Hope in a Hopeless State
A friend was recently diagnosed with bipolar disorder (previously referred to as manic depression). In watching the pain that he and his family went through as he traveled from a severely depressed state through a manic state and down again, I wanted desperately to be able to find some magic cure for it. Unfortunately, it seems there is no magic wand that can "cure" bipolar disorder. However, there are some mainstream and naturopathic treatments that can help lessen the impact of this all-too-frequent tragic condition.
UnderDiagnosed -- Often Mistreated
In spite of the generalized understanding of bipolar's roller coaster behavior, the truth is that there isn't a one-size-fits-all pattern of behavior, making it difficult to properly diagnose. Bipolar behavior ranges from relatively mild to overwhelming in both intensity and duration of episode. What further confuses the diagnosis picture is that people looking for medical help typically do so in periods of depression. Not suprisingly, a primary care physician assumes that the problem is unipolar depression and prescribes accordingly -- most often a selective seratonin reuptake inhibitor (SSRI) antidepressive, such as Paxil or Prozac. Unfortunately, when bipolar patients take an SSRI without other appropriate medication, it can take them from depression straight into a manic episode and then continue to cycle them even faster from manic to depressed and back again.
It is estimated that slightly more than 1% of the population suffers from bipolar disorder -- however, a recent study of patients at an urban clinic showed that a startling 10% of patients had a history of bipolar episodes. I called Mark Olfson, MD, MPH, a clinical and genetic epidemiologist at the New York State Psychiatric Institute and one of the authors of the study, to find what was behind the surprising result. Dr. Olfson explained that the people in the study had, at some previous time, been screened for bipolar disorder, which helps explain the high number, but he adds that there does seem to be a greater incidence of bipolar disorder among lower-income groups. This has been a controversial subject among experts, he says. Some believe that because the disorder can destroy a person's ability to function in the working world, people with it find it difficult to earn a living. Other experts believe that the environmental stresses on low-income groups can cause psychiatric disorders, including bipolar.
Mainstream Treatment Options
Whatever the cause of bipolar disorder -- heredity, brain chemicals and/or stress from life events are thought to be involved -- Dr. Olfson says that mood-stabilizing medication such as lithium, which patients take for life, is the only way for most of them to recover and maintain normal functioning. The importance of such treatment was made clear in a 1999 study on people with Bipolar I (bipolar disorder is categorized as Bipolar Disorder I, II or Cyclothymic Disorder, mood swings of shorter duration). It showed that by taking medication, patients reduced their risk of suicide by eight times. Conversely, studies have shown that populations in areas with water supplies containing lower amounts of lithium (a natural substance that is the basis of the drug lithium) have higher rates of mental hospital admissions, suicides, homicides and other crimes. While the drug of choice has been lithium for decades, Dr. Olfson says that in recent years, a variety of anti-seizure medications have been shown to be helpful. Finding the right balance of drugs, including for some patients antipsychotics, such as olanzapine (Zyprexa), quetiapine (Seroquel), risperidone (Risperdal), clozapine (Clozaril) and aripiprazole (Abilify), can be a delicate task... and requires the expertise of doctors who are trained in treating mental illness.
Lifestyle Is Important
Although most patients must be on medication for life, there are many things they and their families can do to add to their stability and normalize their functioning. Experts strongly endorse a regular program of exercise, both as a way to avoid some medications' side effect of weight gain and to increase a general sense of well-being. Good sleep hygiene -- regular hours... a cool, dark room... and a quiet period before going to bed -- is essential because disturbed sleep patterns often are part of the manic-depressive cycles and can antagonize them further. A small study showed that cognitive-behavioral therapy, a structured method of therapy that teaches patients to recognize negative thoughts and behavioral patterns in order to change them, helps bipolar patients improve functioning.
Naturopathic Support
Mark Stengler, ND, author of The Natural Physician's Healing Therapies (Bottom Line Books) and Prescription for Natural Cures (Wiley), advises taking fish oil along with conventional medication. In a double-blind trial, bipolar patients who took 9.6 grams a day of omega-3 fatty acids from fish oil -- in addition to their conventional medications -- had significant improvements in the depressive phase of the disease compared with those on a placebo. People who are on blood-thinning medications should talk to their doctor before taking this dose of fish oil, because of its potential blood-thinning effect. Fish oil, however, does not seem to affect the manic aspect. Dr. Stengler also advises 200 mg to 300 mg a day of 5-HTP (5-hydroxytryptophan), a precursor to the brain chemical serotonin that relates directly to relieving depression, in divided doses and taken on an empty stomach to help relieve depression. It appears that controlling the depression often modulates the manic "pot boiling over" phase.
Daily Health News contributing editor Andrew L. Rubman, ND, adds that some clinicians have found that the amino acid L-tyrosine helps control the intensity of the manic phase. This raw material is used by the brain to create the balancing neurotransmitter catecholamine. Note: Discuss this and any medication or substance with your doctor before taking.
Dr. Stengler also reminds patients to be sure they regularly consume a healthy diet with plenty of fruits, vegetables, whole grains and protein, and also take a multivitamin to supply essential nutrients for proper brain and neurotransmitter function. A twice-daily multi-B-50 supplement with an additional once-daily hydroxocobalamin form of vitamin B-12 is good. Dr. Stengler adds that individualized homeopathic treatment by a practitioner may be helpful, as may acupuncture.
A diagnosis of bipolar disorder in yourself or a loved one is painful and difficult to accept. But the medical measures available today combined with living a healthy lifestyle allow people to enjoy a nearly normal life in spite of the condition. It does require patience, a strong commitment to self-education and willingness to seek out and follow treatment, but that is a small investment for the rewards of having a stable life.
Carole Jackson, Bottom Line's Daily Health News, July 18, 2005
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