Important Warning: The
following web page is provided for information purposes only. It covers
possible complementary treatment approaches that can be used with bipolar
disorder medications. The adoption of any of these complementary treatments
should be done with a psychiatrist's knowledge and approval as part
of a person's complete treatment plan. In fact since many psychiatrists
may not be familiar with these complimentary treatments we recommend
you print out this information and give it to your psychiatrist or physician
when you meet with them so that they understand the research behind
the therapies.
Complimentary Bipolar Disorder Treatments - Table of Contents
- Bipolar Disorder Treatments that Have Shown Some Benefit in Extensive
Scientific Testing
- Biplar Disorder Treatments Being Researched that are Showing
some Early Positive Results
- Disproven (or Unproven) & Overmarketed "Bipolar Disorder
Treatments"
- Questionable Therapies (ASK YOUR DOCTOR AND USE WITH CAUTION)
- EPA Omega-3 Fish Oils - Research suggests
that people that have Bipolar Disorder may benefit by up to a 25% reduction
in symptoms when they take fish oil capsules that are high in the EPA
(a type of Omega-3 fatty acid) form of oil. It is important to be careful
about the type of fish oil you are using - because not all fish oils
are effective. The researchers at the University of Scheffield tell
us that "What people really need to be looking at is the amount
of EPA in the fish oil they are buying. Our data from previous studies
suggests that DHA is of little use in the treatment of bipolar disorder
but EPA is the substance that yield the best results. Dosage wise it
is suggested that about 2,000 mg/day to 4,000 mg/day ( 2 to 4 grams/day)
should help."
Some of our community members have have had good luck with the Now
Foods "Super EPA" and "MaxEPA" vitamins purchased
from iherb.com -
but we encourage you to shop around for the best deal for you. We must
be particularly careful in purchasing vitamin supplements because it
is an entirely unregulated industry and many less than reputable organizations
sell products that do not actually contain the specified doses or have
other ingredients - this seems like a particular problem with vitamins
coming from Canada. We recommend that any source you choose have a certified
"GMP" (Good Manufacturing Practices) certification and
approval. (Look for the GMP stamp on the label). Also, Look for products
that have a 'UPS' (United States Pharmacopeia) stamp on the label
(Please note that there are no studies that the bipolar disorder
researchers we are in contact with are aware of that support the
idea that any type of vitamin or fatty acid (EFA) will cure bipolar
disorder. There are currently no cures for bipolar disorder.)
- Strengths:
- Low cost and Wide availability of EPA fish oil capsules in
North America, Europe and Asia.
- Low Risk - EPA fish oil has been consumed by people for thousands
of years and appear to have little or no side effect or negative
impact on the body (We recommend only "GMP"
(Good Manufacturing Practices) certified EPA fish oils from
leading vitamin companies (such as Now Foods, and Twinlabs -
to name two).
- Weaknesses:
- Some research has suggested that fish oils may be "pro-oxidative"
and therefore it may be advisable to take some antioxidant vitamins
(vitamin E, vitamin C, Alpha Lipoic Acid, etc.) at the same
time as the fish oil).
- Details and Research:
- Other Vitamins and Nutrients
There is a wealth of anecdotal information out there from people
suffering from a multitude of depressive disorders, who claim that
various nutritional supplements help them to manage their disorder.
The effect of adequate (or supplementary) vitamin and mineral intake
seems to be a fairly individualized matter; as such, any nutritional
adjustments should be checked with your treating psychiatrist, and
self-monitoring of symptoms will probably tell you the most about
what does and does not work for you. Keep track of your own nutritional
profile by getting a lab analysis of essential vitamin and mineral
levels in your blood - this should identify any major deficiencies.
However, there has been some research (in addition to case studies
and anecdotal evidence) that indicate specific nutrient deficiencies
can excaserbate depressive symptoms, anxiety, insomnia, or other symptoms
that commonly trouble people with bipolar disorder. The following
is a partial list, compiled from numerous scientific and personal
patient sources, of nutritional supplements that have shown some benefit:
- Vitamin B Complex - some studies have indicated
that deficiencies in Vitamins B1 (thiamin), B2, B6, and B12 can
contribute to depression. There has also been preliminary evidence
to show that supplements of B-vitamin complexes (in general, these
B vitamins are taken together) improves symptoms in depressed subjects.
- Folate/Folic Acid - found in leafy green vegetables,
oranges, and other fruits (as well as over-the-counter supplements),
folate may improve the functioning of some antidepressants, helping
to reduce depression symptoms. However, another source (Pendulum
Resources - independent info site) warned manic-depressive patients
to use folic acid with caution, as too much may induce mania. This
is probably a good one to ask your doctor or psychiatrist about,
if you have particular problems controlling depressions.
- L-Tryptophan - an amino acid that the body uses
to make the neurotransmitter serotonin. L-tryptophan might possibly
help relieve depression; however, its role in improving the specific
symptoms of bipolar disorder is unclear and unproven. Supplements
are usually only available by prescription. 5-hydroxy-tryptophan
(or 5HT) is a related compound that is sold over- the-counter, and
has shown more positive results in alleviating depression for patients
with bipolar disorder.
- Vitamin C (ascorbic acid) - this vitamin is being
preliminarily examined for beneficial effects in manic-depressive
patients. Vitamin C helps to clear Vanadium from the body, a trace
mineral that is sometimes abnormally high in bipolar patients. The
research studies on this topic (see below) also showed that patient
symptoms improved with a reduced-Vanadium diet. The Yale-New
Haven Health Complementary Medicine website recommends that:
"until more is known, people with bipolar illness should avoid
supplements containing vanadium and consider supplementing with
vitamin C."
- Lecithin (Phosphatidyl Choline) - available in
health food stores, this compound is an acetylcholine (brain neurotransmitter)
precursor). Anecdotal evidence (and to some extent, older research)
report it to have mood stabilizing effects. Most writers recommend
starting with a low dose (about 2 capsules) and gradually increasing
if necessary, splitting up the doses over the course of the day.
- ECT (Electro-Convulsive Therapy)
Research suggests that Electroconvulsive therapy (ECT) has a modest
but definite role to play in the treatment of depression despite the
adverse publicity it has received.
- Various Psychotherapies - CBT, Family,
Interpersonal, etc.
Medication is an essential component to controlling bipolar symptoms;
however, for many people, it is not the only component of treatment.
Patients in research studies who receive a combination of psychotherapy
and medication treatment often have better outcomes than simply medication
or therapy alone. Effective psychotherapy programs can equip you with
solutions to various life challenges (stress, family relationships,
work, school, social gatherings, etc) that can make your illness worse.
Many kinds of therapy programs exist - the ones most frequently cited
in literature are Cognitive Behavioral Therapy, Family Focused Therapy,
and Interpersonal Therapy. Sometimes the therapist can make all the
difference, and not all psychiatrists or therapists are equal. Check
with a local support group or friends/family for recommendations about
good therapists and programs that they have tried. Don't be afraid
to move on if, after a reasonable amount of time, you are not seeing
positive results.
- Maintaining Balance and Predictability In Your Life:
This is actually a very important part of managing bipolar disorder
over the long-term. Helping to control your stress levels and general
health through predictable routines, exercise, good diet, adequate sleep,
and other strategies is essential for helping your medication do its
job. According to studies presented at the International Conference
on Bipolar Disorder in 1997, patients who experienced disruptions in
normal daily activities, including sleeping and eating meals, were more
susceptible to new episodes of mania, depression, and relapse. Patients
who maintained a more predictable routine fared much better.
The following information about the role of stress in exacerbating
bipolar symptoms is from Rev. Dr. James T. Stout, diagnosed with manic-depression
and author of "Rebuilding Your LIfe: Bipolar Disorder" (2004).
It is drawn both from his own experience and from scientific research:
- Stress, both good (for example, meetings, parties, social outings,
movies, working, phone calls, etc) and bad, can worsen symptoms
of mania or depression
- In 60% of cases, the first occurence of major depression or mania
is immediately preceded by a significant stressor
- The more mood swings one experiences, the more one is vulnerable
to future relapses. Moreover, the effectiveness of medication may
be decreased.
- Irregularity in a person's routine can incite mania.
Each person can identify things in their lives that are chronic stressors
for them; they will not necessarily be the same as the ones cited above.
Pay attention to your own life rhythms, and try to list for yourself
what things or events tend to increase y our stress levels and/or trigger
a manic episode. It's a great idea to share such a list with family
and close friends as well, so they can help you maintain a low-stress
environment.
- Suggestions
from the Depression and Bipolar Support Alliance for reducing stress
and otherwise managing a mood disorder with a healthy lifestyle.
Many components can contribute to maintaining overall health and balance
in your own life. Below are some of the researched techniques that have
proven helpful for managing life with bipolar disorder.
- Getting Adequate and Predictable Sleep. Loss of sleep
is stressful for anyone, but studies have shown that sleep loss can
be a specific trigger of manic episodes. In one study from the Western
Psychiatric Institute and Clinic, researchers identified sleep loss
as the strongest common difference between subjects who experienced
manic episodes and subjects who did not (the study had 39 total subjects,
and lasted 8 weeks). Another study in the Journal of Clinical Psychiatry
(Keck 2004) states:
"sleep patterns are reliable indicators of whether a patient with
bipolar disorder is likely to relapse or sustain remission in the near
term. Regularly scheduled nightly sleep periods may help prevent rapid
cycling in patients with mania, while perturbations in circadian rhythms
may be early markers of impending relapse." Because manic episodes
often involve insomnia, mania triggered by a loss of sleep can become
a self-reinforcing cycle.
Getting too much sleep may also trigger depression, so it's
important to establish how much sleep you need to function at your
best. Most people need between 6-8 hours. It is best to establish
a routine time for going to bed and waking up each day, and limit
caffeine and/or nicotine starting in mid-afternoon.
Some medications (most notably, SSRI antidepressants)
can cause insomnia or sleep difficulties. Check with your doctor about
the side effects of the medications (both prescription and over-the-counter)
that you regularly take.
- Getting Adequate Daily Exercise. The mood-lifting
effects of exercise are now well-documented by research. Exercise can
be a vital alternative for managing bipolar depression, given the various
problems that antidepressants can cause for this condition. A study
from Duke University noted that over a 16-week period, majorly depressed
subjects who walked or jogged for 30min 3 times a week enjoyed the same
mood benefits as subjects who recieved medication, or subjects who had
a combination of exercise and medication therapy. Lead researcher James
Blumenthal concludes that: " exercise may be just as effective
as medication and may be a better alternative for certain patients."
Both aerobic and non-aerobic (i.e. strength-training) exercise can
provide benefits; the key seems to be a regular, scheduled routine.
Most studies noting the positive benefits of exercise on mood have
subjects exercising at least 3 times a week. It may take a few weeks
or a month of regular exercise before you notice significant results.
If you have not exercised regularly in the past, it is perfectly fine
to start small and slowly work your way up. A few minutes of walking
(a trip or two around the block) on most days is a great starting
point, and as you feel stronger you can work your way up. Concentrate
on what makes you feel good, and try to choose an activity that you
already enjoy.
- Interpersonal and Social Rhythm Therapy (IPSRT) has
gotten a lot of attention as a promising adjunct to medication treatment.
It is a focused psychotherapy program meant to identify the most chaotic
or unstable elements in an individual's life, and then work to establish
more routine and predictable patterns.
Treatments Undergoing Research that are Showing
some Early Positive Results
Trancranial Magnetic Stimulation (TMS) - There's preliminary
evidence that TMS offers for bipolar disorder a less drastic alternative
to electroconvulsive therapy (ECT), the treatment of last resort for
people with severe depression. At the same time, investigators acknowledge
that there's much they don't know about how TMS affects the brain.
Additional TMS validation studies are needed and are underway. For
more information, or to participate in the studies, contact Stanford
University TMS and Bipolar Disorder Research.
- Stem Cell-Based Therapies - In 2003, researchers
from the University of Illinois Department of Psychiatry stated that
"The use of stem cells for neuroreplacement therapy is no longer
science fiction--it is science fact. We have succeeded in the development
of neural and mesenchymal stem cell transplantation to produce neural
cells in the brain. We have seen the improvement of cognitive function
in a memory-impaired aged animal model following stem cell transplantation.
These results may promise a bright future for stem cell strategies.
"
There is, therefore, some preliminary research evidence that embryonic
stem cells could offer a means to a therapy that could mitigate bipolar
disorder. In 2001, President Bush halted a National Institutes of Health
plan to fund research on embryonic stem cells. Key supporters of the
administration believed that the research immorally destroys early human
life. The cells are extracted from days-old embryos created in fertility
laboratories, consisting of about 150 cells, that are together smaller
than this "." at the end of this sentence. Excess embryonic
stem cells are regularly discarded from human fertility clinics when
they are no longer needed.
(Photo of a microscopic view of a colony of undifferentiated
human embryonic stem cells)
In 2001, the US House of Representatives had passed a bill that criminalized
reproductive cloning, or making cloned babies. But it also targeted
creating cloned human embryos in the laboratory. Many scientists believe
such methods are potentially important in stem-cell research, for
instance as a way to create customized stem cells bearing the DNA
of living individuals.
Currently there is very little embryonic stem cell research taking
place in the US due to the Bush Administration's regulations.
If you believe that a cure for bipolar disorder (as well as Alzheimer's,
diabetes, heart disease, spinal-cord injury or Parkinson's disease)
is worth diverting some of the thousands of embryonic stem cells from
the fertility clinic garbage cans to University researchers working
on cures for these diseases, please support therapeutic embryonic
stem cell cloning (duplicating) and research.
Discredited or Disproved or over-marketed "treatments" for
bipolar disorder
- EM power+ (Empowerplus) by Synergy, or Truehope
Nutritional Support
EM power+ (also referred to as Empowerplus) is a vitamin and mineral
product that was formulated by two lay people (i.e. non-scientists)
in Alberta, Canada as a supposed cure for various psychiatric conditions
like bipolar disorder and bipolar disorder. The product contains 36
different ingredients and was originally made by a lab in Utah but is
now made by another lab in California and has a different formula than
the original product but has the same name.
The company, called Synergy or Truehope Nutritional Support, claims
that there is considerable research to back up their claims but the
early research at the University of Calgary was very preliminary (see
information below) and the clinical trial that was begun at Calgary
was halted by Canadian government officials as the product was not approved.
In fact, the Canadian government has issued a health hazard warning
informing people not to use the product because it has not been proven
safe and because the company is encouraging people to go off prescribed
medications.
The Office for Human Research Protection (OHRP) in the US felt that
the research into this product that was also being done at the University
of Utah did not have sufficient benefit to outweigh the risks. The OHRP
also found that no research was being conducted on this product at Harvard.
There is at least one lawsuit that we are aware of by a family of a
man that states their son went off his medications, began taking the
Empowerplus product, and quickly got worse and now they can't get him
back on his medication because he is psychotic. Another group is working
on a class
action lawsuit against Truehope and the company is now facing six
additional charges by the Canadian government related to unproven claims
that the company has made. We believe that these products are still
freely sold in the USA because there are few laws regulating sale of
"supplements" in the USA.
A recent (July, 2004) news article from Canada suggested that:
"An Alberta health food company (Truehope) that claims to have
a cure for mental illnessesis facing six charges under the Food and
Drugs Act for allegedly importing and selling its product without government
approval.
The charges come nearly a year after RCMP and Health Canada raided
the Raymond main office of Truehope Nutritional Support Ltd.
Truehope, along with its related company Synergy Group of Canada Inc.,
markets a nutritional supplement called Empowerplus that it believes
can cure a variety of mental illnesses such as bipolar disorder.
But Canadian law forbids companies from making health claims about
its products without first compiling a certain amount of scientific
proof to back them up, and Health Canada says Synergy has not yet met
those standards.
Empowerplus is an amalgam of about 36 vitamins, minerals and anti-oxidants,
many of which are commonly sold over the counter. (Note: the product
sells for up to $700 per month making it one of the world's most expensive
mix of common vitamins.)
Health Canada issued an advisory June 6, 2003, warning people not to
take Empowerplus because it could put their health at risk."
If you've been tempted to consider this product we encourage you to
read up on the history of the product and company, compare prices for
other vitamin pills (see information above), talk with your psychiatrist
and make your own fully-informed decision.
bipolar disorder.com considers this product to be unproven, with risks
and costs that currently outweigh possible benefits. In fact we agree
with Dr. Philip Long's assesment of the product:
"This commercial group (TrueHope/Synergy) has claimed to have
discovered a vitamin mixture that has "totally resolved Bipolar
Disorder, bipolar disorder, Depression, Autism, Chronic Fatigue Syndrome,
and Fibromyalgia" (quoting from a brochure I received in Vancouver
advertising their lecture at Douglas College). These false claims
of miraculous cures are a medical fraud - period."
"Think about it - if there was a vitamin mixture that cured
Bipolar Disorder, bipolar disorder, Autism etc. - why wouldn't the
recipe for this major discovery just be posted on the Internet so
all could benefit. EM Power is just a mixture of commonly used vitamins
and minerals that anyone can buy at a local health foods store. Why
the big secret? Why won't EM Power publish what is in their vitamin
mixture? You know the answer - money. EM Power is a typical medical
scam promising miracle cures. This isn't the first, and it won't be
the last, of medical frauds that use naive individuals, like Dr. Kaplan,
to promote a totally bogus miracle cure for mental illness."
Quote from (Dr.
Philip Long), the psychiatrist founder of Internet
Mental Health.
The product is, in our opinion, burdened by excessively positive marketing
claims (it is our belief that any claims that a product is a "cure
for bipolar disorder" need large, duplicated research studies done
by indeptendent organizations otherwise they are just marketing hype
and something to be avoided.) Given the minimal testing the Empowerplus
product has received, as well as by lack of information (the company
won't reveal what is in the product) and very high costs - we've seen
estimates that monthly costs can range from $60 to $700 Canadian $ for
a vitamin mix that would likely cost only a couple of dollars if purchased
independently) - suggesting gross profit margins for the TrueHope "Nonprofit"
in the 95% or higher range - which, if not illegal, certainly is (in
our view) of questionable ethics for a company/nonprofit (they seem
to have a bit of both) that claims to be focused on helping mentally
ill people. We recommend you avoid "TrueHope" - but read
up on the benefits of other vitamins that have much more research behind
them and are available for a fraction of the cost of the "empowerplus"
products. For more information and research on Empowerplus, as well
as expert opinions, see:
- A book on the company and products is available at http://www.pigpills.com
- Here is the Dr.
Phil Long's analysis and opinion on Empowerplus (Note: Dr. Long
is a well known Canadian psychiatrist who founded the non-profit web
site Mentalhealth.com
- one of the world's leading mental health web sites)
- Information on the company and its product history is available at:
Canadian Quackery Watch - Scroll Down Page to get to the Empowerplus
information.
- The Medical Post article on the company: "Vitamin
Company Tells Psych Patients to Stop Meds"
- Another Story: Pigs
Will Fly - Medical Post, January/February 2004
- Even Dr. Hoffer - a strong supporter of vitamins use in the treatment
of bipolar disorder, states that any advice that a psych patient should
go off his meds "should be condemned".
Hoffer
Commentary: http://www.medicalpost.com/mpcontent/article.jsp?content=/content/EXTRACT/RAWART/3721/14A.html
- Health
Canada Warning on Empowerplus:
- Health
Canada executes search warrant related to EM Power plus
- OHRP Condemnation of research:
http://ohrp.osophs.dhhs.gov/detrm_letrs/YR02/aug02e.pdf
- Here is the formal complaint against the University of Calgary by
health Canada. To go to subsequent pages, click on the links on the
bottom:
http://www.friendsoffreedom.org/images/Research%20Articles/True-Hope-vs-Health-Canada/bonnie.html
- Raid!
- First by halting a Calgary trial and then by seizing product shipments,
Health Canada has pulled the plug on a controversial neutraceutical
being sold as a treatment for mental health disorders.
- Citizens For Responsible
Care and Research - on Empowerplus research
- Dr. Jim Phelps analysis of the True hope product
Mega-Vitamin Therapies - Mega-dose Vitamins (very
large - i.e. 200%+ of RDAs (Recommended Daily Allowances) of vitamins have
also been marketed as a "cure" for bipolar disorder. Again - research
has proved this claim innacurate many years ago. As you should expect by
now - if anyone makes any claims about a cure for bipolar disorder - ask
for some 3rd party validation studies from the major bipolar disorder research
centers around the world.
Relevant Research:
Music Therapy - Music therapy is one of those
things that sounds great, if you'll pardon the pun, but doesn't seem to
deliver much. Perhaps it is dependent upon the type of music - since if
you listen to low-key, relaxing music it would seem to be likely that it
would lower your stress levels and therefore be beneficial. If however,
you're listening to acid rock/heavy metal with loud electric guitar solos
- you're probably not doing anyone a favor, including yourself. Right now
the prognosis for music therapy for bipolar disorder unfortunately doesn't
look good - though we certainly wish that it did. Music may, however, be
useful as a means of relaxation or group discussion stimulus. Future research
may reveal more positive results.
Relevant Research:
Questionable Therapies - to be used with
extreme caution, and always under medical guidance
- St John's Wort, or hypericum, is a popular herbal
remedy for mild to moderate depression. However, just because something
is "natural" does not mean it is totally safe to use. In the
case of bipolar patients, St. John's Wort can induce mania just like
prescription antidepressant medications. Moreover, it can interact with
some other common drugs, rendering them significantly less effective
or inducing other dangerous side effects. ALWAYS check with your doctor
before taking any herbal or nutritional remedy on a regular basis, particularly
if you are on other prescription medications.
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