Bipolar Disorder can be a very difficult illness to identify and treat. It may hide itself and remain undetected for years. Sometimes it will disguise itself and be mistaken for other maladies. Often after diagnosis is made and some success has been had at treating it, the illness will change, and former treatments will no longer be effective. All of this can be a frustrating roller coaster ride for patients and their families. But, there is hope. As we gain a greater understanding of what this disease is and how it works, the outlook for better and more effective treatment increases.
What is Bipolar Disorder?
Bipolar Disorder is a chronic long-term brain disorder that is also known as manic-depressive illness. It causes swings in a person’s moods and energy levels, making normal functioning in daily life a real challenge for those who have it. We all go through periods of ups and downs, but the bipolar patient experiences changes in mood that are more severe than normal. Symptoms are of varying degrees, causing problems ranging from troubled work and interpersonal relationships, to serious life-threatening issues such as suicide.
Bipolar is classified in different ways. The swings between highs (mania/manic) and lows (depression/depressive) are referred to as episodes. Mild to moderate mania is called hypomania. People who experience hypomania may feel good and be productive. This is one of the things that can make bipolar so hard to diagnose. Often patients who have hypomania may totally deny or not be aware that they have a problem. Unfortunately, if ignored the condition can worsen into more severe mania or even turn into depression. Severe mania or depression can lead to a condition called psychosis whereby patients may hallucinate or fall into delusions that are not based in reality. Often the symptoms of psychosis reflect where the patient is in his cycle, either experiencing grandiose delusions (such as super-human strength) if he is manic, or delusions of great despair (such as thinking themselves guilty of some great crime) if he is depressive. Sometimes these patients are misdiagnosed with schizophrenia, another form of mental illness. This again causes confusion in the diagnosis of bipolar. To add to the ambiguity of this disease, some patients will experience a mixed bipolar state. These folks show symptoms of both mania and depression simultaneously.
Classic bipolar is called bipolar I (one) disorder. Patients experience recurrent cycles of manic and depressive episodes. Bipolar II disorder involves hypomania alternating with depressive episodes. Another classification is called rapid-cycling. This is diagnosed when 4 or more episodes occur within one year (or less).It has been found that more women than men experience rapid-cycling, and usually in the later stages of the disease. Rapid-cycling has also been linked to thyroid problems.
How common is Bipolar Disorder? It is estimated that approximately 2.6% of the American population over the age of 18 (about 5.7 million adults) have Bipolar Disorder. It most often begins to show it’s affects in late adolescence or young adulthood.
What Causes Bipolar Disorder?
Most researchers believe there is no one single cause for bipolar, but rather that it is caused by a compilation of factors working together. Evidence points to the fact that the disorder runs in families and so there are genetic factors involved. Work is being done to try to identify the presence of specific genes that may influence a person’s chances of developing bipolar. However, the mystery is greater than just the genes factor. Studies have shown that with identical twins that have the same genetic programming, one twin may develop bipolar, while the other may not. To complicate things even further, it has been found that if one twin has bipolar, the other twin is more likely than other siblings to get it too. One theory is that a number of genes may act together along with other factors such as environment in order to cause the onset of the disease.
Brain-imaging tools such as magnetic resonance imaging (MRI), positron emission tomography (PET), and functional magnetic resonance imaging (fMRI) are helping to clarify scientist’s understanding of what happens in the brains of people with bipolar and other types of mental illness. As these images are compared to the brains of normal individuals, researchers can identify the dynamics of this disease with greater accuracy.
What Treatment is Available for Bipolar Disorder?
Psychiatrists have traditionally leaned heavily on the use of medication to manage bipolar disorder, but this is a very complex illness that takes many twists and turns in its course of development. There are problems with these medications. Recent research has shown that particularly with teenage girls,Valproate, an anticonvulsant drug often prescribed for bipolar, can lead to unwanted hormonal changes, and it can also cause polycystic ovary syndrome in females who have been taking it since before 20 years of age. Medication for bipolars is very hard to manage, as usually a combination of an anticonvulsant/mood stabilizer like valproate or lithium (for many years the most common drug prescribed for bipolar) and an antidepressant is prescribed. This is done to avoid the risk of the patient “switching” from mania to depression (or vice-versa) or developing rapid-cycling. That is a lot of medication to put in your body at one time, and is especially a problem for pregnant or nursing women. The side effects of the most popularly prescribed medications can be quite intense. Weight gain is a big problem for patients, along with lowered libido, hair loss, and involuntary movements.
Successful drug-free interventions are also commonly used. These include:
- Cognitive behavioral therapy. This teaches patients to reprogram their thought patterns and behaviors
- Psychoeduction teaches folks about the illness and how to manage it
- Family therapy treats the disease as the family illness that it truly is, and helps all family members to cope
- Interpersonal and social rhythm therapy helps patients learn to manage their relationships and their activities of daily living within the context of their illness
What about natural remedies for bipolar disorder? There is much that can be shared on this subject thanks to an abundance of research in this area. A lot of research has been done regarding the role of good nutrition in bipolar. It seems that certain nutrients are keys to maintaining brain health. Folic acid and all the B vitamins, but especially B12 play an important role. Omega-3 fatty acids found in fish oils are showing promising success in the treatment of bipolar and other mental illnesses. Thyroid levels need to be monitored as well. Using table salt or sea salt that has added iodine is a good way to bolster the thyroid.
One interesting side note regarding nutrients is particularly applicable to the discussion of bipolar disorder. Patients often have substance abuse problems, the theory being that bipolars feel the need to self-medicate and may choose alcohol or street drugs to accomplish that. When these drugs (particularly alcohol) are abused, the body malfunctions in the way it absorbs nutrients. Also, many nutrients normally absorbed are wasted in the process the body uses to rid itself of the alcohol. Thus many bipolar patients are deprived of much needed nutrients to maintain brain health.
Another hot topic of discussion is the role blood sugar plays in the health of a bipolar patient. Blood sugar has been found to be necessary for the brain to function properly. Studies have shown that hypoglycemia (low blood sugar levels) is very commonly found in depressed people. Some health practitioners are recommending that patients stay away from refined sugar and simple carbohydrates, as well as coffee and soft drinks that contain caffeine. Studies have shown caffeine can contribute to hypoglycemia. Cutting out sugar is great, but don’t pull out the box of artificial sweetener! Aspartame is a villain towards bipolar patients, and is suspected of bringing on episodes in some patients. In fact, some researchers believe that we are seeing more and more children developing bipolar due to the vast amounts of aspartame in their diets. There are chemicals in aspartame that wreak havoc with the neuron-transmitters of the brain, and we were never meant to consume these substances.
There are many folks who look to herbal remedies to help manage their bipolar disorder. The Europeans are prescribed herbal medications routinely, and they are manufactured with much the same controls that are put on pharmaceuticals here in the U.S. 80% of the world’s population uses herbs as their primary source of health care.
- St John’s Wort is probably the most commonly used herb for depression. It has been used clinically in Germany for over 40 years. Be careful if you are taking any prescription drugs along side St. John’s Wort. It has been shown to cause some harmful interactions with certain drugs. St John’s Wort has antibacterial and antiviral properties as well.
- SAMe (S-Adenosyl Methionine) is an amino acid that is needed by the brain for healthy neurotransmitter function. It also boosts levels of serotonin, dopamine, and phosphatides. Depressed people often have insufficient levels of these. 5HTP is also an amino acid that is particularly effective in boosting serotonin levels. This has been found to be of help to fibromyalgia and migraine sufferers as well.
- Ginkgo Biloba is great for overall brain health. It improves circulation and increases blood flow to the brain. Also recommended for asthmatics and alzheimer’s patients.
- Siberian Ginseng helps to maintain proper blood sugar levels, and is a stimulant to the immune system. It also helps the body overcome stress. Used for treating diabetes as well.
- Magnesium supplementation is often recommended as well. Many depressed people have insufficient magnesium levels in their bodies.
- Valerian root may help with insomnia that some depressed patients suffer from
- Damiana may increase the libido and reduce sexual dysfunction caused by some antidepressant medications
The bottom line with managing bipolar is that, as with most health conditions, diet, nutritional, and lifestyle choices can greatly impact the impact of the illness on your life. Avoiding alcohol, caffeine, sugar, and artificial sweeteners will help. Eat lots of fresh fruits and vegetables, organic and locally-grown if you can get them, as these contain an abundance of antioxidants and necessary nutrients to keep the brain healthy. Eat cold-water fish or take a good fish oil supplement to guarantee enough omega-3’s in your diet. We all have the power of choice to guide the direction our health takes. It is up to you. Be proactive!