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How do we treat bipolar disorder? Specifically, how do we treat mania or depression associated with bipolar disorder? The treatment of these two clinical states is not the same.

The treatment of mania is dependent upon its severity and acuity. For mild to moderate mania, mood stabilizers such as lithium and valproic acid (Valproate) are still the standard of treatment and may be sufficient to contain the symptoms. Lithium starts to work after 10 to 14 days while valproic acid, about 7 to 10 days.

Also, recent studies have shown the effectiveness of atypical antipsychotics such as risperidone, olanzapine, and quetiapine even when used alone to treat the acute phase of bipolar disorder.

These drugs are relatively safe but they don’t come without side effects. Nausea, vomiting, tremors, and dizziness during the initial phase of treatment are commonly experienced. The more serious side effects such as renal and thyroid problem from lithium, liver dysfunction and pancreatitis from valproic acid, and increased risk of diabetes and high cholesterol from atypical antipsychotics are uncommon. However, regular blood tests are required to monitor any abnormalities.

For moderate to severe cases, atypical antipsychotics such as risperidone and quetiapine should be added to the mood stabilizers during the acute phase. Once the illness has stabilized and the symptoms have subsided, then the atypical neuroleptics can be gradually tapered off. But the mood stabilizers should continue. Regardless of severity, patients usually do well on a combination of mood stabilizer and atypical antipsychotic during the acute phase.

What is the treatment for bipolar depression? In general, the mood stabilizers’ dosage should be optimized or if the patient is not on any medication yet, a mood stabilizer such as lithium should be started. Physicians should make sure that the medication maintains a “therapeutic level.” If not, the dosage should be adjusted. Moreover, possible precipitants such as stresses at home should be addressed.

If these measures don’t help and the depression is so severe, an antidepressant with the least risk to induce mania such as bupropion should be added to the mood stabilizer. When the depression is resolved, then the antidepressant can be gradually tapered off because its prolonged use even in the presence of mood stabilizer can still induce mania.

When should the medication be discontinued? Bipolar patients have to continue taking the medication for several months even after they become normal. High relapse rate is common if medications are prematurely stopped. Also, for patients with multiple or difficult-to-treat episodes, they may need to take the medication for years or even for life to prevent recurrence.

Patients and their physicians should thoroughly discuss the risk and benefits of any treatment intervention. Knowledge about the drug’s indication, side effects, and prognosis with or without treatment is a must.

Furthermore, it is crucial that bipolar patients should also receive individual psychotherapy to help them deal with the many personal and psychosocial issues they face on a daily basis. As you know, medication alone won’t suffice to address financial problems, marital conflict, work issues, and prior abuse.

In summary, the combination of medication and psychotherapy is the best treatment for bipolar disorder.

Copyright © 2004. Dr. Michael G. Rayel - author (First Aid to Mental Illness-Finalist, Reader’s Preference Choice Award 2002) psychiatrist, and inventor of Oikos Game: An Emotional Intelligence Game. For info, visit http://www.oikosgame.com and http://www.soardime.com.

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Welcome and thank you for showing your interest in this free
series which will explore the different treatment
options available for bipolar disorder. In this series
you can expect to discover:

Part 1 - What is bipolar disorder and how is it treated.
Part 2 - What medications are effective in treating bipolar disorder.
Part 3 - Effects of nutrition on bipolar disorder, psychotherapy and other treatments.
Part 4 - Co-occuring illnesses and genetics research.
Part 5 - Brain imaging and what does it show.
Part 6 - Treatment research
Part 7 - Where to find help

Let’s get to it

Introduction

Bipolar Disorder is a mental illness that causes people to
experience extremes in moods from high to low, sometimes
within a single day or week. As of 2005 there is no known
cure for the condition previously known as manic-depressive
illness. But scientists, researchers and physicians are
optimistic as they work to improve the prospect of a
reasonably normal life for sufferers and those they love.
The general public must become more aware of this illness
in order to take action early, thereby avoiding damaging
consequences. Patients themselves ought to pay heed to
whatever therapy is recommended by their physician, whom
they should know well and trust. Only in this way will
people be in the position to successfully manage this
potentially devastating illness.

Early Treatment is Important Contrary to the hopes of many
parents, Bipolar Disorder cannot be diagnosed at birth.
Symptoms usually appear in adolescence or early adulthood.
Unless the sufferer is treated, those symptoms will recur
throughout the course of life. Some people pug up with
bipolar disorder much longer than they should, only because
they do not realize they have the illness. If patients are
not diagnosed early, and cared for, Bipolar Disorder
becomes more difficult to treat. The longer a person
continues without medical attention, the higher the risk of
alcohol and substance abuse, suicide, and serious issues at
home, work and school. Proper treatment is very important
so that the bipolar disorder patient can begin to stabilize
his or her moods. Exaggerated mood swings are at the heart
of this illness, and in many ways define it.

So How is Bipolar Disorder Treated?

Bipolar Disorder is treated through a combination of
medication and psychological treatment and oftentimes,
nutrition. As with many conditions or illnesses, a
collective approach tends to be most effective.

A medical doctor (most often a psychiatrist) with expertise
in the diagnosis and treatment of mental disorders
generally prescribes medication. Treatment should be
ongoing, and not on-and-off. Even with continuoustreatment, mood swings may happen, but if a doctor is notified, he or she can adjust the treatment plan to suitthe patient’s need. It is critical that patients work very
closely with their doctor, communicate openly and honestly
regarding questions or concerns, and feel comfortable
discussing treatment options.

Many bipolar disorder patients record their daily moods,
their treatments, sleep patterns and life events on a
chart. By charting their day, sufferers and their loved
ones become more aware of possible triggers. As a
consequence, they can effectively guide the treatment
process.

In the next issue we’ll explore the different medications
used to treat bipolar disorder.

Copyright 2005 LifeWithBipolar.com

Wishing you a full and joyous life,
Derek Barlow

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If you would like to receive the remaining issues in this
free 7 part series, please visit us at
http://www.LifeWithBipolar.com
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Bipolar Disorder is one of the most difficult to treat. Not only is it difficult to find the right medicine recipe for each person, patient compliance is a major obstacle. Some people suffer debilitating side effects or cannot tolerate the high dosages of some medications. Some start feeling better and make a conscious decision to stop taking their medications. Others simply don’t like taking medication at all. Some of these same people will turn to vitamins, health supplements and holistic answers instead. Herein lies the problem. It seems to me that the general population is much more willing to trust the claims on vitamins bottles and health supplements than that of prescription medications that are governed by the FDA. Who is it that regulates vitamins and health supplements- the “natural healing fairy?

Well, come to find out, many studies are being conducted on holistic approaches to bipolar treatment and they are being funded by organizations like The Stanley Organization, National Institute of Health and the National Institute of Mental Health. Some important organizations are taking notice that maybe there is something to this “natural” approach. Maybe there is and maybe there isn’t. I am convinced that doing everything possible to make this illness more bearable is worth a shot, but I’m not willing to give up my medication yet and neither are any of the organizations funding the studies.

Nothing that you read here is meant to replace any advice that you are given by a trained professional. The information is simply what I researched and the claims may or may not be accurate. Please do not try any holistic approach without consulting with your physician or psychiatrist first. Also, all of these approaches, by their own admission are to be used as an adjunct to psychiatric medications. In other words, they are meant to help reduce the dosage, not replace the medicine all together.

VITAMINS & MINERALS

Mood Stabilizing Substances
Lecithin (Phosphatidyl Choline)
L-Taurine (Amino Acid)
GABA (Amino Acid)

To Fight Depression
B- Complex
Folic Acid
B1 (Thiamin)
B6
B-12
Magnesium & Calcium
Manganese
Zinc
L-Tyrosine
Methionine
L-Phenylalynine & DL-Phenylalynine
L-Triptophan (Amino Acid)

Most of these vitamins and minerals can be found in a good multivitamin. The ones that are separate supplements should be verified with your doctor before you go spend a lot of money on them. I didn’t even start taking my multivitamin without checking it out with my psychiatrist first - but then I’m a little anal when it comes to managing my bipolar and my money. I don’t
know about your insurance but mine doesn’t cover vitamins.

ST JOHN’S WART

This is the supplement that we’ve all heard does wonders for depression. Well, I hate to be the bearer of bad news, but marketing and advertising people create all that hype. I know this, because I work in advertising. I found tons of information on St John’s Wart (SJW) and most of it echoed the same warnings, that bipolar patients should use extreme caution and consult their physicians before attempting to use it. I know I won’t be adding it to my recipe. The only time it seems to be recommended is for people with very mild depression who almost don’t need to take prescription medication and they still suggest checking with your doctor.

Researchers at Harvard Medical School believe that SJW could be a mania trigger for those who are bipolar but who haven’t experienced a manic episode yet. This is similar to what some antidepressants do to people with bipolar. It can also precipitate hypomanic states or rapid cycling. They mentioned that if you have bipolar you should use extreme caution and confer with your doctor before hand.

In Feb 2000, the FDA released a public health advisory warning that there was a risk of dangerous interactions between SJW and certain prescription medications. Bipolar meds included mainly the Tricyclic Antidepressants (TCA’s) Tofranil, Asendin & Elavil and the anticonvulsant Tegretol. It is assumed that the similar TCA’s Vivactil and Palemor and the similar anticonvulsant Trileptal could also be in the risk group.

There are also reports that when SJW is combined with Serotonin Selective Reuptake Inhibitors (SSRI’s) it can cause Serotonin Syndrome. Symptoms of Serotonin Syndrome symptoms can include dizziness, cognitive difficulty, faintness when standing or walking, unsteadiness when walking, muscle spasms and a racing heart beat. Do not combine SJW with any SSRI’s or with the newly FDA approved Tamoxifen that is used
for depression.

OMEGA-3 FATTY ACIDS

Omega-3 Polyunsaturated fatty acids (Omega-3) are found in fish, fish oil and flaxseeds. Yummy! You can bet I was not too excited about the thought of fish oil as a cure for bipolar. Oddly enough, every bit of information I found on Omega-3 was positive. Positive that is as an adjunct to standard bipolar medications. So for people who cannot tolerate high doses or the side effects of their medications, this is something to check out with your doctor.

Many studies have been done, but the one I read most about was a 4 month double-blind placebo controlled study comparing 9.6 g/day of Omega-3 vs. olive oil in 30 patients (Stoll et al., 1999). 8 co-authors concluded that not only were the Omega 3’s well tolerated, but the improved the short term course of the patients with bipolar. They would not suggest using Omega-3 as a first line treatment but would try it for patients who had failed with other medications. Omega-3’s should only be used alone in patients with a very mild form of the illness.

Patients seem to be quite interested in the Omega-3’s because they are a natural supplement with very few side effects and little or no toxic effects. The only reported symptom was mild gastrointestinal distress - generally characterized by loose stools. Many psychiatric medications have this same effect along with a myriad of other more unpleasant ones. If my
meds plagued me with a tremendous number of side effects, I would certainly be looking into this one myself.

TRUEHOPE (Synergy Group of Canada, Ltd.)

If you haven’t heard about this one, it’s pretty interesting - depending on how you look at it. Personally I thought they were a couple of quacks until I started investigating it deeper. I mean, when all you know is that it started out with supplements that they give to pigs who are prone to ear and tail biting, you have to be a little skeptical. Don’t you?

Well, they didn’t start with actual pig nutrients; the biologist of the pair, David Hardy created a supplement for humans that were then given to Anthony Stephan’s 2 bipolar children. You can read the entire story at their website, referenced below. The supplement was named EM Power and consists of common minerals, vitamins and amino acids. In fact, the ingredients are so common that they cannot receive a patent for their work.

Several small independent studies were done through individual doctors with small numbers of patients. The results were good - up to a 50% reduction in symptoms compared to when the patients were on psychotropic drugs. Then Harvard psychiatrist Charles Popper monitored 15 patients within his own practice and the results were reported in the Journal of Clinical Psychiatry. Of the 15 patients that were treated, 11 were stable for 6 - 9 months without taking psychiatric medications. They also did research with Dr. Bonnie Kaplan, PhD. This helped get a grant of a half million dollars to do a placebo-controlled double blind study of 100 bipolar patients at the University of Calgary.

The two drawbacks with EM Power (besides it’s odd
origins) are that it isn’t cheap and it’s a lotof pills to take. Initial treatment requires 32 capsules per day until your symptoms disappear and the cost is approximately $220.00 a month. The maintenance dose averages 16 capsules a day. It is safe for children as well - as long as they can take that many pills.

ACCUPUNCTURE

Boy did I find a ton of information on the treatment of depression and bipolar with the ancient Chinese art of acupuncture. What I didn’t find was any proof. No real trials with quantifiable results. I did find one small study done at the University of Arizona College of Medicine, which simply reported positive results using it for major and unipolar depression. That was it.

That was it except for 2 major grants being given to the University of Texas Southwestern Medical Center in Dallas (where I am trying to get in on some studies!). Both the National Institute of Mental Health and the National Institute of Health have awarded UT Southwestern significant grants to study the effects of acupuncture. NIMH’s grant with be used to study bipolar patients in their depressive states. The NIH grant will be used for a study similar to the one done at the University of Arizona.

The NIMH trial is the first being conducted regarding acupuncture as an adjunct to medication for bipolar disorder. Once again, not a full cure, but the possibility of reducing medications to tolerable levels.

So, after all of this am I still a skeptic? Sure I am. I’m skeptical of everything until I see proof - but that’s just me. Am I skeptical of “Wholistic Healing” - using holistic methods with psychiatric medications and anything else you can do to make your life better? No. I think there are some great alternative options available for those who cannot handle the symptoms or for those who seem to get little or no results from psychiatric medications. My biggest concern is that if you try any of these, please check with your doctor so that you can work together at managing your bipolar. Don’t go it alone!

Terry J. Coyier is a 37-year-old college student studying for an Associates of Applied Sciences degree. She is also a freelance writer who writes about bipolar disorder and other mental illnesses. Terry was diagnosed with bipolar ten years ago. She lives with her son in the Dallas/Ft. Worth Metroplex. Terry is an author on http://www.Writing.Com/ which is a site for Writers and her personal portfolio can be viewed here.

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