Healthy Balance: Therapies for Bipolar Disorder

And though we now know bipolar is a mood disorder-characterized by alternating periods of depression and hypomania, including euphoria, aggression, agitation, rapid speech, racing thoughts, decreased need for sleep, and inflated self-esteem-it’s still one of the least understood and most stigmatized syndromes in mental health.

There are several subcategories of bipolar disorder, each with varying levels of severity and different patterns of symptoms. Bipolar 1, the most severe form, is marked by extreme mood swings that can cause significant disruptions in daily life. Bipolar 2 is marked by shorter, less intense periods of mania, but longer periods of depression. Cyclothymic disorder, the mildest form, usually involves very subtle-but often, almost continual-mood changes.

Confusing Causes

The exact causes are unknown, but it’s clear that people with bipolar have measurable physical changes in their brains-specifically, a significant reduction in the size of the whole brain and in the frontal cortex, the area that’s associated with decision-making and controlling impulsive behavior. As bipolar disorder progresses untreated, the frontal cortex continues to shrink in size.

Genetics play a strong role. Bipolar disorder is much more common in people who have family members with bipolar or other mood disorders. It’s also thought that imbalances in hormones and brain chemicals-specifically, the neurotransmitters noradrenaline, serotonin, and dopamine-are linked with bipolar.

And newer studies point out a marked influence from environmental factors such as stress and trauma. In several studies, a history of childhood sexual, physical, and/or emotional abuse and neglect were significantly more common in adult patients with bipolar disorder. Other studies have found that exposure to stress at critical periods in life may be an important factor that can impact the brain and lead to different mood disorders. And other studies show that people with bipolar disorder are slightly more likely to have experienced head trauma or brain injury.

Conventional Treatments

Before some of these causes were recognized, bipolar disorder was treated through bloodletting, electroconvulsive (shock) therapy, exorcism, imprisonment, induced insulin coma, lobotomy, and, in some cases, euthanasia. In the mid-twentieth century, when mood-stabilizing drugs were developed, it was considered a breakthrough for treatment of bipolar. Lithium, one of the first-and still most common-drugs to be used to treat bipolar, is actually derived from a naturally occurring mineral, part of the same family of minerals that includes sodium and potassium. Other drugs, including antidepressants, antipsychotics, and antiseizure medications, soon followed, with varying degrees of success.

But most of these drugs have side effects, ranging from weight gain and drowsiness to kidney damage, seizures, facial twitches, and severe sodium imbalances that can result in coma or death. Are natural treatments possible? Yes, says William Walsh, PhD, founder of The Walsh Research Institute, Naperville, Ill., a nonprofit organization that studies nutrient therapies in mental disorders.

According to Walsh, there are three primary biochemical classifications of bipolar disorder:

1. Undermethylation, characterized by low levels of serotonin, dopamine, and norepinephrine, as well as other imbalances.
2. Overmethylation, the biochemical opposite of undermethylation, characterized by elevated levels of serotonin, dopamine, and norepinephrine, as well as other imbalances.
3. Pyrrole disorder, or pyroluria, a genetic stress disorder associated with severe mood swings, high anxiety, and depression.

Because each of these is specifically related to nutrient imbalances, each can be treated with high doses of nutrients designed to correct those imbalances; for more information on Walsh’s theories and treatments, visit walshinstitute.org.

Natural Balance

While medications can help improve the lives of people with bipolar disorder, especially those with severe cases, some people with milder forms find they can manage symptoms with a strict regimen of diet, supplements, and lifestyle changes. Natural approaches can also be an important adjunct to medication regimens. Some of the safest and/or best researched:

Eat fish. Or, at least, make sure you’re getting enough omega-3 fatty acids. Studies suggest they can relieve bipolar depression, probably by restoring membrane fluidity and flexibility. The DHA (versus EPA) type of omega-3 fatty acid is the most important. Studies show that DHA levels are significantly decreased in bipolar patients. The dosage used in most studies ranges from 1-4 grams per day.

Gather a bouquet. Made by distilling flower blossoms, and thought to work on an energetic level, Bach Flower Remedies can help soothe milder forms of depression and anxiety. They’re also very safe and gentle. For depression, leading flower remedies include cherry plum, mustard, gorse, sweet chestnut, and pine. For anxiety, the best remedies include aspen, red or white chestnut, rock rose, cherry plum, or Mimulus. Vervain and Scleranthus are also used to balance emotions. For a full list of remedies and the specific symptoms they’re thought to address, visit bachflower.com.

Lift Your Mood

Bipolar disorder is one of several types of depression. Other forms include mild depression, moderate depression, and major (severe) depression. Several other supplements (in addition to those mentioned in this article) influence neurotransmitter production and can help relieve depression. Here are two standouts:

• St. John’s Wort has been found in studies to work better than the leading prescription drugs for depression, and results in fewer side effects. For mild or moderate depression, take 300 mg of a standardized formula three times daily. For severe depression, double the dose. Beware: St. John’s wort can reduce the effectiveness of oral contraceptives and chemo drugs, among others.
• SAMe (S-adenosylmethionine) is involved in making serotonin and other neurotransmitters. Like St. John’s wort, SAMe often works as well as some antidepressant medications, and it also enhances the activity of antidepressant medications. Take 800-1,600 mg daily.

Go decaf. Because caffeine is a potent central nervous system stimulant, it’s likely to exacerbate anxiety and manic episodes. Caffeine can interfere with sleep, and sleep disturbances can trigger mood swings and mania. Some studies have suggested a link between psychiatric disorders and caffeine consumption-one in particular found that people who consumed the most caffeine were also more likely to suffer from psychiatric or substance abuse disorders. Researchers suggested the same genes that predispose people to psychiatric disorders may also predispose them to higher levels of caffeine consumption. Another study showed a link between drinking coffee and increased suicide attempts among bipolar patients. The best advice? Steer clear of caffeine, and stick to soothing herbal teas such as rooibos, chamomile, ginger, peppermint, or hibiscus.

One study found that people who meditate three days a week or more experience significantly less anxiety and depression.

Meditate. A number of studies have found that meditation can significantly improve depression and anxiety in people with bipolar disorder, and that regular meditation results in measurable changes in brain activity. But it’s not enough to do an occasional or infrequent practice-the number of days of meditation per week makes a difference. One study found that people who meditated for three days a week or more experienced significantly less anxiety and depression than those who meditated less often. If you’re new to meditation, take a class or work with an instructor to start, or try an iPhone app such as Simply Being that guides you through a relaxation exercise.

Skip the sugar. Sugar ups and downs can aggravate mood swings in people with bipolar disorder. Additionally, because people with bipolar have a higher risk for metabolic syndrome and diabetes, it makes sense to skip the sweet stuff. Alcohol can also impact mood swings and may interact with medications. And because people with bipolar are at risk for alcoholism and addictions, it’s best to be a teetotaler. At parties, choose club soda with a twist of lime or sugar-free, naturally sweetened sodas such as Zevia.

Try supplements. The following supplements and herbs have shown promise in treating depression and anxiety, and lessening mania. (Note: If you have been diagnosed with bipolar disorder and are currently taking medications, do not stop taking your medications without consulting your physician. Also, because some herbs can interact with antidepressants and other mood-stabilizing medications, it’s critical that you discuss any supplemental treatments with your physician before taking them.)

• Magnesium. Several studies have suggested that magnesium supplements may lessen mania and the rapid cycling of bipolar symptoms.
• Inositol. A compound that’s classed as a B-vitamin, inositol is necessary for the production of serotonin. Studies have suggested that it’s effective in easing bipolar depression, and was as effective as the drug fluvoxamine in treating anxiety and panic disorder.
• Taurine. A mild taurine deficiency is not uncommon in people with bipolar, so supplementing can help. This amino acid, found in many foods, subdues abnormal electrical activity in the brain, and can be helpful in treating bipolar mania.
• Gamma-amino butyric acid (GABA), an amino acid that acts like a neurotransmitter, inhibits nerve transmission in the brain, and can ease nervousness, anxiety, and insomnia, especially when related to racing thoughts.