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
• 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

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.