INTEGRATIVE + ONLINE PSYCHIATRY + HOLISTIC HEALTH

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Pampas Grass in natural setting

Bipolar Holistic Treatment – Part 2

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.

Woman with Bipolar Disorder
©Sangolrl/Dollar Photo Club—Balancing Act.

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
  • personality
  • 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:

  1. improving lifestyle, nutrition, exercise and sleep
  2. addressing environmental issues
  3. stress management
  4. individual or group psychotherapy
  5. avoidance of alcohol and substance abuse
  6. education, behavioral, family, cognitive or trauma therapy
  7. 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:

  1. high in healthy fats
  2. high in vegetables, rich in minerals and anti-oxidants
  3. adequate in good quality protein
  4. low in sugar and starches
  5. 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)

Medication considerations

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:

  1. 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)
  2. 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:

  1. 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
  2. Anxiolytics (anxiety reducing medication) such as: benzodiazepines such as clonazepam and lorazepam that support the neurotransmitter GABA which helps relieve anxiety
  3. 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
  4. 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
Fantastic sunset
©Allk Mullkov/Dollar Photo Club—Beauty in Nature.

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

For additional help and resources check below links:

(psych.com/guides)

(dbsalliance.org/)

(NIMH on Bipolar Disorder)

(adaa.org/)

Question:

What would be your consideration and options if you feel that you or a significant other has difficulty with a bipolar illness? I would be interested in your comments.

Help for Anxiety and Panic

Has anxiety and panic attacks compromised your life?

Peace of mind and personal happiness may elude sufferers who deal with significant anxiety or panic attacks. You may discover that you are one of the many who find these issues replacing life plans, career, social and personal needs with pain and fear. Then you watch a TV commercial, hear a radio advertisement or read ads offering products, pills and all types of remedies for relief. Amidst all this, how do you sensibly choose the best way to get help or relief?

Barbara* a 30-year-old radiology technician, walking to her bus stop after work, was startled by an unexpected, overwhelming feeling of terror and panic. She felt flushed, lightheaded and dizzy. There was a weird sensation of chest constriction and difficulty breathing. Her heart raced and pounded in her chest. Thoughts of dying, losing control, or of going crazy flashed through her mind. With each wave of fear, her heart began to pound even louder. Her hands now felt sweaty, numb and tingling. There was a sense of unreality about things. A friend, noticing her distress, approached, and helped her to a bench near the bus stop. Over the next 5 to 10 minutes the feelings gradually subsided. Feeling some relief, but still shaky, her friend helped her to the nearby hospital emergency room. *(To protect confidentiality, the above is a composite of some clinical experiences and does not represent an actual person or any prior patients).

 Barbara had just suffered a panic attack – a type of severe anxiety.

Unlike the brief and mild anxiety caused by a stressful event, the more severe anxiety disorders are serious medical illnesses. These affect approximately 40 million adults, 18% of the population, age 18 years and older — one in four adults in the U.S., at least once during their lifetime. Anxiety disorders cost the U.S. more than $42 billion a year, about one-third of the country’s $148 billion mental health budget. An estimated 75% of people with an anxiety disorder have at least one other accompanying psychiatric condition. See: http://www.adaa.org/about-adaa/press-room/facts-statistics

These disorders cause overwhelming, even debilitating, anxiety and fear that can become worse if not treated. Less than 30% of individual with these problems seek treatment, and many go undiagnosed by their primary care physicians. Common signs and symptoms of anxiety include muscle tension, trembling, fast heartbeat, fast or troubled breathing, dizziness or impaired concentration, palpitations, sweating, fatigue, irritability, and sleep disturbances.

Panic disorder, a type of severe anxiety, is estimated to affect over two million adult Americans, and is twice as common in women then in men. The lifetime prevalence of panic disorder in the U.S. ranges from 1.5% to 3.5%.  Symptoms of a panic attack include feelings of terror that suddenly strikes.  An episode can occur as a one-time event only or can repeatedly happen, triggered by something remembered or appear without warning — out of the blue.  Panic can cause waking at night; a pounding or racing heart; sweaty, nausea, numbness, tingling, weakness, faint or dizzy feeling. There can also be a sense of unreality; chest pain; fear of impending doom, of going crazy, of losing control; and avoidance of going to certain places. See: Advances in the Treatment of Anxiety Disorders

Panic attacks are both unique and common.

Pannic Attack - the Words in White Color on Cloud of Red Words on Orange Background.

As many as 20% of American’s are affected at least once in their lifetime. Considered one of the most distressing conditions that a person can experience, early recognition and proper treatment are important. Many of the symptoms reported by Barbara above are typical of panic attacks and are considered to be major health problem in the U.S..

Panic is different from fear and other types of anxiety – as panic attacks are unexpected. They are often unprovoked, appear suddenly and increase in intensity over a 5 to 10 minute period, peaks and then rapidly goes away over 20-30 minute period. These episodes can be disabling. One explanation for the cause of the panic disorder is the bodies normal alarm system of mental and physical responses to an actual threat, which triggers and activates to a non-actual threat. Panic increases in severity by hyperventilation or focusing on catastrophic thoughts or fears.

Panic disorder – as in most types of anxiety – affects women more than men, often begins in the 20’s and 30’s, and appears to be more common in some families. Sometimes an initial episode might be related to some identified causal or contributing factors:

  • Actual or transient medical problem as a middle ear infection, allergies, mitral valve prolapse (often a mild dysfunction of this heart valve closure), hyperthyroidism, low blood sugar
  • Earlier life history of significant trauma or post-traumatic stress disorder
  • Medications use or withdrawal, stimulant or substance use, or abuse (caffeine, alcohol, opiates, etc.) in a predisposed person who is vulnerable to panic attacks
  • Life events involving major stress, losses, threats of loss or the feelings of increase vulnerability may precede attacks

The panic disorder once rooted can become recurrent and chronically disabling.

If the panic attack occurs in a specific setting, as in a store or car, irrational fears or phobias about these situations, may occur. If a person begins to avoid these situations, he (or she) can become increasingly housebound, unable to drive and develop agoraphobia (fear of public place) in addition to the panic attacks. If the person doesn’t receive effective early treatment, major incapacitation may develop.

Panic disorder mimics many other medical conditions, and it is not unusual for the sufferer to be seen by a multitude of other medical or health-related services before receiving appropriate treatment. They will often go through extensive testing at great cost. The reassurance that “nothing is wrong that’s serious,” or “it’s all in your head,” doesn’t help. Medical personnel – not familiar with the potential ravaging effect and disability caused by the illness – often treat panic disorder lightly. Treatment of panic is often done with a mild tranquilizer or just reassurance. Dr. Weissman and Associates on November 2, 1989, New England Journal of Medicine, clearly point out the need for concern.  Compared with other psychiatric condition, untreated panic disorder has an increased risk of suicidal ideation. There is an almost three-fold increase in actual suicide attempts, independent of coexistence of major depression, alcohol or drug abuse or agoraphobia.

Recovery starts with the person deciding to seek help, treatment and a more life-affirming path. Hindrances that may need attention early on could include:

  1. Medical illness
  2. Developmental impairments
  3. Dysfunctional patterns of behavior
  4. Rigid beliefs
  5. Lack of social support.

Change happens with:

  • Willingness for self-examination without blaming or taking the victim’s role
  • A commitment to positive action and to the beneficial treatments that are available
  • Gaining awareness and opening up to new knowledge
  • Becoming a more discerning consumer of health information and available care
  • Developing the motivation to take effective action for necessary changes

For more information see:

Holistic approaches to anxiety and panic may include a combination of:

  1. Combination of conventional medications
  2. Lifestyle modifications and life skill education
  3. Alternative holistic treatments
  4. Targeted nutritional applications
  5. Psychotherapeutic interventions
  6. Enhancement of awareness and spiritual practice

Through an integrative approach, individuals can gain direction, move past the immobilization of misinformation and erroneous beliefs, and find possible solutions for their adverse health conditions.

Click here for more information;   Another Resource to read; 
For support: Anxiety and Depression Association of America, ADAA

Article by Ron Parks, MD and edited by Shan Parks September 2015

Question:

What is your next step to help yourself or others that seemed troubled with anxiety or panic?  See next post — “Best Treatment of Panic and Anxiety?”

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