Bipolar disorder, a Naturopathic Perspective.
By Christopher Maloney, ND
Bipolar disorder is conventionally treated with lithium, which inhibits
brain neural transmission by means of a mechanism not yet fully known. Lithium has a wide range of side effects, and some
patients may be resistant to long term use.
Naturopathic medicine covers a broad range of fields, including botanicals,
nutrition, supplementation, lifestyle counseling, and homeopathy. A number of different interventions have been studied for
bipolar disorder and may prove helpful.
Botanicals must be used with caution in bipolar disorder, as several cases
of mania and hypomania have been reported due to botanical use of ginseng (Acta Psychiatr Scand 2002 Jan;105(1):76-7) and
St. John's Wort (World J Biol Psychiatry 2002 Jan;3(1):58-9).
In one report of St. John's Wort and Valerian, a woman with no psychiatric
history experienced acute mania and psychosis (Ned Tijdschr Geneeskd 2001 Oct 6;145(40):1943-5). In the delicate population
of the mentally ill, low dosage and close monitoring should be the a matter of course.
Nutrition offers a far safer course of intervention for bipolar disorder.
At the dramatic end, some researchers are calling for trials of the ketogenic diet currently in use for uncontrollable epilepsy,
citing studies showing that mood disorders often respond to anticonvulsant medication and that the cellular profile of the
ketogenic diet matches the changes made by antidepressants in the brain (Med Hypotheses 2001 Dec;57(6):724-6). Other researchers
have shown that rates of major depression correspond to increased sugar intake in six different countries (Depress Anxiety
2002;16(3):118-20). During manic and bipolar mixed episodes, researchers have found that cholesterol levels in patients have
dropped, and that bipolar patients had overall subnormal cholesterol levels (Eur Arch Psychiatry Clin Neurosci 2002 Jun;252(3):110-4).
Studies of supplying essential fatty acids to bipolar patients have shown positive results (Acta Psychiatr Scand 2000 Jul;102(1):3-11).
In supplementation for bipolar disorder, rapid tryptophan depletion has
also been reported to exacerbate both panic and aggression in vulnerable individuals (J Psychopharmacol 1997;11(4):381-92).
So supplementation with 5-Hydroxy-Tryptophan, a molecule that directly contributes to serotonin production in the brain, would
offset this risk for susceptible individuals. Additionally, normal volunteers experiencing low selenium levels reported increased
levels of hostility and depression (Biol Psychiatry 1996 Jan 15;39(2):121-8). In an at-risk or adolescent population, supplementation
can simplified by the addition of a complete multivitamin.
Lifestyle counseling is a necessary part of treatment, particularly as
addictive behaviors can compound and confuse the treatment picture. In bipolar patients, some patients have found that marijuana
use alleviates their symptoms or offsets the side effects of lithium (J Psychoactive Drugs 1998 Apr-Jun;30(2):171-7). Current
research in this area is impossible, but preliminary research from the 1970's found that the active ingredient in marijuana,
THC, modified sleep brain patterns in patients in a manner comparable to lithium. Unipolar patients placed on THC experienced
lowered mood, but bipolar patients experienced no lowering of mood (Clin Pharmacol Ther 1976 Jun;19(6):782-94).
Effective substance use intervention must hinge on modifying the underlying
need for the drug, since in some cases patients may be self-medicating. Multiple other lifestyle alterations may be of benefit.
Music therapy alone positively affected moods of even the most severely affected patients (J Music Ther 2002 Spring;39(1):20-9).
Homeopathy provides a novel option for intervention with the added benefit
of no drug interaction and minimal side effects. Clinical interventions at Duke University found that homeopathic treatment
alone provided a better than 50% improvement in overall symptoms for a range of mental illness after conventional treatments
had failed to provide relief (Altern Ther Health Med 1997 Jan;3(1):46-9). Research is currently underway to coordinate homeopathic
remedies with current DSM coding for ease in treatment (Altern Ther Health Med 1995 Jul;1(3):36-43).
While no therapy assures success in bipolar disorder, many therapies combined
with counseling and lifestyle intervention give patients the best chance at a greatly improved symptom picture.