Natural Bipolar Cure?

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...First, an act of desperation that could turn into a medical breakthrough. In 1994, Debbie Stephan, an Alberta mother of 10, committed suicide. Her husband, Anthony, was devastated. Debbie had been diagnosed with bipolar disorder. Also, called manic depression illness. It’s a common infliction thought to be caused by changing levels of chemicals in the brain. People with bipolar disorder can have huge mood swings. There’s also a genetic component and it seems to run in the Stephan family. Anthony Stephan saw the same symptoms in his son and his daughter.

Nutritional research for bipolar disorder

Healing Depression & Bipolar Disorder Without Drugs features Gracelyn Guyol’s own story and those of thirteen other people around the country who have cured their depression and bipolar disorder using only natural therapies. In-depth research and the expertise of alternative health-care professionals are included in this landmark guide for patients and caregivers seeking responsible, safe alternatives to psychiatric drugs.

“She had already been taken medication for over four and a half years and she was going to suicide. It [prescription medication] wasn’t helping. My son was on 900 milligrams of Lithium per day and was absolutely out of control,” Anthony Stephan.

Stephan was desperate. A friend told him that his children’s symptoms sounded like a nervous disorder that affected pigs, called “ear and tail biting syndrome.” Stephan found that farmers cured the problem with a new nutritional supplement. It gave it to his kids and he said the improvement was dramatic. Stephan went on to give the supplement [which eventually became EmPowerPlus by TrueHope] to 100 volunteers and later approached researchers at the University of Calgary. They tested the supplement, now called EmPowerPlus on people with bipolar disorder. Yesterday, they announced the results of their study.

Standing by in Calgary is one of the authors of that study, Dr. Bonnie Kaplan. She the professor of Pediatrics at the University of Calgary. She joins us know from her lab at the Alberta Children’s Hospital. Dr. Kaplan, tell us what your study showed.

“What it showed was that in 10 adult men, who took this supplement called EmPowerPlus, there was an enormous symptom improvement. They went from having huge highs and terrible lows to having many fewer mood swings and more moderate mood swings,” Dr. Kaplan.

Okay, so these are people with bipolar depression. Can you paint us a picture what their lives would be like with some of those highs and lows, those mood swings before they started taking the supplement?

“Right. A lot of these people are quit incapacitated by their mood swings. When they’re manic, they’re up for many nights. They’re unable to work. They often make very foolish decisions, very impulsive decisions, spend a lot of money, do a lot of crazy things. And sometimes very irritable and very aggressive. When they’re low, they’re very depressed, very lethargic, and again, unable to work and very dysfunctional. In the worst case scenario, unfortunately, suicide can be an outcome and is often an outcome of bipolar disorder,” Dr. Kaplan.

So, can you describe some of the changes in those patterns that you saw following the taking of the EmPower [by TrueHope] supplement?

“Well, in a word, they’re much better,” Dr. Kaplan. “These are people who feel a lot more normal. Who don’t have the extreme highs and lows. By and large, they’re returning to normal lives. We have people who are going back to school. We have people who are going back to work, who are able to take on responsibilities that they haven’t been able to take on before. It’s really rewarding to see that kind of improvement.”

Were there any side-effects to taking it?

“No. There doesn’t seem to be any negative side effects by and large,” Dr. Kaplan. “The worst thing we’ve occasionally encountered is someone having nausea when they first taking it. In a couple of cases, they’ve cut back on the dose and worked up to the full dose gradually and the nausea is gone.”

It sounds miraculous. What’s going on? A nutritional supplement is working. Why do you think that is?

“It’s not a miracle at all. But scientifically, I think it’s really, really interesting,” Dr. Kaplan.

What is it about it that interests you?

“Wondering how it’s working. We don’t’ know,” Dr. Kaplan. “It’s important to tell you that what I’m about to tell you is speculation. But it appears as if it, EmPower nutritional supplement by TrueHope, is enabling these people’s brains to work in a more normal range. They also, by the way, don’t need the psychotropic [pharmaceutical mind altering drugs] medication that they used to need. In fact, in our case series of 10 patients, they [bipolar patients] were taking on average of 2.8 psychotropic meds when they started EmPower and now they’re down to an average of 1.0. That’s a two-thirds reduction. We’re not anti-medication. Many of these people need psychotropic medication, but to be enable to see them get along on less suggests some how we’re restoring some of their normal brain functions.”

Now, enabling the brain to work in a better way: How?

“How? We really don’t know. There are clues and I think you should get one of your neuroscientists in here for a comment or two about what we know about zinc and its role in the brain and calcium and vitamin B12, which has known to be associated with depressive mood states. Deficiencies in a lot of minerals and some vitamins probably is not a very good way to live. It probably doesn’t make us able to cope with daily life very well and we seem to be correcting for that by this supplement.”

Dr. Kaplan, does that suggest a general link between nutrition and mental health?

“I believe there is one. Even a more interesting thing to speculate about is the genetic bases because some of the families we’ve been working with have a very, very strong history of bipolar disorder and we know from the genetic research that there are predisposing genes. So, if our data continued to look this good what it suggests is what the predisposing genes do might be in the realm metabolic pathways that we can correct at the end point by a nutrient supplement. This isn’t magic. I want to emphasize that. These people still have bipolar disorder and they still need to take their supplement. [EmPowerPlus, TrueHope] is somehow correcting an imbalance that these people are predisposed to have.”

So, Dr. Kaplan, what do you think people should take away from this study of yours?

“Well, ,I’m hoping that it will open a lot of minds to look at supplements and to look at the relationship nutrient deficiency and mood state. Scientifically, that’s the most important thing. Now, in terms of helping the people who are suffering now, this is a bigger challenge because it is not possible to take this supplement and get better unless you are decreasing some psychotropic medications and that requires a physician usually to be involved and it’s very complicated for individual patients.”

So people should go out and start popping nutritional supplements on their own?

“Well, you can’t actually buy this [EmPower, TrueHope] over the counter because the people who have manufactured it are concerned about harm coming to individuals who might start popping these pills on top of a full does of psychotropic medication. They’re [TrueHope] behaving very responsibly in this regard.”

Thank-you very much for telling us about this tonight. Good to talk with you.

“Thanks,” Dr. Kaplan. “It’s a pleasure.”

Insight

Metabolic Pathways: In biochemistry, a metabolic pathway is a series of chemical reactions occurring within a cell. In each pathway a principal chemical is modified by chemical reactions. These reactions are accelerated, more accurately catalyzed, by enzymes. Dietary minerals, vitamins & other cofactors are often needed by the enzyme to perform its task. Many pathways are elaborate. Various metabolic pathways within each cell form that cell's metabolic network. Pathways are needed by an organism to keep its homeostasis.

Metabolism is a step by step modification of the initial molecule to shape it into another product. The result can be used in one of three ways.

• Stored by the cell.
• Be used immediately, as a metabolic product.
• Initiate another metabolic pathway, called a flux generating step.

A molecule called a substrate enters a metabolic pathway depending on the needs of the cell & the availability of the substrate. An increase in concentration of anabolical and catabolical end products would slow the metabolic rate for that particular pathway.
Overview

Metabolic pathways often have these properties:

• They contain many steps, like a cascade. The first step is usually irreversible. The other steps need not be irreversible and in many cases, the pathway can go in opposite direction depending on the current need of the cell.

• Glycolysis features excellent examples of these features:

1. As glucose enters a cell it is immediately phosphorylated by ATP to glucose 6-phosphate in the irreversible first step. This is to prevent the glucose leaving the cell.
2. In times of excess lipid or protein energy sources glycolysis may run in reverse (gluconeogenesis) in order to produce glucose 6-phosphate for storage as glycogen or starch.
• They are regulated, usually by feedback inhibition, or by a cycle where one of the products in the cycle starts the reaction again, such as the Krebs Cycle (see below).
• Anabolic and catabolic pathways in eukaryotes are separated by either compartmentation or by the use of different enzymes and cofactors.



Psychotropic Drugs: A drug that affects emotional state. Psychotropics include antidepressants, sedatives, stimulants, and tranquillizers.
Zinc: An essential trace element that works in close association with vitamins and over 100 enzymes. It is, therefore, involved in almost every physiological function in the body. It forms part of a protein (gustin) in saliva and plays a role in taste and smell. It also helps to heal wounds. Although there is only a little evidence that taking extra zinc can improve athletic performance, some weight-lifters take zinc supplements in the belief that it increases stamina by prolonging muscle contractions.

Zinc deficiency may cause loss of taste and smell, and a reduction of appetite. A deficiency can slow down the healing of wounds (zinc oxide ointment is applied to abrasions to accelerate healing), retard growth in children, and reduce the sperm count of adult males (the concentration of zinc in semen is 100 times greater than in the blood plasma).

The US recommended dietary allowance (RDA) for adults is 15 mg for males and 12 mg for females. The UK Reference Nutrient Intake for adults is 9.5 mg for males and 7.0 mg for females (lactating mothers require higher amounts). Zinc can be obtained from seafood (especially oysters and other shellfish), cereal crops, legumes, wheat germ, and yeast products. Zinc may bind to some constituents of dietary fibre, interfering with its absorption from the gut. Consequently, vegetarians may require a higher than normal intake of this element. As zinc is lost in urine and sweat, exercisers (especially those who train intensively) may also need zinc supplementation. However, zinc supplementation should not exceed the RDA because excessive amounts can have harmful effects including inhibition of copper absorption, which may lead to anaemia.


Calcium: Calcium plays a vital role in the anatomy, physiology and biochemistry of organisms and of the cell, particularly in signal transduction pathways. The skeleton acts as a major mineral storage site for the element and releases Ca2+ ions into the bloodstream under controlled conditions. Circulating calcium is either in the free, ionized form or bound to blood proteins such as serum albumin. The hormone secreted by the parathyroid gland, parathyroid hormone, regulates the resorption of Ca2+ from bone.

Measuring Ca2+ in living tissue

The total amount of Ca2+ present in a tissue may be measured using atomic absorption spectrometry, in which the tissue is vapourized and combusted. To measure Ca2+ in vivo, a range of fluorescent dyes may be used. These dyes are based on Ca2+-binding molecules such as BAPTA and so care is required in their use, because they may actually buffer the Ca2+ changes which they are used to measure.
Organs and tissues

Different tissues contain Ca in different concentrations. In vertebrates Ca (mostly calcium phosphate and some calcium sulfate) is the most important (and specific) element of bone and calcified cartilage.

Some invertebrates use calcium compounds for building their exoskeleton (shells and carapaces) or endoskeleton (echinoderm plates and poriferan calcareous spicules). Many protists also make use of calcium.

There are also some plants that accumulate Ca in their tissues, thus making them more firm. Calcium is stored as Ca-oxalate crystals in plastids.
Cell biology

In eukaryotes, Ca2+ ions are one of the most widespread second messengers used in signal transduction. They make their entrance into the cytoplasm either from outside the cell through the cell membrane via calcium channels (such as Ca-binding proteins), or from some internal calcium storages.
Ca2+ entering the cell plasma causes the specific action of the cell, whatever this action is: secretory cells release vesicles with their secretion, muscle cells contract, synapses release synaptic vesicles and go into processes of synaptic plasticity, etc.

Calcium's function in muscle contraction was found as early as 1882 by Ringer and led the way for further investigations to reveal its role as a messenger about a century later. Because its action is interconnected with cAMP, they are called synarchic messengers. Calcium can bind to several different calcium-modulated proteins such as troponin-C (the first one to be identified) or calmodulin. The ions are stored in the sarcoplasmic reticulum of muscle cells.

In mammals, levels of intracellular calcium are regulated by transport proteins that remove it from the cell. For example, the sodium-calcium exchanger uses energy from the electrochemical gradient of sodium by pumping calcium out of the cell in exchange for the entry of sodium. The [[plasma membrane Ca2+ ATPase|plasma membrane Ca2+ ATPase]] (PMCA) obtains energy to pump calcium out of the cell by hydrolysing adenosine triphosphate (ATP).

Ca2+ ions can damage cells if they enter in excessive numbers (for example in the case of excitotoxicity, or overexcitation of neural circuits, which can occur in neurodegenerative diseases or after insults such as brain trauma or stroke). Excessive entry of calcium into a cell may damage it or even cause it to undergo apoptosis or death by necrosis.
One cause of hypercalcemia is hyperparathyroidism.

Calcium in plants

Structural roles

Ca2+ ions are an essential component of plant cell walls and cell membranes, and are used as cations to balance organic anions in the plant vacuole.[1] The Ca2+ concentration of the vacuole may reach millimolar levels. The most striking use of Ca2+ ions as a structural element in plants occurs in the marine coccolithophores, which use Ca2+ to form the calcium carbonate plates with which they are covered.

Cell signaling

Ca2+ ions are usually kept at nanomolar levels in the cytosol of plant cells, and act in a number of signal transduction pathways.
Food sources

The USDA web site has a very complete table of calcium content (in mg) of common foods per common measures (link below).

Calcium amount in foods, 100g:
• almonds = 234 mg
• orange = 40 mg
• human milk = 33 mg
• milk powder = 909 mg
• parmesan (cheese) = 1140 mg
• ricotta (skimmed milk cheese) = 90 mg
• egg, 1 = 54 mg
• molasses = 273 mg
• brown sugar = 85 mg
• white sugar = 0 mg
• honey = 5 mg
• flour = 41 mg
• wheat germ = 72 mg
• beef = 12 mg
• horse meat = 10 mg
• cod = 11 mg
• trout = 19 mg
• common hazels = 250 mg
• nuts = 99 mg
• lentils = 79 mg
• Rice, white, long-grain, parboiled, enriched, cooked = 19 mg


Vitamin B12: A cobalt-containing compound, cobalamin, essential for normal metabolism of folic acid, and hence for cell division. Deficiency leads to pernicious anaemia when immature red blood cell precursors are released into the bloodstream, and there is degeneration of the spinal cord. The absorption of vitamin B12 requires a specific protein (intrinsic factor) which is secreted in the gastric juice and it is failure of absorption, rather than dietary deficiency, that is the more usual cause of the problem. However, B12 is found only in animal foods so vegans have to rely on bacterial preparations.

Meat, eggs, and dairy produce are rich sources and dietary deficiency is unlikely except among vegans.

Vitamin B12 deficiency in animals is characterized primarily by anemia and neuropathy. In humans, this deficiency is called pernicious anemia. People suffering from this disease lack a factor secreted in gastric juice which, by affecting absorption directly and by protecting vitamin B12 from intestinal destruction, enables the vitamin to be absorbed. See also Anemia.

Requirements for vitamin B12 are increased by reproduction or hyperthyroidism. Of the known vitamins B12 is the most active biologically. A daily injection of 1 microgram of vitamin B12 will prevent the recurrence of symptoms in people with pernicious anemia. For normal people a diet containing 3–5 ?g per day (providing 1–1.5 ?g absorbed) will satisfy vitamin B12 requirements. See also Vitamin.


Nutritional Deficiency: Many diseases in humans are thought to be directly or indirectly related to nutrition, These include, but are not limited to, deficiency diseases, caused by a lack of essential nutrients.

Additionally, several diseases are directly or indirectly impacted by dietary habits, and require very close attention to the nutrient content of food.

Overnutrition (eating too much)

Proteins/fats/carbohydrates
• Cardiovascular disease (Leading cause of death in the western world); a primary cause is thought to be ingestion of saturated fat and trans fat
• Some cancers
• Diabetes mellitus
• Insulin resistance
• Obesity
• Metabolic syndrome
Vitamins
Microminerals and Macrominerals
Deficiencies (eating too little)
Proteins/fats/carbohydrates
• protein-energy malnutrition
o kwashiorkor
o marasmus
o Mental retardation [1]

Vitamin

Also see Avitaminosis, and table of deficiency diseases at human vitamins
• beriberi
• rickets
• scurvy
• pellagra
• poor immune system function, potentially leading to a wide range of other illnesses.
- night blindness - dry skin -
Microminerals and Macrominerals
• metabolic or nutritionally related disease such as diabetes mellitus or endemic goitre
• zinc deficiency (growth retardation)
• osteoporosis - caused by calcium deficiency
• Iodine deficiency


Nutrient or Dietary Supplement: The wide assortment of minerals, vitamins, and sundry herbs that are taken as nutritional supplements to regular food.
• There has been a rapid increase in the use of supplements since the early 1990s, leading to debates over whether or how tightly such supplements should be regulated by the FDA. (At this writing, because they are not medicines, they need not pass the stringent tests that medicines must undergo).

A dietary supplement is intended to supply nutrients, (vitamins, minerals, fatty acids or amino acids) that are missing or not consumed in sufficient quantity in a person's diet. This category may also include herbal supplements which claim to treat or prevent certain diseases or conditions.

United States

In the United States, a dietary supplement is defined under the Dietary Supplement Health and Education Act of 1994[1] (DSHEA) as a product that is intended to supplement the diet and bears or contains one or more of the following dietary ingredients:
• a vitamin
• a mineral
• an herb or other botanical (excluding tobacco)
• an amino acid
• a dietary substance for use by people to supplement the diet by increasing the total dietary intake, or

• a concentrate, metabolite, constituent, extract, or combination of any of the above
Furthermore, it must be:

• intended for ingestion in pill, capsule, tablet, powder or liquid form
• not represented for use as a conventional food or as the sole item of a meal or diet
• labeled as a "dietary supplement"

Pursuant to the DSHEA, the Food and Drug Administration regulates dietary supplements as foods, and not as drugs. The FDA does not approve dietary supplements based on their safety and efficacy; the FDA can take action only after a dietary supplement has been proven harmful. However, certain foods (such as infant formula and medical foods) are deemed special nutritionals because they are consumed by highly vulnerable populations and are thus regulated more strictly than the majority of dietary supplements. The FDA claims that their rationale for a lack of regulation is a "freedom to choose" by the consumer, but there are economic benefits as well. The FDA chooses not to regulate dietary supplements because clinical trials are lengthy and costly. They tend to believe that the supplement is beneficial until problems arise.[2]

The claims that a dietary supplement makes are essential to its classification. If a dietary supplement claims to cure, mitigate, or treat a disease, it would be considered to be an unauthorized new drug and in violation of the applicable regulations and statutes. As the FDA states it in a response to this question in a FAQ:

Is it legal to market a dietary supplement product as a treatment or cure for a specific disease or condition?

No, a product sold as a dietary supplement and promoted on its label or in labeling* as a treatment, prevention or cure for a specific disease or condition would be considered an unapproved--and thus illegal--drug. To maintain the product's status as a dietary supplement, the label and labeling must be consistent with the provisions in the Dietary Supplement Health and Education Act (DSHEA) of 1994.
*Labeling refers to the label as well as accompanying material that is used by a manufacturer to promote and market a specific product.

Dietary supplements are permitted to make structure/function claims. These are broad claims that the product can support the structure or function of the body (e.g., "glucosamine helps support healthy joints"). The FDA must be notified of these claims within 30 days of their first use, and there is a requirement that these claims be substantiated.

Other claims that required approval from FDA include health claims and qualified health claims. Health claims are permitted to be made if they meet the requirements for the claims found in the applicable regulations. Qualified health claims can be made through a petition process, including scientific information, if FDA has not approved a prior petition.


Bipolar Disorder:
Definition
Bipolar, or manic-depressive disorder, is a mood disorder that causes radical emotional changes and mood swings, from manic highs to depressive lows. The majority of bipolar individuals experience alternating episodes of mania and depression.

Description

In the United States alone, bipolar disorder afflicts approximately 2.3 million people, and nearly 20% of this population will attempt suicide without effective treatment intervention. The average age at onset of bipolar disorder is from adolescence through the early twenties. However, because of the complexity of the disorder, a correct diagnosis can be delayed for several years or more. In a survey of bipolar patients conducted by the National Depressive and Manic Depressive Association (NDMDA), one-half of respondents reported visiting three or more professionals before receiving a correct diagnosis, and over one-third reported a wait of 10 years or more before they were correctly diagnosed. The treatment of mental conditions, such as bipolar disorder, should improve as the the affordable care act and the resulting health care reform tax credit are widening the coverage scope. This comes in handy not only during treatment but also when calculating deductions on an efile at tax time.

The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), the diagnostic standard for mental health professionals in the United States, defines four separate categories of bipolar disorder: bipolar I, bipolar II, cyclothymia, and bipolar not-otherwise-specified (NOS).
Bipolar I disorder is characterized by manic episodes, the "high" of the manic-depressive cycle. A bipolar patient experiencing mania often has feelings of self-importance, elation, talkativeness, increased sociability, and a desire to embark on goal-oriented activities, coupled with the characteristics of irritability, impatience, impulsiveness, hyperactivity, and a decreased need for sleep. Usually this manic period is followed by a period of depression, although a few bipolar I individuals may not experience a major depressive episode. Mixed states, where both manic or hypomanic symptoms and depressive symptoms occur at the same time, also occur frequently with bipolar I patients (for example, depression with racing thoughts of mania). Also, dysphoric mania is common (mania characterized by anger and irritability).

Bipolar II disorder is characterized by major depressive episodes alternating with episodes of hypomania, a milder form of mania. Bipolar depression may be difficult to distinguish from a unipolar major depressive episode. Patients with bipolar depression tend to have extremely low energy, retarded mental and physical processes, and more profound fatigue (for example, hypersomnia; a sleep disorder marked by a need for excessive sleep or sleepiness when awake) than unipolar depressives.
Cyclothymia refers to the cycling of hypomanic episodes with depression that does not reach major depressive proportions. One-third of patients with cyclothymia will develop bipolar I or II disorder later in life.

A phenomenon known as rapid cycling occurs in up to 20% of bipolar I and II patients. In rapid cycling, manic and depressive episodes must alternate frequently, at least four times in 12 months, to meet the diagnostic definition. In some cases of "ultra-rapid cycling," the patient may bounce between manic and depressive states several times within a 24-hour period. This condition is very hard to distinguish from mixed states.

Bipolar NOS is a category for bipolar states that do not clearly fit into the bipolar I, II, or cyclothymia diagnoses.

Causes & Symptoms

The source of bipolar disorder has not been clearly defined. Because two-thirds of bipolar patients have a family history of affective or emotional disorders, researchers have searched for a genetic link to the disorder. Several studies have uncovered a number of possible genetic connections to the predisposition for bipolar disorder. Recent studies emphasize a hereditary connection and early research links several chromosomes, one particularly related to bipolar II, to development of the disorder. A 2003 study found that schizophrenia and bipolar disorder could have similar genetic causes that arise from certain problems with genes associated with myelin development in the central nervous system. (Myelin is a white, fat-like substance that forms a sort of layer or sheath around nerve fibers.)

Another possible biological cause under investigation is the presence of an excessive calcium build-up in the cells of bipolar patients. Also, dopamine and other neurochemical transmitters appear to be implicated in bipolar disorder and these are under intense investigation.
Over one-half of patients diagnosed with bipolar disorder have a history of substance abuse. There is a high rate of association between cocaine abuse and bipolar disorder. Some studies have shown up to 30% of abusers meeting the criteria for bipolar disorder. The emotional and physical highs and lows of cocaine use correspond to the manic depression of the bipolar patient, making the disorder difficult to diagnose.

For some bipolar patients, manic and depressive episodes coincide with seasonal changes. Depressive episodes are typical during winter and fall, and manic episodes are more probable in the spring and summer months.

Symptoms of bipolar depressive episodes include low energy levels, feelings of despair, difficulty concentrating, extreme fatigue, and psychomotor retardation (slowed mental and physical capabilities). Manic episodes are characterized by feelings of euphoria, lack of inhibitions, racing thoughts, diminished need for sleep, talkativeness, risk taking, and irritability. In extreme cases, mania can induce hallucinations and other psychotic symptoms such as grandiose illusions.

Diagnosis

Bipolar disorder usually is diagnosed and treated by a psychiatrist and/or a psychologist with medical assistance. In addition to an interview, several clinical inventories or scales may be used to assess the patient's mental status and determine the presence of bipolar symptoms. These include the Millon Clinical Multiaxial Inventory III (MCMI-III), Minnesota Multiphasic Personality Inventory II (MMPI-2), the Internal State Scale (ISS), the Self-Report Manic Inventory (SRMI), and the Young Mania Rating Scale (YMRS). The tests are verbal and/or written and are administered in both hospital and outpatient settings.

Psychologists and psychiatrists typically use the criteria listed in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) as a guideline for diagnosis of bipolar disorder and other mental illnesses. DSM-IV describes a manic episode as an abnormally elevated or irritable mood lasting a period of at least one week that is distinguished by at least three of the mania symptoms: inflated self-esteem, decreased need for sleep, talkativeness, racing thoughts, distractibility, increase in goal-directed activity, or excessive involvement in pleasurable activities that have a high potential for painful consequences. If the mood of the patient is irritable and not elevated, four of the symptoms are required.

Although many clinicians find the criteria too rigid, a hypomanic diagnosis requires a duration of at least four days with at least three of the symptoms indicated for manic episodes (four if mood is irritable and not elevated). DSM-IV notes that unlike manic episodes, hypomanic episodes do not cause a marked impairment in social or occupational functioning, do not require hospitalization, and do not have psychotic features. In addition, because hypomanic episodes are characterized by high energy and goal directed activities and often result in a positive outcome, or are perceived in a positive manner by the patient, bipolar II disorder can go undiagnosed.

In late 2001, a study reported at an international psychiatric conference that impulsivity remains a key distinguishing characteristic for bipolar disorder, at least when patients are in manic phases.
Bipolar symptoms often present differently in children and adolescents. Manic episodes in these age groups typically are characterized by more psychotic features than in adults, which may lead to a misdiagnosis of schizophrenia. Children and adolescents also tend toward irritability and aggressiveness instead of elation. Further, symptoms tend to be chronic, or ongoing, rather than acute, or episodic. Bipolar children are easily distracted, impulsive, and hyperactive, which can lead to a misdiagnosis of attention-deficit hyperactivity disorder (ADHD). Furthermore, their aggression often leads to violence, which may be misdiagnosed as a conduct disorder.
Substance abuse, thyroid disease, and use of prescription or over-the-counter medication can mask or mimic the presence of bipolar disorder. In cases of substance abuse, the patient must ordinarily undergo a period of detoxification and abstinence before a mood disorder is diagnosed and treatment begins.

Treatment

Alternative treatments for bipolar disorder generally are considered to be complementary treatments to conventional therapies. General recommendations for controlling bipolar symptoms include maintaining a calm environment, avoiding overstimulation, getting plenty of rest, regular exercise, and proper diet. Psychotherapy and counseling are generally recommended treatments for the disease, whether treated alternatively or allopathically. Psychotherapy, such as cognitive-behavioral therapy, can be a useful tool in helping patients and their families adjust to the disorder and in reducing the risk of suicide. Also, educational counseling is recommended for the patient and family. In fact, a 2003 report revealed that people on medication for bipolar disorder have better results if they also participate in family-focused therapy.

Chinese herbs also may help to soften mood swings. Traditional Chinese medicine (TCM) remedies are prescribed based on the patient's overall constitution and the presentation of symptoms. These remedies can stabilize moods, not just treat swings in mood. A TCM practitioner might recommend a mixture called the Iron Filings Combination (which includes the Chinese herbs asparagus, ophiopogon, fritillaria, arisaema, orange peel, polygala, acorus, forsythia, hoelen, fu-shen, scrophularia, uncaria stem, salvia, and iron filings) to treat certain types of mania in the bipolar patient. There are other formulas for depression. A trained practitioner should guide all of these remedies. Compliance can be better with natural remedies if they work. These remedies do not flatten moods and people in manic states do not like to be suppressed.

Acupuncture can be used for treatment to help maintain a more even temperament.
Biofeedback is effective in helping some patients control symptoms such as irritability, poor self control, racing thoughts, and sleep problems. A diet low in vanadium (a mineral found in meats and other foods) and high in vitamin C may be helpful in reducing depression.
In 2003, a report stated that rhythm therapy, or simply taking steps to go to bed and wake up at consistent times each day, helps some people with bipolar disorder maintain mood stability, especially when faced with psychosocial stress.

Recommended herbal remedies to ease depressive episodes may include damiana (Turnera diffusa), ginseng (Panax ginseng), kola (Cola nitida), lady's slipper (Cypripedium calceolus), lavender (Lavandula angustifolia), lime blossom (Tilia x vulgaris), oats (Avena sativa), rosemary (Rosmarinus officinalis), skullcap (Scutellaria laterifolia), St. John's wort (Hypericum perforatum), valerian (Valeriana officinalis), and vervain (Verbena officinalis).

Allopathic Treatment

Allopathic treatment of bipolar disorder is usually by means of medication. A combination of mood stabilizing agents with antidepressants, antipsychotics, and anticonvulsants is used to regulate manic and depressive episodes.

Mood stabilizing agents such as lithium, carbamazepine, and valproate are prescribed to regulate the manic highs and lows of bipolar disorder:

• Lithium (Cibalith-S, Eskalith, Lithane, Lithobid, Lithonate, Lithotabs) is one of the oldest and most frequently prescribed drugs available for the treatment of bipolar mania and depression. Lithium has also been shown to be effective in regulating bipolar depression, but is not recommended for mixed mania. Possible side effects of the drug include weight gain, thirst, nausea and hand tremors. Prolonged lithium use may also cause hyperthyroidism (a disease of the thryoid that is marked by heart palpitations, nervousness, the presence of goiter, sweating, and a wide array of other symptoms).

• Carbamazepine (Tegretol, Atretol) is an anticonvulsant drug usually prescribed in conjunction with other mood stabilizing agents. The drug is often used to treat bipolar patients who have not responded well to lithium therapy. Blurred vision and abnormal eye movement are two possible side effects of carbamazepine therapy.

• Valproate (divalproex sodium, or Depakote; valproic acid, or Depakene) is one of the few drugs available that has been proven effective in treating rapid cycling bipolar and mixed states patients. Valproate is prescribed alone or in combination with carbamazepine and/or lithium. Stomach cramps, indigestion, diarrhea, hair loss, appetite loss, nausea, and unusual weight loss or gain are some of the common side effects of valproate.

Because antidepressants may stimulate manic episodes in some bipolar patients, their use is typically short-term. Selective serotonin reuptake inhibitors (SSRIs) or, less often, monoamine oxidase inhibitors (MAOIs) are prescribed for episodes of bipolar depression. Tricyclic antidepressants used to treat unipolar depression may trigger rapid cycling in bipolar patients and are, therefore, not a preferred treatment option for bipolar depression.

Electroconvulsive therapy (ECT), has a high success rate for treating both unipolar and bipolar depression, and mania. However, because of the convenience of drug treatment and the stigma sometimes attached to ECT therapy, ECT usually is employed after all pharmaceutical treatment options have been explored. ECT is given under anesthesia and patients are given a muscle relaxant medication to prevent convulsions. The treatment consists of a series of electrical pulses that move into the brain through electrodes on the patient's head. Although the exact mechanisms behind the success of ECT therapy are not known, it is believed that this electrical current alters the electrochemical processes of the brain, consequently relieving depression. In bipolar patients, ECT often is used in conjunction with drug therapy.

Long-acting benzodiazepines such as clonazepam (Klonapin) and alprazolam (Xanax) are used for rapid treatment of manic symptoms to calm and sedate patients until mania or hypomania have waned and mood stabilizing agents can take effect. Neuroleptics such as chlorpromazine (Thorazine) and haloperidol (Haldol) also are used to control mania while a mood stabilizer such as lithium or valproate takes effect. Clozapine (Clozaril) is an atypical antipsychotic medication used to control manic episodes in patients who have not responded to typical mood stabilizing agents. The drug also has been a useful prophylactic, or preventative treatment, in some bipolar patients.

The treatment rTMS, or repeated transcranial magnetic stimulation, is a relatively new and still experimental treatment for the depressive phase of bipolar disorder. In rTMS, a large magnet is placed on the patient's head and magnetic fields of different frequency are generated to stimulate the left front cortex of the brain. Unlike ECT, rTMS requires no anesthesia and does not induce seizures.

Expected Results

While most patients will show some positive response to treatment, response varies widely, from full recovery to a complete lack of response to all treatments, alternative or allopathic. Drug therapies frequently need adjustment to achieve the maximum benefit for the patient. Bipolar disorder is a chronic recurrent illness in over 90% of those afflicted, and one that requires lifelong observation and treatment after diagnosis. Patients with untreated or inadequately treated bipolar disorder have a suicide rate of 15-25% and a nine-year decrease in life expectancy. With proper treatment, the life expectancy of the bipolar patient will increase by nearly seven years and work productivity increases by 10 years.

Prevention

The ongoing medical management of bipolar disorder is critical to preventing relapse, or recurrence, of manic episodes. Even in carefully controlled treatment programs, bipolar patients may experience recurring episodes of the disorder. Patient education in the form of psychotherapy or self-help groups is crucial for training bipolar patients to recognize signs of mania and depression and to take an active part in their treatment program.

Insight

A Promise of Hope, Autumn Stringam. Some children inherit "the family nose." Autumn Stringam and her brother Joseph inherited the family bipolar disorder, a severe mental illness that led to their mother's and grandfather's suicides. Autumn, at 22, was psychotic and in in a psychiatric hospital on suicide watch; Joseph, at 15, was prone to violent episodes so terrifying the family feared for their lives. But after they began taking a nutritional supplement developed by their father and based, incredibly, on a formula given to aggressive hogs--Autumn's and Joseph's symptoms disappeared. Today they both lead normal, productive lives.

A Promise of Hope is the personal story of Autumn Stringam's flight from madness to wellness, all due to the vitamin and mineral supplement that works on the premise that some forms of mental illness are caused by nutritional deficiencies. An honest book that exposes the hidden torment of bipolar disorder, it is the story of a daughter seeking to forgive her mother. A Promise of Hope is also an astonishing scientific account that moves from a kitchen table in Alberta to the treatment offices of a distinguished Harvard pshyciatrist and into the labs of a skeptical medial establishment. It climaxes in a bitter--but eventually triumphant--battles with Health Canada, in which the tiny supplement company is exonerated and praised for saving the lives of thousands of Canadians previously thought lost to mental illness. More than anything, A Promise of Hope is a powerful story and a call for a new understanding of the causes of mental illness and its treatments.

Books

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Press, Inc., 1994.
Whybrow, Peter C. A Mood Apart. New York: Harper Collins, 1997.
Periodicals

Biederman, Joseph A. "Is There a Childhood Form of Bipolar Disorder?" Harvard Mental Health Letter. 13, no. 9 (March 1997): 8.

Bowden, Charles L. "Choosing the Appropriate Therapy for Bipolar Disorder." Medscape Mental Health. 2, no. 8 (1997). http://www.medscape.com.

Bowden, Charles L. "Update on Bipolar Disorder: Epidemiology, Etiology, Diagnosis, and Prognosis." Medscape Mental Health. 2, no. 6 (1997). http://www.medscape.com.
"Family-focused Therapy May Reduce Relapse Rate." Health & Medicine Week (September 29, 2003): 70.
Francis, A., J.P Docherty, and D.A. Kahn. "The Expert Consensus Guideline Series: Treatment of Bipolar Disorder." Journal of Clinical Psychiatry. 57, supplement 12A (November 1996): 1-89.
Sherman, Carl. "Progress in Bipolar Genetics slow, but promising." Clinical Psychiatry News. 29, no. 12 (December 2001): 4.
Sherman, Carl. "Impulsivity a Key Characteristic of Bipolar Disorder." Clinical Psychiatry News. 29, no. 11 (November 2001): 35.
"Schizophrenia and Bipolar Disorder Could Have Similar Genetic Causes." Genomics & Genetics Weekly (September 26, 2003): 85.
Spete, Heidi. "Rhythm Therapy Can Stabilize Bipolar Disorder Patients." Clinical Psychiatry News. (July 2003): 55.

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