Bipolar disorder: managing your symptoms from an integrative perspective

Bipolar disorder in overview
Approximately 1% of the adult population experiences persisting mood swings and fulfills criteria for the diagnosis of bipolar disorder. Bipolar disorder is a heritable mental illness. First-degree relatives of Bipolar individuals are much more likely to develop the disorder than the population at large. Bipolar illness in one identical twin corresponds to a 70% risk that the other twin will also have the disorder. This risk is estimated at 15% in non-identical twins. Recurrent episodes of mania are often associated with progressive deterioration in social and occupational functioning, and often lead to job loss and divorce. Approximately two thirds of individuals diagnosed with bipolar disorder are unemployed, although most have attended college. One fourth of Bipolar I patients attempt suicide, and 15% eventually succeed.

A diagnosis of bipolar disorder is made after an individual experiences at least one episode of mania. Mania is a symptom pattern that lasts several days or longer and consists of emotional, behavioral or cognitive symptoms including rapid speech, racing thoughts, euphoric or irritable mood, agitation, inflated self-esteem, distractibility, excessive or inappropriate involvement in pleasurable activities and diminished need for sleep. Symptoms of psychosis such as hearing voices, paranoia or delusional beliefs, may occur during episodes of severe mania or depression. A manic episode causes significant impairment in one’s ability to work, go to school or be in a relationship. In contrast ‘hypomania’ is a milder form of mania characterized by less severe symptoms that is shorter in duration. The majority of individuals diagnosed with bipolar disorder experience episodes of depressed mood more often than mania or hypomania.

Many individuals diagnosed with bipolar disorder also have problems with alcohol or drug abuse, which they may use to ‘self-medicate’ mood swings. Chronic alcohol or drug abuse can also cause erratic changes in mood that resemble the mood swings seen in bipolar disorder. Medical problems that can cause mood swings similar to the symptoms of bipolar disorder include thyroid disease, multiple sclerosis, and strokes affecting certain brain regions.

Limitations of conventional treatments
Prescription medications used to treat bipolar disorder include so-called ‘mood stabilizers’ such as lithium carbonate and divalproex; antidepressants; antipsychotics; and sedative-hypnotics. Unfortunately, currently available prescription medications used to treat both the depressive and manic phases of bipolar disorder have only limited effectiveness. This is due in part to a high rate of non-compliance with conventional pharmacological treatments among many bipolar patients, and due in part to limited efficacy of medications themselves. It is estimated that less than one third of all individuals who meet criteria for bipolar disorder receive any treatment for manic or depressive symptoms during the active phase of their illness. Because less severe symptoms of mania (i.e. ‘hypomania’) often go unreported, and because many symptoms of hypomania resemble agitation or anxiety, there is on-going debate over the rate of occurrence of bipolar disorder compared to major depressive disorder. Only half of currently available prescription medications used to treat bipolar mood symptoms are based on strong research evidence of efficacy. Fewer than half of individuals who take conventional maintenance treatments for bipolar disorder following an initial manic episode experience sustained control of their symptoms. Further, the relapse rate among bipolar patients who adhere to lithium carbonate or other conventional mood stabilizers is also very high at approximately 40%. Finally, the use of prescription antidepressants does not reduce the frequency of depressive symptoms in bipolar patients over the long term nor does it lead to increased time spent in remission.

As many as one half of patients who are treated for Bipolar disorder fail to adhere to their recommended regimens of conventional mood stabilizers, often because of adverse effects. Bipolar patients who discontinue lithium carbonate or other conventional mood stabilizers are almost certain to relapse. There is evidence that discontinuation of lithium carbonate, and other prescription medications, is associated with reduced efficacy if these medications are resumed in the future. A review of 7 studies (4 of which were randomized) involving 358 patients concluded that adding an antidepressant to lithium therapy does not substantially increase protection against bipolar depressive recurrences.

Non-medication treatments of bipolar disorder
The limited effectiveness of available mainstream treatments of bipolar disorder invite serious consideration of non-medication approaches. Natural supplements used to treat bipolar disorder include omega-3 fatty acids, magnesium, N-acetyl-cysteine, micronutrient formulas and Chinese herbal formulas. Some natural supplements may be safely combined with prescription medications increasing their efficacy. Most natural supplements are safe when a quality brand is used at the recommended dosage however some herbals and other natural supplements can have serious adverse effects especially when taken at inappropriate high dosages or in combination with prescription medications or other supplements. Non-biological approaches such as mindfulness-based cognitive therapy and yoga may help individuals improve their capacity for emotional self-regulation thus reducing the severity of mood swings.

If you are currently struggling with bipolar disorder and taking a medication that isn’t helping you control your mood swings, you are experiencing adverse effects, or you simply can’t afford to continue taking a medication that is working, you will benefit from my book Bipolar Disorder: The Integrative Mental Health Solution. The book provides practical information about a variety of non-medication approaches that will help you feel and function better such as herbals and other natural supplements, whole body approaches, meditation and mind-body practices, and many others.

Bipolar Disorder: The Integrative Mental Health Solution will help you:
• Understand bipolar disorder better
• Take inventory of your symptoms
• Learn about non-medication treatments of bipolar disorder
• Develop a customized treatment plan that is right for you
• Re-evaluate your treatment plan and make changes if your initial plan doesn’t work

Click here to preview or buy my book, Bipolar disorder: The Integrative Mental Health Solution.

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