Behaviour, Depression | August 9, 2017 | Author: Naturopath
Bipolar is a complex mental health disorder that is defined by dramatic or unusual mood episodes of highs, (mania or hypomania) and lows, (depression). The episodes of mania and depression can range from mild to extreme in their intensity and severity. Episodes can come on gradually over many days or even weeks or they can come on suddenly, occurring over the course of a few days.
To be classified as episodes, symptoms must occur as a constellation of features that affect not only mood but also sleep, energy, thinking, and behaviour. These symptoms must last for at least several days, representing a change from a person’s usual self.
Bipolar disorder affects approximately 60 million people worldwide. 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.
During a manic episode, people can also become out of control, feel very anxious, and become frustrated and angry.
They can become reckless without realising it, engage in dangerous behaviour and take huge risks.
Mania can also cause psychotic thoughts and actions.
Complementary and alternative medicine is one of the most practiced but least researched forms of treatment for bipolar disorder. The reason lies in the complexities in its assessment and effectiveness for major depression and other mood disorders.
S-Adenosyl Methionine, also known as SAMe, is a naturally occurring compound that is produced and consumed primarily in the liver. It is involved in a number of important processes and plays an important role in the production and break down of the brain chemicals, serotonin, melatonin, and dopamine.
Several researchers have appraised the clinical and pharmacological benefits SAMe has in the treatment of depression and as an adjunct in treatment resistant depression or those who do not respond to anti-depressants.
SAMe also displays beneficial effects when used alongside bipolar medication with good tolerability and appears to be a safe treatment for patients with major depression.
SAMe is available in a supplemental form and is made from adenosine triphosphate and methionine. It can be used for boosting mood in depression and improving energy levels. SAMe has been reported to be safe and effective for the treatment of depression associated with bipolar disorder, acting similarly to antidepressants, but with fewer side effects.
N-acetylcysteine, a precursor of glutathione, is an important antioxidant in the brain and reduces oxidative stress. Increased oxidative stress and altered glutathione metabolism have been reported in bipolar disorder. Patients on mood stabilizers who were given N-acetylcysteine 2 g/day showed a significant improvement in depression, mania, quality of life, and social and occupational functioning.
Research suggests that N-acetylcysteine for use in bipolar disorder is highly beneficial and well tolerated. It needs to be taken for 8 weeks at the suggested 2g/day dose in order to achieve a positive response.
When it comes to use in bipolar disorder, choline has been found to be effective in ameliorating symptoms of mania. One study in particular found that when given to bipolar patients who were stabilized on lithium medication, choline supplementation resulted in marked improvement of manic symptoms and has since been found to have a direct anti-manic effect.
This is a very important find considering that a majority of natural therapies that have been studied for the treatment of bipolar, have performed poorly for episodes of mania regardless of how effective they were in helping the episodes of depression.
Choline is not considered a vitamin or mineral, instead it is an essential micronutrient that is important for liver, brain and nerve function as well as brain development, muscle movement, adequate energy levels and healthy metabolism. Choline is present in the form of phosphatidylcholine, a compound that makes up the structural component of fat, and thus can be found in different types of foods that naturally contain certain fats.
Choline is a water soluble nutrient that is related to other vitamins, such as folate and those in the B vitamin family. Just like B vitamins, choline plays a similar role in supporting brain function. It also helps in the process of methylation, which is used to create DNA, for nerve signalling, and for detoxification. It is important for the functioning of a key neurotransmitter called acetylcholine, which similarly helps nerves to communicate and muscles to move, acts as an anti-aging neurotransmitter, and performs other basic processes.
5-Hydroxy-L-tryptophan (5-HTP) is the metabolite of the essential amino acid L-tryptophan in the synthesis of serotonin and a deficiency in serotonin can cause major depression. 5-HTP is well absorbed from oral supplementation and it easily crosses the blood-brain barrier and effectively increases central nervous system synthesis of serotonin. In the central nervous system, serotonin levels have been implicated in the regulation of sleep, depression, anxiety, aggression, appetite, temperature, sexual behaviour, and pain sensation.
5-hydroxy-L-tryptophan at a daily dose of between 200–300 mg/day has been found to be effective for major depression. Data suggests that perhaps it works even better when used in conjunction with a patient’s antidepressant medication.Further, no adverse interactions have been reported between 5-hydroxy-L-tryptophan and the monoamine oxidase inhibitors, another family of anti-depressant medication. 5-HTP only available through your Doctor or naturopath.
Omega-3 fatty acids play several important roles in brain development and functioning.
Evidence of a deficiency suggests that these fatty acids are relevant to promote brain development and to regulate behavioural and neurochemical aspects related to mood disorders, such as stress responses, depression and aggression. They also help dopamine, another brain neurotransmitter, to function optimally.
Bipolar patients generally have a lower membrane level of omega-3 fatty acids which could explain why neurotransmitter function is not optimal. Research shows that omega-3 fatty acids seem to be an effective adjunctive treatment for bipolar related depression. Outcomes of studies reveal that omega-3 helps in the reduction and remission of depressive symptoms, whereas no significant effects were found with symptoms of mania.
Bipolar disorder is impacted by diet and nutrition. An improvement in the quality of the diet should improve a bipolar patient's overall health risk profile, but it may also improve their psychiatric outcomes.
The ketogenic diet has been around since the 1920s. It’s a high-fat, low-carbohydrate diet that mimics the state the body would go into if an individual was fasting.
Normally, carbohydrates such as glucose, supply the body and brain with energy. Glucose is the brain’s preferred source of fuel. When carbohydrates are cut from the diet, fat takes over as the body’s primary energy source. The liver breaks down fats into substances called ketones, which are naturally higher in energy than carbohydrates. Ketones travel through the bloodstream to fuel the brain.
The ketogenic diet is used in the treatment of epilepsy as are anti-seizure medications which are used as a form of treatment for bipolar disorder. Therefore research conducted in this area has focussed on the assumption that if the medication used in epilepsy helps those with bipolar disorder then perhaps the diet that helps with epilepsy could also help with bipolar. During a depressed or manic episode, energy production slows in the brain.
People with bipolar disorder have higher than normal amounts of sodium inside their cells. Lithium and other mood stabilizing drugs used to treat bipolar disorder work by lowering sodium levels in cells. The ketogenic diet has the same type of effect.
It has been found that patients who have been able to maintain ketosis for prolonged periods of time experienced mood stabilization that exceeded what had been achieved with medication. There were no significant adverse effects reported and results show that the ketogenic diet demonstrates a potentially sustainable option for mood stabilization in bipolar disorder.
On the ketogenic diet, a person is required to eat a ratio of 3:1 to 5:1 fats to protein plus carbohydrates.
In other words, three to five times the amount of fat compared to protein and carbohydrates combined. The bulk of the diet is made up of fats from foods like fish, such as sardines and salmon, butter, red meat, avocado, chicken, eggs, cheese, coconut milk, seeds, and nuts. Most of the carbohydrates come from vegetables.
Psychiatrists treating patients with mental health disorders should be aware of available natural therapies for bipolar. They should know about nutritional supplements that can help with bouts of depression and of mania as well as appropriate doses for those supplements and the possible side effects they could potentially carry when used with prescription medication. This will allow for alternative and complementary treatments for patients that may bring good results and have fewer side effects to medication offered.