Meditation, Mindfulness, or Introspective Practices
have well proven their value in holistic mental health work for mood, anxiety, addiction, and health issues. Meditation can be an essential tool for happiness and mental health. Enhancement of longevity and decrease in brain aging has also been demonstrated as an added benefit. In many other areas, there are proven benefits as in work, school, athletic performance, sleep, and creativity. The mere awareness in meditation – that thoughts and emotion are of a changing and transient nature – is enlightening for those felt imprisoned by harsh negative thoughts and emotions.
The Thyroid Gland (Butterfly Shaped), Autoimmunity, Mood, and Health
The association of mood, thyroid dysfunction, and autoimmunity is a possible contributing and treatable element in mood disturbances. Integrative Psychiatry encourages looking beyond labels, symptoms, and diagnosis. An integrative approach cautions against premature jumping to treatment with what is favored, familiar, or expedient. Integrative Psychiatry fosters awareness of complexity and the possible presence of underlying and correctable factors.
A Holistic integrative approach to the study and treatment of Bipolar Illness — BPI (also referred to as Bipolar or Manic-Depressive Disorder) offers a better path to disease understanding, treatment and prevention. See prior post “Holistic Approach to Bipolar Illness”.
Ben is not doing well with his bipolar illness.
Ben* is on several medications prescribed by his psychiatrist and has just come back from a recent psychiatric hospitalization for his bipolar disorder. He had been hospitalized after he had an emergency room visit for a suicide attempt, after he had taken an overdose of his medications. Prior to that, he had progressively worsening depression with feelings of hopelessness, helplessness and had lost interest in almost everything. He felt that there was no help for him as his mood cycling illness was only getting worse – even with all the medications he was taking. The medications made him feel like a “Zombie.” He was sleeping less with frequent violent nightmares that had woken him up multiple times during the night. He had periods of severe depressed mood when he would stay in bed for most of the day. He would have then have some days of feeling relatively fine. He then would experience periods of feeling – super “hyped-up” – full of energy with little need for sleep, talkative with racing thoughts, craving sex and food all the time, feeling like he was a famous rock star, and spending huge amounts of money on things he really didn’t need. He had lost all of his recent jobs and was now divorced from his second wife.
In addition to his regular psychiatrist, his family encouraged him to see and work with a holistic, integrative health care practitioner and therapist. It was uncovered that he also had a significant alcohol problem (as did his bipolar and alcoholic mother), a history of severe early life trauma – probably PTSD, severe gluten sensitivity, and autoimmune thyroid disease with thyroid imbalance. When he was directed to specific treatment and therapy programs for his bipolar illness, his PTSD, alcoholism, nutritional problems and thyroid disease; he was then able to work closer with his regular psychiatrist. His medications were reduced, and for the first time he began to sleep better with less mood cycling. His new therapy work also helped him to identify and work through some painful childhood issues. He also felt that he regained his spiritual connection.
*(To protect confidentiality, the above is a composite of some clinical experiences and does not represent an actual person or any prior patients).
Finding a better model for helping BPI.
A broader open health-care model offers the potential for improved research, diagnosis and treatment of BPI. All disciplines can be included in an integrative model – including biochemistry, nutrition, psycho-pharmacology, psychiatry, genetics, spirituality, psychology, sociology, physiology, endocrinology, environmental medicine and complementary mind/body/spiritual therapies. Effective outcomes can happen with patience, and the commitment to finding a suitable care and treatment program.
Early recognition, comprehensive assessment and an integrative approach to treatment – including natural therapies – can help bipolar sufferers improve their chances of stabilization, improvement in relationships, and productivity and work. As proper assessment and diagnosis can be of critical importance, seeking out skilled and experienced health-care practitioners is important – such as a psychologist, a psychiatrist, and/or a holistically oriented health-care provider who is trained in mental health work. People with bipolar illness are sometimes misdiagnosed as having just depression or other conditions – and treated as such – often resulting in a poor treatment outcome. These individuals would have responded better to a broader holistic and integrative type of treatment program that had benefited Ben’s recovery as described above.
Every individual is unique in their treatment needs.
Any individual who has difficulties with mood changes is unique regarding their treatment needs. BPI can be influenced by factors as:
a person background
earlier life experiences, exposures or trauma
current lifestyle, nutrition, environment
individual medical issues, genetics
psychological or addiction issues
traumatic brain injury
A person’s capacity to grow in awareness, learning, and to succeed with lifestyle changes will influence the choices and success of any selected treatment. As there are many individual differences as well as variation in the type and severity of bipolar conditions, the needs and type of treatment will vary or differ from person to person.
Natural non-medication approaches
Some of the non-medication or more natural approaches would be:
improving lifestyle, nutrition, exercise and sleep
addressing environmental issues
individual or group psychotherapy
avoidance of alcohol and substance abuse
education, behavioral, family, cognitive or trauma therapy
other complementary mind-body-spiritual oriented programs.
Other complementary practices or therapies would be:
relaxation training, yoga
Oriental Medicine, acupuncture
religious, meditation and spiritual practices
regular exercise and sleep
use of fish oil, rich in EPA and DHA – has been shown to complement other treatments of BPI.
There is a body of work suggesting that nutrition and certain dietary programs can help in treatment of mood disorder, as a diet:
high in healthy fats
high in vegetables, rich in minerals and anti-oxidants
adequate in good quality protein
low in sugar and starches
that avoids gluten (found in wheat, rye and barely — felt to be a trigger in some people for inflammation and auto-immune diseases). (see Grain Brain)
Specially designed light boxes, if carefully used under the guidance of an experienced health-care provider, are sometimes useful (especially if there is a seasonal component to the depression and mood cycling). Assessment and correction for any nutritional, metabolic, hormonal (as thyroid deficiencies), allergic or environmental problems need to be considered.
A genetic biochemical problem that can be improved with nutrition, called hypomethylation is worth assessing – as there is evidence that it affects the expression of bipolar symptoms – and if treated can bring benefits and improve outcomes. Methylation is also relevant to drug-nutrient interaction in the treatment of BPI and is one of possible underlying factors that can contribute to medications not working effectively. (see “Bipolar Disorder” by Vinitsky and Parks, Advancing Medicine with Food and Nutrients, 2nd edition, Chapter 32, Dec. 2012, CRC Press)
Some of the conditions or consideration for medication interventions and treatment are:
worsening of BPI with poor response to non-medication approaches
development of thought or cognitive impairment such as psychotic symptoms with delusion, hallucination or dangerous behavior, especially when accompanied by poor judgment and risk of self or other harm
actual or imminent need for a safe protective environment — psychiatric hospitalization
lack of capacity or willingness to follow non-medication treatment regimens or protocols
personal choosing of medication treatment over non-medications (after being fully educated about all options, including therapy programs or natural alternatives – other than medications) about risk of using medication vs. not taking them, potential for adverse immediate or long-term risks, or side effects from medication
According to some studies, those with bipolar disorder – not treated with appropriate medication or a mood-stabilizing agent when needed – have a significant increase risk of a more chronic condition, more frequent relapses of the illness and more severe outcomes – as suicide*. More than 50 percent of people will abuse drugs or alcohol if the disorder is not recognized or treated.
Concerns about medication and risk:
potential for short term, long term, or potential side effects: including weight gain, diabetes, metabolic problems, high blood pressure, heart disease, abnormal restlessness and/or involuntary movement disorders of face, mouth and limb (mostly a risk with anti-psychotic medication and possibly from some of the antidepressants)
potential for making mood cycling worse or triggering more severe episodes of mania or psychosis.
So it is important for the individual to be educated about the use medication, benefits and risk – weighing the potential benefits of medication being helpful – especially in a well designed comprehensive treatment program – vs. risks of medication use and side effects.
There are several classes of medications considered when felt necessary in BPI, including:
Anti-depressants: as citalopram and sertraline, which are selective serotonin re-uptake inhibitors – SSRIs that increase the amount chemical nerve factors (neurotransmitters) that helps relieve depression
Anxiolytics (anxiety reducing medication) such as: benzodiazepines such as clonazepam and lorazepam that support the neurotransmitter GABA which helps relieve anxiety
Mood Stabilizers as lithium, valproate and lamotrigine that helps to balance and stabilize brain activity and neurotransmitters (active brain chemicals) which sometimes have an antidepressant effect – as lamotrigine
Antipsychotic Medication as: aripiprazole, risperidone, and lurasidone: helps to eliminate or reduce psychotic thoughts, which is abnormal or disturbed thinking as delusions and hallucination, helpful in reducing agitation, helpful with mood stabilization and sometimes helpful in reducing depression; read more: nimh.nih.gov/health
Appreciating the many facets of BPI, the varied presentation and potential for adverse impact on people’s lives underscores the importance of early recognition, thorough assessment, and initiation of comprehensive and holistic/integrative treatment as outlined above. Effective treatment of BPI sufferers can potentially bring a return to a more stable, functional, fulfilling and productive life.
*If you or some one you know is thinking about self harm or suicide, seek help immediately (Call your doctor, 911 or go to a hospital ER, or Call the 24-hour National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255).
Article by Ron Parks, MD; edited by Shan Parks
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often referred to as bipolar disorder or manic depression, affects more than 2.2 million people in the United States. BPI is characterized by bouts of illness with significant often disabling symptoms, alternating with periods of less or no symptoms. These may be a sign of the disorder: unusual shifts in mood, energy or the ability to function.
What is happening to Sarah?*
Because of the insistence of her family and one of her ex-husbands, Sarah had been to several mental health evaluations. She had been married and divorced four times and in and out of many jobs. She had an early life history of trauma: at age 14, she was sexually abused by her divorced mother’s live-in boyfriend; at age 15, she was raped when at a party. She occasionally had nightmares about the incidences and had triggered flashbacks, or panic like attacks, when she smelled certain odors or sounds reminiscent of her rape. She had made several suicidal attempts during recurring periods of severe depression. Hospitalization was required two times when her doctors considered her to be a danger to herself. Her mother and one aunt had a history of bipolar illness. Sarah never had any severe period of mood activation or mania, though one of her treating psychiatrist thought she had periods of what he called hypomania (milder periods of mood, behavior activation or changes). Her diagnosis was Bipolar II type of BPI and PTSD (Post Traumatic Stress Disorder). Her best response to treatment finally came when she received appropriate treatments and therapy for both BPI and PTSD, and when she also sought out the help of a holistically oriented health care provider who encouraged her to follow a more optimal health, nutritional, spiritual lifestyle program. *(To protect confidentiality, the above is a composite of some clinical experiences and does not represent an actual person or any prior patients).
Sarah’s family and significant others began to pay attention and to take action when her once normal ups and downs of everyday life began to get more dramatic, extreme and destructive. If you, a family member, or someone you know shows unusual shifts in mood and energy with uncharacteristic behaviors, it may be an early sign of bipolar illness (BPI).
Getting evaluation and treatment when needed.
Evaluation by a trained professional such as a psychologist or psychiatrist should be considered when changes in moods are severe, persistent, and interfering with daily life. Identify BPI early in its course and treat with a comprehensive, holistic treatment program. If not, the illness can have devastating effects on relationships, careers and health – as was the case of Sarah.
Recurrence of bipolar episodes with depression, anxiety, mania or hypomania has adverse effects on family, social and occupational functioning. BPI disrupts many normal day to day activities in areas as:
social functioning and relationships
work and productivity
sleep and physical health
Recognize bipolar illness in all its forms.
The illness can lead to impaired thinking (cognition), poor judgments, increased distractibility (poor focus), dysphoria (painful moods) and physical discomfort with increased preoccupations with health problems. There can be compromised functioning as with:
more impulsive or volatile behavior and expression
loss of interest, pleasure and motivation in doing things
BPI’s early appearance is often not recognized by significant others or by health-care providers. A key feature that separates the illness from recurring depression is the occurrence of hypomania or a more severe manic episode. A manic episode is a period of elevated, expansive or irritable moods, and increase goal-directed activity or energy – often lasting for at least a week – which is a characteristic of the more severe bipolar I type of BPI.
Other commonly associated symptoms may include:
inflated self-esteem or grandiosity
decreased need to sleep
more talkative than usual or pressure to keep talking
flight of ideas or the experience of racing thoughts
increase goal-directed activity
excessive involvement in high risk activities
marked impairment in social and work functioning
sometimes need for hospitalization (if potential for harm to self or others and/or the presence of poor judgement and thought disturbance – psychotic symptoms)
In Bipolar I disorder, the manic episode may have been preceded or followed by hypomania or major depressive episodes. Milder “hypomanic” episodes can have:
a persistent elevated, expansive or irritable mood
signs of sharpened and overly active thinking (hyper-focused)
increased energy and activity that last for at least four consecutive days (present for most of the day – nearly every day)
This “hypomania” alternates with frequent periods of depression and are typical of the less dramatic bipolar II type of the bipolar illness. Recurrent depression is characteristic of both conditions, and the depth of the depression usually determines overall severity.
Both bipolar I and bipolar II types of BPI can be both severe and disabling. Bipolar I disorder more specifically describes a sufferer who has experienced distinct periods of severe depression or hypomania, alternating with at least one episode of severe activation or mania. Bipolar II disorder, by definition, has not had any manic episode. If mania later presents in bipolar II individuals, this results in reclassification to Bipolar I type of BPI.
Symptoms of Bipolar II have a similarity to those seen in Bipolar I but are often milder, less severe, or more subtle as:
inflated self-esteem or grandiosity
decreased need for sleep
more talkative than usual or pressure to keep talking
flight of ideas or racing thoughts
increase in goal directed, hyper-focused activity (school, work, socially or sexually)
Some subtler bipolar I or bipolar II conditions, at any given time, can present with milder and more difficult to recognize symptoms as irritability, anxiety, and moodiness – alternating with periods of less pronounced depression. Another classification, for the entire range of BPI in its varying expression, is — bipolar spectrum illness — which would include even the less recognizable forms of recurrent depression with milder periods of activation, hypomania and less dramatic symptoms.
For clear description and definition of BPI, go to the current American Psychiatric Association — the official nomenclature that has been codified and defined in the DSM-5 (published by American Psychiatric Publishing).
What is the cause of bipolar illness and who is affected?
Bipolar illness is considered an inherited condition related to instability in brain neurotransmitters (nerve chemicals) regulation, which leads to greater vulnerability to emotional or physical stress, over-stimulation, upsetting life experiences, drug or alcohol use, and interference with rest and sleep. The brain is not able to properly calm or activate itself, or restore its usual healthy balance.
Research studies strongly support inherited genetic factors as important contributors to BPI. First-degree relatives of people with BPI are seven times more likely to develop bipolar I type of BPI. Environmental factors (epigenetic factors) are also suspected to affect bipolar illness — physical factors (as radiation or trauma), chemical factors (as pesticides, toxic metals, and air pollution) and biologic influences (as bacteria, mold, viruses).
Lifetime prevalence estimates are 1% for bipolar I disorder — BP 1 type of BPI, 1.1% for bipolar II disorder (BP 2 type of BPI), and 2.4% to 4.7% for sub-threshold BPI (a person is not meeting the full symptom criteria for BP 1 or BP 2). Age of onset range from childhood to the mid-20s and later, and BPI onset is unusual after age 40. Recurrence of active BPI over a five year period is very common – with the associate in between times of no symptoms, minor symptoms, or with significant residual symptoms. (see “Bipolar Disorder” by Vinitsky and Parks, Advancing Medicine with Food and Nutrients, 2nd edition, Chapter 32, Dec. 2012, CRC Press)
When can depression actually be bipolar illness?
Recurrent depression is often bipolar illness unrecognized. Additional clues to underlying BPI include:
poor response to treatment for depression
manic or psychotic symptoms
rapid mood fluctuations triggered by antidepressants
family history of bipolar illness
onset or recurrent depression before the 20s
severe premenstrual syndrome, PMS, or premenstrual dysphoria syndrome (PMDS)
atypical depression with a lot of irritability, sleep disturbance and anxiety.
At its worst, BPI can lead to higher mortality from suicide and other co-occurring medical illnesses. Among psychiatric disorders, BPI has a significant risk of death from suicide. The risk in bipolar 2 type of BPI for suicide is greater than bipolar 1 type of BPI – according to some studies. Unrecognized co-occurrence of BPI, with other mental or physical illness, can lead to ineffectual treatment and poor outcomes. Six months after suffering a myocardial infarction, victims with major depression – commonly seen in BPI – had six times the mortality rate of non-depressed patients. Presentation of BPI in the older population, greater than 50 years, will often have other medical problems at the time of diagnoses – including cognitive changes. More than 50 percent of people will abuse drugs or alcohol if BPI is not recognized and treated.
Bipolar illness can be overlooked or misdiagnosed resulting in inadequate treatment.
People with this disorder are sometimes misdiagnosed as having just depression, and treated as such, often resulting in a poor treatment outcome. These individuals would respond better to a bipolar illness focused treatment program. (see for more information)
A holistic or integrative approach to the study and treatment of BPI offers a better path to disease understanding, treatment and prevention of future illness.
With a broader open health-care model, there is the potential for improved research, diagnosis and treatment of BPI. All disciplines can be included in an integrative model – including biochemistry; psycho-pharmacology; toxicology; genetics; spirituality; psychology; physiology; endocrinology; sociology; and nutritional, metabolic, environmental, psychiatric medicine and complementary mind/body/spiritual therapies. Effective outcomes can happen with patience and commitment to finding a suitable care and treatment program as occurred with Sarah – as described above.
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