By Dr. Mercola
An estimated 5.1 million Americans have bipolar disorder,1 also known as manic-depressive illness, which is characterized by unusual and typically dramatic shifts in mood and energy. Emotions tend to be intense, with the patient seesawing between ecstatic joy and hopeless depression.
Hallucinations and delusions of grandeur are common during the manic phase, leading the patient to engage in risky and irrational behaviors, such as not looking both ways before crossing the street because they think they're invincible, or jumping out of a window, convinced they can fly.
The PBS documentary, "Ride the Tiger: A Guide Through the Bipolar Brain,"2 originally aired on April, 2016, explores our current understanding of the illness, and puts a human face on the struggle with commentary by those challenged with it.
Highly accomplished individuals diagnosed with bipolar featured in the program include actress Patty Duke, who was diagnosed in 1982, and Patrick Kennedy, a former U.S. Representative.
By seeking to understand how the bipolar brain malfunctions, researchers believe they can get closer to understanding the inner workings of the brain, potentially unlocking treatments for other types of psychiatric problems as well.
Drugs Versus Lifestyle
While medication is typically the first line of treatment for bipolar and other mental illnesses, they can take up to two months to work and are often frustratingly ineffective. Lithium is a "gold standard" treatment for bipolar, but even lithium works for only one-third of patients.
Another drug shown to offer relief from severe depression and bipolar depression within mere hours of administration is ketamine, a dissociative anesthetic normally used for starting and maintaining anesthesia. Research suggests ketamine helps induce neuroplasticity, allowing your brain to grow new neurons and connections.
However, this drug also fails to work in many, and often fails to provide long-lasting relief. When it comes to treatment, lifestyle changes are often the most powerful, and as noted in the program, need to be included in the treatment if it is to be successful. This includes:
- Maintaining a regular sleep cycle
- Addressing your diet and avoiding stimulants such as caffeine, drugs and alcohol
- Stress relief
- Maintaining healthy emotional connections with family and friends
Scientists are also turning to more novel strategies in an effort to control the illness, seeking ways to possibly "preempt, fix or rewire" the patient's brain back to normal.
Treatments That Help Rewire the Brain
Optogenetics is one such strategy. The technique involves the use of light and light-responsive proteins to control neuronal activity. Using this technique, the scientist can control not only the physical movement of the subject, but also the behavior.
For example, by shining a light on a specific gene-altered neuron, it can dial down the activity to reduce anxiety. Kafui Dzirasa, Ph.D., has taken it a step further, creating what he calls a closed loop actuator.
Using brain map data obtained through optogenetics, the closed loop actuator circumvents "broken" or dysfunctional areas between neurons to reestablish normal communication in that specific area of the brain. The upside of this is that you're only stimulating and correcting the area that needs it.
Drugs, on the other hand, affect the brain in its entirety, for better or worse. While it may correct one problem, it often creates others. While showing great promise, Dzirasa is not about to implant the device in human brains any time soon.
But he hopes the device may eventually lead to other treatment strategies. Other devices used in the treatment of bipolar disorder and severe depression include:
- Deep brain stimulation, which acts much like a pacemaker for the brain, using electrical impulses to stimulate certain brain areas to regulate mood
- Electroconvulsive therapy, which has been shown to induce remission in up to 80 percent of patients and appears particularly effective for those with bipolar depression. One significant drawback is the potential for permanent memory loss
- Transcranial magnetic stimulation, a noninvasive procedure using magnetic fields to stimulate brain cells
These techniques basically employ electricity or magnetism as a way to change the way neurons connect, allowing your brain to create new neuronal connections and pathways (neuroplasticity), thereby bypassing the "traffic jam" that's blocking normal communication between the neurons.
But such devices are not the only way to rewire your thought circuits. Talk therapy, meditation, prayer and "positive thinking" have also been shown to have a distinct and positive influence on the wiring in your brain.
Nutrition Is Essential for Proper Brain Function
An estimated 1 in 20 Americans over the age of 12 struggles with depression.3 Dr. Hyla Cass, a psychiatrist who uses integrative medicine in her practice, places great focus on nutrition and healthy lifestyle habits. As mentioned earlier, this is crucial regardless of what type of mental disorder you're facing.
One of Cass' mentors was Dr. Abram Hoffer, a co-founder of orthomolecular medicine, which refers to the concept of nutritional deficiencies being a source of mental illness. In particular, Hoffer used high doses of niacin (B3) to successfully treat schizophrenics. Amazingly, he was able to get many of these severely ill mental patients well enough to get married and go on to lead normal lives.
As it turns out, pellagra, a disorder caused by extreme niacin deficiency, produces the same psychiatric symptoms found in schizophrenia. In fact, Hoffer discovered that many schizophrenic patients were niacin-dependent, meaning they needed far more niacin on a regular basis than normal in order to remain well.
Other researchers have found niacin may also be successfully used in the treatment of other mental disorders, such as attention deficit disorder, general psychosis, anxiety, depression and obsessive-compulsive disorder.
Food sensitivities can also play a role. For example, gluten can produce symptoms of depression if you're sensitive to it. In such a case, the key is to remove gluten from your diet entirely. You cannot simply cut down. It must be removed completely. Cass has seen many patients recover from severe depression when going gluten-free. It's also important to avoid junk food, as it promotes gut inflammation.
According to Cass, one of the first steps in addressing a mental health problem is to clean up your diet and address your gut health. Otherwise, you'll have virtually no chance of getting emotionally and mentally well. On her website, CassMD.com, you can find a free report called "Reclaim Your Brain," which details nutritional substances you can use to address conditions like anxiety and depression.
Nutritional Deficiencies Implicated in Psychiatric Disorders
In one recent meta-analysis, fish oil, vitamin D, methylfolate (an effective form of folic acid) and S-adenosylmethionine (SAMe) were found to improve the effectiveness of serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors and tricyclic antidepressants.4,5,6 Fish oil produced the most significant improvement, which makes sense if you understand the importance of animal-based omega-3 for brain health. Although not studied, krill oil would likely do better, and clean fish would do the best.
In fact, considering antidepressants have the clinical effectiveness of a placebo,7,8,9,10 it's no wonder nutritional supplements can "boost" the drugs' effectiveness. The supplements may well have been the true benefit, but that possibility was not taken into consideration in this analysis. Still, studies have shown that both omega-3 and vitamin D11 can improve mental health all on their own.
The 2001 book, "The Omega-3 Connection," written by Harvard psychiatrist Dr. Andrew Stoll, was among the first works to bring attention to and support the use of omega-3 fats for depression. Omega-3s have also been shown to improve more serious mental disorders, including schizophrenia, psychosis and bipolar disorder.12
While there's no set recommended dose of omega-3 fats, some health organizations recommend a daily dose of 250 to 500 milligrams (mg) of EPA and DHA for healthy adults. If you suffer from depression, higher doses may be called for. In one study,13 an omega-3 supplement with a dose range of 200 to 2,200 mg of EPA per day was effective against primary depression.
As for vitamin D, researchers have suggested vitamin D may play a role in depression by regulating brain chemicals called monoamines, which include serotonin.14 As a general rule, depressed individuals have lower vitamin D levels than non-depressed people,15 and having a vitamin D level below 20 ng/mL can raise your risk of depression by 85 percent compared to having a level greater than 30 ng/mL.16
B vitamins are also really important for proper brain function, and deficiencies of one or more B vitamins can result in psychiatric symptoms. For example, vitamin B12 deficiency can trigger confusion, agitation, depression,17 mania, psychosis and paranoid delusions.18,19 One recent study20,21 found vitamins B6, B8 (inositol) and B12 in combination were very effective for improving schizophrenic symptoms when taken in high doses — more so than standard drug treatments alone. Low doses were ineffective.
Lowering Inflammation Is Important for Mental Health
Studies have also linked depression to chronic inflammation and dysfunction of the gut-brain axis.22 One likely theory as to why certain nutrients work so well for depression is because they are potent anti-inflammatories. Indeed, many studies have confirmed that treating gastrointestinal inflammation helps improve symptoms of depression.23 The gut-brain connection is well-recognized as a basic tenet of physiology and medicine, so this isn't all that surprising, even though it's often overlooked.
A previous article24 titled "Are Probiotics the New Prozac?" reviews some of the supporting evidence. For example, animal research has linked changes in gut flora to changes in affective behaviors, and in humans, probiotics (beneficial bacteria) have been shown to alter brain function.25
Previous research has also shown that certain probiotics can help alleviate anxiety. For example, one study26 found the probiotic Bifidobacterium longum NCC3001 normalized anxiety-like behavior in mice with infectious colitis by modulating the vagal pathways within the gut-brain.
Other research27 found that the probiotic Lactobacillus rhamnosus had a marked effect on GABA levels — an inhibitory neurotransmitter involved in regulating many physiological and psychological processes — in certain brain regions and lowered the stress-induced hormone corticosterone, resulting in reduced anxiety- and depression-related behavior. (It is likely other lactobacillus species also provide this benefit, but this was the only one that was tested.)
Gut Bacteria May Play a Role in Bipolar Disorder and Schizophrenia
Researchers have also found strong connections between the gut microbiome and schizophrenia and bipolar disorder.28 As recently reported by Psych Central:29
"The gut and the brain are connected by what is called the enteric nervous system [ENS]. While the ENS can act independently, it can also influence the central nervous system. It does this through millions of neurons as well as neurotransmitters like serotonin, dopamine, glutamate and norepinephrine. When one of these systems dysfunctions, it can heavily impact the other, causing symptoms of depression and anxiety.
One way the digestive system can dysfunction is with an alteration in the gut's microbiome. The immune system is also vulnerable to changes in the microbiome … Part of the immune response to harmful microorganisms is inflammation. This inflammation occurs throughout the body, including areas around the brain, which can trigger or worsen symptoms of bipolar disorder."
For example, studies have found:
- Schizophrenics have less biodiversity overall and 400 times higher population of lactic acid producing bacteria than healthy individuals. Certain metabolic pathways differ as well, including those for glutamate and vitamin B1230
- Schizophrenics also have significantly higher amounts of Lactobacillus phage phiadh, a microorganism associated with a higher risk for diabetes, than healthy controls31
- Those with bipolar disorder or schizophrenia tend to have chronic low-grade inflammation, associated with gut dysfunction and an imbalanced gut microbiome
- People with bipolar or schizophrenia also have elevated levels of antibodies against Saccharomyces cerevisiae, a yeast associated with Crohn's disease. Many are also sensitive to lactose and gluten, which can trigger inflammation32
- Individuals hospitalized with acute mania have increased exposure to antibiotics.33 While the authors suggested this finding means these patients tend to have higher rates of bacterial infections, this link could also point at the hazards associated with killing off your microbiome with antibiotics, which decimate both good and bad bacteria without discrimination
Holistic Mental Health Suggestions
Regardless of the nature or severity of your mental health problem, in order to successfully treat it, you need to take a holistic approach. Rarely will medication be the sole answer. Following are some guidelines and suggestions — presented in no particular order — to keep in mind.
✓ Withdraw from antidepressants and other drugs under medical supervision
If you're currently on an antidepressant and want to get off it, ideally you'll want to have the cooperation of your prescribing physician. Some are happy to help you to withdraw if they know you're going to be responsible about it.
Others may not want to bother, or they don't believe you can get off the medication. As noted by Cass, you may need to do some reading in order to be better prepared.
Dr. Joseph Glenmullen from Harvard wrote a very helpful book on how to withdraw called "The Antidepressant Solution." You can also turn to an organization with a referral list of doctors who practice more biologically or naturally, such as the American College for Advancement in Medicine (www.ACAM.org.)
Once you have the cooperation of your prescribing physician, start lowering the dosage of the medication you're taking. As noted by Cass, there are protocols for gradually reducing the dose that your doctor should be well aware of. At the same time, start taking a multivitamin.
Start taking low doses. If you're quitting an SSRI under doctor supervision, Cass suggests going on a low dose of 5-hydroxytryptophan (5-HTP). For bipolar patients, holistic psychiatrists may prescribe nutritional supplements such as fish oil (omega-3 fats), inositol, niacin, tryptophan and others, depending on your individual needs.
✓ Address Lyme disease
Bipolar symptoms can also be related to Lyme disease, so if Lyme infection is present, that needs to be addressed, also by a more functionally oriented doctor.
✓ Combat inflammation
Keeping inflammation in check is an important part of any effective treatment plan. If you're gluten sensitive, you will need to remove all gluten from your diet. A food sensitivity test can help ascertain this. Switching to a whole food diet as described in my optimal nutrition plan can go a long way toward lowering the inflammation level in your body and brain.
✓ Optimize your vitamin D level
Vitamin D deficiency is another important biological factor that can play a significant role in mental health, especially depression. A double-blind randomized trial34 published in 2008 concluded that supplementing with high doses of vitamin D "seems to ameliorate these symptoms indicating a possible causal relationship."
Recent research35 also claims that low vitamin D levels appear to be associated with suicide attempts.
Ideally, maintain your vitamin D level between 40 and 60 ng/mL year-round. If you cannot get sufficient sun exposure to maintain this level, taking an oral vitamin D3 supplement would be advisable. Just remember to also take vitamin K2 and magnesium, as these all work together.
✓ Nourish your gut microbiome
Reducing gut inflammation is imperative when addressing mental health issues,36 so optimizing your gut flora is a critical piece. To promote healthy gut flora, increase your consumption of fiber and probiotic foods, such as fermented vegetables, kimchee, natto, kefir and others.
✓ Clean up your sleep hygiene
Make sure you're getting enough high quality sleep, as sleep is essential for optimal mood and mental health. A fitness tracker that tracks your sleep can be a useful tool. According to Cass, the inability to fall asleep and stay asleep can be due to elevated cortisol levels, so if you have trouble sleeping, you may want to get your saliva cortisol level tested with an Adrenal Stress Index test.
If you're already taking hormones, you can try applying a small dab of progesterone cream on your neck or face when you awaken during the night and can't call back to sleep. Another alternative is to take adaptogens, herbal products that help lower cortisol and adjust your body to stress.
There are also other excellent herbs and amino acids that help you to fall asleep and stay asleep. Meditation can also help.
✓ Add to your self-help tool bag
Slowing your breathing using the Butyeko breathing technique increases your partial pressure of carbon dioxide (CO2), which has enormous psychological benefits and can quickly reduce anxiety.
Other helpful tools include Eye Movement Desensitization and Reprocessing (EMDR), and Emotional Freedom Techniques (EFT). EFT is well-studied, and research shows it can significantly increase positive emotions and decrease negative emotional states. One scientific review found statistically significant benefits in using EFT for anxiety, depression, PTSD and phobias.
EFT is particularly powerful for treating stress and anxiety because it specifically targets your amygdala and hippocampus, which are the parts of your brain that help you decide whether or not something is a threat.37,38 For serious or complex issues, seek out a qualified health care professional that is trained in EFT39 to help guide you through the process.
✓ Eat real food and avoid all processed foods
High sugar and starchy nonfiber carbohydrates lead to excessive insulin release, which can result in falling blood sugar levels, or hypoglycemia. In turn, hypoglycemia causes your brain to secrete glutamate in levels that can cause agitation, depression, anger, anxiety and panic attacks. Sugar also fans the flames of inflammation in your body.
In addition to being high in sugar and grains, processed foods also contain a variety of additives that can affect your brain function and mental state, especially MSG and artificial sweeteners such as aspartame.
Recent research also shows that glyphosate, used in large quantities on genetically engineered crops like corn, soy and sugar beets, limits your body's ability to detoxify foreign chemical compounds.
As a result, the damaging effects of those toxins are magnified, potentially resulting in a wide variety of diseases, including brain disorders that have both psychological and behavioral effects.
✓ Get adequate B vitamins
Vitamin B12 deficiency can contribute to depression and affects 1 in 4 people. Niacin (B3), B6, biotin (B8) and folate (B9) deficiencies can also produce psychiatric effects.
✓ Get plenty of high quality animal-based omega-3 fats
The animal-based omega-3 fats DHA and EPA are crucial for good brain function and mental health.40,41 Good sources include fatty fish that are also low in mercury, such as wild caught Alaskan salmon, sardines and anchovies.
If you don't eat these types of fish on a regular basis, it would be advisable to take a high quality omega-3 supplement such as krill oil, which has a number of benefits over fish oil, including better absorption.42
✓ Beneficial herbs and supplements: SAMe, 5-HTP and St. John's Wort
SAMe is an amino acid derivative that occurs naturally in all cells. It plays a role in many biological reactions by transferring its methyl group to DNA, proteins, phospholipids and biogenic amines. Several scientific studies indicate that SAMe may be useful in the treatment of depression. 5-HTP is another natural alternative to traditional antidepressants.
When your body sets about manufacturing serotonin, it first makes 5-HTP. Taking 5-HTP as a supplement may raise serotonin levels. The evidence suggests 5-HTP outperforms a placebo when it comes to alleviating depression43 — more than can be said about antidepressants.
One caveat: Anxiety and social phobias can worsen with higher levels of serotonin, so it may be contraindicated if your anxiety is already high. St. John's Wort has also been shown to provide relief from mild depressive symptoms.
✓ Get adequate daily exercise
Studies show there is a strong correlation between improved mood and aerobic capacity. There's also a growing acceptance that the mind-body connection is very real, and that maintaining good physical health can significantly lower your risk of developing depression in the first place.
Exercising creates new GABA-producing neurons that help induce a natural state of calm. It also boosts your levels of serotonin, dopamine and norepinephrine, which help buffer the effects of stress.