Bipolar disorder is a psychological disturbance in which you may suffer from a manic state (impulsive, aggressive behavior) alone, or alternating manic and depressive states. The pattern of mood swings can vary widely. In some people, years can separate manic and depressive episodes. In other people, the cycles occur three or four times a year with respites in between. For still others,the cycles can rapidly and continuously alternate.

Often, this disorder is difficult to correctly diagnose, because its depression appears the same as other types of depression. Unless a therapist observes or knows about the manic phase, the true diagnosis may remain hidden. There are two types, bipolar I and bipolar II. In bipolar I, both phases (mania and depression) are very pronounced. In bipolar II, the mania is mild and the depression can be mild or severe. Bipolar II is more difficult to diagnose but is the most common form. It has fewer and shorter periods of remission, tends to run in families, and is less responsive to treatment. The origin of bipolar disorder is thought to be a genetic imbalance in brain chemicals.

Common Symptoms: Manic Phase

• Excessive self esteem or grandiosity
• Euphoria or irritability
• Excessive talk
• Racing thoughts
• Unusual energy with less need for sleep
• Impulsiveness with reckless pursuit of gratification (buying sprees, promiscuous sex, high-risk investments, fast driving, and so on)
• Hallucinations and delusion
• Inability to concentrate
• Increase in social or work activities

Common Symptoms: Depressive Phase

• Low self-esteem
• Apathy, inertia
• Sadness, loneliness, helplessness
• Fatigue
• Insomnia
• Slow speech
• Suicidal thoughts
• Substance abuse
• Guilt

What You Need to Know

It is important to eliminate other psychological disorders that can have similar symptoms, including school phobias, ADD/ADHD, dementia, schizophrenia, and psychotic states induced by drugs or alcohol. In addition, substance abuse is common in bipolar disorder, and any substance abuser should be evaluated for this disorder. Drugs and alcohol can interfere with the correct diagnosis (they also precipitate phase swings, so if you are diagnosed, you should avoid them for the rest of your life). Hyperthyroidism (elevated thyroid) can look like mania; some of the treatments for bipolar disorder (especially lithium) can lower thyroid hormone level, which can increase the hyperthyroidism; and bipolar patients can be very sensitive to variations in thyroid function, which means the effects of the hyperthyroidism can be even further exaggerated. I recommend that you undergo a thyroid profile (thyroxine index or FTI, and TSH) initially and then monitor your thyroid levels regularly. If you have low or borderline results, your doctor can prescribe thyroid medication.

Your Herbal Healing Action Plan for Bipolar Disorder Treatment

• For severe manic or depressive phases, hospitalization is usually required to protect you and others from harm.
• Do not take St. John’s wort or SAMe for your depression because they can make you more manic or more depressive.

Step 1: Take Prescription Lithium or Depakote

Because bipolar disorder can be dangerous, you must get the symptoms under control as soon as possible by using prescription medications. The prescription drug lithium carbonate is usually the first choice, and it primarily controls the mania. Lithium blood levels must be monitored to ensure that you are receiving the proper dose of medication. Depakote is another prescription medication now used for this disorder, and your doctor must check blood levels as well for proper dosage.

Step 2: Take 5-HTP for Mild Depression

Because lithium primarily controls the mania, you need to take something for the depression phase. For mild depression, 5-HTP (200mg three times daily, along with the lithium) may be effective. It may take two to three weeks for you to notice improvement.

NOTE: Be sure to use only products that are “peak X-free.” Peak X is a contaminant that can cause significant side effects and even death.

Step 3: Take a Prescription SSRI Antidepressant Along with Lithium

If step 2 is not effective or the depression is more severe, stop taking the 5-HTP. At this point, your doctor may prescribe an SSRI antidepressant (Prozac, Paxil, Zoloft, or others) with lithium. If SSRIs give you intolerable side effects, tricyclic antidepressants such as amitriptyline may be the ones to use next. (Do not take 5-HTP with an SSRI because side effects will increase.) One major side effect of SSRIs is decrease in sexual libido, both in men and women. To reverse or reduce this side effect, take gingko biloba, 60mg to 120mg per day.

Step 4: Use EEG Biofeedback

EEG biofeedback has been shown to be effective in helping control manic symptoms. In mild bipolar disorder, some people can stop taking lithium if EEG biofeedback is successful, so it is worth a try after you become stabilized by the above steps.

Step 5: Take Trace Minerals and Vitamins

A recent study has shown that taking a combination of trace minerals and vitamins significantly decreases symptoms and reduces the need for the medications in steps 1 and 3. I recommend taking a good multivitamin containing one to two times the RDA values. Keep in mind that it may take four to six months to achieve maximum benefit.

Step 6: Take Vitamin C, Fish Oil, and/or Phosphatidylcholine (Lecithin)

If you still have symptoms after following the previous steps, take vitamin C, 3g daily, and phosphatidylcholine, 15g to 25g per day, in pure form or as lecithin, to increase the brain levels of acetylcholine, a neurotransmitter that may cause symptoms of manic-depression if deficient in the brain. Fish oil (2g to 6g daily) can decrease depressive symptoms and increase remission times, but it doesn’t help the mania.

Step 7: Use Light Therapy

If your bipolar depression becomes worse in winter, light therapy may be helpful. You sit for 20 to 30 minutes a day in front of a special light box that produces a full spectrum light of 10,000 lux. Ask your doctor where you can obtain one.

Step 8: Take Prescription CarbamazePine, Valproic Acid, or Haloperidol

If you are still suffering from manic episodes, and lithium and the above steps have not been effective, carbamazepine may be the next drug of choice. Other drugs that can be used as substitutes include valproic acid or haloperidol. These are all prescription medications and should be monitored by your doctor.

Step 9: Undergo Electroconvulsive Therapy

When bipolar disorder fails to respond to all other treatment measures, electroconvulsive (shock) therapy (ECT) is indicated, especially for people who are very depressed or suicidal. This is a last resort, but it may be necessary for uncontrolled bipolar disorder.

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