulnerable. Meditation (and similarly, even healing prayer) practices can be done entirely on your own time at home, are free, simple and have been trusted for improving emotional control for thousands of years. Yoga, considered a form of “moving meditation,” is also beneficial for the same reasons and is suitable for people who find it hard to meditate sitting or laying still.

A 2011 study published in the Journal of Psychiatric Practice found that people with bipolar disorder who participated in a mindfulness-based cognitive therapy program for eight weeks reported significant improvements in executive functioning, memory, and ability to initiate and complete tasks, as measured by the Behavior Rating Inventory of Executive Function and the Frontal Systems Behavior Scale. They also experienced “changes in cognitive functioning which were correlated with increases in mindful, nonjudgmental observance and awareness of thoughts, feelings, and sensations, and were not associated with decreases in depression.” (6)

5. Herbs and Supplements

Certain herbs and supplements have been shown to improve depressive symptoms and can help control anxiety. (7) These include:

  • Natural plant-based adaptogens herbs, including gingeng, holy basil, ashwaganda and rhodiola, help control the body’s stress response, lower cortisol, improve energy/focus and balance hormones in various ways.
  • St. John’s wort (Hypericum perforatum) is a natural antidepressant that can be helpful for getting good sleep.
  • Omega-3 fatty acids are derived from fish oil and help lower depression symptoms and inflammation.
  • Essential oils for depression include lavender, bergamot, ylang ylang and chamomile, which can be used in the shower, inhaled/used for aromatherapy, or applied to the skin as a way of bringing on relaxation and reducing muscle tension.
  • When people with manic depression add a high-quality probiotic supplement to their routine, the rate of rehospitalization from manic episodes goes down significantly. (8) That’s not surprising, considering the gut-brain connection that greatly influences mental health.

6. Reducing Stress

Any activity or hobby that feels fun, reaffirming, creative and soothing is a good way to blow off steam and control depressive or manic symptoms in a skillful, positive way. Different things work for different people to help relieve stress, including keeping a journal or writing, doing art or listening to music, spending time outdoors, taking a relaxing bath, or spending more time with family and friends. It’s important to cut out time every day to specifically do things that make you feel connected to others, happy and relaxed, even if it’s just for a short period of time (such as one hour at night before bed or first thing in the morning).

The more that you can make stress-reducing activities part of your regular routine, the likelier you are to stick with them and manage your symptoms. (9) It helps to make plans for fun, social activities that you can look forward to in the future and to keep organized in terms of keeping up with therapy appointments.

One helpful practice is keeping a journal in which you record how you’re feeling each day in order to track symptoms and draw some patterns. You can try recording your thoughts, feeling and behaviors daily in order to see what kind of activities keep you feeling most stable and happy, compared to those that make you feel vulnerable and easily triggered into experiencing mood swings.


Facts About Manic Depression

  • 5.7 million American adults (about 2.6 percent of the U.S. population 18 and older) have bipolar disorder, according to the National Institute of Mental Health. (10)
  • Manic depression/bipolar disorder usually appears in the late teens and early adult years (especially between ages 15 and 24). It’s much rarer among children and those over 65 years old.
  • At least half of all cases of manic depression start before age 25, although for some children symptoms can appear before the teenage years.
  • Normally this condition persists through someone’s lifetime, especially if the person doesn’t seek treatment, but symptoms can be well-managed through lifestyle changes, therapy and sometimes medication.
  • Up to 90 percent of people with manic depression have to be hospitalized at some point, especially those not managing their symptoms well; 75 percent need to be hospitalized at least two to three times. (11)
  • Bipolar disorder can sometimes be confused with anxiety disorders, clinical depression, schizophrenia and even learning disabilities like ADHD (especially in children and teens, who can display hyperactive behaviors similar to mania). (12)
  • Research shows that between 1994–1995 and 2002–2003 in the U.S., there was an increase in doctor office visits regarding manic depression of nearly 40-fold for children! Adult visits also doubled during this time.

Depression vs. Manic Depression

The primary difference between depression (whether clinical, short-term or major depression) and manic depression is that people with depression don’t experience manic “high” episodes. Those with depression tend to experience ongoing low moods and suffer from extreme sadness, loss of motivation and low energy for a period of time, normally not interrupted by common symptoms of mania like extreme happiness/excitement, hallucinating and becoming overly energized, for example. Depression is also more common than manic depression, affecting about 6 percent to 7 percent of the U.S. population at any given time. (13)

Although they have important differences, bipolar disorder/manic depression and clinical depression do have some similarities. They can both cause irritability, aggression, suicidal thoughts, and changes in body sensations, sleep and appetite.

A lesser form of mania, called hypomania (also referred to as bipolar disorder II), can also accompany some people with depression. Compared with bipolar disorder/manic depression, those with hypomania usually experience much less severe and life-impairing manic symptoms.

According to the DSM-5, the diagnostic manual published by the American Psychiatric Association that helps psychiatrists diagnose mental disorders, those with hypomania also have an absence of psychosis (delusions or hallucinations), and their work, relationships and general quality of life don’t suffer from manic symptoms. (14)

 

 


Symptoms of Manic Depression (Bipolar Disorder)

Throughout a given time period, those with bipolar disorder experience very different symptoms, depending on whether they are currently in a manic phase or on the other side of the pendulum in a depressive phase. Symptoms and moods also differ a lot from person to person. For most people, either very high or very low moods are experienced for several days at a time. Others might stay in a manic or depressive phase for several months.

Most people with bipolar disorder have stable, normal moods with few symptoms for stretches of time, but on the other hand some hardly ever feel “normal” and jump from one end of the spectrum to the other over and over again.

Common manic symptoms include:

  • very happy moods and excitement
  • hallucinations/psychosis or delusions (seeing and hearing things that don’t actually exist, sometimes thought of as “increased creativity”)
  • at times paranoia and extreme anxiety
  • irritability, aggression and sometimes rage
  • insomnia and trouble sleeping normally
  • strong motivation and ideas related to new plans
  • loss of appetite and sometimes weight loss
  • fast talking and fidgeting
  • spending more money than usual on affordable things or spending lots of energy/time on unnecessary projects

 Common depression signs and symptoms include:

  • very low moods, including feeling worthless, insignificant and hopeless
  • for some suicidal thoughts can occur
  • fatigue or lethargy (even though many people tend to sleep for long duration during this phase)
  • low motivation
  • brain fog and trouble concentrating, working, making decisions and remembering things
  • loss of interest or enjoyment in activities and hobbies
  • higher likelihood for abusing alcohol and drugs

Many times someone with manic depression will seek medical help and receive a diagnosis when that person has been in a depression phase for some time. This might be when family, co-workers and friends are more likely to notice a change in personality and suggest seeking treatment. On the other hand, many people with bipolar disorder never choose to get help and therefore continue to suffer unnecessarily. Seeking help from a therapist can be on the most important thing someone with manic depression does, since research shows that up to 20 percent of people who leave depression or other mood disorders untreated wind up taking their own lives. (15)


Causes of Bipolar Disorder/Manic Depression

  • Genetics: Like depression, anxiety and other mental disorders, there’s a genetic component to bipolar disorder, and it tends to run in families. According to the National Institute of Mental health, people with certain genes are more likely to develop bipolar disorder than others, although genetics alone are not likely to cause the condition. Even identical twins who have bipolar disorder in their family don’t always have the same outcome despite having identical genes. Most children with a family history of bipolar disorder will not develop the illness, and it seems that other factors need to trigger its development, including life events, upbringing and lifestyle habits that affect the brain.
  • Chemical imbalances and brain functioning: The brain’s physical structure and chemical activities affect someone’s moods and are related to the onset of mental disorders, including manic depression. Some research has shown that brains of people with bipolar disorder are different from those of healthy people, sometimes showing “multi-dimensional impairments” that are similar to those seen in people with schizophrenia (another disorder that features mood swings). It’s possible that ongoing inflammation also worsens these structural and chemical changes.
  • Lifestyle/upbringing: Research using MRI brain scans has found that the part of the brain called the prefrontal cortex (associated with “executive” functions, such as solving problems and making decisions) in people with bipolar disorder tends to be smaller and less active compared to adults who don’t have bipolar disorder. Psychiatric experts still have a lot to learn about how different upbringings and environments change brain structures, but it seems that someone’s recurring negative/fearful thoughts and behaviors can actually physically change the brain’s chemical channels through “neuroplasticity.” This increases the odds of experiencing harmful moods more often in the future and developing mood-related disorders. (16)

 

Key Points about Manic Depression (Bipolar Disorder)

  • Experts believe at least 5 million to 6 million people suffer from this condition in the U.S. alone.
  • Manic depression/bipolar disorder usually appears in the late teens and early adult years (especially between ages 15 and 24). It’s much rarer among children and those over 65 years old.
  • Up to 90 percent of people with manic depression have to be hospitalized at some point, especially those not managing their symptoms well; 75 percent need to be hospitalized at least two to three times.
  • Even when medication is used, these treatment options below can help stabilize the condition and improve recovery: education and medical care, exercise ideally outside, eating a healthy diet, yoga and meditation, certain herbs and supplements, and reducing stress.
  • Common manic symptoms include very happy moods and excitement; hallucinations/psychosis or delusions; at times paranoia and extreme anxiety; irritability, aggression and sometimes rage; insomnia and trouble sleeping normally; strong motivation and ideas related to new plans; loss of appetite and sometimes weight loss; fast talking and fidgeting; spending more money than usual on affordable things or spending lots of energy/time on unnecessary projects. Common depression signs and symptoms include very low moods, including feeling worthless, insignificant and hopeless; suicidal thoughts; fatigue or lethargy; low motivation; brain fog and trouble concentrating, working, making decisions and remembering things; loss of interest or enjoyment in activities and hobbies; higher likelihood for abusing alcohol and drugs.
  • The three main causes of manic depression seem to be genetics, chemical imbalances and brain functioning, and lifestyle/upbringing.
  • The primary difference between depression (whether clinical, short-term or major depression) and manic depression is that people with depression don’t experience manic “high” episodes. Those with depression tend to experience ongoing low moods and suffer from extreme sadness, loss of motivation and low energy for a period of time, normally not interrupted by common symptoms of mania like extreme happiness/excitement, hallucinating and becoming overly energized, for example. Depression is also more common than manic depression, affecting about 6 percent to 7 percent of the U.S. population at any given time.

Read Next: Bacopa: The Brain-Boosting Alternative Treatment to Psychotropic Drugs

Natural Remedies for Bipolar Disorder

There are safe, powerful, and effective natural remedies for bipolar disorder.

Dr. Cain, ND MA is the only integrative bipolar doctor in the country who has a masters degree in clinical psychology and a naturopathic medical degree. She is licensed as a physician in the state of Arizona and has training in diagnosis, medication management, and treatment of bipolar disorder, depression, and anxiety.

“My health has improved, my relationships are stronger, and I’m full of energy and hope. This differs entirely from my previous 31 years of unsuccessful medications, therapies, and useless testing. I wish I’d started naturopathic treatment with Dr. Cain, ND MA years ago!” – A Satisfied Client

 

What is Bipolar Disorder, Manic Depression, or Manic-Depressive Disorder?

Bipolar disorder, previously called manic depression or manic-depressive disorder, is a psychiatric condition characterized by extreme shifts in moods. These mood swings tend to cycle from depressive symptoms (or major depression) to manic episodes (or hypomania). Patterns tend to be well demarcated and cyclical.

 

What are the different types of Bipolar Disorder?

There are four main types of bipolar disorder: Bipolar Disorder Type I (or Bipolar I Disorder), Bipolar Disorder Type II (or Bipolar II Disorder), Cyclothymic Disorder (or Cyclothymia), and “other” types of bipolar disorder.

Let’s deconstruct each of these a little bit more: 

 

Bipolar 1 Disorder

  • Bipolar I Disorder is characterized by true mania alternating (sometimes) with depression. I say sometimes because some cases of bipolar disorder do not present with any depression until much later in the disease. Mania is on the opposite pole of depression and may be characterized by high energy, sleeplessness, grandiosity, risk-taking-behaviors, talkativeness, agitation, excitability, and extreme mania may present with psychosis or a loss of reality. Mania lasts for over a week and may go on for months in more severe cases. The most severe aspect of bipolar type I is mania which can be debilitating and frightening for the sufferer and their loved ones.
  • Bipolar II Disorder differs from type I in that the depression predominates and the mania is less extreme. People with Bipolar Disorder type II tend to suffer from extreme depression, otherwise known as Major Depression, and hypomania. Hypomania differs from mania in that it is of shorter duration (often under 4 days). Depressive episodes can last from weeks to months.
  • Cyclothymia is defined as mood cycles that last for at least two years, that alternate back and forth similar to bipolar disorder type I and II. However, depression and hypomania do not meet the full criteria for hypomania and major depression.

 

What causes Bipolar Disorder?

There are many genetic, environmental, and neurochemical factors that impact the development of bipolar disorder.

In this section, we will talk about the high yield differentials that should be considered in identifying the root cause of your symptoms of bipolar disorder. It is important to emphasize that this is not a complete or exhaustive list and it will be extremely important for you to establish care with a highly trained integrative bipolar doctor.

 

 

Brain Changes

In bipolar disorder, we see changes in the frontal lobe, amygdala, and hippocampus of the brain. These changes differ depending on if the person is in a state of depression or mania. The frontal lobe acts as breaks for the brain and In depression, we see more activity in the frontal lobe which results in suppression of behaviors. The amygdala is the emotional center of the brain and in depression, the amygdala is turned down to cause lethargy lack of motivation and sadness. Contrastingly, in mania, the frontal lobe is turned down resulting in impulsivity while the amygdala is turned up and the person experiences intense emotions like elation, paranoia, irritability, and fear. The Hippocampus is involved in memory, in bipolar disorder we see changes in hippocampal tissue and this is why sometimes we see forgetfulness in mania and depression. Brain scans can give us information on your brain’s health and level of activity during different mood states to identify causes of your feelings and behaviors.

 

Genetics

We see an increased risk of developing bipolar disorder if there is a first-degree relation affected by bipolar disorder. Research has identified single nucleotide polymorphisms (SNPs) associated with an increased risk of developing bipolar disorder. Examples of these SNPs can be found in the genes CACNA1C, ODZ4, AND NCAN. I typically recommend my clients do genetic testing and Organic Acid Testing so that we can identify risk factors create epigenetically tailored treatment plans.

 

Neurotransmitters

Neurotransmitters are cells that send chemical messages and drive thought, emotions, and behavior. The primary neurotransmitters are serotonin, dopamine, epinephrine, norepinephrine, GABA, and glutamate. Your neurotransmitters are greatly impacted by your genetic makeup, environment, gut-health, and even traumas (whether emotional or physical).

Pharmaceutical treatments aim to manipulate neurotransmitters in an attempt to regulate mood and behavior. My recommendation is to look at neurotransmitter breakdown products and combine this data with amino-acid function, detoxification, genetics, and epigenetic testing in order to first determine what is happening in the brain chemistry and create uniquely tailored protocols to balance the neurochemistry. My favorite test is the Mental Health Panel in conjunction with genetic testing conducted by your primary care doctor.

 

Toxicity

When referring to toxicity the research has shown a link between different types of environmental chemicals and damage to our brains, organs, cells, even our DNA. Identifying the root cause of your symptoms must involve looking at environmental toxicity.

Here are examples of different toxins and the impact they can have on mental/emotional functioning;

 

Dr. Nicole’s, ND MA Top Bipolar Disorder solutions: Integrative treatments for Bipolar Disorder

 

Identify the root cause of your symptoms and address them directly

Dr. Cain’s, ND MA natural remedy for bipolar disorder depends on identifying what is out of balance in the body. Once we treat the root cause of the symptoms they will fade away. Here is the typical battery of tests I order for my new clients presenting with depression and/or bipolar disorder:

  1. OAT testing: The OAT test is an extremely comprehensive urine test in assessing the multivariable causes and modifying factors in the development and maintenance of bipolar disorder. The OAT test tells us about how your body is reacting to your DNA in its environment. It achieves this by examining over 70 health markers. It provides information about mood-regulating neurotransmitters, oxidative stress levels, mineral and vitamin levels. It also provides individualized data regarding gut health and recommendations pertaining to diet and your genetic individuality and speaks to optimal supplementation and dietary changes that actually impact your unique microbiology.
  2. Basic blood work: CBC, CMP, Thyroid (FT3, FT4, TSH, RT3), Iron Panel (Ferritin, TIBC, Serum Iron, HFE gene), Lipids (ideally a vertical auto profile (VAP) test), Urinalysis, GGT, HGA1C, Homocysteine, HSCRP, Fibrinogen, MMA, Serum B12, MTHFR, COMT, APOE, Cortisol x3
  3. Hormone testing: FSH, LH, Fractionated Estrogens, Progesterone, Pregnenolone, Prolactin, DHEA-S, Testosterone (Free & Total), & SHBG.

 

Toxins & Bipolar Disorder

To read the latest research on bipolar disorder and toxicity, click on each of the articles below:

To see if toxicity is causing or contributing to your bipolar disorder, the GLP Tox and Hair Toxic Metals Analysis would be a great start!

 

Oxidative Buildup

There is an extensive amount of research linking bipolar disorder and oxidative build up. Oxidative stress damages your DNA, is harmful to your brain and organs, and causes symptoms of bipolar disorder. If your symptoms of bipolar disorder are associated with oxidative stress build-up, proper identification and treatment is absolutely necessary.

 

Latest Research

To read the latest research on bipolar disorder and oxidative stress, click on each of the articles below:

To see if oxidative stress is causing or contributing to your bipolar disorder, the DNA Oxidative Damage Assay would be great.

 

Food Allergy Testing for Bipolar Disorder & candida testing for Bipolar Disorder

The health of the gut impact how your body makes its mood-altering neurotransmitters. In fact, 95% of your serotonin is made in the gut, and medications that primarily focus on modifying serotonin, have high side effect profiles in the gut. If you have bipolar disorder, it is likely that your diet is playing a role. There is no one-size-fits-all when it comes to diet. Finding out your unique needs will give you direction on a way you can eat to feel like yourself again.

Top 4 Bipolar Diet Tips

  1. Reduce inflammation by eating Chia seeds, ginger, cashew nuts, broccoli, blueberries, spinach, and broth (especially organic bone broth). Avoid sugar, carbohydrates, fried foods, food dyes, soda/pop, preservatives.
  2. Feed your brain with lean protein, wild/ Alaskan fish, and healthy oils (avocado, coconut, walnut). Avoid alcohol, caffeine, nicotine, pork, excess red meat.
  3. Detox by consuming lots of water, minerals, vegetables from the brassica family (broccoli, brussel sprouts), high fiber foods (legumes, beans)
  4. Heal your gut by taking supplements such as GI Revive, Therbiotic, and Similase. To learn more about the gut/brain axis, check out Dr. Nicole’s Gut Psychology Program.

 

Spiritual Practice

According to research, contemplative and spiritual practices may have remarkable benefits to your emotional and physical health. These types of practices can vary dramatically and the more that they are tailored to you, the better they will serve you. Here are some ideas for contemplative practices that have been shown to offer benefits to your health: Meditation, prayer, yoga, journaling, and attending services with a spiritual community. Read the book Resilience: The Science of Mastering Life’s Greatest Challenges by Dr. Steven Southwick to learn more about how spirituality can help you overcome trauma and live a life on purpose, with purpose.

 

How Dr. Cain’s, ND MA Natural Solutions for Bipolar Disorder Works:

At your first visit, Dr. Cain, ND MA will make sure you are accurately diagnosed. There are other conditions that have symptoms that overlap with bipolar disorder, for example, post-traumatic stress disorder, trauma, and borderline personality disorder. Having an accurate diagnosis can help you find the right treatment.

Dr. Cain, ND MA seeks to get to the root cause of your symptoms. At your initial visit, she will look at your records and may order laboratory work to rule out other potential causes of your symptoms. At the end of your first visit or at your second visit Dr. Cain, ND MA will prescribe you a homeopathic natural remedy for bipolar disorder. Homeopathic medicines are natural medicines that are safe, effective, and approved by the FDA for the treatment of many illnesses. Homeopathic medicines will not interact with your prescription drugs and they can work fast. Your homeopathic prescription may consist of natural mood stabilizers for bipolar disorder as well as remedies that counteract the root causes of your mood disorders.

Homeopathy can be incredibly effective in helping clients lower the doses of their medications, and Dr. Cain, ND MA has even successfully helped many clients completely wean off their medications.

The Benefits of Homeopathic Treatment for Bipolar Disorder:

  • Homeopathy is 100% safe.
  • Homeopathy is a natural treatment.
  • Homeopathy is FDA approved to be sold at grocery stores.
  • Homeopathic remedies are affordable with the average remedy costing between $7-15.
  • There are no side effects.
  • Homeopathy can be used with your medications.
  • Homeopathic remedies help your body heal so that your symptoms naturally go away.

Homeopathy will not only treat your mood but it can help with your other concerns as well and help you recover as a whole person.

Ready to Get Started?

To get started, you can choose to join the Private Anxiety Freedom Facebook Group for a community of people to lift you up, you can take a course to learn more about how to empower your health with natural solutions, or become a consulting client of Dr. Nicole Cain, ND MA in Arizona. Not in Arizona? Dr. Nicole Cain, ND MA takes on a select group of consulting clients depending on your unique situation. For more details, you can click here or call Dr. Nicole Cains ND MA’s admin at 877-339-3295.

Learn To Manage Your Symptoms

Bipolar disorders get a bad rap.

In movies and TV, bipolar characters offer a dramatic case for an exciting, out-of-control life. They stagger between high and low emotions, spend money they don’t have, sleep around, and drink and drug at will. They talk too fast and act impulsively without considering anything or anyone.

Away from the screen, however, bipolar illness can feel very different. People with the disorder often spend far more time either perfectly fine, depressed, or in a mix of depressed and upbeat moods rather than surfing continuous manic highs. And, most importantly, given a correct diagnosis, medication, and therapy, many can achieve stable and fulfilling lives.

Why do these misconceptions arise? Maybe because, unlike other mental illnesses, bipolar disorders have acquired a kind of romantic mystique.  Taken only in their high and low extremities, they have become a stand-in for a heightened, creative life.

After all, many famous writers, artists, and musicians share the diagnosis, ranging from Alvin Ailey to Catherine Zeta-Jones. Not to mention Russell Brand, Kanye West, Carrie Fischer, Kurt Cobain, Lou Reed, Demi Lovato, Mariah Carey, and on and on. But it’s worth noting that while some studies show that those with a genetic tendency toward bipolar disorder may be more creative, that doesn’t apply to everyone. And that, for many people with bipolar disorder, a stable consistent routine often allows creativity to flow.

Article continues below

Concerned about Bipolar Disorder?

Take our 2-minute Bipolar quiz to see if you may benefit from further diagnosis and treatment.

Take Bipolar Quiz

What Does It Mean to Be Bipolar?

Once called manic depression, bipolar disorder is a mental health condition characterized by unusual shifts in mood, energy, activity levels, concentration and an inability to carry out daily tasks.  Moods can range from highs (mania or hypomania) where you feel extremely energized, elated or unusually irritable to lows (depression) which can lead to sadness, indifference, or hopelessness.1

Although bipolar disorder is a lifelong condition, it’s possible to manage mood swings and other symptoms by following a treatment plan that, in most cases, includes medications and psychotherapy.

“In general, bipolar disorder is much better controlled if treatment is continuous and tailored to each person since different people respond to treatment in different ways,” says Diana Samuel, MD, assistant professor of clinical psychiatry at the Columbia University Medical Center. “The combination of psychotherapy and medications together tends to be more effective, providing improvement in symptoms sooner.”

Diagnosing Bipolar Disorder

Most bipolar disorder falls into three main categories. They include:

Bipolar I

Characterized by episodes of mania that last at least seven days and may require hospitalization. Depressive episodes that follow can last up to two weeks. If these symptoms happen simultaneously, it’s called a mixed episode.

Bipolar II

Defined by a pattern of depressive and hypomanic episodes. Hypomania is a mood elevation that increases energy, agitation, and pressured speech. The mania is not as intense as bipolar I, but the depressive episodes are severe and may last longer.

Cyclothymic Disorder (also called Cyclothymia)

Defined by periods of hypomanic and depressive symptoms lasting for at least 2 years (1 year in children and adolescents). However, symptoms do not meet the diagnostic requirements for a hypomanic episode and a depressive episode.

People can experience symptoms of bipolar disorder that do not match the three categories above, which are referred to as “other specified and unspecified bipolar and related disorders.”2

While these categories may seem easily differentiated, reaching a diagnosis for bipolar disorder can be difficult. People who have bipolar disorder often seek help when they are feeling low, so a careful medical history is essential to ensure that bipolar disorder is not mistaken for major depression.

“More than 50% of folks present with depression as their first episode,” says Trisha Suppes, MD, PhD, professor of psychiatry and behavioral sciences at Stanford University and the director of the Bipolar Disorders and Depression Research Program at the VA Palo Alto Health Care System. “In the early course of the illness, people with bipolar I or II may not have had any hypomanic or manic episodes or experiences.”

In addition, while mania is one of the “most recognized syndromes in psychiatry since it is so distinctive, bipolar II is often characterized by hypomania, which many people may not initially identify as a problem,”’ says Dr. Suppes.  “They may simply feel they are somewhat more energetic or sleeping somewhat less. They could even be just more hyper-productive or hyper-functional. They might not see that as a hypomanic symptom because the state could be mixed—both positive and negative.”

Getting a diagnosis correct is extremely important, however, since it can influence the course of treatment. Giving a patient with bipolar I disorder an antidepressant may trigger a manic episode.

“If you knew someone with bipolar I disorder was depressed, you wouldn’t give them an antidepressant,” Dr. Suppes explains.  “You’d give them a mood stabilizer, whereas with bipolar II, an antidepressant could be the treatment of choice.”

Bipolar Disorder and Related Mental Health Comorbidities

Along with depression, about 92% of people with bipolar disorder may also experience other psychiatric disorders during their lifetimes, which may further complicate a diagnosis.3 These include:

Substance Abuse

Of all psychiatric conditions, bipolar disorder is most likely to co-occur with alcohol or drug abuse.4

“For people with bipolar disorders it’s extremely important not to abuse substances,” Dr. Suppes says. “It can change the course of the illness and is really hard on the brain.”

“Cutting down or eliminating alcohol/drug use can be extremely important since the combination of bipolar disorder and alcohol/drug use each can worsen the severity of the other,” Dr. Samuel adds.

Post-Traumatic Stress Disorder (PTSD)

can develop after experiencing a significant traumatic event. People with depression or bipolar disorder are more likely to develop PTSD―both because having a mood disorder increases the risk of experiencing a traumatic event and because having a mood disorder makes it more likely a person who experiences a traumatic event develops PTSD. 5,6

Anxiety

It is also common for people with bipolar disorder to also have an anxiety disorder.7

Attention-Deficit Hyperactivity Disorder (ADHD)

“Bipolar disorder and ADHD have overlapping symptoms that can make it challenging to differentiate between the two,” Dr. Samuel explains.  “Both bipolar disorder and ADHD can present with difficulties in managing focus and being easily distracted, irritable, and speaking quickly.” Many people with bipolar disorders may also have ADHD.

Eating Disorders

Binge eating or bulimia may also accompany bipolar disorders.

Treating Bipolar Disorders

As stated previously, a combination of medication and therapy usually works best for people living with bipolar disorder.

Medications for Bipolar Disorder

When it comes to bipolar I disorder, “Lithium is still considered the first-line treatment for mood stabilization but in recent years, there have been many medications that can effectively treat bipolar disorder other than lithium,” Dr. Samuel says.

“Mood stabilizers are the most commonly prescribed type of medication for bipolar disorder. Antipsychotic medications and, to a lesser extent, antidepressants may also be indicated. Also, many antipsychotic medications have an indication for mood stabilization,” she said.

Medications may include:

  • Mood stabilizers. Used to control manic or hypomanic episodes, these include lithium (Lithobid), valproic acid (Depakene), divalproex sodium (Depakote), carbamazepine (Tegretol, Equetro, others), and lamotrigine (Lamictal)).
  • Antipsychotics. Adding an antipsychotic may help relieve depressive or manic symptoms that persist despite treatment with other drugs. Taking these alone or with a mood stabilizer may help. Such drugs include: olanzapine (Zyprexa), risperidone (Risperdal), quetiapine (Seroquel), aripiprazole (Abilify), ziprasidone (Geodon), lurasidone (Latuda) or asenapine (Saphris).
  • Antidepressants. Employed to manage depression, antidepressants are usually prescribed with a mood stabilizer or antipsychotic, since an antidepressant alone can sometimes trigger a manic episode.
  • Antidepressant-antipsychotic. The medication Symbyax combines the antidepressant fluoxetine and the antipsychotic olanzapine. It works as a depression treatment and a mood stabilizer.
  • Anti-anxiety medications. Benzodiazepines may help with anxiety and improve sleep but are usually used on a short-term.8

In addition, cariprazine (Vraylar), has been recently been approved by the FDA for patients with both manic and depressive episodes in bipolar I disorder.9

“It’s very important that patients be absolutely honest with themselves and their doctor about which meds work and which don’t,” Dr. Suppes says. “Also, if they’re having side effects that are not tolerable. It doesn’t matter what they are. There’s a lot of different drug choices and if you work with your doctor, my hope is you’ll find a combination that you are comfortable taking in an ongoing way.”

Finding the right medications for you can sometimes be a trial-and-error affair that takes patience since some medications require weeks or months to reach their full effect. Health providers usually change only a single medication at a time to make it easier to identify which medications work to relieve symptoms with the fewest bothersome side effects. And even if you’ve arrived at the perfect mix, aging and changing symptoms may send require adjustments.

Never make changes on your own or stop taking your medications. If you stop your medication, you may experience withdrawal effects, or your symptoms may worsen or return. You may become very depressed, feel suicidal, or go into a manic or hypomanic episode. If you think you need to make a change, call your doctor.

Psychotherapy

Several types of therapy may be helpful in treating bipolar issues. These include: 10

  • Interpersonal and social rhythm therapy (IPSRT). IPSRT focuses on stabilizing daily rhythms, since following a consistent routine in sleeping, eating, and exercising may help you to manage your moods.
  • Cognitive behavioral therapy (CBT). By identifying unhealthy, negative beliefs and behaviors and replacing them with healthy, positive ones, CBT can help identify what triggers your bipolar episodes. You also learn effective strategies to manage stress and to cope with upsetting situations.
  • Dialectical Behavior Therapy: Including both individual and group therapy, DBT teaches mindfulness and acceptance skills such as “the ability to experience moment-to-moment thoughts, emotions and their accompanying physical sensations from an observer’s stance, without negative judgment.”
  • Psychoeducation. Learning about bipolar disorder can help you and your loved ones understand the condition. Knowing what’s going on can help you get the best support, identify issues, make a plan to prevent relapse, and stick with treatment.
  • Family-focused therapy. Family support and communication can help you stick with your treatment plan and help you and your loved ones recognize and manage warning signs of mood swings.

Additional Bipolar Treatment Options

Depending on your needs, other treatments may be added to your depression therapy.

In electroconvulsive therapy (ECT), electrical currents are passed through the brain to trigger a brief seizure in the hopes of creating changes in brain chemistry that will reverse symptoms of certain mental illnesses. ECT may be an option for bipolar treatments in cases where medications don’t work, antidepressants may not be indicated (such as pregnancy), or where the is a high risk of suicide.

Transcranial magnetic stimulation (TMS) is being investigated as an option for those who haven’t responded to antidepressants.

In addition, studies are underway to examine if ketamine might be considered as an option in treating depression in people with bipolar disorder if they are on a mood stabilizer and/or antipsychotic in conjunction with receiving intranasal or intravenous ketamine. 11

Alternative Treatments for Bipolar Disorder

“Treatment for bipolar disorder most often requires a multiprong approach,” Dr. Samuel says.  long with taking your medications and attending regular therapy sessions, things like establishing a healthy sleep schedule and cutting down or eliminating drug and/or alcohol use can help.

Some people treat their symptoms with herbs (St. John’s Wart), dietary supplements (vitamin D), hormones (DHEA), and/or omega-3 fatty acids but research is inconclusive. However, a large meta-analysis conducted in 2013 found that some evidence is emerging in support of complementary-alternative treatments (CAM) for people who do not respond well to traditional medications or have intolerable side effects. If you are thinking of going the natural route, it’s important to speak with your doctor as bipolar disorder is a progressive illness and symptoms can worsen if they aren’t properly treated. 12

Lifestyle changes like adding regular aerobic exercise may lessen depression and anxiety in some people. Anaerobic exercise—such as weightlifting, yoga, and Pilates—might also help reduce stress, which can trigger mood swings.

Tracking your moods, treatments, sleep patterns, and life events can help you and your health care providers treat your bipolar disorder over time. Smartphone apps that collect self-reports, self-ratings, and activity data, can easily be shared with therapists and health care providers.

Bipolar Treatment Resources

For Immediate Help

If you are in crisis: Call the toll-free National Suicide Prevention Lifeline at 1-800-273-TALK (8255), available 24 hours a day, 7 days a week. The service is available to everyone. All calls are confidential. Contact social media outlets directly if you are concerned about a friend’s social media updates or dial 911 in an emergency.

FAQS

What is the best treatment for bipolar?

The best treatment for bipolar disorders is a combination of medications and psychotherapy tailored to the individual. While bipolar disease cannot be cured, a consistent treatment plan can help you live an active, healthy life.

Can bipolar be treated naturally/without drugs?

While living a healthy lifestyle that includes exercise and a regular sleep schedule can help people with bipolar disease regulate their moods, medications are usually required to stabilize moods and prevent depression.

How successful is bipolar treatment?

Bipolar treatment is usually successful, allowing many people to live active and health lives. A certain percentage of people, however, may have a very difficult time stabilizing their disease and may require quite a few medications.

What is the first line of treatment for bipolar?

The first line of treatment is lithium but in recent years there have been many medications that can effectively treat bipolar disorder other than lithium.

Article Sources

      1. National Institute of Mental Health (NIMH). Bipolar Disorder. Accessed March 2, 2021
      2. Butler M, Urosevic S, Desai P, et al. Treatment for Bipolar Disorder in Adults: A Systematic Review [Internet]. Comparative Effectiveness Review, No. 208.Rockville (MD): Agency for Healthcare Research and Quality (US); 2018 Aug. Accessed February 26, 2021.
      3. National Institue of Mental Health. Available at Bipolar Disorder. Accessed March 2, 2021
      4. Otto M, et al. Posttraumatic stress disorder in patients with bipolar disorder: a review of prevalence, correlates, and treatment strategies First published: 12 November. Posttraumatic stress disorder in patients with bipolar disorder: a review of prevalence, correlates, and treatment strategies. Accessed March 2, 2021
      5. Brady KT, Sonne S. The relationship between substance abuse and bipolar disorder. J Clin Psychiatry. 1995;56(Suppl 3):19–24. PMID: 7883738 [Reference list] Accessed March 2, 2021
      6. Depression and Bipolar Support Alliance. Available at Post-Traumatic Stress Disorder (PTSD). Accessed March 2, 2021
      7. El-Mallakh, R.S., Hollifield, M. Comorbid Anxiety in Bipolar Disorder Alters Treatment and Prognosis. Psychiatr Q 79, 139–150 (2008). Accessed February 26, 2021
      8. Mayo Clinic. Available at Bipolar disorder.  Accessed March 2, 2021
      9. Food and Drug Administration. Available at Vraylar FDA Approval History. Accessed February 26, 2021
      10. National Alliance on Mental Illness. Different Types of Therapy for Bipolar Disorder. Accessed February 26, 2021
      11. Grunebaum M, et al, Ketamine versus midazolam in bipolar depression with suicidal thoughts: A pilot midazolam‐controlled randomized clinical trial, 28 April 2017. Accessed February 26, 2021
      12. Qureshi NA, Al-Bedah AM. Mood disorders and complementary and alternative medicine: a literature review. Neuropsychiatr Dis Treat. 2013;9:639-658. doi:10.2147/NDT.S43419

Last Updated: Mar 5, 2021

Herbs for Bipolar Disorder

There are a number of herbal remedies you can try for bipolar disorder (manic depression). Although the glossy, new veneer of today’s supplements may make them look attractive, it’s just as important to be a smart consumer in this area as it is with traditional medicine.

Being informed about the benefits and drawbacks of herbal remedies can be more difficult, however. Medications for bipolar disorder receive approval from the U.S. Food and Drug Administration after years of research. Study results and detailed information about these compounds are available in numerous books, online, or directly from the manufacturers.

With supplements, that’s not always the case. It seems like every week another news story appears in the media making claims for a new antioxidant compound or herbal medication. These books, magazine articles, websites, and such sometimes wrap conjecture up in a thin veneer of science. They may reference studies that are misinterpreted, that appeared in disreputable journals, or that were so poorly designed or biased that no journal would publish them.

Supplement salespeople, and particularly those who take part in multilevel marketing schemes, seem to have taken lessons from their predecessors in the days of the traveling medicine show. They have little to lose by making outrageous claims for their products, and much to gain financially. Here are just a few of the unsupported claims found in a single five-minute sweep of supplement-sales sites on the Internet:

  • “Glutathione slows the aging clock, prevents disease and increases life.”
  • “Pycogenol…dramatically relieves ADD/ADHD, improves skin smoothness and elasticity, reduces prostate inflammation and other inflammatory conditions, reduces diabetic retinopathy and neuropathy, improves circulation and enhances cell vitality…” [and, according to this site, cures almost anything else that might ail you!]
  • “Sage and bee pollen nourish the brain.”
  • “Soybean lecithin has been found to clean out veins and arteries–dissolve the gooey sludge cholesterol–and thus increase circulation, relieve heart, vein and artery problems. It has cured many diabetics–cured brain clots, strokes, paralyzed legs, hands and arms!”

Take the time to browse your local store’s shelves, and you’ll probably spot a number of dubious products. Some companies try to deceive you with sound-alike names, packaging that mimics other products, or suggestive names that hint at cures. Other colorful bottles of pills contain substances that can’t actually be absorbed by the body in oral form–for example, “DNA” (deoxyribonucleic acid, the building block of human genetic material) graces the shelves of some shops. One manufacturer of this useless “supplement” claims that “it is the key element in the reprogramming and stimulation of lazy cells to avoid, improve, or correct problems in the respiratory, digestive, nervous, or glandular systems.” This company notes that its “DNA” is extracted from fetal cells; other brands are apparently nothing but capsules of brewer’s yeast.

Some other supplements provide end products of internal procedures, such as glutathione, instead of the precursors needed for the body to make a sufficient supply on its own, such as vitamin E. This approach may not work. When in doubt, consult with your doctor or a competent nutritionist.

How can you assess supplement claims? Start by relying primarily on reputable reference books for your basic information, rather than on advertisements or the popular press. Watch out for any product whose salespeople claim it will cure anything. Supplements and vitamins may enhance health and promote wellness, but they rarely effect cures. Be wary of universal usefulness claims. The worst offenders in supplement advertising tout their wares as cure-alls for a multitude of unrelated conditions.

There are a few other sales pitches that should make you wary. If a product’s literature references the myth of the long-lived Hunzas, someone’s trying to pull the wool over your eyes. This tale of hardy Russian mountain folk who supposedly all live to be well over one hundred years old was refuted long ago by reputable researchers. If it’s a natural substance but a particular company claims to be the only one to know the secret of its usefulness, that really doesn’t make much sense. Be especially cautious when sales pitches are written in pseudoscientific language that doesn’t hold up under close examination with a dictionary. This is a popular ploy. For example, one supplement sold by multilevel marketers claims to “support cellular communication through a dietary supplement of monosaccharides needed for glycoconjugate synthesis.” Translated into plain English, this product is a sugar pill.

Even when you have seen the science behind a vitamin or supplement treatment, there’s still the problem of quality and purity. It’s almost impossible for consumers to know for sure that a tablet or powder contains the substances advertised at the strength and purity promised. Whenever possible, do business with reputable manufacturers that back up their products with potency guarantees or standards. In many European countries, potency is governed by government standards; in the US, it’s a matter of corporate choice.

Natural does not mean harmless. Whenever a vitamin or supplement is powerful enough to heal, it also has the power to harm if misused. Be sure to work closely with your physician or a nutritionist if your child will be taking anything more complex than a daily multivitamin.

Herbal Remedies for Bipolar Disorder

Many herbs have been used to treat different conditions through the ages. Herbalists call these substances nervines, and some may prove useful for treating specific symptoms of bipolar disorder.

Of all the herbs, the nervines group of plant extracts are among the strongest and so are the most likely to cause serious side effects. Because of this possibility, you should always consult with your physician first before trying any of these herbs — especially if you are already taking medication for bipolar disorder.

The common types of nervines that have been tried by people with bipolar disorder include:

  • Black cohosh (Cimicifuga racemosa). A nervous system depressant and sedative, sometimes used by people with autoimmune conditions for its anti-inflammatory effects. Its active ingredient appears to bind to estrogen receptor sites, so it may cause hormonal activity.
  • Damiana (Turnera aphrodisiaca). A traditional remedy for depression. As its Latin name indicates, it is also believed to have aphrodisiac properties. Whatever the case may be there, it does seem to act on the hormonal system. Its energizing quality might be dangerous for bipolar patients.
  • Gingko biloba. An extract of the gingko tree, advertised as an herb that can improve your memory. There is some clinical evidence for this claim. It is an antioxidant, and is prescribed in Germany for treatment of dementia. It is believed to increase blood flow to the brain.
  • Ginseng (Panax quinquefolium). Has an energizing effect that may be helpful to people whose depression is accompanied by extreme fatigue and lethargy.
  • Grapeseed oil and pycogenol. Both are extra-powerful antioxidants. (Pycogenol is derived from marine pine trees.)
  • Gotu kola (Centella asiatica, Hydrocotyl asiatica). An Ayurvedic herbal stimulant sometimes recommended for depression and anxiety.
  • Licorice (Glycyrrhiza glabra, Liquiritia officinalis). Boosts hormone production, including hormones active in the digestive tract and brain.
  • Sarsaparilla (Hemidesmus indicus). Like licorice, it seems to affect hormone production as well as settling the stomach and calming the nerves.
  • St. John’s Wort (Hypericum perforatum). Has gained popularity as an herbal antidepressant. It has the backing of a decent amount of research. Those choosing to use this remedy should follow the same precautions as with SSRIs and MAOIs, two families of pharmaceutical antidepressants. It can also cause increased sensitivity to light. It is available by prescription in Germany, where it is the most widely used antidepressant. It is potentially dangerous to use St. John’s Wort with prescription antidepressants or any other medication that could affect serotonin.

Although most herbal remedies are relatively safe, you should consult with your doctor before trying one of these. Some herbs interact badly with certain medications, and can lead to serious and possibly harmful side effects.

90,000 Everything You Need to Know About Bipolar Disorder – Interview with Professor Wolf Rössler

Prof. Dr. med. Wolf Rössler

Wolf Rössler, 72, studied medicine and psychology in Heidelberg. For many years he was director and head of the University Psychiatric Hospital in Zurich and a professor at the University of Zurich. He is currently Senior Professor at the Charité Clinic in Berlin, teaches at the University of São Paulo in Brazil and is the Executive Medical Director of The Kusnacht Practice in the Zurich area


Bipolar disorder is a mental disorder characterized by mood swings with phenomenal ups and downs.In 2014, 3.4% of young people in the UK aged 16 to 24 tested positive for bipolar disorder. The disorder is well documented and well researched, but if left untreated, it can cause serious damage to a person’s life, as well as to their closest friends and family.


We met with Professor Wolf Rössler, MD, Executive Medical Director of The Kusnacht Practice, and talked to him about bipolar disorder.He shared with us his knowledge and experience gained over almost 50 years of work.

Research shows that it takes an average of 9 years to get a correct diagnosis of bipolar disorder. What makes it difficult to diagnose bipolar disorder (bipolar disorder)?

Wolf Rössler: About three percent of the population has bipolar disorder. Bipolar disorder is a frequently recurring and chronic mental illness that shortens life expectancy and causes functional impairment in social, professional and family life.

There are several forms of bipolar disorder: bipolar I disorder and bipolar II disorder. Bipolar I disorder is characterized by recurrent episodes of depression and mania, while bipolar II disorder is characterized by recurrent depression and hypomania, a milder form of mania.

People with manic symptoms are more likely to abuse alcohol, cannabis or benzodiazepines. In particular, people with manic symptoms rarely seek help, and when they do ask for support, their substance use disorders come to the fore.Delayed diagnoses, misdiagnoses or lack of desire to seek help are the main reasons for significant delays in treatment.

How do I know if someone has a BPD and what can I do to get help? What are the first signs of bipolar disorder?

V.R .: Psychiatric diagnoses are not the essence of natural disease. These are categories without natural boundaries. Since most of human behavior is on a continuum, there is no clear cut-off point between healthy and diseased states.Thus, it is difficult to determine the point at which the need for treatment appears. Thus, most of the symptoms that characterize bipolar disorder are common knowledge. Sometimes we feel overwhelmed and completely drained, sometimes we feel better, energized and active. What constitutes bipolar disorder (or any other mental disorder) then is the severity, degree of distress and duration of symptoms, and how these symptoms affect the ability to work and function in a family or partnership.

What are the main symptoms of bipolar disorder?

V.R .: The poles of bipolar disorder are, on the one hand, mania, and on the other, depression. Often the patient switches between these conditions. We diagnose mania if an unusually elevated or even irritable mood persists for at least a week and at least three of the following characteristics are present: increased activity, anxiety, talkativeness, flight of ideas, denial of social inhibitions, decreased need for sleep, high self-esteem, absent-mindedness. reckless behavior, increased libido.

Hypomania does not meet the criteria for full-blown mania and can be described as a weakened form of it. We talk about irritable mood hypomania for four days in a row and if at least three of the following symptoms are present: increased activity, anxiety, difficulty concentrating, distraction, decreased need for sleep, increased libido, carelessness or irresponsible behavior, increased communication skills. This usually does not affect your personal lifestyle.Finally, we talk about depression if the following main symptoms are present within two weeks: depressed mood, loss of interest and joy, lack of tone and additional symptoms such as loss of self-esteem, feelings of guilt, thoughts of death and suicide, suicidal behavior. decreased ability to think soberly and concentrate, psychomotor agitation or lethargy, insomnia, increased or decreased appetite.

Do we know what causes bipolar disorder?

V.R .: In fact, as in the case of all other mental disorders, here we follow the model of stress vulnerability. On the one hand, many people are particularly vulnerable to mental disorders. There is no specific gene responsible for this, but many different genes contribute to this vulnerability, which is also expressed in certain personality traits. On the other hand, there are environmental factors, such as occupational stress or severe stress in a family or partnership, or stressful events, such as death or job loss, that can cause bipolar disorder in these circumstances.

Who is most affected by bipolar disorder?

VR: As mentioned above, there are various factors, the combination of which can contribute to the onset of the disease. Vulnerable people who experience severe environmental stress are most at risk, and vice versa.

How does BAR affect daily life? Can you live a healthy lifestyle with bipolar disorder?

VR: Again, this depends on the severity of the disease.Even if it is a recurrent disorder with intermediate phases of recovery, the affected person’s behavior during the episode, be it depression or mania, can harm their daily life, but can also have implications for their future life. The spectrum of potential consequences ranges from suicide when depressed, to wasting one’s savings on gambling or engaging in other risky behaviors, such as uncontrolled sexual behavior in a manic state.Bipolar disorder is also a heavy burden on partnerships, which often end in breakup.

What are the behavioral strategies for people with bipolar disorder? How can they help themselves?

V.R .: It is extremely important to build sustainable relationships with patients and with care professionals. If a person’s condition worsens during therapy, you need to be prepared for this. In more severe cases, it is critical to understand the patient’s own disorder.He or she can also contribute by leading a healthy and stable lifestyle and by not using alcohol or drugs.

What medications and treatment options are available for people with bipolar disorder? How does The Kusnacht Practice use its resources to provide care for clients with bipolar disorder?

VR: The Kusnacht Practice follows international guidelines for the treatment of bipolar disorders. There are various effective medications and treatment strategies, mostly combined.Lithium salts are one of the most studied psychiatric drugs. It is used as a prophylaxis and significantly reduces the risk of suicide and the risk of relapse. There are other so-called mood stabilizers, mainly antiepileptic drugs. There is an ongoing professional debate about the use of antidepressants, as some experts speculate that these drugs can trigger manic episodes.

Medicines are combined with various psychotherapeutic approaches depending on the specific mental problems and preferences of our patients.We also value psychoeducation by providing information on various disorders, risk factors and what the patient can contribute to a healthy life, if possible, without relapse. In addition, we are also trying to balance brain metabolism with micronutrients and micronutrients to increase vitality and well-being. A balanced diet and exercise are also part of our strategies for maintaining a healthy lifestyle.

Finally, we use state-of-the-art technologies, such as various types of brain stimulation, neurofeedback and biofeedback, to help our patients cope more effectively with stressful situations.When our therapy is over, we provide ongoing post-treatment care for all of our patients. All this together creates a special and unique approach to The Kusnacht Practice

What are the stages of treatment for bipolar disorder? How does this process look like in The Kusnacht Practice?

VR: The order of all the elements of treatment and the strategies described depends mainly on the stage at which the patient is. If a patient is admitted to The Kusnacht Practice in the acute phase, of course, priority is given to medication.At other stages, medications are adapted, but psychotherapeutic approaches and brain stimulation, as well as balancing brain metabolism, come to the fore. If the patient has serious substance use problems, we also focus on the root of those problems. Thus, each treatment becomes individual when the patient enters the clinic.

Strong and prolonged mood swings are detrimental not only to the patient, but also to the whole family. Are there successful approaches for families with a family member with bipolar disorder?

V.R .: As mentioned earlier, bipolar disorder is a heavy burden on families and partners. The breakdown of a family because of this is not uncommon. Thus, the involvement of families, partners and their children should be central to comprehensive treatment for people with bipolar disorder. Mental and physical health problems are common among relatives and caregivers. Thus, closeness to relatives, as well as to the victims themselves, is a central and highly effective approach to treatment.

Social perception and understanding of the disease is currently changing due to what celebrities talk about this problem. What kind of protection do people with BPD need?

V.R .: The stigma of mental disorders is still widespread, although not as dramatic as it used to be. If a few decades ago, mentally ill people disappeared for the rest of their lives outside the walls of psychiatric hospitals, today many of them live among us, although most of them are silent, not revealing their mental problems.

The stigma of mental illness is not the same for all mental disorders. People with schizophrenic disorder are most stigmatized because they are considered dangerous and unpredictable. Indeed, there is a destigmatization process going on with bipolar disorder, as many celebrities have mentioned that they suffer from this disorder.

The destigmatization process continues. The best argument is that about 50% of the population suffers from this mental disorder during their lifetime.This means that almost everyone knows a person or even family members with a mental disorder. It is important for us to break down this wall of silence in order to make it clear that mental problems are at the center of our society, and not something that affects only a few closed individuals.

Professor Rössler, thank you very much for sharing your experience and your time.

V.R .: Thank you.

If you or someone you know shows symptoms of bipolar disorder, seek professional support.The Kusnacht Practice specialists are experienced in treating a wide range of mental disorders, including bipolar disorder. For help, visit our website or write to us at

[email protected]

Bipolar disorder: complex treatment of multifaceted pathology

K.N. Fountoulakis, M. Siamouli, S. Magiria, G.S. Kaprinis, E. Vieta, M. Valenti, D. Fresno

The term bipolar disorder (BD) is the modern name for a pathology previously commonly known as manic-depressive psychosis.The first descriptions of similar cases are contained in the writings of Hippocrates and Areteus. The definition of BR as a disease was given by Falret in 1851.

Currently, there are two types of BR (BR-I and BR-II), the total prevalence of which is 3.7% of the population.

Both types of BR cause disability. Treatment focuses on symptom relief, psychosocial rehabilitation, and relapse prevention.

Relevance

Analyzing the available scientific data on the treatment of BD, one can see that the diagnosis of the disease is a serious problem – it is often retrospective and carries the risk of bias and distorted patient memories, which calls into question its reliability and validity.

Another problem is that certain treatments may be effective in patients with a certain set of symptoms and not effective in other combinations of symptoms. Therefore, treatment should be considered separately for each episode (mania, hypomania, bipolar depression) and disease phase (acute, chronic, maintenance of remission).
The evidence for the effectiveness of therapies for BD is based on the results of double-blind, placebo-controlled studies.The most reliable data were obtained in studies that included patients in the acute and chronic phases of the disease, which lasted 6 or 12 months, respectively. Nevertheless, reliable data on all aspects of mood disorders have not yet been obtained.

The choice of the reference drug remains an open question. Discussions are continuing on the feasibility of conducting studies in five groups – placebo, study drug, and three comparison drugs (lithium, antidepressant, antipsychotic), however, due to the very high cost, this concept has not found practical application.Placebo studies do not always provide accurate data due to the high variability in placebo response, both between studies and within a study. In addition, to assess the differences between placebo and active substance in patients receiving maintenance treatment, the observation period should be at least 6 months.

Another factor complicating the design of clinical trials and the interpretation of their results is the fact that discontinuation of the drug, especially lithium, can affect the patient’s clinical condition and the natural course of the disease.For example, abrupt discontinuation of treatment may cause treatment-refractory mania, which is likely to have an impact on study results. It should also be borne in mind that with age, patients have an increase in resistance to monotherapy.

Current guidelines for the treatment of bipolar disorder

To date, many treatment guidelines for bipolar disorder have been published. Recent guidelines have been produced by CANMAT and NICE, but even these documents have not been able to integrate the latest research.

The general direction of treatment for BD is the sequential use of atypical antipsychotics as monotherapy and antidepressants for a limited period of time, as well as combination therapy with antimanial drugs. The recommendations of the most reputable organizations are presented in Table 1.

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University named after Aristotle, Thessaloniki, Greece (1-4)

University of Barcelona, ​​Spain (5-7)

Bipolar World: Life Between Mania and Depression

Maria: “In my heart I was even glad.It was a real revelation to find out that I was so sucks not because of a disease unknown to science, not because of a curse imposed in childhood, not because of my own weakness and inferiority, but because of a slight imbalance of neurotransmitters in the brain, which is quite can be corrected.

– Are your hands shaking? The dear lady psychiatrist asked sympathetically.
– Does the head hurt or in the chest?
– Is everything annoying?

And smiled disarmingly:
– And for that you have one more pill!

This does not mean at all that life has improved immediately.It is very, very difficult to admit that you are mentally ill, addicted to drugs for life. Especially when you are young, ambitious and dream of conquering the world.

At first I tried to be treated with traditional bipolar remedies – alcohol and drinking in clubs. It only made it worse, and I still switched to pills. Choosing the right medication is also a pleasure: nausea, dizziness, panic attacks, lethargic reactions, blurred vision are just a few of the typical side effects.Until the necessary drug is selected and starts to work, weeks, and maybe months will pass. My typical Monday looked something like this: in the morning I go to the psychiatrist, then I rush to the workshop. On the way, I manage to get lost in the subway, burst into tears because of this, and then I laugh for a long time at my stupidity. Over time, of course, you get used to it, you get used to this “new normal”. You train a sense of humor, which is simply necessary when you constantly find yourself in awkward situations.

You start collecting information bit by bit (it is almost impossible to find something intelligible about bipolar disorder in Russian), you are looking for brothers in mind.The last is the funniest part. While there are only a couple of small communities online in Russian (tlgrm and vk), knowing English opens up a whole world for you, a real alternative subculture. There are millions of them all over the world. They call themselves “bipolar bears”. They write books, paint pictures, go to support groups, get to know each other.

“Who is with me on the X-Men?” – writes the Prince of Darkness (in the field “about myself” it says: lithium 1000 seroquel 100 mitrazonal 25).

You can be yours if you quote Stephen Fry and cry like Kurt Cobain.The X-Men also enjoy special respect – after all, we, bipolar, are mutants with superpowers! They hate and are proud of their disease: the most popular slogan is I hate being bipolar it’s awesome. They fight to be considered special, not sick. There have even been attempts to create a bipolar pride movement.

After all, bipolar disorder is the only mental illness that does not affect intelligence.On the contrary, there is a wealth of research on its connection to creativity. The most valuable thing in these communities is the opportunity to be accepted and understood. Find out that you are not the only one who begins to feel like a person only after a dose of antipsychotic and half an hour of breathing exercises. After a couple of months of communication with my “bears”, I no longer felt like an unhappy disabled person, but a special, almost chosen one (you shouldn’t be surprised, a throwing to extremes typical for a bipolar person) ”.

Bipolar personality disorder: from megalomania to the bottom

What are the symptoms of bipolar personality disorder and how people who have experienced mania and hell feel.

The brain is a mysterious powerful thing, which for some reason we misunderstandably call “my brain”. We have absolutely no reason for this: who is whose is a separate question.

Tatiana Chernigovskaya

Illness or bad temper

Bipolar personality disorder affects many people around the world. Many do not even know about it. It seems to them that this is a common depression or mood swings.Today you are the sweetest person, full of energy and ecstatically rejoice at every little thing. Tomorrow you want everyone to die, or you yourself dream of death. In the meantime, bipolar personality disorder is not a bad character, but a mental disorder that can lead to serious consequences, sometimes even fatal outcome.

Experts say that this is a disease of the 21st century and the number of people susceptible to bipolar disorder is steadily increasing. Almost everyone can get sick.More often women are susceptible to this, why is unknown.

Causes of bipolar personality disorder

In most cases, doctors cannot diagnose the cause of bipolar personality disorder. There are several prerequisites that can lead to the development of this disease.

Heredity

In the literal sense of the word, this disease cannot be called genetic. However, hereditary factors are of some importance. The change in the psyche may be associated with a “failure” of a certain chain of genes that regulate the state of nerve impulses in the brain.

Brain malfunction

Dysfunction of nerve impulse conductors in the brain. In this case, a failure occurs in the movement of serotonin, as well as dopamine and norepinephrine. It is believed that during each episode of the disease, paths are “laid” in the brain through nerve cells, which further contribute to the development of the disease.

Stress

And not only negative, but any exciting event that knocks a person out of his usual mental state.The radical pluses and minuses of mood build up and the brain cannot cope with them.

Symptoms of bipolar disorder by phase

Manic

Groundless euphoria. Often so strong that a person feels omnipotent and invulnerable

Thoughts jump from one to another, sometimes it seems that several thoughts are in the head at the same time

Speech is very fast, nervousness and excitement are felt

Short sleep or night wakefulness without fatigue

Promiscuous sex life

Gambling or other addictions

Intolerance to people, feeling of superiority

Hallucinations, visions

Depressive

Sadness, apathy, pessimistic mood

Severe anxiety

Chronic fatigue

Difficulty concentrating

Inhibition

Indifference to what previously brought joy

Exacerbation of chronic pathologies

Poor general health

Insomnia

Thoughts and suicide

True Stories

“Southern Affairs” spoke to people who experienced heaven and hell in a bipolar world.For obvious reasons, our interlocutors chose not to give their names.

When euphoria was replaced by depression, hellish days came

Yana, 34 years old.

I have always been an exalted person. I remember mood swings since childhood. In her youth, she did things that are usually attributed to difficult teenagers.

When I started to pursue a career, mood swings began to appear more and more vividly.I really liked the takeoffs, it seemed as if the whole world was at my feet. I was intoxicated by the flight of creative thought, irrepressible energy, the ability to solve a hundred problems at the same time.

But when the euphoria was replaced by depression, hellish days came. Naturally, their own experiences seemed heavier and more existential than they really were. To say that I dreamed of dying is to say nothing. And death seemed meaningless to me.

But even in those agonizingly dark days, I didn’t think I was sick.It seemed that this is a natural development of my personality. Sometimes, as a masochist, I reveled in pain, thinking that I had to learn to cope with all the difficulties myself.

This continued until the hallucinations began. Every sleepless night, an old man’s phantom appeared in my bedroom doorway. He did not cross the threshold of the room, but hesitated in the doorway, as if he did not understand where to go. The old man seemed frightened and confused. For the first few days, I calmed myself and chased visions. But every night he came again and again, fear and uncertainty grew in me and in the old man.I started screaming at night. And since the brain was still returning to me during the day, and in order not to frighten the neighbors, I went to the doctor.

Then I first heard about the diagnosis – bipolar disorder. The doctor prescribed medication for me. I must say not cheap and I have been treated for several years, but now my life is without a dark bottom and mad hysteria.

And only now I understand that that old man saved me. Or maybe that old man was me … It’s hard to say.

I didn’t feel anything anymore.The pain has eaten away at my soul and has already eaten my body

Marina, 39 years old.

I have bipolar personality disorder. Now I can even talk about it with a smile, because now I know what is happening to me.

It all started at the age of 15. I was a bright, precocious personality. My popularity went far beyond the school, the district. I was full of super ideas, and inexhaustible energy threw me from one hangout to another. I was welcome everywhere, but I did shows and energized people.So I was enough for about six months.

Then I turned into an exhausted piece of shit. I considered myself worthless, life was meaningless. I didn’t want anything, I only thought that I was born in vain. The endlessly aching pain tore all the insides. I couldn’t even understand where it hurts.

There was no thought to ask for help. First, I understood what they would say: this is a teenage period. Or else: you need to fall in love. And there are many more platitudes that sad teenagers usually say.Such ups and downs continued until the very birth.

At the age of 20, I had a son. She was in remission for three years. Mood swings were smoother. In periods of mania, I was simply enough for everything, and in moments of depression, thoughts about the child saved me.

But when I turned 24 it all started with renewed vigor. Moreover, the phases of euphoria were no better than depression. I scattered my excited emotions everywhere. From me the pearl is female sexuality and emancipation. I made lovers, I am ashamed to tell what and where I was doing.Me all the time, I could not sleep for several days.

When my hormones and adrenaline were working out, fits of frenzy began, mixed with rage. I could walk like a zombie, but when a spoon fell, pearl aggression to its fullest, and I threw everything: from dishes to TV.

Then came apathy and deep depression. Health problems started. Then for the first time I realized that I had to save, if not myself, then my family. I went to the doctor, but, unfortunately, those antidepressants that were prescribed to me only worsened my condition.I had to come to terms with these states for several more years.

Then my husband left me. I must say that for many years he bravely endured all my spree, tantrums and depression. But there is a limit to everything. A week later, after he left, I lost ten kilograms (from 54 to 44 kg), and almost all my hair fell out. I lost my bearings in space: I could go to the store and get lost in three blocks.

Then she stopped going outside altogether, hardly ate or slept.I sent my son to my relatives, and my friends already knew that in depression I was not available. I just sat in the kitchen for days and looked at one point. I don’t even remember how I felt. It seems to me nothing, because the pain has eaten away the whole soul and has already devoured the body.

My work colleagues found me in this state. They suspected something was wrong, because at work I was always hyperresponsible and active, and now I just stopped communicating. I don’t know how, but they managed to drag me to the doctor.

Six months later, I began to live.I am still under the supervision of a doctor, for several years now. Thanks to my colleagues who have now become friends. Thanks to my doctor, he is a real pro. If I had found it earlier, I would not have wasted so many years.

Author

Anna Mitrofanova

90,000 Natural Antidepressants | | Bipolar.su

We offer a selection of the best natural antidepressants to help cope with the autumn blues. Chocolate is the # 1 product in the role of an antidepressant. But not white or milky, but black. Cocoa beans, from which chocolate is obtained, contain a substance phenylethylamine, which promotes the production of happiness hormones in the body – endorphins. In addition, the cocoa beans contain magnesium, which can help with stress.

Bananas

Bananas are called “fruits of happiness”.Bananas contain substances that are close to the hormones of happiness (serotonin and endorphins), as well as potassium and magnesium. These substances increase mental performance, induce a burst of energy, reduce the likelihood of nervous breakdowns, and may help treat depression.
Nuts are a source of omega-3 fatty acids that can support the proper function of brain cells and help relieve symptoms of depression. In addition, nuts contain the amino acid tryptophan and a mood-boosting vitamin B6 and a mineral called selenium, which is essential for maintaining a good mood.

Dairy products

Milk, or rather, the antioxidants, trace elements and B vitamins contained in it successfully fight nervous disorders, soothe, increase the level of tryptophan in the blood and provoke the production of serotonin. Hard cheese cheers you up thanks to amino acids – tyramine, tricamine, phenylethylamine. Cottage cheese, which is high in vitamins B2 and B12, can be recommended for people suffering from depression.

Seafood

Fatty fish (herring, sardines, mackerel, salmon, cod, salmon) are especially recommended, which are very rich in omega-3 fatty acids.These acids are considered the worst enemies of stress. Due to the high content of vitamins. A, D, B2, B12, PP, protein, phosphorus and zinc, oily fish has antidepressant and immunostimulating effects. It is highly recommended to eat seaweed, which is enriched with B vitamins, which regulate the adrenal glands and, accordingly, the hormone adrenaline, the lack of which can cause chronic fatigue.

Oatmeal and buckwheat

Oatmeal and buckwheat contain the amino acid tryptophan.When processed in the body, tryptophan forms the “happiness hormone” serotonin. These foods are also rich in carbohydrates. Carbohydrates, slowly absorbed, normalize blood sugar levels, respectively, and insulin levels, which, in turn, is responsible for transporting tryptophan to the brain.

Meat

Lean beef is recommended for meat products. It is an excellent source of iron, zinc and B vitamins and does not contain harmful fats. Chicken meat is very useful, it contains tryptophan, like oatmeal with buckwheat.Chicken broth is good for stress.

Broccoli

Broccoli contains folic acid, which can help cope with anxiety, stress and panic attacks. Broccoli is rich in vitamins A, C, E, B1, B2, PP and nutrients such as potassium, calcium, iron, sodium, phosphorus, magnesium, copper, manganese, iodine, chromium and boron.
Konstantin Blokhin, psychotherapist, candidate of psychological sciences, “Time of Joy”
Source: http: // joyjoyjoy.ru / estesstvennye-antidepressanty.html

Cyclothymia: how it differs from bipolar disorder and how to treat it

What is cyclothymia

Cyclothymia (from the Greek words “cycle” and “thymia” – soul) is a mental disorder , with which at least times in several weeks a person’s mood changes dramatically. He experiences either extreme apathy, longing, sadness, or euphoria, vigor, a desire to move mountains. And a balanced middle, an island of calm, when everything around would not be painted in uniquely black or exceptionally light colors, there is practically no in the life of a person with such a violation.

Where does cyclothymia come from

The reasons for the disorder are not known . Researchers speculate that cyclothymia may be genetic and inherited, just as it does with a tendency to develop depression or bipolar disorder.

In some cases, stressful situations, such as unhappy love, illness or the death of someone close, become the trigger for cyclothymia. Chronic stress can also play a role.

Cyclothymia most often begins during adolescence. At first, she is not noticed, confused with the usual teenage imbalance. However, over the years, symptoms can become more severe and destructive.

How cyclothymia differs from bipolar disorder

They do have a lot in common. To such an extent that cyclothymic disorder is generally considered to be a mild bipolar disorder. And this seeming lightness of the condition is a problem, since it makes it very difficult to diagnose.

How bipolar disorder manifests itself

Bipolar, or manic-depressive psychosis, has severe symptoms. That is, noticeable mood swings from a conditional minimum (depression) to a maximum (mania).

Typically, bipolar disorder is a combination of four conditions: episodes of moderate to severe depression, and mania and hypomania.

These episodes can last for weeks or months. And if we are talking about depression, even for years.But nevertheless, the transition from one mood to another is so abrupt that it is impossible to miss it.

Mania and hypomania

Mania and hypomania manifest themselves with the same symptoms. It’s just that the first is more pronounced and harder: it causes more noticeable problems at work, in school, in relationships.

To diagnose a manic or hypomanic episode, at least three signs are enough:

  • an exaggerated feeling of well-being, happiness;
  • increased energy;
  • excited state – a person seems hot-tempered, irritable, easily and very actively fired up with new ideas;
  • overly optimistic view of the world;
  • reduction in the need for sleep;
  • unusual talkativeness;
  • quick, confused thoughts;
  • problems concentrating;
  • inability to assess the consequences of their actions, inclination to risky behavior – excessive spending, casual sex, episodes of dangerous driving.
Severe to moderate depression

Depressive episodes also have the same symptoms. A severe depressive episode inherent in bipolar disorder is diagnosed if these symptoms are very pronounced and there are at least five of them:

  • Constantly depressed mood. Sadness, a feeling of emptiness and hopelessness.
  • Noticeable loss of motivation and interest in anything, including favorite activities and hobbies. And if a person nevertheless continues his usual activity, it does not bring him pleasure and is performed automatically.
  • Weight fluctuations. They occur due to the fact that in a depressed state, a person begins to eat less or more than usual.
  • Sleep disturbances such as insomnia or excessive sleepiness during the day.
  • Anxiety, anxiety or, on the contrary, complete apathy.
  • Constant fatigue.
  • Feeling worthless or guilty.
  • Inability to plan and make decisions.
  • Suicidal thoughts.

How cyclothymia manifests itself

Unlike bipolar disorder, cyclothymia is a blurred condition .The emotional ups and downs of this disorder are not so serious: there is only hypomania and mild depression. So people with mood swings often assume that they are okay and do not seek help.

Because of the mildness, smoothness of manic and depressive episodes, cyclothymia often remains undiagnosed and is not treated. Although it should be.

Why cyclothymia is dangerous

Regular “swing” from the period of rise to the period of decline and back deplete the nervous system.A person becomes easily excitable, nervous, cannot predict how he will behave in a given situation.

Such unpredictability seriously affects personal and work relationships, does not allow starting a family, interferes with a career, and pushes you to rash actions.

All this makes cyclothymia not a relatively harmless emotionality, but a full-fledged mental disorder, which is included by in the International Classifier of Diseases (ICD-10).

But the decline in the quality of life is not the only problem.Over time, cyclothymia often develops into anxiety or bipolar disorder.

How cyclothymia is diagnosed

Mood swings happen in everyone, and they do not always speak of a mental disorder. According to the American Psychiatric Association’s diagnostic criteria, certain conditions must be met in order to be diagnosed with cyclothymia. This is how experts from the American Mayo Clinic describe them.

  • A person regularly has periods of depression, when everything is bad, everything falls out of hand, is not interested in anything, does not want anything, followed by periods of energy, excitement, feelings of happiness.Then the attack of melancholy and apathy is repeated. And so in a circle.
  • These mood swings occur for at least two years.
  • During a two-year period, at least half of the time a person spends either in apathy or in a state similar to euphoria.
  • A person either cannot remember periods without excitement or melancholy at all, or they last for a short time – no longer than a couple of months.
  • Symptoms are not related to substance use or any diagnosed medical condition.

What to do if you suspect cyclothymia

Unfortunately, this disorder does not go away on its own. Therefore, it is important to seek help before cyclothymia develops into bipolar disorder.

You should talk about your condition with a therapist or, better, with a psychotherapist. The doctor will help you understand whether the symptoms are a sign of a mental disorder or if we are talking about a natural emotionality associated with fatigue and other life circumstances.

If it seems to you that a loved one has symptoms of cyclothymia, try to have a sincere conversation with him. You cannot force someone to seek professional help, but you can offer support and help find a qualified doctor.

How cyclothymia is treated

The meaning of treatment is as follows:

  1. Stop cyclothymia to prevent it from developing into bipolar disorder.
  2. Reduce mood swings.
  3. Prevent the patient from falling back into depression or unproductive euphoria.

Generally, to achieve these goals, doctors suggest to do so.

Get psychotherapy

Cognitive-behavioral therapy has proven itself the best. It makes it possible to understand exactly what events, experiences cause sudden mood swings. Knowing this, a person will be able to avoid triggers, and if you cannot completely avoid them, then it is better to control yourself.And the therapist will also teach you how to resist stress.

Establish and maintain a daily routine

For people with mood disorders, it can act as a kind of anchor that helps to maintain calm and balance.

The schedule will clearly define what time to wake up, when to have breakfast, lunch and dinner, what time to take for walks and exercise, when to go to bed. It is important to follow the routine strictly until it becomes a healthy habit.

Take medications prescribed by your doctor

There is no magic pill for cyclothymia. But the doctor can prescribe drugs that will make the mood more stable. For example, the same ones used in the treatment of bipolar disorder – lithium, antiepileptic drugs.

In some cases, antidepressants are prescribed, but they are a double-edged sword. Such remedies help to improve a bad mood, but can drive you to the other extreme – euphoria.Therefore, in no case should they be taken without the appointment of a physician.

Adjust your lifestyle

First, get enough sleep. An adult should sleep at least 7-9 hours a day. Resting less can affect mood and mental stability.

Second, exercise regularly. Exercise releases chemicals that improve mood, reduce stress levels and make you feel more confident and balanced.

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Senile depression | Suomen Mielenterveysseura

Depression is the most common mental health disorder among the elderly. Fatigue, insomnia, lack of vitality, anxiety, or anxiety can be symptoms of onset depression. Depression in old age can manifest itself solely with physical symptoms, such as lack of appetite, weight loss, unexplained pain, and digestive disorders.Other symptoms may include impotence, difficulty concentrating, and inability to experience joy.

Depression affects the capacity of the elderly person. Daily routines may be difficult and the elderly may seek to isolate themselves. Depression also reduces the urge to move. However, motor exercise is an effective way to overcome depression, so lack of motor activity makes the condition worse. Inactivity reduces the ability of an elderly person to function.For this reason, even mild depression should be taken seriously and treated appropriately.

Mild depression often develops against the background of the experience of a fatigue or stress due to a decrease in disability. Grief and discouragement caused by life changes are natural experiences, however, when prolonged, they can provoke the development of depression that needs treatment.

In terms of the development of depression, the greatest risks are widowhood, reduced social contacts and financial difficulties.If depression is already present at a young age, then it is most likely that the stress caused by life changes will provoke a new outbreak of depression.

In addition to changes in the life situation, the background for the development of depression in the elderly can be, for example, a memory disorder or some kind of somatic illness. If a person develops depression for the first time only in old age, a physical illness may be the cause. When diagnosing depression in older adults, physical health should always be evaluated.Sometimes depression develops after recovery from a physical illness. For example, cancers are at risk for depression.

It is sometimes difficult to distinguish between depression and memory disorders because symptoms such as forgetfulness and personality changes can be very similar. Depression can be a symptom indicating the onset of a memory disorder. You can find more information on memory disorders on the website of the Memory Union (Muistiliitto). If you suspect memory impairment or depression in yourself or your loved one, it is advisable to see a doctor.

Senile depression is difficult to notice

Elderly people and their relatives should be careful, because senile depression can be difficult to identify. Symptoms can be confused with ordinary stress or interpreted as age-specific. So-called mild depression is especially common among the elderly. In these cases, the symptoms may not meet the criteria for the diagnosis of depression. Therefore, depression may remain untreated and untreated.

“It took a lot of effort for us relatives to get our grandmother treated for depression.”

An elderly person may often seek help from a doctor for various problems, and not only for somatic diseases, but will not receive direct treatment for depression. A focus on physical symptoms can be confusing even for a healthcare professional, especially if the elderly person does not provide more details about their mental health.An elderly person can only tell a doctor about physical symptoms, if only because it never occurred to him that a mental state could be a symptom of an illness. Sometimes it may be that an elderly person does not consider it possible to complain to a doctor about mental symptoms, because mental disorders can be associated with intense feelings of shame.

It is also possible that depression manifests itself as anxiety, which can arise in connection with depression.However, actual depression is not treated with anxiety medications.

Treatment of senile depression

Treatment for depression usually includes talking and drug therapy. In the case of the elderly, it should also be remembered that drug treatment alone is not a sufficient and adequate method. Conversational help is usually provided by a psychiatric health worker at the clinic. An elderly person can also apply for psychotherapy, but the Pension Fund does not compensate psychotherapy for persons over 65, and it is necessary to apply for the services of a psychotherapist independently.Read more about psychotherapy.

“It is important to remember that depression is very common among Finns and can be treated like other diseases. If you suspect depression, you should always consult a doctor so that depression does not go without treatment. ”

In mild depression, strengthening of social contacts and increasing other types of vigorous activity are generally recommended. Help can be found in hobbies and meeting other people.You also need to take care of nutrition and self-care. The support of loved ones is also always important. Seniors with depression often need specific, practical help, such as taking care of taking medications on time or going to the grocery store.

Various activities and hobbies are of great importance, but they should not be forced into them. It is recommended to be kindly encouraged and not to forget that rest is sometimes necessary. It is important that the activity is interesting and suitable for the elderly person.Since in the case of depression we are talking about the sum of different aspects, the impact on them is multifaceted and even very small things can help.

However, it is important to remember that meeting other people is extremely important to your well-being. A depressed person easily closes in his home, but attending clubs or day care for the elderly, even several times a week, promotes recovery.

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