Mania Vitamins: Attention to Potency of Therapy

Thoughts on mania

Our brains feed on stimulation. New experiences, and ideas, and learning in general, are exciting.
But with mania, excitement comes without the counterbalance. So one cannot distinguish whether one idea is more relevant than another. And information can come so fast, that it cannot be integrated with past knowledge. Eventually, neurotransmitter pathways can be so overloaded that neurons do not have time to recover between messages.
Essentially, excitatory messaging and/or second-messaging predominate, excluding inhibitory activity needed to maintain useful function.

A severe enough mania can elude an arsenal of potent meds (even the more powerful herbs).
And even when you are able to suppress the mania, research is beginning to suggest that by attacking aggressively (perhaps, especially with substances not intrinsic to brain biochemistry) you may have set the stage for bipolar deterioration longterm.

Acute manias and vitamins
On the other hand, orthomolecular physicians are finding that nutrient therapies which nourish inhibitory mechanisms and normalize excitatory systems tend to work increasingly well with time, while usually proceeding gradually enough* to sidestep the above mania escalation and chronic repercussions.

See my posts here on inhibitory aminos, from June 21 to Aug 24, 2010, and also the outline of Mania and Stabilization info at the top of the Borage Books Nutrient Summary page.

* Nonetheless, in some cases, e.g., with violence or heart problems, a more rapid improvement may be necessary. See previous post on IV therapies.

Addressing root causes
Aside from resolving acute episodes,  ferreting out and addressing root causes (e.g., methylation imbalances, hormonal issues, pyroluria, problems with metal metabolism, etc.) is particularly important to long-term mood stability. See Ongoing Mood Stability, Biotypes, Toxicity, and Health at the bottom of the Borage Books Nutrient Summary page.

For further details, including contraindications, see my book, Natural Healing for Bipolar Disorder.

Reminder: This information is presented for educational purposes only, and should not be construed as treatment recommendations. Treatments should be fine-tuned to individual biochemical requirements. Also note: sudden changes in medications can be disastrous. See:
http://naturalhealingforbipolardisorder.blogspot.com/2010/04/nutrient-approaches-for-bipolar-and.html
If you have concerns about meds, or if you need treatment for mania, bipolar, or any other medical condition, please consult a knowledgeable physician.

Radiation Protection Vitamins and Other Natural Approaches

See my new blog: http://radiationprotectionvitamins.blogspot.com/

Bipolar Vitamins and Mood Stability

In general vitamins work gradually. The right nutrients, tailored to unique individual needs, will steadily promote and build brain health (and support body health as well), because, along with oxygen, nutrients are the main constituents of brain biochemistry.

 

Most of the time, for bipolars, the gradual improvement that vitamins provide is ideal, as the alternative, rapid change, tends to increase cycling and ultimately destabilize mood. After all, in the abstract sense, we probably all intuit that the cure for bipolar disorder is moderation.  

Even so, rapid change is sometimes needed during life-threatening mood states. This is the point at which people are usually taken to the hospital. Wouldn't it be great if the hospital had IV orthomolecular treatment available (i.e., intravenous nutrients as per unique need)? So a person could stabilize while supporting brain function and vitality?

For some of the work now being done with IV vitamins, see:
Dr. Joan Larson's site

For a general overview of  the nutrients now being studied for bipolar, see:
http://boragebooks.com/bipolar_treatments.html

or, to learn more, check out my book, Natural Healing for Bipolar Disorder

Videos: Histadelia: Depression, OCD, SAMe and Serotonin

Some great histadelia (neurotransmitter undermethylation) videos by Dr. William J. Walsh, a pioneering researcher of the effects of brain methylation imbalances on mental symptoms:

Dr. Walsh explains symptoms  of undermethylation (histadelia) including OCD (obsessive compulsive disorder) and depression, the relevance of SAMe and serotonin and other vitamin therapies, and the prevalence of histadelia in people of high accomplishment and drive (athletes, scientists, CEOs). http://www.youtube.com/watch?v=VZ7ZakljZu8



Dr Walsh on histamine tests, brain methylation, histapenia and histadelia symptoms and vitamins, and epigenetics: http://www.youtube.com/watch?v=7CRTL0-kDmI


For more info, see my book, Natural Healing for Bipolar Disorder

Bipolar Vitamins: Histadelia and Folic Acid

Folic acid is a critical vitamin for both mood and neurological health in general.

So why should histadelics restrict it?

1 They are already overloaded in folic acid.
2 Histadelics do not readily turn folic acid into methyl folate, which is needed to support  neurotransmitter methylation. Instead folic acid accumulates, worsening histadelic depression.


So the focus of therapy becomes: restrict folate, and support brain methylation (see previous posts).

Note: We are talking here only of histadelics, that is, people with undermethylation of brain neurotransmitters, and already elevated folate. For almost everyone else with mood problems, folic acid tends to be essential.

For more information, see my book, Natural Healing for Bipolar Disorder.

Reminder: This information is presented for educational purposes only, and should not be construed as treatment recommendations. If you need treatment for histadelia, bipolar, or any other medical condition, please consult a knowledgeable physician.

Bipolar Depression: Histadelia Vitamins II

Nutrients commonly used for histadelic bipolars include:
SAMe, methionine, vitamin B6, magnesium and TMG, as per individual requirements. See:  the sample histadelia page from Natural Healing for Bipolar Disorder (as per my previous post).

Further histadelia nutrients can include:

Calcium — often depleted. Calcium decreases histamine and supports release of antidepressant neurotransmitters.
Inositol — may reduce anxiety, promote sleep. Critical to signalling. Counterbalances choline and supports folate, vitamin B6, vitamin B12, betaine and methionine.  Too much may promote anxiety or panic in some bipolars, but not usually histadelics.
Methyl  B12 — Needed to turn homocysteine to methionine. Especially critical if oxidative stress is prevalent.
Omega 3 — supports methylation.
Niacinamide — modest amounts, introduced gradually, with attention to reactions. If voices occur,  B3 tends to be crucial. Anxiety may also signal greater need.
Zinc — Counters overstimulation. Supports homocysteine metabolism to cysteine or methionine.

Antioxidant support. With undermethylation, oxidative stress increases, and further compromises methylation pathways and depletes neurotransmitter precursors. Consider the following antioxidants:
Glutathione — of prime importantce. Needed to support formation of methyl B12.
Selenium and E — works with glutathione.
Vitamin C — decreases histamine; moderates stimulation; antidepressant.
Vitamin A — helps counter the seasonal allergies.
Vitamin D — supports calcium absorption and helps counter depression. 
Acetyl-L-carnitine — a great mitochondrial antioxidant; need may be suggested by low mental energy. However, may overstimulated.
Other antioxidants, as relevant.

Other nutrients, sometimes indicated 
Serotonin support (e.g, St Johnswort, tryptophan, 5HTP) — modest intake may help balance mood, especially if depleted.
Kava — calms limbic activation, but overstimulating for some.
Tyrosine — may  temporarily help counter the depression, especially if depleted, at least until methylation increases.
Copper — supports dopamine and norepinephrine formation, decreases histamine. In histadelics, metal metabolism disorders tends toward overactivity, decreasing copper. If so, small doses,  in some cases, may become useful (but not if it worsens oxidative stress).

Diet

Plentiful quality animal proteins (preferably fish from mercury-free waters; organic meats, free-range poultry) provide methionine. A good whole foods diet is recommended, with lots of complex carbohydrates and vegetables (though intake of greens, in some cases where folate is too high, needs to be moderated), healthy fats, and some fresh fruit. Minimize/avoid immunoreactive foods. Dairy provides calcium, which the histadelic needs, but is commonly an allergen (if so, consider goat milk products and a possible need for more zinc). Avoid sugar, white flour, fried and hydrogenated fat.

Restrictions 
Folic acid, is typically excessive relative to methylation status, so often must be significantly restricted.
Choline (which counterbalances norepinephrine) may worsen histadelic depression, so may need to be limited. DMAE, especially, tends to be detrimental,
GABA often is less than helpful during low-catecholamine histadelic depression.

This material reflects approaches developed by Doctors: Walsh, Hoffer, Pfeiffer, Jaffe, Kruesi, Bibus, and others.  See Natural Healing for Bipolar Disorder for further info, including contraindications and references

Reminder: These are general summaries presented to educate the public and are not treatment recommendations. Treatment depends on the individual's unique biochemistry and response pattern. Attention to contraindications is essential.  If you need treatment for histadelia, bipolar, or any other medical condition, please consult a knowledgeable physician.

Bipolar Depression: Histadelia Nutrients

Additional histadelia nutrients next post. Stay tuned.
Meanwhile, for a more complete overview, see my site and my book Natural Healing for Bipolar Disorder.

Bipolar depression: Histadelia treatment

Again, histadelia can look like bipolar, bipolar depression, psychotic depression, obsessive compulsive, schizoaffective, dual diagnosis, or (especially if also pyroluric) conduct disorders.

For an overview of symptoms and therapeutic nutrients, see these concise descriptions of the biotypes by Dr. William Walsh. Histadelia is first:
http://alternativementalhealth.com/articles/commoncauses.htm

For histadelia subgroups and more details on the approach of Dr. Walsh,
see this page from Natural Healing for Bipolar Disorder.

Note: Histadelics do better if isolation and loneliness can be reduced, and if they can be effectively supported in continuing to take vitamins and avoid addictions.

For more info, see boragebooks.com

Reminder: These are general summaries presented to educate the public and are not treatment recommendations. Treatment depends on the individual's unique biochemistry and response pattern. Attention to contraindications is essential.  If you need treatment for histadelia, bipolar, or any other medical condition, please consult a knowledgeable physician.

Bipolar Depression and Histadelia Symptoms

Histadelia signs and symptoms can be generally broken down as follows:

Effects on the mind: Chronic profound depression, suicidality, episodes of blank mind, obsessions, compulsions (e.g., gambling, shopping, pulling out hair), delusions and phobias. Strong will, perfectionism, perhaps hypomania.

May have been diagnosed with: Psychotic depression, bipolar, unipolar, mixed state, schizoaffective, dual diagnosis, OCD, delusional or oppositional defiant disorder.

High metabolism effects: Elevated body temperature, insomnia, lean body, good appetite, severe inner tension.
Elevated body fluids: Mucous, saliva, semen, digestive fluids, sweat.

Prone to: Seasonal allergies,  frequent colds, asthma, osteoporosis, arthritis, headaches, body pain, automimmune disorders, addictions. 

Lab: High blood histamine remains the clearest indication. 

For more, see my book, Natural Healing for Bipolar Disorder. 



. 

Bipolar Depression: Histadelia, Serotonin and Norepinephrine

Histadelia is the most common biotype in bipolars. It is characterized by undermethylation of brain neurotransmitters, including key antidepressant neurotransmitters such as serotonin, norepinephrine and dopamine. This causes chronic severe suicidal depression.

In the last post, I directed you to:

The Mood Cure Questionaire by Julia Ross

and the rest of her site. And to:

Dr. Priscilla Slagle's free ebook (The Way Up From Down):

which also talks about the use of amino acid precursors (e.g. tyrosine and tryptophan) for depression.

However, for histadelics, the major focus is not so much on supplying the precursors for serotonin, norepinephrine or dopamine, but on whether these neurotransmitters are being methylated. Intake of tyrosine, tryptophan, etc., may be helpful to some extent, but the key therapeutic target, and generally the most stabilizing treatment for the histadelic bipolar, is on getting these neurotransmitters working properly.

That is, by supporting neurotransmitter methylation with specific nutrients, while avoiding others which are counterproductive for the histadelic (such as folic acid).

 I will talk about signs and symptoms, as well as lab tests, in the next post.

For more info til then, you can always see my book: Natural Healing for Bipolar Disorder.

Depression Nutrients: The difference between Unipolar and Bipolar Therapies

To begin with, let's look at nutrient approaches used for unipolar depression (especially amino acid therapies). Check out:

The Mood Cure Questionaire by Julia Ross

While there, you may want to explore the entire site.

Dr. Priscilla Slagle's free ebook (The Way Up From Down):

And the "Recommendation Summary" half way down the page.

The problem is, many treatments (either pharmaceutical or nutritional) developed for unipolar depression can destabilize bipolars.

This is because bipolars can be particularly sensitive to changes in brain stimulation. In general, the more extreme the antidepressant treatment, and the more quickly it works, the greater the likelihood of triggering mania,  more rapid or frequent cycling, and general worsening of the illness over the long term.

So  —

(1) Bipolar antidepressant nutrients should be as gentle and gradual as possible, while still addressing symptoms sufficiently. For instance, one might want to consider tyrosine instead of phenylalanine, tryptophan instead of 5HTP, green tea instead of coffee,  etc., And the lowest doses that do the job. Generally: good food, relevant vitamins, exercise, creativity, friendship, and moderation rather than overstimulation.

(2) Even though trying to elevate mood, concurrent therapies that support stability are critical!

More later. 

For more information, see my book, Natural Healing for Bipolar Disorder.

Nutritional Approaches for Bipolar Disorder: Overview

Now that we're faced with autumn I'm going to focus more on mood-elevating vitamins/nutrients.
To start,  you may want to review my overview of investigational targets:
Natural Healing for Bipolar Disorder: Nutritional Approaches on the Borage Books website.

For fuller descriptions, as well as lab tests, contraindications, studies, etc.,
See my book, Natural Healing for Bipolar Disorder.
You can buy it here.

Great Natural Health Conferences

After cloistering myself for almost seven years (writing and researching Natural Healing for Bipolar Disorder), and so looking with a fresh eye, I have been struck by how absolutely stunning natural health conferences can be.

This year, I made my way  to
The Society for Orthomolecular Health Medicine's Scientific Meeting at the end of February.

The International Society for Orthomolecular Medicine's Annual International Conference: Orthomolecular Medicine Today  in late April.
The Cancer Control Society's Annual Cancer Convention on Labor Day Weekend.  

Each one was a veritable festival of life, intelligence, striving, and hope.

Kudos to the organizers, who have, for decades now, brought together health professionals, researchers, writers, recovered patients, and people looking to learn, to interweave a tapestry of current developments and possibilities in the field of natural medicine.

So readers, mark your calendars for next year.

Bipolar Aminos: Taurine or GABA?

Taurine and/or GABA?

Both are held to support mood and neurological stability, relaxation and sleep, and generally reduce neurotransmitter overstimulation in many individuals. So how does one choose?

Taurine: some of the physical considerations

1 Heart issues (common in bipolar mania) or eye problems may be additional indications of need for taurine. (Note: Taurine is concentrated in the heart and eye (as well as the brain)).
2 Taurine may be especially needed if the diet is high in fats or if having problems handling fats due to insufficient bile.

What to watch out for:

1 Taurine in some cases, counterintuitively, contributes to agitation, irritability, and mania, perhaps related to a need for more zinc (as in histapenia, pyroluria, and metal metabolism dysfunction).
2 High doses of taurine (and magnesium, and very high doses of vitamin C) may contribute to diarrhea.
3 Taurine may be less than useful in some persons with significant low blood pressure or hypoglycemia.

With such problems, and especially if chronic pain is involved, GABA may be a better choice.

On the other hand, for many bipolars, a particular pattern of GABA, taurine, and glycine (or magnesium glycinate) over the day (one example might be: one amino AM, a different one at lunch, all three PM) may optimize benefit. The physician and patient can work together, over time, to fine tune amino acid choices and dosage.

See posts from June 21 to August 24 for more on inhibitory aminos. And, for fuller coverage, including studies, see my book, Natural Healing for Bipolar Disorder.

Mania Nutrients: Taurine

Taurine, like GABA, is an amino acid and a major inhibitory neurotransmitter. It generally regulates electrical and chemical communication between neurons, depressing the firing of brain cells, and reducing brain stimulation. 

Some bipolars seem to do better with GABA, others with taurine, or a combo of both. Dr. Joan Larson, PhD, finds taurine (500 mg, 3x/day) can stabilize mood as effectively as pharmacological lithium. 

Mechanisms that may help counter mania
1 Taurine concentrates and acts in electrically excitable tissues, stabilizing membrane excitability, and exhibiting anticonvulsant properties.  (Thus, Dr Walsh suggests it may be most relevant for bipolars with neurological symptoms.)
See: Seizural/bipolar connections and inhibitory aminos
2 Acts in brain regions which modulate mood (hippocampus (critical to memory), the pineal (light/dark response), and the olfactory lobe.
3 Inhibits stimulating, and activates inhibiting, neurotransmitters. (Suppresses release of dopamine, norepinephrine, glutamate, and aspartate (stimulating transmitters). On the inhibitory side, increases acetylcholine, and may increase hippocampal histamine (which counterbalances dopamine).
4 Regulates electrolytes, influencing membrane stability, receptor activity, second messenger signalling, electrical communication along the axon, and chemical communication between cells.
5 Modulates creation and activity of cAMP (which helps initiate the second messenger cascade).

6 Moderates hormonal activity. Decreases thyroid and adrenal overactivity. Supports normal thyroid function. Reduces blood sugar, enhances use and storage.
7 Antioxidant. Helps regulate copper and iron. Supports immune function and helps prevent chemical sensitivity.
8 Needed in fat absorption, metabolism, elimination. (Fats are critical to neural signalling, and the formation of hormones which affect mood.)

You can find a good introduction to taurine in the second half of Dr. Priscilla Slagle's Jan 15, 2000 Newsletter.  
Also see, Birdsall, TC, Therapeutic applications of taurine. Altern Med Rev. 3(2):128-36; April 1998.
 
For references, and further discussion of bipolar issues, see Natural Healing for Bipolar Disorder.

Reminder: Treatment must be tailored to each individual's unique biochemical requirements, including contraindications. If you need treatment for bipolar disorder, or any other medical condition, consult a knowledgeable physician. In some cases, this will be an orthomolecular or other nutritionally-oriented physician.

Words of Support

Thought I'd pass along these words of support

from Marcia Purse: From Blue Zebra: About Me, About You  (Wed, Aug 11, 2010)

Along with this Video of Famous Bipolars

Bipolar nutrients: GABA may also stimulate

 GABA may also stimulate -- which is one of the reasons we cannot always assume it will be antimanic for everyone.
http://cellscience.com/reviews1/GABA_excitation_the_bipolar_neurotransmitter.html

See previous few posts for more on GABA.
For a wider context see Natural Healing for Bipolar Disorder

Bipolar Nutrients: Glutamate and Psychosis

Speaking of glutamate (see previous two posts), a new study on glutamate/dopamine balances
suggests that in vulnerable persons, changes in the relation of hippocampal glutamate to striatal dopamine systems may increase the risk of upcoming psychosis.
Stone JM, Howes OD, et al, Altered Relationship Between Hippocampal Glutamate Levels and Striatal Dopamine Function in Subjects at Ultra High Risk of Psychosis, Biol Psychiatry,2010 Jul 15. [Epub ahead of print]

Bipolar Nutrients: Comments on GABA/ Glutamate

A great introduction to GABA from EJD. (previous post)

Some cautions:

1 Many manics do seem to do better with GABA, taurine, magnesium glycinate, (and skullcap, theanine, etc.),* in various combinations, as per individual requirements. Similarly, see:  Seizural/bipolar connections and inhibitory aminos 

However, keep in mind that attention to inhibitors may not be the only important therapeutic concern, and for some manic subgroups, may not even be productive. 

* And, limiting excitotoxins (like glutamate) is probably always a good idea for manics.   

2 Alcohol is not a good choice for bipolars. Virtually all studies show alcohol use significantly worsens bipolar outcome. And many bipolars (especially manics) will have a hard time keeping intake to the small amount EJD suggests as the mild GABA-increasing benefit wears off. 

Look instead to nutritive supports to increase GABA.

3 Some mania subgroups tend to improve with a few of the foods EJD warns against:
In histapenic manias, dark leafy greens can be useful, due to the high folic acid content.
In high thyroid manias, broccoli, and the sulfur-rich crucifer family, which reduces thyroid access to iodine, generally help reduce stimulation.

For descriptions of inhibitory aminos, bipolar subgroups, etc., see my book, Natural Healing for Bipolar Disorder.

Reminder: The material in this blog is for educational purposes only, and is not intended as medical  diagnosis or treatment recommendations. Treatment must be tailored to each individual's unique biochemical requirements, including contraindications. If you need treatment for bipolar disorder, or any other medical condition, consult a knowledgeable physician. In some cases, this will be an orthomolecular or other nutritionally-oriented physician.

Bipolar Nutrients: GABA/Glutamate Balance, Vitamin K2, Salicylates, Ketones

As an introduction to GABA, let's look at the perspectives of EJD. The responses to his post are also interesting.

In brief, EJD proposes:
1 GABA is the most important factor in bipolar. Low GABA/glutamate ratio fosters bipolar mania
2 Possible ways to increase GABA: valerian, theanine, taurine, skullcap, kavakava, glutamine,  calcium/magnesium, relaxation techniques. And, of course, GABA (if available), 
3 A low carb, ketogenic diet increases GABA. Vinegar before meals, acts similarly, but can gets used up too fast.
4 Vitamin K2 (modest amounts) helps neutralize glutamate, metabolizing it to a bone-building compound.
5 Restrict/avoid salicylates -- by altering dopamine, activating NMDA receptors, and inhibiting GABA -- elevate, then sink mood, and often, as well, cause brain fog (B12 helps).


He also notes that:
Dopamine is the major antidepressant neurotransmitter. Serotonin is more of a regulator of dopamine and mood, than a direct antidepressant.
Genetic changes in enzymes*  that break down catecholamines, may favor preserving adrenalin over dopamine, lending irritability to any manias.

*EJD points to COMT; a responder suggests MAO.

Go to EJD's post for specifics.

I include EJD's ideas here as an interesting intro to GABA, worth thinking about. But do keep in mind that this is just one person's experience and conjectures, and that EJD is neither a physician nor a medical researcher.
And remember that bipolar treatment must be tailored to each individual's unique biochemical requirements.  Not all bipolars respond well to GABA, etc..  More in the next post.

Reminder: If you need treatment for bipolar disorder, or any other medical condition, consult a knowledgeable physician. In some cases, this will be an orthomolecular or other nutritionally-oriented physician.

Seizural/bipolar connections and inhibitory aminos

The amino acids, GABA, taurine, and glycine function as inhibitory neurotransmitters in the brain, reducing stimulation. They are often employed in natural treatments of certain types of seizures. In fact, some epilepsy meds seem to work by acting on the GABA system.
     At the same time, if indicated, GABA and/or taurine (glycine is milder) seem to be among the more potent mood-stabilizing, mania-moderating nutrients.

But does suppression of seizures have anything to do with promotion of mood stability? 

A number of researchers have suggested subconvulsive limbic seizures may underly bipolar disorder, but the jury is still out. Meanwhile, we might want to consider what bipolar and seizural disorders might have in common.

1 Kindling seems to occur in both disorders

(Post 1982, 89, 97, 2001, Ghaemi 1999, Bell 1992, Brewerton 1997) 
In epilepsy, repeated, continuous or excessive exposure to convulsive stimuli eventually increases the intensity and frequency of reactions. Over time, progressively milder stimulation is capable of triggering symptoms, eventually leading to apparently "spontaneous" seizures.
    Sound familiar? Think about the role of amphetamines, antidepressants, allergens, sugar and junk food, hyperthyroid, environmental stressors, and other stimulants in triggering episodes. And of the tendency of a single initial mania, whatever the cause, to lead to a future episode in 90-95% of cases. And how after years of mood disorder without orthomolecular treatment, episodes often become more frequent, but triggers tend to become more minor and more difficult to identify. 

2 Abnormal signalling plus kindling can induce seizures and may trigger mood episodes

Stoll and Severus (1996) suggest the interaction of kindling and abnormal signal transduction may be a primary trigger of mania and mood instability.
     Consider that all established mood stabilizers dampen excess signalling, and so block kindling. (Most inhibit calcium and sodium transfer across the neural membrane. Several interfere with the creation of inositol- and choline-related second messengers, and/or inhibit kinase and G protein activity.)  Thus, fewer messages are conveyed, and mania and seizures are suppressed.

3 Most mood-stabilizing meds are anticonvulsive and antikindling
(Post 1992, 95, 97, Ketter 1994, Ghaemi 1999, Bell 1992, Weiss 1995)
 Carbamazepine (CBZ), valproate (VPA), lamotrigene, and calcium channel blockers all have significant anticonvulsive properties.

     About two-thirds of bipolars have been found to respond best to CBZ or VPA;  two-thirds, to lithium.  Lithium shows minor anticonvulsive activity, while CBZ and VPA are clearly anticonvulsant and antikindling,  especially in the temporal and limbic regions of the brain associated with mood disorders.  Moreover, neurological problems (e.g., history of seizures, head injury, or abnormal EEGs) strongly suggest responsiveness.
     So the question remains, do these drugs work because they are antikindling and anticonvulsant?

4 Similarly, many nutrients identified as helpful to bipolars are also reputed to have antiseizure or antikindling properties — not only taurine, GABA, and glycine, but also most of the nutrients noted in previous posts (magnesium, zinc, C, and certain B vitamins). 
     More on taurine, GABA, and glycine in future posts. 

For further description of inhibitory aminos, seizural/bipolar connections, biotype issues, etc., and for contraindications and references, see my book: Natural Healing for Bipolar Disorder.


Reminder: Treatment must be tailored to each individual's unique biochemical requirements, including contraindications. If you need treatment for bipolar disorder, epilepsy, or any other medical condition, consult a knowledgeable physician. In some cases, this will be an orthomolecular or other nutritionally-oriented physician.

Nutrients and Bipolar Mania: Aminos Acid Therapies in Context

Amino acid therapy for bipolar disorder is becoming relatively popular.
It may be one of the more potent symptomatic approaches. 
However, keep in mind that excess aminos (some more than others) can be harmful, especially with long-term use, and may interact with drugs. For a starter,  see:
http://www.moodcure.com/aminoacidprecautions.html

Remember that getting as close as you can to specific underlying causes, i.e., the individual's unique biochemical (i.e., nutritional/orthomolecular) requirements, is what supports long-term stability.

One of many examples: while the amino acid, taurine has been used successfully to calm many bipolar manias, in people who are zinc-depleted (e.g. pyrolurics, many histapenics, many under stress, etc.) it can be counterproductive, actually increasing agitation.

So attention to the entire nutrient/health picture is imperative (methylation imbalances, pyrrole disorder, oxidative stress, hormonal issues, neurological problems, metal metabolism dysfunction, second messenger dysfunction, allergies, toxins, nutrient dependencies, depletion or overload, etc., as dictated by individual needs. 

For more on these conditions, see Natural Healing for Bipolar Disorder, and meanwhile,  stay tuned!

See also Nutritional Therapies for Bipolar, and Biochemical Individuality

Bipolar Nutrients: Intro to Inhibitory Aminos

So, there are three main biotypes to consider in bipolar disorder.
See:

Nutritional therapies: Three Major Approaches

and Some preliminary indications of nutritional outcome

We've been discussing pyroluria for some time (April 19, 20, 23, May 6, 7, 14, 21, and May 28 to June 17), but it's just one of the biotypes, probably present in less than one third of bipolars.  
The mechanisms underlying the other two major biotypes involve the status of neurotransmitter activation or suppression.
So before talking about these, I'd like to give you some background on amino acids and neurotransmitters. 

As a short introduction, see Margot Kidder's comments on the inhibitory aminos:

http://www.alternativementalhealth.com/articles/aminobipolar.htm

Important: Since we are now focused on mania, the info on tyrosine, and the inclusion in her regimen of  tyrosine, phenylalanine, and glutamine are not relevant  here.

Psychiatry and nutritional biochemistry: Studies

You can find some great studies on the role of nutritional biochemistry in major psychiatic disorders at the  biobalance.org site:  http://www.biobalance.org.au/articles#58

Bipolar Nutrients: More on pyroluria therapy

Other important therapeutic issues for the pyroluric:

Antioxidant nutrients - oxidative stress is always involved; some researchers wonder to what degree it is causal.  Take into account copper content in some antioxidant nutrients.

Essential fatty acids - with significant pyroluria, GLA is often more helpful than omega 3.
See Bibus/Walsh article at: http://www.biobalance.org.au/articles/15

Adrenal support - pyroluria is a stress disorder, taxing the adrenals. Adrenal support includes such nutrients as B5, C, B vitamins, etc., and attention to blood sugar issues.

Therapy for Candida or other illnesses (often fostered by the low B6 and zinc, critical nutrients for immune function).

Even the mildest stress (e.g., leaving the house) can produce major deterioration in some pyrolurics. Not all stressors can be avoided. Increased support with relevant nutrients is imperative when anticipating or undergoing, and for some time after, mental or physical stress (illness, fatigue, toxicity, psychosocial stress, etc).

Similarly, limiting exposure to toxins is important, to the degree possible. Consider also,
metal metabolism functionality.

Medication issues - particular care is warranted, as pyrolurics often react intensely to mediation, and to changes in med intake.

Note: Pyrolurics deteriorate quickly on the wrong treatment or in the wrong environment, but also respond rapidly to appropriate therapy.

We have only skimmed the surface here. For further discussion on pyroluria, and for references, see my book, Natural Healing for Bipolar Disorder.

Reminder: The material in this blog is for educational purposes only. Actual treatment must be fine-tuned to each patient's unique biochemical requirements. So, if you need treatment for bipolar disorder or any other medical condition, consult a knowledgeable physician.

Bipolar Nutrients: Pyroluria mineral balances

With the relatively high doses of zinc and B6 (or P5P) for pyroluria, the balance with other minerals becomes an important consideration.


Manganese 
Manganese is given almost routinely to pyrolurics, in whom it is usually depleted, and then decreased further by the high supplemental zinc.


Insufficient manganese can foster depression and memory problems, and compromise sugar and protein metabolism, and joint function.
On the other hand, excess can raise blood pressure in susceptible persons, and may contribute to movement disorders in histadelics.

Pyroluric dosage is typically 5-20 mg, depending on individual requirements (Dr. Joan Larson, PhD)

Zinc/ B6 (or P5P)/ manganese imbalances can foster seizures.

Thus, untreated pyrolurics are prone to seizures. Similarly, nutrient intake must be fine-tuned to support neurological stability.


Magnesium
See more on magnesium in my blogpost on May 10th, and the two posts on April 20th. 


Magnesium/B6 balance

Dr. Bernard Rimland, PhD, finds magnesium helps prevent sound sensitivity and irritability from excess B6.

 

Copper/Zinc Balance

After months of high zinc, the pyroluric sometimes needs very small quantities of copper to support zinc absorption, or to prevent anemia, support antioxidant and immune function, or nourish the musculoskeletal system.
On the other hand, if given too much, the pyroluric will worsen, and psychosis or other severe symptoms may emerge.
-- Dr. Carl Pfeiffer, MD, PhD

Labs

Urinary pyrroles
B6: EGOT, red cell P5P
plasma or red cell zinc, copper, magnesium
whole blood manganese
Also consider symptomatic response. 

Actual treatment must be tailored to each patient's unique biochemical requirements. So, if you need treatment for bipolar disorder, consult a knowledgeable physician.

Bipolar Nutrients: Mega vitamin B6 and zinc in pyroluria

Why are pyroluric doses of zinc and vitamin B6 so high?

Pyrolurics regularly excrete large quantities of  zinc and B6, and even more when under stress.
So with significant pyroluria, corrective doses may seem relatively massive, but remember that most of the zinc and B6 won't even be used.
 

Pyroluria, Vitamin B6 and/or P5P
Dr. Bonnet, MD, says:
"Usually pyroluric people require doses between 250 to 1500 mg. Some require up to 2000 mg, and there is an occasional patient that does need more. In the past, we always had to keep a close watch on the dosage, especially watching for a more serious side effect, numbness in the toes...
"With Pyridoxal-5-Phosphate (P-5-P), the active form of vitamin B6, we have been able to prevent the peripheral neuropathy."

General guidelines from Dr. Carl Pfeiffer, MD, PhD

B6 and/or P5P increased to the dose at which  the patient can remember one dream per night, no more.
In substituting for B6, P5P should generally be given at 1/5 to 1/10 the B6 dose.

Labs

Urinary pyrroles
B6: EGOT, red cell P5P
Also consider symptomatic indications.

Some symptoms of deficiency

Depression, poor memory, fatigue, agitation, irritability
Nausea and other digestive symptoms; pallor; immune dysfunction; female hormone imbalance

Of excess

Peripheral neuropathy (numbness, tingling)
For more, see Natural Healing for Bipolar Disorder 


Pyroluria and zinc
Dr. Woody McGiness, MD, says:
"Very high doses of zinc are needed to normalize the plasma zinc level -- 50 to 200 mg daily...
Probably going to need to take 200 mg or so (build up slowly) before it starts to build your stores, just test with the assay to make sure you're not getting too much."

Pfeiffer's general guideline

Zinc and other relevant nutrients should be increased when anticipating or under stress.

Labs

Urinary pyrroles
Plasma or red cell zinc and copper
Liquid zinc taste test
Also consider symptomatic indications.

Some symptoms of deficiency

Stress, anxiety, psychosis, insomnia, irritability, paranoia
White spots, or soft, light nails; acne; weak sense of taste and smell; poor  appetite
Frequent infections; joint pain; slow healing of wounds
Of excess
Lethargy, dizziness, mental and physical suppression
Nausea; immune dysfunction; anemia; kidney dysfunction
For more, see Natural Healing for Bipolar Disorder 

Further considerations in the next entry.

This information should not be used in place of medical diagnosis and treatment. Nutrient choices must be tailored to unique biochemical requirements. The purpose here is solely educational.

Bipolar Disorder Nutrients: More Pyroluria Links

More good links on pyroluria:

Dr. Bonnet interview:
http://www.thehealingpartnership.org/psychiatric_care.htm

Dr. Woody McGinnis, MD, Dr. William Walsh, PhD, et al, Discerning the Mauve Factor, Parts 1 and 2,
PDFs, available at:
http://www.biobalance.org.au/articles#58

Dr. Joan Larson and Larry Hobbs, Pyroluria, B6 and zinc deficiency, anxiety and depression:
http://www.youtube.com/watch?v=o1OJ87eA0Lg

Direct Healthcare Access Lab:
http://www.kryptopyrrole.com/

Research:
http://home.tiscali.nl/~t159602/de/hpu/literatur.html

Bipolar Disorder Nutrients: The Pyroluria Biotype

Since we've been talking of zinc, and vitamins B6 and B3, pyroluria (pyrrole disorder) is probably a good biotype to look at first.
To get some idea, see one of the of the pages on pyroluria in Natural Healing for Bipolar Disorder:
http://boragebooks.com/bipolar_5_pyroluria.html


And for more details, check the following site, including its links to articles by Doctors William J. Walsh, PhD, Carl C. Pfeiffer, PhD, MD, Woody McGinnis, MD, and Jeremy E. Kaslow, MD:
http://www.nutritional-healing.com.au/content/articles-content.php?heading=Pyroluria


For further info on nutrients, health issues, contraindications, etc., see Natural Healing for Bipolar Disorder

Bipolar Disorder: Outcome with Nutritional Biotype Therapy

re: http://alternativementalhealth.com/articles/commoncauses.htm

Among psychiatric patients who fit into these biotypes, corresponding nutritional therapies,  tailored to individual patient requirements, produced a high rate of great improvement or recovery-- substantially beyond what is commonly reported by mainstream psychiatry -- as per the 20,000 patient database of Dr. Carl C. Pfeiffer and colleagues, as well as the 20,000 patient database of Dr. William J. Walsh, et al.

The emphasis in Pfeiffer's group for a long time was schizophrenia; but over time grew to include mood disorders and other major psychiatric disorders. Generally, for most patients eligible for, and pursuing biotype treatment, 75-85% recovered or improved greatly; less, if ill for decades. Improvement corresponded with normalizing of biotype parameters.

Walsh's group first emphasized behavior disorders and criminality (with substantial results mainly in those given biotype treatment when young); then expanded to include learning disorders, autism, schizophrenia, mood disorders, etc. Patients received at least 90 lab assays each.

Results of Walsh's outcome study (Walsh, 2007, 2008) on over 1800 bipolars:
Approximately 80% of bipolars showed biotype imbalances.
For the 70% of these who stuck with the nutrient program (always an issue for bipolars), 50% eventually recovered to the extent that their physicians weaned them off medication. Results were best when biotype treatment was begun early in the illness..
So of the 1800, 20% did not show biotype imbalances, 24% did not stick with the nutrient program.
But 50% of the 1100 plus who kept up with biotype nutrients recovered or were greatly improved; many of the rest also benefitted.
This may represent the best well-substantiated bipolar outcome thus far, whatever the treatment, nutritional or pharmaceutical.

Note: Recovery is not cure.  Nutrients are in almost all cases indicated throughout one's life. One common side effect: a healthier, longer life.

For more info on biotypes, see Edelman's books at: http://boragebooks.com

Bipolar Disorder: Pfeiffer/Walsh Biotypes and Corresponding Nutrients

Here is a short description by Dr. William J. Walsh of major biochemistries (biotypes) and corresponding nutrient therapies -- found in a substantial portion of bipolars -- with some corresponding nutrient therapies.
http://alternativementalhealth.com/articles/commoncauses.htm

Actual treatment must be tailored to each patient's unique biochemical requirements. So, if you need treatment for bipolar disorder, consult a knowledgeable physician.

Bipolar Nutrient Article: Integrative Medicine Approach

Again, one of the problems with starting to discuss potential mania vitamins and minerals in this blog is that it's easy to miss the wider therapeutic context -- given this medium, I can only say so much at any one time. In Natural Healing for Bipolar Disorder,  on the other hand, you have it all together in one book, and can pick specifics as you are drawn to them.


So, you can either buy my book or, meanwhile, you can gain some perspective by looking at one of the better articles on bipolar:

Bipolar Disorder as Cell Membrane Dysfunction. Progress Toward Integrative Management

by Parris M Kidd, PhD, Alt Med Rev, 6/2004.


Either at:
http://findarticles.com/p/articles/mi_m0FDN/is_2_9/ai_n6112778/
If you choose this site, you have to click 34 times at the numbers or next button on the top.
Or you can get the pdf from Dr. Kidd's website:
http://www.dockidd.com/
Right side of page, under Brain Health Science,  third entry.

Nutritional (orthomolecular) psychiatry film: Masks of Madness

For a great video introduction to the field of Nutritional (Orthomolecular) Psychiatry (Megavitamin Therapy),
see this 15 minute excerpt from the film,

Masks of Madness

at http://orthomed.org/isf/isfmasks.html   

produced by the International Society for Orthomolecular Medicine

Manic psychosis: Vitamin B3 and Vitamin C

Megavitamin Therapy (which evolved into, Orthomolecular Psychiatry) began with the Hoffer/Osmond research into niacin (a form of vitamin B3) and vitamin C. See my post at: http://naturalhealingforschizophrenia.blogspot.com/2010/02/how-did-orthomolecular-psychiatry-begin.html

Over the next half century, although other supportive nutrients have been discovered, orthomolecular physicians and researchers have continued to find megadose vitamin B3 and megadose vitamin C to be major therapeutic agents for most adult psychoses,* including manic and depressive psychoses. This applies to all biotypes, even histadelia (more on biotypes later). 

That is, niacin and C, within the context of a complex of indicated nutrients, health therapies, and other treatments, as per individual biochemical requirements, including contraindications.

For references, consult the literature, and see my books, Natural Healing for Schizophrenia and Natural Healing for Bipolar Disorder.

Caution: My blog entries are solely educational. If you need treatment, consult a knowledgeable physician.

* Some exceptions: for pyrolurics and for young people, B6 or B6 plus B3, may often be more effective than B3 alone.

Nutrition and Mania: Zinc, Pyroluria, Root Causes

Because it is mania season for most, I have taken the occasion to very briefly introduce a few vitamins and minerals which tend to calm brain overstimulation. Soon we will proceed to inhibitory aminos.

Before going on with these symptomatic tidbits, I would like to emphasize the ultimate importance of getting to the deepest underlying influences.

For example, for a certain subset of manics with pyroluria, just taking zinc would be less effective than therapy completely addressing the pyrrole disorder. More later.

For a wider perspective on underlying influences, see my Table of Contents,
and my book, Natural Healing for Bipolar Disorder

Note: This blog necessarily presents only the most cursory notes on nutritional approaches. Its purpose is solely educational, with the hope of sparking your curiosity to learn more. 
If you need treatment, please seek the services of a knowledgeable physician.

Upcoming talk: Nutritional Approaches for Bipolar and Schizophrenia

I will be presenting on

Nutritional Approaches to Bipolar Disorder and Schizophrenia

Wednesday, May 26, 3:30 PM

State of Oregon, Addictions & Mental Health Spring Conference
Red Lion Inn, 3301 Market Street NE, Salem, OR

For more information,  call (503) 370-7888

Nutrients and Bipolar Mania: Magnesium as a Calcium Channel Blocker

Magnesium, is our major natural calcium channel blocker. 
 
Calcium channel blockers (CCBs) inactivate calcium channels, reducing calcium entrance into the cell and increasing levels without (e.g., serum), generally increasing inhibition.


Pharmaceutical trials suggest CCBs support mood stabilization in some bipolars, particularly rapid, and ultra rapid cyclers. and may be most effective in mania, Some studies suggests preventive benefit, particularly when used with lithium.


Magnesium, similarly, controls calcium pumps and blocks calcium uptake to the nerve cell, reducing stimulation, and seems to convey similar effects on mood.

See Natural Healing for Bipolar Disorder for references and further discussion.

Food as Medicine

Foods (and herbs) are the raw biochemicals of which our cells are ultimately composed, the most elemental means to fix, revitalize, and balance our biochemistry and health. Moreover, benefits tend to steadily increase as cells get repleted, and multiple nutrients generally tend to be synergistic rather than detrimental.

So why are nutrients not the first line of defense in mainstream psychiatry and medicine?

For more info, see my book, Natural Healing for Bipolar Disorder.

Natural Healing for Bipolar Disorder: Discussion

Reminder: Feel free to write me here, ask questions, post comments, share experiences, ideas and theories, etc.

Bipolar Nutrients: Excessive Zinc and Oversedation

A case report (Murphy 1970),  pointed out by Dr. Pfeiffer, illustrates the sedative effects of large quantities of zinc:

A 16-year-old boy decided to use zinc for his health, but not knowing how much to take, he spread the equivalent of 12,000 mg. elemental zinc on a peanut butter sandwich.

Supplements commonly contain 10-30 mg. Pyrolurics (discussed soon, or for a starter, see ) are prescribed more (in some cases 100-150 mg, or higher), but only because they continuously neutralize and excrete zinc.
The boy consumed about a hundred times the pyroluric dose, and over a thousand times the dose most people need.)

Luckily, the peanut butter slowed zinc release and symptom onset.
What happened? He became dizzy, staggered, and his writing grew illegible. He mainly slept , and was increasingly difficult to waken over five to six days.

But as the zinc left his body, he recovered completely.

See Natural Healing for Bipolar Disorder for more information on nutritional therapeutic approaches.

Nutrients and Bipolar Mania: Reactions to high doses

Orthomolecular medicine used to be called Megavitamin therapy. As the name suggests, the approach, in general, is to bring dosage toward the level that has the optimum positive effect.

But how do you know if you have too much?

I am not going to cover all indications, contraindications, etc. For more complete discussions, see my book.  (And do consult a knowledgeable physician for treatment.)

Meanwhile, here are some easy-to-notice reactions to too much
of the nutrients we've already talked about:

Vitamin C - diarrhea.

Magnesium - (1) diarrhea; (2) some potential for oversedation; especially with a magnesium sulfate (epsom salt) bath (which is inadvisable if also taking sedative psych meds or herbs).

Vitamin D - (1) insomnia (especially if taken later in the day); (2) overstimulation (e.g., usually with many thousands of mg.)

Zinc -  (1) nausea, though this may just be due to not enough B6; (2) with very high doses, oversedation. See the next entry.

Nutrients and Bipolar Mania: Why Zinc?

Consider some of the means by which zinc might benefit mania:

— Helps moderate levels of the major stimulating neurotransmitters, dopamine and norepinephrine.
— Supports creation of GABA, a major inhibitory neurotransmitter, and is critical when taking taurine
— Crucial in handling stress. Depleted continuously in pyroluria (a common stress disorder in bipolars, see: http://boragebooks.com/bipolar_5_pyroluria.html )
— Critical in decreasing overloads of stimulating metals, such as copper and iron, and certain heavy metals.
— Supports balanced blood sugar (thereby, mood stability).
— Helps counter dairy and grain sensitivity (implicated in both mood and cognitive dysfunction).
— Some ability to neutralize excitotoxicity (which can trigger mania).

For more on zinc, mania, and bipolar disorder, including references, see my book, Natural Healing for Bipolar Disorder.

Nutrients and Bipolar Mania: Overview

Before proceeding further on nutrients and mania, here is a general overview of  investigational targets. 

Note: Only some of these would be relevant for any given individual. 

Minerals: magnesium glycinate, zinc, trace-mineral-dose lithium orotate, etc. May need to restrict copper and/or iron.
Inhibitory aminos: taurine (plus zinc), GABA (especially with histapenia or pyroluria), glycine (pyroluria). Perhaps, serotonin precursors.
B1, B3, B6, or other B vitamins.
Vitamin C. Other antioxidants.
Choline. Perhaps, omega 3 and/or GLA.
Kava (especially with histadelia), valerian (histapenia), theanine, skullcap, Bach Rescue Remedy, passion flower.
Moderate thyroid overactivity; support blood sugar and adrenal balance.
Treat histapenia, pyroluria, MT disorder, etc..
Attend to Candida, allergies, toxicity, malabsorption, immune, neurological, and other health issues.
Decrease stressors (e.g., quiet, darkened room; regular meals, sleep, etc).
Increase support with seasonal change and other stressors.

Important: These investigational targets should not to be construed as treatment directives. This material is presented for educational purposes only. 
 

Remember that therapy must be tailored to each individual's unique biochemical requirements, including contraindications. So if you need treatment for bipolar disorder, or any other medical condition, consult a knowledgeable physician. In some cases, this will be an orthomolecular or other nutritionally-oriented physician. 

For further info, see:"Natural Healing for Bipolar Disorder," available from boragebooks.com

Vitamin C, Mood, and Mania

For a sense of the importance of vitamin C in both mania and depression, you can look at a page from my book, Natural Healing for Bipolar Disorder, at:
http://boragebooks.com/bipolar_2_vitaminc.html

Nutrients and Mood: A great website

For a great background on magnesium, including effects on mood, see:
http://george-eby-research.com/html/depression-anxiety.html
http://www.youtube.com/watch?v=OmzDnbJoTxU

For more info on magnesium and its interaction with bipolar, see my book, Natural Healing for Bipolar Disorder.

Nutrients and Bipolar Mania: Magnesium: Some of the research

Some of the research:

Weston, 1921 — IV magnesium sulfate produced relaxation, sleep, and sedation in 50 patients with mania, agitation or agitated depression.

Blabicher 1997 — IV magnesium sulfate was effective as an adjunct for severe mania.

Heiden 1999 — seven of ten severely agitated treatment-resistant manics improved markedly on up to 23 days of IV magnesium sulfate, added to medication. Neuroleptic and benzo doses were able to be significantly reduced.

Giannini 2000 — magnesium oxide augmentation of verapamil was significantly more effective for mania as compared to controls on the drug alone.

Chouinard 1990 —  response in at least 50% of severe, treatment-resistant, rapid cyclers was equivalent to, or better than, that to lithium.

Nutritional Therapies for Bipolar, and Biochemical Individuality

Therapeutic choices ultimately resolve down to the individual's unique biochemical needs.
Everyone is different, has different genetics, and different environmental experiences, and so has different therapeutic requirements.

The task of the physician is to look deep, and ferret out each individual's specific needs (e.g.,  by attention to symptoms, individual and family history, biochemical and physiological labs, and response to treatment, etc.)


Thus, the statements in this blog cannot help but be generalizations, and will not apply to everyone. As they say:  One man's meat is another man's poison.
Hence, keep in mind, that my purpose in this blog is certainly not prescriptive, but solely educational.

And, if you need treatment for bipolar disorder, or any other medical condition, please seek the services of a knowledgeable physician. 

 See the introduction, by Jeffrey Bland, PhD, to the classic on the subject, Biochemical Individuality, by Roger Williams, PhD.

 For more on bipolar,  see Natural Healing for Bipolar Disorder

Orthomolecular therapies for mania: Introduction

One would ultimately want to heal key underlying causes, but until that process is completed, symptomatic approaches (e.g., stopping the mania) are often critical.

Orthomolecular therapies for mania involve:

1 Stabilizing nutrients, herbs and diet.
2 Biotype therapies, as relevant.
3 Attention to allergies/ environmental illness, Candida,  hormone balances, immune status, neurological function, and other health conditions, as relevant.
4 Moderation of mental and physical stressors
5 Medication changes only when indicated.

More to follow.

See Natural Healing for Bipolar Disorder, for detailed descriptions.

Spring Mania Cautions

At this season, when sunlight beckons, days get longer, and mania looms (for some), many bipolars decide to stop or reduce meds, or just forget to take them.

This is a recipe for disaster, e.g., a mania followed by an almost inevitable depression, higher drug doses, perhaps hospitalization, often further mood destabilization.

Be careful.

Give yourself time to heal.

See previous entry.

Nutrient Approaches for Bipolar and Ongoing Medication

Nutrient therapy does not preclude bipolar medications.
Orthomolecular therapists start therapy with whatever meds the patient is taking.

Decreasing meds is not the goal of nutrient treatment, but often occurs because, with therapeutic improvement, the specific dosage may no longer be medically indicated.
Eventually, as recovery emerges, this process may lead to complete withdrawal, but not necessarily (e.g., the brain may have become irreversibly adapted to the med).

But even when nutrients create definite improvement, orthomolecular therapists are generally very cautious when reducing meds. 

Why?
An uncalled for, or too rapid reduction, often triggers symptom flareups, engenders life-threatening risk, and usually leads to increased meds, perhaps hospitalization and, often, greater difficulty regaining previous improvements, i.e., the illness generally becomes less responsive to treatment.

So orthomolecular reductions typically involve  5-10% steps, usually only one med at a time.
These steps may take place over months, or even years.
The pace is generally dictated by the degree of therapeutic improvement and mood stability at each stage.
With each step, many orthomolecular physicians increase nutritional and other support, and closely monitor patient reactions.
If symptoms worsen, relevant nutrients and other support are increased, and an increase toward the previous med dose may be undertaken.

Reductions only occur if medically indicated:
1 Symptoms improving enough so the old dose is no longer relevant, or
2 Improving enough so medication effects become excessive (e.g., antipsychotics or anxiolytics overly suppressing mental activity), or
3 Adjustments as a mood episode ends (e.g., tapering of antidepressants after a depression resolves; and  antipsychotics or anxiolytics, after a mania; if indicated).
4 Meds are causing a medical emergency, or other dangerous medical situation.

WARNING: To reiterate, reducing bipolar meds poses a life-or-death risk, especially when done too quickly or when not indicated. Do not reduce meds without sufficient therapeutic support, and the guidance of a knowledgeable physician.

Thus, the risk of suicide in the first year or so after withdrawing from lithium (and most likely other mood stabilizers) is known to skyrocket to as great, or greater than before treatment began.
And if the pace is too rapid, or therapeutic support insufficient, reductions in antidepressants, antipsychotics, or  anxiolytics can lead to a particularly potent depression, mania, psychosis or anxiety, with attendant risk.

For more on nutrient therapy for bipolars, see my book, Natural Healing for Bipolar Disorder

Your questions & comments on nutrients and bipolar are welcome!

Readers, please do feel free to comment, ask questions, share experiences.

Happy spring! Vitamin D and mania?

Vitamin D helps balance blood sugar, promote natural biorhythms, counter  free radicals, and protect against allergies and seizures, actions likely to support mood-stability.
Several thousand IU doses have recently become popular.
See:  vitamindcouncil.org/mentalIllness.shtml

Most bipolars know that increasing seasonal sunlight may trigger spring/summer mania
See: http://boragebooks.com/bipolar_8_biorhythms.html
But what role does vitamin D play?

Consider:
1 - Vitamin D supports the creation of thyroid hormone, and of the major antidepressant neurotransmitters, serotonin, dopamine and norepinephrine; and it helps with calcium use; altogether suggesting  antidepressant activity. And that is just what researchers are reporting. (See, for instance, Vieth 2004, Gloth 1999, Landsdowne 1998)
Thus, D seems to be antidepressant, so is potentially promanic.   See previous entry, Therapeutic Moderation, & Attention to Causes

2- Vitamin D is created by the interaction of sunlight with skin. Levels typically increase about 50% over the year, from approximately 16 ng/mL in winter to 24  in the summer. Vieth 2004
Schneider 2000 found levels in depressives at 80% that of normals.
If the continuum holds, manics would have above-normal levels.

Question is, especially in those bipolars prone to mania as hours of sun increase, does several thousand IU of supplemental D, at a time when body levels are already rising, further fuel those manias...  making temporary intake reductions advisable?

For more info, see my book, available at naturalhealingforbipolardisorder.com/bipolar.html

Antimanic Nutrient Adjustments

Typically, the stronger antidepressant nutrients and herbs would have been tapered around the time that depression ended (e.g., phenylalanine, korean ginseng, etc; perhaps tyrosine, serotonin, inositol, ginkgo, NADH, etc., depending on how strongly they influence mood in the individual.)

But even some nutrients, foods, and herbs which mainly support vibrant health and general stability (e.g., multiples, essential fatty acids, chlorophyll sources, vitamin D, etc.)  may need to be reduced some before an anticipated mania, or as it progresses, again, depending on individual reactions.

For a general overview, see:
http://boragebooks.com/bipolar_treatments.html

Therapeutic Moderation, & Attention to Causes

Bipolars are highly reactive to changes in stimulation.

So when you give a bipolar too potent, too lengthy, and/or too frequent an antidepressant, you just might cause the depression to end in a mania and, perhaps, some time later, a more severe depression than usual.  (Frye, Ketter 2001, Post 2003, Brigham 2001)  In fact, psychiatrists have become a lot more cautious about giving antidepressants to bipolars.

Similar concerns are beginning to surface around the antipsychotic meds used for mania and psychotic depression. (Whybrow 1997, Brigham 2001) 

So that mainstream psychiatry has given voice to the advisability, where possible, of weaning antidepressants and antipsychotics around the time that the corresponding episode resolves. (Unfortunately, when such meds are stopped, especially if done abruptly, rebounds can be disastrous.)
 
In the same manner, street drugs, trauma, psychosocial stress, even seasonal change and junk-food diets, can trigger episodes.

And as a general rule, with each additional episode, the illness becomes increasingly difficult to treat. (Masters 1996, Goldberg 1999)

New episodes are rarely triggered by nutrients, although potent, rapidly-acting, symptomatic nutrients can do so (e.g., SAMe, mistakenly given to people prone to brain overmethylation).

So when symptomatic treatment is required (e.g., to stop a depression), the ideal goal might be the mildest treatment strong enough to achieve the desired degree of response.


As the focus of treatment moves toward underlying causes this yo-yo effect phases out.
I like the vision of health care put forth by Hyla Cass, MD, on her website:

"Treat the whole person - mind, body, spirit, and environment.

Determine the deepest root causes, using scientific lab testing if needed.

Treat as deeply, naturally, and safely as possible,"

For further discussion, and for sources, see my book, Natural Healing for Bipolar Disorder

Bipolar Research Issues

Bipolar disorder does not lend itself to adequately controlled double blinds with clear outcomes. This drawback applies to both pharmaceutical and orthomolecular studies.

Standard research is rarely conclusive because:
1 Changes in the cycling pattern can be confused with improvement. 
2 A measure which elicits a good acute response can, over time, increase deterioration.

3 Bipolar hypersensitivity to even mild stressors (e.g., the study) can alter results.

4 Manics may be uncooperative, or may readily drop out, distorting results. Hypomanias may not be obvious to the researcher, and unreported by patients.

5 Most studies are not long enough to account for cycling, rebounds, slowly-emerging improvement, long-term deterioration, etc.

Problems in accounting for biochemical individuality
1 Intricate interactions of treatment with individual biochemistry and health are difficult to control for.
2 Responsive subgroups may not be readily apparent.

Issues specific to pharmaceutical studies
1 Data on adverse effects is often lost due to the high drop-out rate common in pharmaceutical studies (Horrobin 2002).*
2 The effects of drugs, polypharmacy,  and drug discontinuation are not easily separated from effects of illness.**
3 The high cost of large double blinds largely shapes what is convincingly studied to proposals for which large pharmaceutical companies and other wealthy concerns are willing to pay.*** (Abramson 2004)
* Horrobin points out that typically, 40-60% of subjects drop out of six-to-eight-week studies of psychiatric medications (mostly to avoid side effects); in one-year studies, 60-90%. Benefits are thus validated for only a small percentage of patients.
** For example,  in many of the early studies, lithium was abruptly withdrawn from controls, a practice now known to promote mania. (Ketter 2001, Bauer 1996, Gold 1987)
*** Abramson (2004) claims that studies financed by drug companies are five times more likely to find in favor of the company's drug of choice.
 

Moral considerations 

The proposed treatment (or lack of it in controls) might trigger a new episode, promote rapid cycling, or otherwise increase illness severity, or fatality.  (Compton 2001)
To limit such consequences, current mainstream studies often compare a proposed medication to one already in use. This approach, unfortunately, makes conclusions about the new drug dependent on the lack of flaws in studies of the original drug.
This issue over depriving the control group also shapes nutritional studies. Doctors are loathe to deny bipolars what they believe are effective nutrients, for the sake of experimental results.


Evolving experimental design
Long-term naturalistic studies
Because of such factors, sufficiently controlled double-blinds studying bipolar treatment are unlikely. (Bauer 1996, Compton 2001) (So, for instance, despite prior "controlled" double-blind research, decades passed before recognizing that significant antidepressant use often fosters rapid-cycling, or otherwise worsens long-term outcome. (Post 2003, Ketter, Frye 2001))
Consequently, some mainstream researchers now recommend open, naturalistic, longitudinal studies, i.e., following patients over many years, probably decades. (Bauer 1996, Compton 2001 Ketter, Frye 2001)
This type of design particularly lends itself to exploring how bipolars fare over the long term, with multiple nutrients, tailored to health, diet, medication, evolving biochemistry, cycling pattern, etc.


Nutrient research

Nonetheless, although definitive conclusions may be years away, the research supporting orthomolecular approaches is promising. This research has entailed:

1 Double blinds and other controlled studies of certain key nutrients.

2 Outcome studies for multiple nutrients, usually tailored to individual biotype requirements. The best such study is probably Dr. Walsh's outcome data for 1800 bipolars, involving extensive biochemical and nutritive data on blood, urine, and hair, correlated with psychiatric rating scales and clinical results.
3 Other clinical data, especially that with lengthy follow-up.

4 Other nutritional/herbal research on associated psychiatric conditions (e.g., GABA’s effects on anxiety; valerian’s benefit to insomnia, etc.).
5 Research on nutritional, herbal, and medical therapies for confounding physical conditions (thyroid disorder, allergy, Candida, sugar imbalance, neurotoxicity, etc.)

For sources and further discussion, see my book, Natural Healing for Bipolar Disorder.