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.
Regarding the following, please see your scoring for these separate conditions.
Bipolar disorder is not a single condition, but an umbrella term which includes a number of very different biochemical abnormalities. I’m bothered by any attempt to generalize over the bipolar phenotypes & to blindly recommend any formulation or therapy for all of them. The key is to determine a patient’s biochemical individuality, and to provide focused appropriate treatment. In our database of 1,500 bipolar patients, about 25% are overmethylated, 35% are undermethylated, and the remaining 40% do not exhibit a methylation disorder.
The three primary biochemical classifications of bipolar disorder are the following:
A. Undermethylation: This condition is innate & is characterized by low levels of serotonin, dopamine, and norepinephrine, high whole blood histamine and elevated absolute basophils. This population has a high incidence of seasonal allergies, OCD tendencies, perfectionism, high libido, sparse body hair, and several other characteristics. They usually respond well to methionine, SAMe, calcium, magnesium, omega-3 essential oils (DHA & EPA), B-6, inositol, and vitamins A, C, and E. They should avoid supplements containing folic acid. In severe cases involving psychosis, the dominant symptom is usually delusional thinking rather than hallucinations. They tend to speak very little & may sit motionless for extended periods. They may appear outwardly calm, but suffer from extreme internal anxiety.
B. Overmethylation: This condition is the biochemical opposite of undermethylation. It is characterized by elevated levels of serotonin, dopamine, and norepinephrine, low whole blood histamine, and low absolute basophils. This population is characterized by the following typical symptoms: Absence of seasonal, inhalent allergies, but a multitude of chemical or food sensitivities, high anxiety which is evident to all, low libido, obsessions but not compulsions, tendency for paranoia and auditory hallucinations, underachievement as a child, heavy body hair, hyperactivity, “nervous” legs, and grandiosity. They usually respond well to folic acid, B-12, niacinamide, DMAE, choline, manganese, zinc, omega-3 essential oils (DHA and EPA) and vitamins C and E, but should avoid supplements of methionine, SAMe, inositol, TMG and DMG.
C. Pyrrole Disorder: This condition, also called pyroluria, is a genetic stress disorder associated with severe mood swings, high anxiety, and depression. The biochemical signature of this disorder includes elevated urine kryptopyrroles, a double deficiency of zinc and B-6, and low levels of arachidonic acid. Pyrolurics are devastated by stresses including physical injury emotional trauma, illness, sleep deprivation, etc. Symptoms include sensitivity to light and loud noises, tendency to skip breakfast, dry skin, abnormal fat distribution, rage episodes, little or no dream recall, reading disorders, underachievement, histrionic behaviors, and severe anxiety. They usually respond quickly to supplements of zinc, B-6, Primrose Oil, and augmenting nutrients.
To me, a bipolar patient who becomes “well” with greatly-reduced medication requirements may have achieved complete success. I don’t believe that medication doses need to go to zero, as long as side effects are absent and long-term effects are minimal or absent. Ph[/glossary].D., past senior scientist, Pfeiffer Treatment Center www.hriptc.org]
Signs, symptoms & indicators of Bipolar Disorder, Manic-Depressive
Emotional instability
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]
Conditions that suggest Bipolar Disorder, Manic-Depressive
Bipolar disorder
Counter Indicators
Good mood stability
Risk factors for Bipolar Disorder, Manic-Depressive
Bipolar Disorder, Manic-Depressive suggests the following may be present
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.
Pyroluria
About 18% of those with bipolar disorder are also pyroluric.
Bipolar Disorder, Manic-Depressive could instead be
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.
Recommendations for Bipolar Disorder, Manic-Depressive
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.
Doctors and patients should be aware that some will develop kidney problems when taking lithium, and that kidney function should be monitered. “A … safety alarm was triggered by reports of kidney damage in the late 1970s. Subsequent reports have questioned the significance of anatomical findings, and functional impairment and relationship to lithium treatment. Recent findings support the conclusion that progressive impairment of glomerular and tubular function in patients during lithium maintenance is the exception rather than the rule and is related more to lithium intoxication, maintenance plasma lithium levels, concurrent medications, somatic illness, and age than on time on lithium.”[Neuropsychopharmacology (1998) 19 200-205.10.1038/sj.npp.1395203]
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.
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.
Reading List
Here is a website with good alternative information on the treatment of bipolar disorder.
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]
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.
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.
Key
| Weak or unproven link |
| Strong or generally accepted link |
| Proven definite or direct link |
| Very strongly or absolutely counter-indicative |
| May do some good |
| Likely to help |
| Highly recommended |
| May have adverse consequences |
| Avoid absolutely |
Glossary
Bipolar Disorder
Also known as manic-depression, this disorder is characterized by alternating periods of extreme moods, usually swinging from being overly elated or irritable (mania) to sad and hopeless (depression) and then back again, with periods of normal mood in between. The frequency of the swings between these two states, and the duration of the mood, varies from person to person.
Serotonin
A phenolic amine neurotransmitter (C10H12N2O) that is a powerful vasoconstrictor and is found especially in the brain, blood serum and gastric membranes of mammals. Considered essential for relaxation, sleep, and concentration.
Dopamine
A neurohormone; precursor to norepinephrine which acts as a stimulant to the nervous system.
Noradrenaline
(Norepinephrine): A catecholamine hormone secreted from the adrenal medulla and post-ganglionic adrenergic fibers in response to hypotension or emotional stress.
Histamine
A chemical in the body tissues, produced by the breakdown of histidine. It is released in allergic reactions and causes widening of capillaries, decreased blood pressure, increased release of gastric juice, fluid leakage forming itchy skin and hives, and tightening of smooth muscles of the bronchial tube and uterus.
Basophil
The basophils account for about 1% of the granulocyte count (60 to 75% of the white blood cells). They release chemicals such as histamine and play a role in the inflammatory response to infection.
Allergy
Hypersensitivity caused by exposure to a particular antigen (allergen), resulting in an increased reactivity to that antigen on subsequent exposure, sometimes with harmful immunologic consequences.
Methionine
Essential amino acid. Dietary source of sulfur and methyl groups. Important for proper growth in infants, nitrogen balance in adults, healthy nails and skin and the synthesis of taurine, cysteine, phosphatidylcholine (lecithin), bile, carnitine and endorphins. It is an antioxidant nutrient and lipotropic agent which promotes the physiological utilization of fat.
Calcium
The body's most abundant mineral. Its primary function is to help build and maintain bones and teeth. Calcium is also important to heart health, nerves, muscles and skin. Calcium helps control blood acid-alkaline balance, plays a role in cell division, muscle growth and iron utilization, activates certain enzymes, and helps transport nutrients through cell membranes. Calcium also forms a cellular cement called ground substance that helps hold cells and tissues together.
Magnesium
An essential mineral. The chief function of magnesium is to activate certain enzymes, especially those related to carbohydrate metabolism. Another role is to maintain the electrical potential across nerve and muscle membranes. It is essential for proper heartbeat and nerve transmission. Magnesium controls many cellular functions. It is involved in protein formation, DNA production and function and in the storage and release of energy in ATP. Magnesium is closely related to calcium and phosphorus in body function. The average adult body contains approximately one ounce of magnesium. It is the fifth mineral in abundance within the body--behind calcium, phosphorus, potassium and sodium. Although about 70 percent of the body's magnesium is contained in the teeth and bones, its most important functions are carried out by the remainder which is present in the cells of the soft tissues and in the fluid surrounding those cells.
Essential Oil
Volatile terpene derivative responsible for the odor or taste of a plant.
DHA
Docosahexanoic Acid. A metabolite of the omega-3 fatty acid alpha-linolenic acid.
EPA
Environmental Protection Agency. Also: Eicosapentanoic Acid. A metabolite of the omega-3 fatty acid alpha-linolenic acid.
Vitamin B6
Influences many body functions including regulating blood glucose levels, manufacturing hemoglobin and aiding the utilization of protein, carbohydrates and fats. It also aids in the function of the nervous system.
Inositol
Usually considered part of the vitamin B complex. It is thought that along with choline, inositol is necessary for the formation of lecithin within the body. Involved in calcium mobilization.
Folic Acid
A B-complex vitamin that functions along with vitamin B-12 and vitamin C in the utilization of proteins. It has an essential role in the formation of heme (the iron containing protein in hemoglobin necessary for the formation of red blood cells) and DNA. Folic acid is essential during pregnancy to prevent neural tubular defects in the developing fetus.
Hallucination
A false or distorted perception of objects or events, including sensations of sight, sound, taste, smell or touch, typically accompanied by a powerful belief in their reality.
Anxiety
Apprehension of danger, or dread, accompanied by nervous restlessness, tension, increased heart rate, and shortness of breath unrelated to a clearly identifiable stimulus.
Cobalamin
Vitamin B-12. Essential for normal growth and functioning of all body cells, especially those of bone marrow (red blood cell formation), gastrointestinal tract and nervous system, it prevents pernicious anemia and plays a crucial part in the reproduction of every cell of the body i.e. synthesis of genetic material (DNA).
Niacin
(Vitamin B-3): A coenzyme B-complex vitamin that assists in the breakdown of carbohydrates, fats and proteins. Essential for the health of the skin, nerves, tongue and digestive system. It is found in every cell of the body and is necessary for energy production. Niacin is also needed for DNA formation.
Choline
A lipotropic substance sometimes included in the vitamin B complex as essential for the metabolism of fats in the body. Precursor to acetylcholine, a major neurotransmitter in the brain. Choline prevents the deposition of fats in the liver and facilitates the movement of fats into the cells. Deficiency leads to cirrhosis of the liver.
Manganese
An essential mineral found in trace amounts in tissues of the body. Adults normally contain an average of 10 to 20mg of manganese in their bodies, most of which is contained in bone, the liver and the kidneys. Manganese is essential to several critical enzymes necessary for energy production, bone and blood formation, nerve function and protein metabolism. It is involved in the metabolism of fats and glucose, the production of cholesterol and it allows the body to use thiamine and Vitamin E. It is also involved in the building and degrading of proteins and nucleic acid, biogenic amine metabolism, which involves the transmitting of nerve impulses.
Zinc
An essential trace mineral. The functions of zinc are enzymatic. There are over 70 metalloenzymes known to require zinc for their functions. The main biochemicals in which zinc has been found to be necessary include: enzymes and enzymatic function, protein synthesis and carbohydrate metabolism. Zinc is a constituent of insulin and male reproductive fluid. Zinc is necessary for the proper metabolism of alcohol, to get rid of the lactic acid that builds up in working muscles and to transfer it to the lungs. Zinc is involved in the health of the immune system, assists vitamin A utilization and is involved in the formation of bone and teeth.
TMG
Tri-methyl-glycine. After supplying a methyl group, TMG becomes di-methyl-glycine. DMG, a natural component of animal and plant metabolism, positively influences the immune response in laboratory animals and humans and boosts physical and mental performance.
Pyroluria
This condition is caused by an overproduction during hemoglobin synthesis of kryptopyrrole, which chemically combines with vitamin B6 and zinc, resulting in their excretion and a severe deficiency of both of these essential nutrients. Most pyroluric individuals never develop schizophrenia symptoms.
Arachidonic Acid
A polyunsaturated 20-carbon essential fatty acid occurring in animal fats and also formed by biosynthesis from dietary linoleic acid (Omega 6). It is a precursor in the biosynthesis of leukotrienes, prostaglandins, and thromboxanes. Excess tends to produce inflammation.
Hypothyroidism
Diminished production of thyroid hormone, leading to low metabolic rate, tendency to gain weight, and sleepiness.
Schizophrenia
Any of a group of psychotic disorders usually characterized by withdrawal from reality, illogical patterns of thinking, delusions, and hallucinations, and accompanied in varying degrees by other emotional, behavioral, or intellectual disturbances. Schizophrenia is associated with dopamine imbalances in the brain and defects of the frontal lobe and is caused by genetic, other biological, and psychosocial factors.
Thyroid
Thyroid Gland: An organ with many veins. It is at the front of the neck. It is essential to normal body growth in infancy and childhood. It releases thyroid hormones - iodine-containing compounds that increase the rate of metabolism, affect body temperature, regulate protein, fat, and carbohydrate catabolism in all cells. They keep up growth hormone release, skeletal maturation, and heart rate, force, and output. They promote central nervous system growth, stimulate the making of many enzymes, and are necessary for muscle tone and vigor.
Antibody
A type of serum protein (globulin) synthesized by white blood cells of the lymphoid type in response to an antigenic (foreign substance) stimulus. Antibodies are complex substances formed to neutralize or destroy these antigens in the blood. Antibody activity normally fights infection but can be damaging in allergies and a group of diseases that are called autoimmune diseases.
T4
Thyroxin, thyroid hormone also prepared synthetically, for treatment of hypothyroidism and myxedema.
Chronic
Usually Chronic illness: Illness extending over a long period of time.