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Complementary Bipolar Disorder Care

March 11, 2011 Written by JP       [Font too small?]

Bipolar disorder has been in the news lately because of the incessant coverage of a well known celebrity who appears to be in the midst of a mental breakdown. News outlets of every stripe just can’t get enough of this story. It doesn’t much matter whether the root cause of this current spectacle is drug use, a psychiatric condition or some combination thereof. The bottom line is that the antics involved are simply too sensational to ignore. But that’s not the reason why bipolar disorder is on my radar. Please don’t get me wrong – the psychological unraveling of any person is profoundly sad and troubling. However, when over 2% of the world’s population is affected by one form or another of bipolar spectrum disorder (BPS), that fact should occupy a much more prominent spot in the news than the struggle of any one individual.

Bipolar disorder is characterized by mood swings ranging from severe depression to manic highs. The cycling of these symptoms varies and, in some instances, both low mood and euphoria can co-exist. Severity too presents itself in a spectrum of intensity from the most debilitating classification, bipolar I disorder, to milder forms such as cyclothymia.

The latest edition of the journal Archives of General Psychiatry is the bearer of the stark statistics I mentioned in the opening paragraph. The 2.4% bipolar incidence rate is based on an evaluation of 61,392 adults in 11 countries. What’s even more disturbing to note is that fewer than half of those with bipolar disorder will receive mental health care during the course of their illness. That fact becomes even harder to swallow when you consider that roughly three-quarters of those with BPS also contend with comorbidities such as anxiety and panic disorders. (1,2)

The good news is that there are a number of complementary practices and nutritional supplements that may be of value to those living with bipolar disorder. Before I describe them, I want to emphasize that the following adjunctive options are not an alternative to professional care. Anyone who exhibits signs of or suspects that they may be dealing with a manic depressive mindset needs to seek the guidance of a trained mental health professional, at which point, alternative treatment modalities can be considered and implemented when appropriate.

The August 2010 issue of the journal Psychological Medicine features a systematic review of the “current evidence on the neurobiological changes and clinical benefits related to mindfulness meditation practice in psychiatric disorders”. The authors of the piece, based at the Institute of Psychiatry at the University of Bologna, Italy, report that Mindfulness Based Cognitive Therapy (MBCT) has shown promise in “reducing relapses of depression in patients with three or more episodes”. MBCT is a relatively new mind-body therapy that combines elements of cognitive behavioral therapy with mindfulness meditation. Two peer-reviewed trials from 2010 and 2008 indicate that MBCT can reduce the severity of anxiety and depressive symptoms in those with bipolar disorder. At least two additional studies are currently underway to test and verify this promising line of research. (3,4,5,6,7)

Omega-3 fatty acids, such as those found in flax seed oil and fish oil, may likewise be of value to adults and children with BPS. A trial published in March 2010 examined the impact of giving up to 12 grams/day of flax oil or olive oil to 51 adolescents and children with “symptomatic bipolar I or bipolar II disorder”. At first, the results seemed rather underwhelming. On average, those receiving flax oil did not exhibit significant improvement in depressive symptoms as compared to the placebo (olive oil) group. However, upon a more methodical analysis, the researchers found that patients who efficiently converted an omega-3 fatty acid in flax (alpha linolenic acid) into a more usable form (EPA) demonstrated a decrease in illness severity. This finding may explain why several previous trials using fish oil reported much more promising results. EPA or eicosapentaenoic acid is one of the main omega-3 fatty acids contained in fish oil. What’s more, a recent meta-analysis presented in the Journal of the American College of Nutrition specifically singles out EPA as the primary fatty acid responsible for the antidepressant properties of fish oil. (8,9,10,11,12)

Case reports are considered one of the least reliable forms of medical evidence. They detail specific findings in an individual patient that may be a fluke or could possibly have implications for other patients or even the population at large. This is why prestigious medical journals sometimes accept case histories for publication. In rare instances the medical literature will go so far as to present multiple case reports about a given substance. A micronutrient supplement by the name of EMPowerplus falls into this unusual category. The product itself contains 36 familiar ingredients which are mostly comprised of well known minerals and vitamins. A database analysis in the September 2010 issue of the journal BMC Psychiatry describes the most compelling evidence to date about EMPowerplus. In the open label analysis, a group of 120 adolescents and children with bipolar disorder were evaluated with respect to their response to EMPowerplus supplementation. A total of 46% of the young subjects responded to the treatment as assessed by a 50% or more reduction in symptom severity. Medication use among these “responders” also dropped by 52% over the 3 to 6 month evaluation period. It’s interesting to note that attention deficit hyperactivity disorder (ADHD) symptoms also diminished in the youngsters regardless of age or gender. But, no matter how promising these findings appear to be, the authors of the paper are quick to point out that controlled, scientific studies are still needed to verify the initial promise of the published case studies and this database analysis. (13,14,15)

Bipolar Severity May Decline As Serum EPA (Omega-3) Levels Rise

Source: Bipolar Disord. 2010 Mar;12(2):142-54. (link)

The current edition of the Journal of Affective Disorders provides clues about why dietary improvement and nutritional supplements may be of value to those with bipolar disorder. Researchers from the University of Melbourne, Australia delved into the topic of diet quality in healthy women and those with BPS. They discovered a distinct dietary pattern that dramatically raised the likelihood of being bipolar: eating foods with a higher glycemic load that are typically associated with “modern” or “western” dietary habits. In contrast, women who ate a more “traditional” diet were 47% less likely to be bipolar. Not only does this imply that a diet rich in carbohydrates and processed foods contributes to poor mental health, but it also suggests that eating a traditional, whole food based diet may afford some degree of protection. (16)

In order to truly embrace the concept of holism, I make it a point to look for the unintended consequences of embracing any given treatment. When I consider the three natural health candidates described today, it seems highly unlikely to me that their use would cause harm. Fish oil, meditation and multivitamin-minerals are hardly common health hazards when applied judiciously. But beyond that, I think all three also hold promise in addressing some of the medical issues that often go hand-in-hand with bipolar disorder. Specialists in the field of cardiology and psychiatry have long noted that bipolar patients frequently exhibit “excess cardiovascular risk”. All three of the alternatives mentioned today are documented as agents that can lower the risk of heart disease. This is yet another reason to consider an integrative treatment strategy even, or especially, when dealing with serious mental health concerns. (17,18,19,20,21)

Note: Please check out the “Comments & Updates” section of this blog – at the bottom of the page. You can find the latest research about this topic there!

Be well!

JP

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10 Comments & Updates to “Complementary Bipolar Disorder Care”

  1. Keith Says:

    Bi-polar is a very serious disorder. I know people who have had it and it can be devastating on a person’s life. Good post.

  2. JP Says:

    Thank you, Keith.

    Be well!

    JP

  3. Heidi Says:

    Thank you for this post. I have bipolar disorder. Although I am under great care by my doctor, I worry about the ‘side-effects’ of this illness (esp. cardiovascular issues). Alternative or supplemental treatments are always worth a look/try. Thank you for providing such great information.

  4. JP Says:

    Thank you, Heidi!

    Be well!

    JP

  5. JP Says:

    Updated 12/21/15:

    http://online.liebertpub.com/doi/10.1089/cap.2015.0132

    J Child Adolesc Psychopharmacol. 2015 Dec;25(10):764-74.

    A Randomized Controlled Trial of Individual Family Psychoeducational Psychotherapy and Omega-3 Fatty Acids in Youth with Subsyndromal Bipolar Disorder.

    OBJECTIVE: This pilot study evaluates efficacy of omega-3 fatty acid supplementation (Ω3), individual family psychoeducational psychotherapy (IF-PEP), and their combination in youth with subsyndromal bipolar disorders (bipolar disorder not otherwise specified [BP-NOS], cyclothymic disorder [CYC]).

    METHODS: This study was a 12 week, randomized trial of Ω3 versus placebo and IF-PEP versus active monitoring (AM) using a 2 × 2 design (Ω3 + PEP: n = 5; Ω3 + AM: n = 5; placebo + PEP: n = 7; placebo + AM: n = 6). Twenty-three youth ages 7-14 with BP-NOS or CYC were recruited via community advertisements and clinician referrals. Participants could be taking stable medication for attention-deficit/hyperactivity disorder and sleep aids, but no other psychotropics. Independent evaluators assessed participants at screen, baseline, and 2, 4, 6, 9, and 12 weeks. Primary outcome measures were the Kiddie Schedule for Affective Disorders (K-SADS) Depression (KDRS) and Mania (KMRS) Rating Scales, Children’s Depression Rating Scale-Revised (CDRS-R), and Young Mania Rating Scale (YMRS). Ω3/placebo conditions were double-blind; independent evaluators were blind to psychotherapy condition.

    RESULTS: Most participants (83%) completed the 12 week trial. Side effects were uncommon and mild. Intent-to-treat analyses indicated significant improvement in depressive symptoms (KDRS) for combined treatment relative to placebo and AM (p = 0.01, d = 1.70). Across groups, manic symptoms improved over time without significant treatment effects. Effect of IF-PEP on child depression compared with AM was medium (d = 0.63, CDRS-R) to large (d = 1.24, KDRS). Effect of Ω3 on depression was medium (d = 0.48, KDRS).

    CONCLUSION: IF-PEP and Ω3 are well tolerated and associated with improved mood symptoms among youth with BP-NOS and CYC.

    Be well!

    JP

  6. JP Says:

    Updated 05/27/16:

    http://www.ncbi.nlm.nih.gov/pubmed/27226262

    Bipolar Disord. 2016 May;18(3):221-32.

    Blue-blocking glasses as additive treatment for mania: a randomized placebo-controlled trial.

    OBJECTIVES: The discovery of the blue lightsensitive retinal photoreceptor responsible for signaling daytime to the brain suggested that light to the circadian system could be inhibited by using blue-blocking orange tinted glasses. Blue-blocking (BB) glasses are a potential treatment option for bipolar mania. We examined the effectiveness of BB glasses in hospitalized patients with bipolar disorder in a manic state.

    METHODS: In a single-blinded, randomized, placebo-controlled trial (RCT), eligible patients (with bipolar mania; age 18-70 years) were recruited from five clinics in Norway. Patients were assigned to BB glasses or placebo (clear glasses) from 6 p.m. to 8 a.m. for 7 days, in addition to treatment as usual. Symptoms were assessed daily by use of the Young Mania Rating Scale (YMRS). Motor activity was assessed by actigraphy, and compared to data from a healthy control group. Wearing glasses for one evening/night qualified for inclusion in the intention-to-treat analysis.

    RESULTS: From February 2012 to February 2015, 32 patients were enrolled. Eight patients dropped out and one was excluded, resulting in 12 patients in the BB group and 11 patients in the placebo group. The mean decline in YMRS score was 14.1 [95% confidence interval (CI): 9.7-18.5] in the BB group, and 1.7 (95% CI: -4.0 to 7.4) in the placebo group, yielding an effect size of 1.86 (Cohen’s d). In the BB group, one patient reported headache and two patients experienced easily reversible depressive symptoms.

    CONCLUSIONS: This RCT shows that BB glasses are effective and feasible as add-on treatment for bipolar mania.

    Be well!

    JP

  7. JP Says:

    Updated 06/13/16:

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4882968/

    Int J Prev Med. 2016 May 19;7:77.

    Effects of Omega-3 Supplement in the Treatment of Patients with Bipolar I Disorder.

    BACKGROUND: Fatty acids play various physiological roles in the organism; they are crucial for the structure of cell membranes, metabolic processes, transmission of nerve impulses and brain functions. In recent years, particular attention has been paid to the rich sources of omega-3 for the treatment of many diseases, especially mental illnesses. The present study aimed to investigate the effects of omega-3 supplement in the treatment of patients with bipolar I disorder (BID).

    METHODS: In this double-blind clinical trial, 100 patients suffering from BIDs were randomly divided into two, i.e. control (n = 50) and experimental (n = 50) groups. In addition to the other standard treatments, 1000 mg of omega-3 supplement was given to the experimental group on daily basis for 3 months and placebo was given to the control group. The Young Mania Rating Scale was completed for both groups before and after the intervention. Afterward, data were analyzed using paired t-test, independent t-test, and Chi-square test.

    RESULTS: Before intervention, mean severity of mania in the experimental group (23.50 ± 7.02) and control group (23.70 ± 8.09) was not significant (P ≤ 0.89). The difference after the intervention in the experimental group (10.64 ± 3.3) and control group (20.12 ± 6.78) was significant (P < 0.01). The mean intensity of mania before (23.50 ± 7.02) and after (10.64 ± 3.3) intervention reported to be significant at P < 0.05.

    CONCLUSIONS: Since omega-3 supplement was effective for the treatment of BID, it is suggested to use omega-3 supplements as an adjuvant therapy along with the other pharmacotherapies.

    Be well!

    JP

  8. JP Says:

    Updated 10/04/17:

    https://www.ncbi.nlm.nih.gov/pubmed/28969438

    Am J Psychiatry. 2017 Oct 3.

    Adjunctive Bright Light Therapy for Bipolar Depression: A Randomized Double-Blind Placebo-Controlled Trial.

    OBJECTIVE: Patients with bipolar disorder have recurrent major depression, residual mood symptoms, and limited treatment options. Building on promising pilot data, the authors conducted a 6-week randomized double-blind placebo-controlled trial to investigate the efficacy of adjunctive bright light therapy at midday for bipolar depression. The aims were to determine remission rate, depression symptom level, and rate of mood polarity switch, as well as to explore sleep quality.

    METHOD: The study enrolled depressed adults with bipolar I or II disorder who were receiving stable dosages of antimanic medication (excluding patients with hypomania or mania, mixed symptoms, or rapid cycling). Patients were randomly assigned to treatment with either 7,000-lux bright white light or 50-lux dim red placebo light (N=23 for each group). Symptoms were assessed weekly with the Structured Interview Guide for the Hamilton Depression Scale With Atypical Depression Supplement (SIGH-ADS), the Mania Rating Scale, and the Pittsburgh Sleep Quality Index. Remission was defined as having a SIGH-ADS score of 8 or less.

    RESULTS: At baseline, both groups had moderate depression and no hypomanic or manic symptoms. Compared with the placebo light group, the group treated with bright white light experienced a significantly higher remission rate (68.2% compared with 22.2%; adjusted odds ratio=12.6) at weeks 4-6 and significantly lower depression scores (9.2 [SD=6.6] compared with 14.9 [SD=9.2]; adjusted β=-5.91) at the endpoint visit. No mood polarity switches were observed. Sleep quality improved in both groups and did not differ significantly between them.

    CONCLUSIONS: The data from this study provide robust evidence that supports the efficacy of midday bright light therapy for bipolar depression.

    Be well!

    JP

  9. JP Says:

    Updated 08/19/18:

    https://www.karger.com/Article/Abstract/492537

    Neuropsychobiology. 2018 Sep 18:1-8.

    The Impact of Probiotic Supplements on Cognitive Parameters in Euthymic Individuals with Bipolar Disorder: A Pilot Study.

    INTRODUCTION: Cognitive dysfunction is prevalent in depressive as well as manic episodes in individuals with Bipolar Disorder (BD). Even more, after symptom remission, many individuals with BD experience persisting cognitive impairment also in euthymic periods, leading to high illness burden and low quality of life. According to a recent research in animals and healthy humans, microbiota may influence cognitive processes via the brain-gut axis. A strategy to examine the role of the microbiota in different diseases is the intake of supplements that modulate the gut microbiome. The aim of this pilot study was to analyze the impact of probiotic supplements on cognitive parameters in a cohort of euthymic individuals with BD, receiving daily probiotic treatment over a time period of 3 months.

    METHODS: A total of 20 euthymic individuals with BD received probiotic supplement over a time period of 3 months and completed a cognitive test battery at 3 time points (t1 at time of inclusion, t2 after one month and t3 after 3 months of probiotic intake).

    RESULTS: We found a significant improvement of performance concerning attention and psychomotor processing speed measured with the Digit Symbol Test after one (t2) as well as after 3 months (t3) of treatment (F = 8.60; η2 = 0.49, p < 0.01). Furthermore, executive function measured with the TMT-B, increased significantly over 3 months (F = 3.68; η2 = 0.29, p < 0.05).

    CONCLUSION: The results confirm the hypotheses that probiotic supplement might help stable individuals with BD to improve the cognitive function, which in turn might lead to better psychosocial, occupational, work and financial functioning. Nevertheless, the idea of this potential new treatment is challenging because of the variety of the human's gut microbiota.

    Be well!

    JP

  10. JP Says:

    Updated 10/22/18:

    https://www.karger.com/Article/Abstract/493867

    Neuropsychobiology. 2018 Oct 19:1-9.

    Probiotic Treatment in Individuals with Euthymic Bipolar Disorder: A Pilot-Study on Clinical Changes and Compliance.

    The importance of the microbiome for psychological well-being has gained rising interest in the last decade. A strategy to examine the role of the microbiome in different diseases is the intake of supplements that modulate the gut microbiome. Despite promising results in animal studies, research in humans is sparse to date and especially in individuals with psychiatric disorders almost missing. The current report of the ProbioBIP-one pilot study aims at describing general effects of the intake of the probiotic OMNi-BiOTiC Stress repair® on psychological parameters as well as gastrointestinal symptoms and general compliance in a cohort of euthymic individuals with bipolar disorder (BD), receiving daily probiotic treatment over a time period of 3 months. Twenty-seven individuals with BD took part in the present study (mean age = 50.7 years, SD = 12.2; females 40.7%). In sum, there was a high compliance rate with 81.5% of the study participants completing all 3 study visits and 85% of planned probiotic ingestions taken. Gastrointestinal problems were prevalent in more than half of the patients at the time of inclusion (t1). Expectedly, in the whole cohort, a high proportion of study participants experienced changes concerning digestion during probiotic treatment, around one third reported positive changes (reduced flatulence and easier and more frequent bowel movements) after 1 month (t2) and further after 3 months (t3). In contrast, a smaller part of study participants reported gastrointestinal discomfort after 1 and after 3 months (mainly flatulence and obstipation). We found a significantly reduced cognitive reactivity to sad mood between t2 and t3 indicating that participants under probiotic supplementation perceived themselves to be less distracted by ruminative thoughts. Further changes in psychiatric symptoms were small due to the euthymic state and already low scoring at the time of inclusion. Nevertheless, we found a significant symptom reduction in the rating scales measuring manic symptoms. From a clinical point of view, probiotic supplementation might provide a well-tolerated tool to positively influence gastrointestinal quality of life as well as mental and somatic health, cognition and immune response and potentially have effects on psychiatric symptoms.

    Be well!

    JP

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