Bi-Polar Alternatives

[Guest guest]

Bi-Polar Alternatives JoAnn Guest Jul 31, 2003 18:54 PDT

 

NOTE: Following is general information about alternative approaches to

the treatment of manic-depression, in response to a number of inquiries

about the topic. This information will be periodically updated, and so

all comments, additions, corrections and stories of personal experiences

are highly welcomed!

 

 

INTRODUCTION

 

Most doctors who treat patients suffering from bipolar depression, as

well as the patients themselves, would probably agree that it is a

condition that is challenging to treat in a fully effective manner.

Although an increasing number of pharmaceutical compounds to address

depressions and to stabilize moods are becoming available, these are not

always fully satisfactory for many patients.

 

Many bipolars, for example, find that medications that are available can

lead to significant side effects, and therefore find themselves having

to choose between living with these unpleasant effects or discontinuing

medications (or decreasing dosages) and somehow learning to manage

despite severe mood swings. Others find that despite an exhaustive

trial-and-error process involving different combinations of drugs, their

mood swings continue to present major problems for them.

 

Finally, many bipolar women who want to have children face the option

of either undergoing extremely difficult mood swings while pregnant or

taking a risk that their children will suffer birth defects, since all

of the available mood stabilizers are known or suspected to be harmful

to developing fetuses in human populations.

 

This summary of information about alternative medicine is designed to

help to address these problems by giving bipolars an additional tool

they can use to control their illness.

 

In some cases, such alternative methods may work in a complementary way

to the use of conventional medications, helping them to work better or,

in some cases, to lower necessary dosages.

 

In other cases, alternative

treatments may be effective on their own, allowing some people to

gradually taper off of their existing medications or (in cases where

current mood stabilizers are deemed unacceptable by the patient and

doctor because of health complications) may help to lessen mood swings

to the point where patients can lead more normal and satisfying lives.

 

Alternative methods to the management of bipolar disorder tend to work

in one or more of three different ways.

 

 

First, some therapies seem to work in a similar fashion to

pharmaceuticals, but with fewer side effects, in the direct management

of moods.

 

For example, acupuncture seems to be fairly effective at

controlling mania for many people over the short-term, while the herb

St. Johns Wort seems to have activity as an anti-depressant.

 

Second, some alternative methods look for alternate explanations for

what psychiatrists may have labeled as manic-depression.

 

For example,

food allergies may cause severe mood swings in some people, and

untreated endocrine problems of all sorts are widely recognized as

causing mood difficulties.

 

Third, some treatments attempt to improve the overall health of the

individual, under the theory that this will allow the body to more

effectively fight off mood problems (especially depressions). Such

theories suggest that when an individual's health becomes taxed, the

" weakest link " is the one that is likely to snap.

 

 

Many alternative practitioners, in fact, state that despite their best

efforts, lithium is still a necessity for some patients, although they

may tend to attempt to minimize the necessary dosage through a variety

of other means.

 

Most alternative practitioners, however, seem to believe that the need

for the long-term use of antidepressants by bipolar or unipolar

depressives can usually be eliminated through the use of alternative

treatments, although it may take a substantial amount of work before

this can be accomplished.

 

In many cases, however, decreasing the dosage of anti-manic agents is

almost as desirable as eliminating the need for medications entirely,

since side effects tend to be substantially less at smaller dosages for

most patients.

 

Most of the therapies listed below tend to be relatively safe and have

few side effects for most people. Nevertheless, a few points should be

kept in mind.

 

First, the patient's doctor should be kept aware of the types of

alternative treatments that are being used, and should closely monitor

any positive or negative effects that might occur as well as any

attempts to decrease the dosages of any medications that are being used.

 

Manic-depression is a serious illness that may have fatal consequences

if inadequately treated, and psychiatric medications may have severe

side effects if they are discontinued too abruptly or not kept in

balance with one another.

 

In general, most psychiatrists (especially

ones that specialize in medications, who are preferable for bipolars

since their medications are often difficult to manage) are not very

well-versed in alternative methods of treating bipolar disorder and may

put up some resistance or need to be supplied with relevant information

before they will render an opinion.

 

In general, if a practitioner strongly objects to a particular treatment

for a particular reason, then it may make sense to look into other

methods instead.

 

On the other hand, if a doctor objects to all non-drug

approaches, then the patient may have to take a stand that he or she

wants to try some of these approaches anyway, or may need to find

another doctor, if alternative methods are to be pursued.

 

We strongly encourage you to use this information only as a starting

point, and to read more about the methods that you are interested in

pursuing and/or to seek out appropriate specialists. In general,

although alternative therapies can be helpful, they do seem to require a

substantial commitment on the part of the individual---they are not

nearly as convenient as simply taking a few pills every day.

 

In addition, using alternative techniques can be quite expensive, since

most insurance companies do not cover such treatments as acupuncture,

nutritional supplements or even food allergy testing.

 

Still, for people

who find conventional medications to be insufficient or unacceptable for

one reason or another, the availability of alternative medications can

be potentially useful and therefore worth pursuing.

 

 

GENERAL BOOKS

 

 

" Optimal Wellness, " Ralph Golan, M.D., Ballantine Books, New York, 1995.

A wonderful book that discusses a variety of conditions (including most

of those discussed below) that can lead to suboptimal health. For those

who want just one book on the topic of alternative approaches to health

(including mental health), this would be a good choice.

 

 

" The Good News About Depression, " Mark S. Gold, M.D., Bantam Books, New

York, 1993. Not a " holistic medicine " book per se, but discusses a

variety of alternative diagnoses to depression

 

The next four books deal specifically with issues related to alternative

treatments of depression and manic-depression, and provide roughly the

same kinds of information. Any of them would be a good choice.

 

" Beyond Prozac, " Michael J. Norden, M.D., HarperCollins, New York, 1995.

 

" Dealing with Depression Naturally, " Syd Baumel, Keats Publishing, New

Canaan, CT, 1995.

 

" The Canary and Chronic Fatigue, " by Majid Ali, M.D., Life Span Press,

Denville, NJ, 1994. Although written in a somewhat haphazard manner,

this is a substantive book dealing with the topic in a relatively

innovative manner by a respected physician and associate professor of

pathology at Columbia University.

 

 

 

NUTRITIONAL APPROACHES

 

 

A wide variety of vitamins, minerals and amino acids are related to the

maintenance of a normal mood; deficiencies of any of these can present

problems. Advocates of nutritional approaches to the treatment of mood

disorders give several reasons why supplementation may be appropriate.

 

First, most Americans do not eat ideal diets (for instance, they tend

to consume substantial quantities of processed foods and empty calories

such as sugar, white flour and alcohol, and often neglect to eat certain

important food groups entirely), meaning that they may be deficient in

even the Recommended Daily Allowances (RDAs) for many nutritional

compounds.

 

In addition, many people believe that the RDAs for many substances are

designed only to protect the individual from life-threatening disease

(e.g. scurvy, beri-beri, etc.), and that more subtle physical

dysfunction (such as mood problems) may occur as a result of

deficiencies even when the RDAs are achieved.

 

Finally, some evidence suggests that certain people, such as those

inclined toward mood disorders, require greater-than-normal amounts of

some nutritional substances for optimal functioning, either because they

do not easily absorb certain compounds, or because their abnormal

metabolisms make higher amounts necessary.

 

Nutritional substances such as herbs may be useful not because they are

inherently required by the body, but because they exhibit

pharmacological actions that can suppress the symptoms of depression

and/or help the body to repair itself. The action of such substances

should be considered similar to that of prescription medications used to

treat mood disorders; however, natural substances of this sort usually

cause far fewer side effects than do most prescribed drugs.

 

Those interested in exploring a nutritionally based approach to the

management of mood disorders should be aware that most physicians

(including psychiatrists) tend to be relatively ignorant and skeptical

about the efficacy of this course of action.

 

This is probably the case because most physicians tend to receive

little training in nutrition (most medical schools devote, at most, only

an hour or two of lecture time in a broader class to the topic), and

because less controlled research has been done on the efficacy and

safety of nutritional substances than on pharmaceuticals (primarily

because drug companies have no incentive to research such substances

since they cannot be patented, advocates of a nutritionally based

approach argue).

 

Nevertheless, an increasing number of books, many

written by well-credentialed physicians, covering this topic are

available, as listed below.

 

Following is a summary of some various nutritional substances that have

been shown or reputed to be useful in the management of mood disorders

such as depression or manic-depression:

 

 

Mood-Stabilizing Compounds

 

 

Relatively few substances are said to have the ability to control mood

swings directly in the manner that prescription mood-stabilizers do. In

addition, it may be the case that those substances that have been

identified may be more useful in controlling rapid-cycling (which tends

to be addressed with anticonvulsants by psychopharmacologists) than in

the longer, more " traditional " swings that are often successfully

addressed through the use of lithium.

 

For this reason, lithium (itself a

natural substance and probably required by the body in trace quantities)

is often recommended by those people favoring a nutritional approach to

mood disorders; however, alternative practitioners seem to be more

likely to recommend the lowest possible dosage of this substance (often

substantially lower than those prescribed by many psychiatrists),

supplemented with other measures.

 

Other than lithium, substances that may have mood-stabilizing effects

include the following:

 

1. Phosphatidyl Choline (Lecithin) - A fairly convincing number of

studies suggest that this substance has significant effects on the

manic-depressive, with some claiming that it stabilizes moods while

others suggesting that it serves as a mood depressant. It is probable

that it actually has both actions (as does the prescription drug

Depakote). For that reason, although lecithin may be useful in helping

to stabilize moods, it should probably be used cautiously, with the

patient starting at a fairly low dosage (perhaps 2 capsules of a 35%

concentration of the substance per day) and then increasing gradually

until moods are stabilized or mild depression is encountered. The

recommended amount of this substance for this use seems to vary

widely---some people suggest that relatively small amounts (perhaps 3-12

capsules per day) can be quite effective, while others suggest that only

much greater amounts tend to be fully effective. (More concentrated

forms of this substance are available but not usually stocked in health

food stores.) Even if lecithin is only partially successful in reducing

mood swings, however, this may still be helpful for those who want to

reduce their dosages of prescription medications (for instance, because

of side effects at higher amounts) or for those who suffer less severe

mood swings. Most writers seem to recommend splitting up the dosages of

lecithin over the course of the day (2-3 times per day), or taking the

full dosage at night, although there do not seem to be any studies

addressing this issue.

 

2. L-Taurine - Taurine is an amino acid that has been shown to have

anti-convulsant qualities, and appears to be potentially helpful for

both epileptics and those suffering from manic-depression (especially

the rapid-cycling form). The usual recommended dosage seems to be

500-1000 mg, 1-3 times per day, although there seems to be no

experimental or anecdotal evidence that larger dosages can cause any

unwanted side effects. As with all amino acids, pharmaceutical quality

product in capsules is preferable, despite the higher cost----capsules

tend to be absorbed more easily, and lesser-quality forms may have the

potential of being subject to contamination (such as that which occurred

with tryptophan several years ago). Divided dosages are probably

preferable.

 

3. GABA - GABA is usually classified as amino acid, although it actually

serves as a neurotransmitter (there are more GABA sites in the brain

than for any of the other neurotransmitters such as dopamine or

serotonin). GABA basically serves as an inhibitory transmitter, keeping

the brain and body from going into " overdrive. " Currently, for instance,

pharmaceutical companies are working on a GABA Reuptake Inhibitor that

would artificially keep more GABA in the synapses of the brain (similar

to what Prozac and related drugs do for serotonin) as a treatment for

anxiety). Supplementation of GABA seems to be quite effective for

anxiety disorders as well as insomnia (especially the type of insomnia

where racing thoughts keep the individual from falling asleep). In

addition, although there has been little if any research reported on

this, there is also reason to believe that GABA may be effective in the

treatment of manic-depression, since many of the substances that are

currently used for this purpose (including Depakote and, obviously,

gaba-pentin) affect GABA usage. Those who want to experiment with the

usage of GABA for anxiety or manic-depression should start at a low

dosage (perhaps 250 mg at bedtime or when anxiety occurs) and observe

their reactions before taking a larger amount. This may be especially

important for those people taking mood stabilizers that may affect GABA

usage, since the interaction between the two may cause an undesirable

overreaction to occur (just as those who are taking serotonin-based

drugs such as Prozac should be careful about taking serotonin's

precursor, tryptophan). Undesirable effects of too much GABA may include

tingling or numbness in extremities or trunk of the body and shortness

of breath; if this occurs, take a smaller amount in the future.

 

 

Other Nutrients Related to Mood

 

1. B Complex -The B vitamins are important factors in determining mood;

deficiencies of any or all of these vitamins can produce significant

symptoms relating to depression, anxiety, irritability, lethargy and

fatigue. Many bipolars state that supplementation of B vitamins is

extremely important to helping them to feel better. In general, B

vitamins tend to work best together as a group; taking too much of any

of them may result in deficiencies of others and, therefore, unwanted

symptoms. B complex tends to be sold in B50 (50 mg of most of these

vitamins, 50 mcg of a few, and 400 or 800 mcg of folic acid) or B100

(100 mg/mcg) dosages; bipolars may find relief with as little as 1 B50

or as many as 6 B100s per day. As with many other supplements, capsule

form may be preferable although it is more expensive (some people say

manic-depressives do not absorb this vitamin complex easily), and

divided dosages also may be preferred. Although other factors (such as

some medications) may interfere, a dark yellow-orange urine color may

suggest that the individual is taking a sufficient quantity of this

vitamin complex.

 

2. B1 (Thiamin) - Although B vitamins are usually best taken as a group,

there are certain circumstances when larger amounts of a particular

vitamin may be useful. Thiamin deficiencies tend to produce the

following clusterof symptoms, frequently reported by the

manic-depressive: chronic fatigue, irritability, memory loss,

personality changes (such as aggression), insomnia, anxiety,

restlessness, night terrors, appetite loss, sensitivity to noise,

numbness and tingling in hands and feet, and circulation problems.

Supplementation is usually 100 to 500 mg of this vitamin per day, in

addition to the B complex.

 

3. B6 (Pyridoxine/Pyridoxal-5-Phosphate) - Deficiency of this vitamin

can cause irritability, which is expressed by many manic-depressives.

Those women who suffer from PMS, birth-control-pill-induced

irritability, and post-partum depression often have deficiencies of this

vitamin. In addition to the irritability quotient, there are several

ways to detect deficiencies for this substance. a) Try the following

test: Extend your hand, palm up, then try to bend the two joints in your

fingers (not the knuckles of your hand), until your fingertips reach

your palm. (This is not a fist, only two joints are bent.) Do this with

both hands. If it is difficult, if finger joints don't allow tips to

reach your palms, a pyridoxine deficiency is likely. b) Have yourself

tested for pyroluria. This is a condition where an above-average amount

of a substance called " kryptopyroles " circulate in the body. The

substance is harmless in itself; however, it tends to attach itself to

both B6 and zinc and to pull these substances out of the body through

the urine, causing deficiencies of both. Most doctors are unaware of

this test, but if you insist they will be able to order it from Norsom

Medical Laboratories, 7243 West Wilson Avenue, Harwood Heights, IL,

60656, (708) 867-9709 . c) Deficiency of B6 causes motion sickness; if

you tend toward this malady, you may be more confident that you have a

deficiency of this vitamin. Supplementation of B6 is a bit tricky, since

high dosages over long periods of time may result in numbness of fingers

and (especially) toes and (if extremely high dosages of several thousand

milligrams per day are used for an extended period of time) permanent

nerve damage. Precautions include: a) Don't take B6 by itself; include

an at least somewhat proportional amount of B complex. Some people think

that it is not the excess B6 itself that causes problems, but rather the

deficiency of the other vitamins that excess amounts leads to. b) Use

the more bioavailable pyridoxal-5-phosphate form. c) Don't take amounts

in excess of what is necessary to control symptoms. d) If symptoms of

tingling or numbness in the toes or fingers results, reduce the dosage

immediately. Recommended amounts of pyridoxal-5-phosphate (in addition

to that obtained from a B complex) range from as little as 10 mg per day

to as much as 250 mg; 50 mg is probably sufficient for most people. (If

regular B6 is used, the amounts used are generally 50-500 mg, with 100

mg as an acceptable amount for many people.)

 

4. B12 - B12 is a vitamin necessary for energy production; a deficiency

of it can cause fatigue, anemia and lack of coordination. B12 is a

vitamin that is difficult to absorb through the digestive system; in

particular, older people (whose digestive systems are less efficient

than younger ones) are often deficient in this vitamins. In addition,

since this vitamin is present mostly in meats, vegetarians are often

deficient. In general, the sublingual or nasal forms of this vitamin are

preferred (B12 shots are also available through physicians); between 500

to 2000 mcg per day is generally thought to be an appropriate amount for

supplementation. In extreme circumstances, doctors can also give shots

of several thousand mcg. (No adverse side effects to even very large

amounts seem to have been reported.)

 

5. Folic Acid - Folic acid is a vitamin that has recently received

significant attention in the media for its importance in preventing

spinal malformations in fetuses. Manic-depressives, however, need to be

careful about taking high dosages (probably in excess of 3000 mcg per

day), since anecdotal evidence has suggested that this maylead to manic

behavior. Large dosages of folic acid also reduces the efficiency of

anticonvulsants such as Depakote for epileptics and (probably)

manic-depressives. Finally, as most people are aware, the use of drugs

such as Depakote can lead to spinal malformations in fetuses. All of

this suggests that folic acid seems to act in a way that is opposite

from Depakote or other anticonvulsants, and therefore should usually be

avoided except in the amounts present in foods or B complex. (Vitamin

pills are allowed, by decree of the FDA, to include no more than 800 mcg

of folic acid, so unless a substantial number of these are taken per

day, this probably shouldn't be a problem.) An exception is when the

patient has a demonstrated deficiency of folic acid (observable through

blood tests), either spontaneous or caused through the use of

anticonvulsants or other drugs; in this case, supplementation to bring

the vitamin to the normal blood level may be used.

 

6. Magnesium and Calcium - A majority of Americans do not consume the

RDA of magnesium. This is problematic since magnesium deficiency may

lead to various problems such as anxiety, insomnia (especially that

which consists of waking up in the middle of the night and being unable

to go back to sleep), fatigue (as experienced in chronic fatigue

syndrome), fibromyalgia, high blood pressure or PMS. Supplementation of

this mineral is therefore desired for most people, especially those with

mood problems. Magnesium is usually supplemented concurrently with

calcium, since the two work together and since absorption tends to be

greater when they are taken together. (Calcium may also act to relax the

individual.) The usual recommendation is 2 parts calcium to 1 part

magnesium---for example, 1000 mg of calcium and 500 mg of

magnesium---taken at bedtime; however, a higher ratio of magnesium may

be used to control PMS or similar conditions. Calcium carbonate is the

most easily obtained form of calcium but is the lest digestible; many

people (especially older individuals) will obtain better results through

the use of other forms such as amino acid chelates, calcium citrate or

hydroxapatite.

 

7. Manganese - Manganese is a trace mineral that, in deficiency, can

produce fatigue, irritability, memory problems and (most specific for

diagnosis) ear noises such as ringing.

 

8. Zinc - An deficiency in zinc can contribute to mental problems, and

is especially common among people who suffer from pyroluria (see the

section on B6 above). Deficiencies of this mineral are common, since

it's hard to get enough zinc from the typical American diet (unless

oysters are regularly consumed). Recent studies suggest that zinc

supplementation is especially important during pregnancy. Generally,

supplementation of no more than 30 mg is recommended unless a diagnosis

of pyroluria has been made through lab tests.

 

9. L-Tyrosine - L-tyrosine is an amino acid that serves as a precursor

to the neurotransmitters norepinephrine and dopamine, which have been

shown to be deficient in many manic-depressives during their depressed

cycles. The supplementation of this amino acid may help the body to form

more of these substances during these difficult times; in addition, it

may be helpful in cases when clinical or subclinical thyroid disease is

present. General recommendations are usually 500-5,000 mg per day, on an

empty stomach in the morning or early afternoon (start at a low level

and then work up gradually). As with all amino acids, try to get

pharmaceutical grade product in capsules.

 

10. L-Phenylalynine and DL-Phenylalynine - Phenylalynine is a precursor

to tyrosine, and so exhibits many of the same effects. In addition, the

supplementation of phenylalynine can help the body to produce a

substance called " phenylethylamine, " which has been shown to be

deficient in many manic-depressives. (Phenylethylamine is also present

in chocolate and marijuana, and is created by the body in greater

amounts when the individual is " in love " ; conversely, a deficiency such

as that suffered by many manic-depressives may lead to an unhappy

feeling similar to that which " normal " people feel when they are

heartbroken.) Phenylethylamine is supposedly present to a greater degree

in the DL form of phenylalynine than the L form; however, the DL form

may be more likely to increase blood pressure. (The issue of blood

pressure increases is often cited as a problem for both the DL and L

forms. This increase should be no more than 10 points for an hour or two

after the substance is consumed; however, those people who are inclined

toward high blood pressure should monitor theirs carefully and decrease

or discontinue their use of this substance if a problem is observed.)

The usual recommendation for the COMBINATION of tyrosine and

phenylalynine (DL or L) is 500 to 5,000 mg per day, on an empty stomach

in the morning or early afternoon. It is generally recommended that

users start with a low dose and work up gradually.

 

11. Methionine - Methionine is an amino acid that has been shown to be

helpful for some individuals suffering from depression. (Its metabolite,

SAM, has also been used to treat depression in some countries, but is

not currently available in the United States.) A reasonable dosage seems

to be 500-2000 mg per day.

 

12. L-Tryptophan and 5-Hydroxy-Tryptophan - L-tryptophan is an amino

acid that serves as a precursor to the neurotransmitter serotonin (the

one that is affected by SSRI drugs such as Prozac, Zoloft and the like).

L-tryptophan was quite popular in treating depression and insomnia

during the 1980s; however, in 1990 the substance was deemed responsible

for a number of deaths and pulled from the market in the United States.

Although the deaths were later attributed to a contamination of the

product (non-pharmaceutical grade) made by one particular manufacturer,

L-Tryptophan is currently available primarily by prescription in the

United States, although this may change in the near future. (Some

retailers have been known to sell veterinary versions of the amino acid

for human use, however; one problem with this is that animal-grade amino

acids may not be of the highest quality.) One phamacy that sells

l-Tryptophan by prescription is Belmar, 1-800-525-943. It is also

available over-the-counter in some European countries such as Holland.

 

However, another related product, 5-hydroxy-tryptophan, is currently

available over the counter. 5-HTP is a metabolite of tryptophan (that is

made in the body) that may work even better than tryptophan, so it may

be worth a try for people who suffer from depression, irritability or

other symptoms

 

http://www.resinets.com/health/bipolarb.htm

 

 

 

 

The complete " Whole Body " Health line consists of the " AIM GARDEN TRIO "

Ask About Health Professional Support Series: AIM Barleygreen

 

" Wisdom of the Past, Food of the Future "

 

http://www.geocities.com/mrsjoguest/AIM.html

 

 

 

 

 

 

 

 

[Guest guest]

, foxhillers@a...

wrote:

> In a message dated 7/31/03 10:10:47 PM Eastern Daylight Time,

> angelprincessjo writes:

 

> > 11. Methionine - Methionine is an amino acid that has been shown

to be helpful for some individuals suffering from depression. (Its

metabolite, SAM, has also been used to treat depression in some

countries, but is not currently available in the United States.) A

reasonable dosage seems to be 500-2000 mg per day.

>

>

> Correction by mjh: SAM-e is available in the USA, and, by

recommendation of

> my rheumatologist, I have been taking it since October 1999 and it

has been amazingly helpful. I buy it by the case online and find

this brand more effective for me than the two brands available in

local stores.... which I used at first.

There are also several popular books out on SAM-e now, too.

 

Thanks for the update. Some of these sites need to keep their

information current. I know this to be true because my daughterinlaw

uses SAMe on a regular basis.

 

JoAnn