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| Bipolar Disorder, Manic-Depressive |
Last updated: Sep 22, 2008 |
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Bipolar Disorder, Manic-Depressive |
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Signs, symptoms and indicators | Conditions that suggest it | Contributing risk factors | Other conditions that may be present | It could instead be... | Recommendations
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Manic-depressive illness, also called bipolar disorder, is a condition in which periods of depression alternate with periods of mania or lesser degrees of excitement. Manic-depressive illness affects slightly less than 2% of the population to some degree. The illness is believed to be hereditary, although the exact genetic defect is still unknown. Manic-depressive illness is equally common in men and women and usually first encountered from the teenage years through to early thirties.
Manic-depressive illness usually begins with depression and includes at least one period of mania at some time during the illness. Episodes of depression typically last 3 to 6 months. In the most severe form of the illness, called Bipolar I Disorder, depression alternates with intense mania. In the less severe form, called Bipolar II Disorder, short depressive episodes alternate with hypomania (mild mania). Symptoms of Bipolar II Disorder often change with the seasons, for example depression in the fall and winter, and brief excitement in the spring or summer.
In an even milder form of Manic-depressive illness called Cyclothymic Disorder, periods of elation and depression are less severe, typically lasting only a few days and recurring fairly often at irregular intervals. Although Cyclothymic Disorder may ultimately evolve into Manic-depressive illness, in many people it never leads to major depression or mania. Having a Cyclothymic Disorder may contribute to a person's success in business, leadership, achievement, and artistic creativity. However, it may also cause uneven work and school records, frequent change of residence, repeated romantic breakups or marital failure, or alcohol and drug abuse. In about a third of people with Cyclothymic Disorder, these symptoms can lead to a mood disorder that requires treatment.
The diagnosis of Manic-depressive illness is based on the distinctive pattern of symptoms. A doctor determines whether the person is experiencing a manic or depressive episode so that the correct treatment can be given. About one in three people with Bipolar Disorder experience manic (or hypomanic) and depressive symptoms simultaneously. This condition is known as a Mixed Bipolar State.
Most people with Bipolar Disorder have extreme cycles only once every few years. Those with rapid cycles may go through four or more episodes of mania and depression per year; those with ultra-rapid cycles have episodes shorter than a week, with distinct and dramatic moods shifts within a 24-hour period. Some people with Bipolar Disorder may have weeks, months, or even years with absolutely no extreme ups and downs at all. Manic-depressive illness recurs in nearly all cases. People who cycle rapidly are more difficult to treat.
In some cases, alternative methods may work in a complementary way to the use of conventional medications, helping them to work better or, in some cases, to lower necessary dosages. In other cases, alternative treatments may be effective on their own, allowing a reduction in existing medications or lessening mood swings to the point where patients can lead more normal and satisfying lives.
Hypomania shares symptoms and characteristics similar to the mania aspect of manic depression, but to a less severe degree. The characteristics of a hypomanic episode include:
- Euphoric mood lasting for at least several days on end which can switch to irritability, intolerance and rage
- Increased activity and high energy levels
- Rapid speech and flow of ideas
- Extrovert nature, seeking out people, including strangers
- Exalted self-esteem
- Loss of judgment
- Spending too much money
- Lack of inhibitions and increased sexual drive
- Increased productivity and creativity
- Feeling a need for less sleep
You can feel very good during a hypomanic episode and will probably disagree with anyone who argues to the contrary. “I felt great, really successful, like an achiever.”
Hypomania is episodic so if you experience more than one episode, you will have periods where your mood is stable between them. People diagnosed with hypomania rarely experience delusions. Diagnostic manuals state that hypomania should not be diagnosed if the person experiences delusions. Hypomania is usually not so problematic as to severely affect a person’s work or social life. It is also unusual for someone with this diagnosis to need to stay in hospital. Hypomanic episodes are usually rapid in onset and can last from several weeks to months.
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Signs, symptoms & indicators of Bipolar Disorder, Manic-Depressive: | |  | | | | Symptoms - Mind - Emotional | Emotional instability | Symptoms - Reproductive - Female Cycle |
Long menstrual cycles | Women with Bipolar disorder taking medication report a high rate of long menstrual cycles, and significant mood changes in relation to menstrual cycle phase. [Bipolar Disorders, February 2003, 5:1; p.48] |
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Conditions that suggest Bipolar Disorder, Manic-Depressive: | |  | | | | Symptoms - Mind - General | Counter-indicators:
Good mood stability |
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Risk factors for Bipolar Disorder, Manic-Depressive:
Bipolar Disorder, Manic-Depressive suggests the following may be present: | |  | | | | Hormones | Histadelia (Histamine High) | About 35% of bipolar patients have high histamine levels. |
Histapenia (Histamine Low) | About 25% of bipolar patients have low histamine levels. |
Hypothyroidism | Depression, whether unipolar or bipolar, can be a symptom of hypothyroidism. Here is the testimony of one woman who found out the hard way:
[About 10 years ago, for a period of 5 years, I was hospitalized 5 times for psychiatric emergencies, with diagnoses of schizophrenia, bipolar, psychotic depression, and so on. Now, after years of treatment with slow-release Armour thyroid (a compounded medication prescribed by a doctor who practices functional medicine) I no longer take any antidepressants or any other kind of psychiatric medications. I learned about Hashimoto's and I insisted on antibody tests which showed that Hashimotos disease was my problem. Even then, the endocrinologists I saw would not treat me, telling me to stay with my psychiatrist, which is why I went to a doctor who practices functional medicine. I am not saying that all people with mental health diagnoses such as bipolar disease have a thyroid problem! But, one problem is that thyroid testing may exclude many people who can benefit from thyroid treatment by calling them "normal". Also, TSH alone may not be sufficient to diagnose a thyroid problem. E.L.M.
A good friend of mine has been treated by a psychiatrist for years with bipolar disorder. The depression part of it kept getting worse, particularly in the winter and spring. Finally, because of my own experience, I suggested she talk with her doctor about thyroid problems. She was tested by her doctor. She did not have antibodies. However, her doctor told her that her free T3 (a measure of the active form of thyroid in the bloodstream) was too low, and put her on thyroid medication. She prescribed a combination of T4 and T3. It will take many months, perhaps a few years, for my friend to know how much this helps with her seasonal problems. But she is feeling better already. And if this could happen to me, it could happen to other people too.] E.L.M. |
| Metabolic |
Pyroluria |
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Bipolar Disorder, Manic-Depressive could instead be: | |  | | | | Mental | Depression | Although currently classified as separate illnesses, there is increasing interest in the psychiatric community in viewing unipolar depression, Bipolar Disorder, and anxiety disorders as part of a larger, overlapping spectrum of mental disorders. This trend is supported by findings that many individuals who are first diagnosed with unipolar depression are eventually diagnosed as actually suffering from Bipolar Disorder. One interesting study, [Diagnostic conversion from depression to bipolar disorders], tracked 406 patients with major mood disorders over a 20-year period. Of 309 patients presenting with depression, 121 (39.2 percent) eventually manifested as Bipolar (24.3 percent to Bipolar Type I, 14.9 percent to Bipolar Type II). This growing debate over the accuracy of diagnostic classifications might seem to be purely academic except for the effect it has on treatment protocols. As antidepressant mono-therapy is the mainstay treatment for depressive, and to some degree anxiety disorders, it is typically not recommended for Bipolar Disorder without the addition of mood stabilizing medications.
As many as 1 in 4 people diagnosed in primary care with major depressive disorder have been found to screen positive for a previous manic episode, suggesting that they may actually have bipolar disorder rather than depression. Bipolar disorder is a serious and chronic psychiatric illness, associated with high risk of suicide and other disorders. It is characterised by both manic and depressive episodes. Evidence shows that misdiagnosis of bipolar disorder is common, and that the diagnosis is made, on average, as many as 10 years after the onset of symptoms. The most common misdiagnosis is with unipolar depression, which is characterised by depressed mood without manic episodes. This cross-sectional survey of primary care patients was conducted at the Neasham Road surgery in Darlington in the UK. |
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Recommendations for Bipolar Disorder, Manic-Depressive: | |  | | | | Drug | Conventional Drugs / Information | People with this condition generally require life-long treatment with lithium or other drugs to control manic episodes, sometimes with antidepressants to control the depression, although it improves both depression and mania. In fact, the occurrence of depression in a person who has been taking lithium is often an indication that a higher dose is needed. For lithium to reach its maximum effectiveness, 2 or even 3 weeks is often required.
Some of the brand names under which lithium is sold are Lithane, Eskalith, Lithobid and Cibalith. Lithium is effective only for about half the people with bipolar disorder.
Some doctors believe that a significant bipolar disorder will not respond sufficiently to alternative interventions alone.
There aren't many studies with Seroquel (quetiapine fumarate) as the only medication used to treat bipolar disorder. As far as the anecdotal evidence goes, people are reasonably satisfied with this medication when it does work for bipolar mania. It does do a good job at boosting an antidepressant's effect on the depression side of things and often can work as a stand-alone mood stabilizer, dealing with both mania and depression, despite being approved to treat only mania. |
| Lab Tests/Rule-Outs |
Test Essential Fatty Acid Profile | Mineral |
Lithium (low dose) | A limited amount of testimonial evidence exists in support of the use of lithium orotate (150mg per day) in this condition. This is an OTC product. |
| Nutrient |
Lecithin / Choline / GPC | A number of studies suggest that lecithin has significant effects on the manic-depressive, with some claiming that it stabilizes moods or serves as a mood depressant. Although lecithin may be useful in helping to stabilize moods, it should be used cautiously since there may be a predominantly depressing action in certain individuals. |
EPA (eicosapentanoic acid) | Several studies have shown that essential fatty acids may be beneficial in treating Bipolar Disorder. The omega-3 metabolite responsible is believed to be EPA. At least one study found DHA, the other common metabolite, to be ineffective. This means if you were using a fish oil product, it shoud have a high EPA/DHA ratio; in other words, be EPA rich. [Omega-3 Fatty Acids in Bipolar Disorder: A Preliminary Double-blind, Placebo-controlled Trial. Arch Gen Psychiatry. 1999;56: pp.407-412] |
Not recommended:
TMG (Tri-methyl-glycine) / SAMe | SAMe can cause a person with bipolar depression (a history of irritability, temper outbursts and swings in mood, energy level and need for sleep) to become manic. The bipolar form of depression is very common and is often misdiagnosed as plain depression. People should not use SAMe or TMG without first having a thorough evaluation to rule out bipolar disorder. |
DMAE | Vitamins |
Multiple Vitamin Supplement | The need for medication was reduced by 63% in 11 of 14 bipolar patients who completed a study lasting 6 months.This was accomplished by the use of a specific broad spectrum nutritional supplement called E.M. Power+ (now Empowerplus), distributed by the Synergy Group of Canada. Their home page provides all you need to know about this encouraging product. |
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KEY |  | Weak or unproven link |  |  | Strong or generally accepted link |  |  | Very strongly or absolutely counter-indicative |  |  | May do some good |  |  | Likely to help |  |  | Highly recommended |  |  | May have adverse consequences |  |  | Avoid absolutely |
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