(also referred to as...) Bipolar Affective Disorder, Type I, Bipolar Affective Disorder, Type II,
Cyclothymic Disorder, Mania, Manic Depression, Manic Depressive Illness, Mood Disorder
Description Manic-depressive disorder is an illness with cyclic states of mania and depression. In 85% of the cases, depression dominates the personality cycle. During the mania, an individual's moods are elevated and this is typically accompanied by disorders of energy, both physical and emotional.
Symptoms and Signs: Manic people become more expansive. They may go on shopping sprees and spend money they do not have, or get involved in activities that may be considered risky, such as reckless driving, illicit drug use, or promiscuous sexual pursuits. Manic depression is truly a bipolar disease, with the mania being the exact opposite of the depressive phase. During the mania, the patient may need less sleep (2 to 3 hours daily), less food, and everything is very intense. Manic patients may also experience symptoms of paranoia and being overly suspicious or grandiose. During the depressed mood, there is a slowness of thinking and motor activity and a lowness of mood. Also, depressed people often complain of slowness in bodily functions, such as disturbances in sleep and reduced desire for food, sex, and pleasurable pursuits. Depressed people often find that food does not taste as good as it once did. They lose the ability to enjoy pleasurable activities, whether these are sports, hobbies, or sexual activity.
Depressive Phase During the depressive phase, manic patients have a dysphoric mood, or loss of interest or pleasure in all or most of their usual activities and pastimes. Symptoms include depression, sadness, hopelessness, and irritability. At least four of the following symptoms must have been present nearly every day for at least two weeks: - Any of the following: weight loss, decreased appetite, weight gain, increased appetite.
- Insomnia or hypersomnia (excessive sleeping).
- Loss of interest or pleasure in once enjoyed activities or loss of libido.
- Decreased energy or fatigue.
- Feelings of worthlessness, self-reproach, or excessive or inappropriate guilt.
- Decreased perceived ability or actual decreased ability to think or concentrate; indecisiveness, mental dullness.
- Suicidal thoughts, repeated thoughts of death, desire to die, or actual suicide attempt.
- Physical restlessness or decreased mobility.
Physical Findings Excessively painful trigger points and areas of tenderness over the entire body upon palpation.
Manic Phase The manic phase has at least one distinct episode with a predominantly elevated, expansive, hyperactive, or irritable mood that may be violent. The elevated mood may be persistent or alternate and coincide with depression. In addition, there is a period of three weeks or more (or duration of any period of time if hospitalization is required) where, for most of the time, at least three of the following symptoms have been present (four if the patient has only been irritable) and have persisted to a significant degree: - Increased physical activity or physical restlessness; increased libido.
- More talkative than usual or increased pressure or drive to keep talking; increased interest in new people, activities or creative interests.
- Self-perceived awareness that the mind is racing.
- Grandiosity (inflated self-esteem) that may be delusional.
- Weight loss; decreased need for sleep or insomnia.
- Easily distracted: attention too easily drawn to unimportant or irrelevant external stimuli.
- Unrecognized involvement in behaviours or actions that are risky, such as reckless driving, shopping sprees, sexual promiscuity, et cetera.
Causes: There are several possible causes of manic-depressive disorder, that can range from circumstantial events, to neurotransmitter imbalances, to toxicity. Manic-depressive disorders may also be attributable to disturbed serotonin metabolism. What to Expect: A full blown manic attack requires hospitalization. During the mania phase, patients may hurt themselves or others. The standard treatment of manic-depressive disorder is lithium, which is highly effective in stabilizing mood and is especially useful in preventing the manic phase. Lithium is a naturally occurring substance that manic-depressives need in higher doses. Often, a combination of drugs are used, such as antidepressants that can often induce mania and hypomania. It is therefore very difficult to effectively control the lows in bipolar depressives with drug therapy.
Remedies
Amino Acids An amino acid complex is used to supply protein needed for normal brain function and to combat depression. Take an amino acid complex as directed on an empty stomach twice daily. L-Glycine functions as an inhibitory neurotransmitter and is indicated for manic depression. Glycine is found in most protein-rich foods. It is also found as part of a multi-amino acid complex and protein powder supplements. L-glycine may also be available in isolated form. Take as directed. L-Tyrosine is important in treating depression and helps to stabilize mood swings. The recommended dose is 500mg twice during the day and again at bedtime. Take with water on an empty stomach (Do not take with milk). Tyrosine can also be taken with 50mg vitamin B6 and 100mg vitamin C for better absorption. NOTE: Do not take this supplement if you are on a MAO inhibitor (commonly prescribed for depression). A deficiency if taurine can result in hyperactivity, anxiety and poor brain function. Taurine is found in eggs, fish, meat, and milk. It is not found in vegetable protein. If supplementing, take 500mg three times daily on an empty stomach. Depending on the country in which you live, you may require a prescription to obtain taurine as an isolated supplement. Avoid the amino acids ornithine and arginine. These substances may make the symptoms worse. According to an article in the New England Journal of Medicine, individuals with depression and manic-depressive disorder appear to be hypersensitive to acetylcholine, a neurotransmitter. It is thus recommended that choline not be taken in a dose that exceeds the amount provided in a multi-vitamin.
Aromatherapy For the mania phase, sedating essential oils may be used. Ideal choices include: eucalyptus, lavender, and melissa (lemon balm). Citriodora citronella, lemon, and lemon verbena also have a strong sedative effect. During the depressive state, allspice, ambrette, bergamot, Canadian balsam, cassie, clary sage, creeping hyssop, frankincense, French basil, grapefruit, helichrysum, hemlock spruce, jasmine, lemon verbena, lavender, melissa, orange blossom, rose (cabbage and damask), sandalwood, vetiver, and ylang ylang are very helpful.
Bach Flower Remedies Bach flower remedies may help to alleviate some of the symptoms associated with manic-depressive disorder. Before you use Bach flower remedies, please read Bach Flower Remedies, Introduction -- Preparing a Treatment for general dosage information. For mood swings, Rescue Remedy may be used when there is an acute state of panic, aggression, hysteria, and mental numbness. White Chestnut may be used when there are persistent worrying thoughts and a desire to escape from the tormenting thoughts of his/her own mind. Scleranthus may be helpful when there are extreme mood swings. Aspen, Cherry Plum, and Rescue Remedy may be used for delusions. For depression, use Gentian, Gorse, Mustard, Sweet Chestnut, and Wild Rose. Impatiens and Vervain may be used when there are symptoms of impulsiveness. Although Bach Flower Remedies can never replace medical attention, the essences of Agrimony, Cherry Plum, Mimulus, and Rescue Remedy may be used for suicidal tendencies until help arrives. Lastly, if there are feelings of aggression, violent actions or thoughts, Cherry Plum, Holly, Impatiens, Scleranthus, Rescue Remedy, and Vine may be used.
Foods Eat a diet consisting of vegetables, fruits, nuts, seeds, beans and legumes. Whole grains and whole grain products are recommended except for those that contain gluten, such as wheat, which should be consumed in moderation only. A low vanadium diet is recommended. This entails eliminating all refined and processed foods and promoting the consumption of fresh fruits and vegetables. Avoid: meat, alcohol, dairy products, hot sauces, spicy foods, fried foods, fatty foods, rich foods, salty foods, coffee, sweets and sugar, processed foods, refined foods, any foods with artificial additives (colours, flavour enhancers, emulsifiers, preservatives, etc.) Increase foods rich in Vitamin B-Complex (Brewer's yeast, liver, and whole grains) and vitamin C (citrus fruits, cantaloupe, green peppers, broccoli, papaya, and strawberries). Increase the consumption of oyster, rosemary, mushroom, miso, and liver. Increase liver cleansing foods such as beets, carrots, artichokes, lemon, parsnips, dandelion greens, watercress, and burdock root. Be aware that food allergies can trigger mood swings. Use an elimination diet to find which foods may be causing problems and restrict them from the diet. For more information, see the dedicated section on Food Allergies. Lecithin is important for proper brain function. Take 12 to 30g daily. NOTE: Lecithin may cause stomach upset.
Food Supplements Flaxseed oil is important for improved cerebral circulation and blood vessel stability. It is also involved in the manufacture of several brain hormones and chemicals. Take 1 to 2 tablespoons daily.
Herbs Passionflower is a mild sedative that can be used to relax the nervous system. Its main uses are for nervous tension, anxiety, and insomnia. To prepare an infusion, pour one cup boiling water over one teaspoon herb and infuse 10 minutes. Take three times daily. If supplementing, take 2 capsules up to four times daily. If using in tincture form, take 20 to 30 drops in 1 cup of warm water. St. John's Wort is probably the best known herbal antidepressant. It can be used as an adjunct to lithium but without the common side effects of the pharmaceutical antidepressants. Take 300 to 500mg 2 to 3 times daily with meals. Other recommendations suggest aiming for a hypericin content of 0.3% (from a standardized or guaranteed potency preparation). Scullcap may be used as a sedative and is a safe, reliable herb for promoting relaxation. Scullcap is high in minerals that nourish the nervous system. It may be combined with other nervines such as hops, wood betony, and passionflower for a synergistic effect. To prepare an infusion, use 1 to 2 teaspoons dried herb per cup of boiling water. Steep 10 to 15 minutes. Drink up to 3 cups daily. Add honey or lemon to reduce the bitter flavour. Valerian root is high in calcium, which nourishes nerve tissue. It is sedating and relaxing and is traditionally used for hysteria and irritability. To prepare an infusion place 1/2 to 1 teaspoon in hot water. If supplementing, capsules are the preferred method of use as valerian has a rather displeasing taste and smell. Take 150 to 300mg daily. You may also look for preparations standardized to 0.8% valeric acid. The lower dosage will help relieve anxiety while the higher dosage will promote sleep. If using in tincture form, take 60 to 100 drops three times daily.
Homeopathy Certain remedies can be used in acute situations if your symptoms fit the symptom picture of the remedy. For dosages, see the dedicated section on Homeopathy. Consult your homeopath or naturopath to determine your constitutional remedy: the remedy that best fits you as a whole person. Your homeopath or naturopath will take a complete case history considering all of your mental and physical ailments and match these symptoms with the symptom picture of the remedy. Agaricus muscarius: From overexertion and prolonged study; a history of slow mental development (slow to walk and speak); worse in the evenings, averse to conversation, mental labor, delirious. Anacardium: Low self-esteem; cruelty to animals or people; desire to prove one's self; irresistible desire to curse and swear; severe depression which may be suicidal; history of abusive families, relationships or marriages; weak memory; fear of failure; fears, delusions or dreams of being pursued; indecisive and conflicted feelings about many things; alcohol or drug abuse; absence of moral values. Aurum metallicum: Melancholy, desire to die, strong desire to weep, sees obstacles everywhere Hyoscyamus: Acute mania with intense paranoia, suspicion and jealousy; relatively passive state; talks to people not there, the dead or himself; talks excessively, mind revels in strange and ridiculous things; cursing, lewd talk or inappropriate jokes or comments; exhibitionism or touches genitals; desire to kill; depression and shameful feelings Lachesis: Passionate, intense emotions; jealousy and envy; suspicion, even paranoia; excessive talking; anger; aggressiveness; hatred and longings for revenge; worse sleep and morning on waking; impulsive insanity; anxiety of conscience; depressed and anxious, may be suicidal. Manic states with pressured speech, aggressiveness, sleeplessness. Symptoms may follow grief. Lithium carbonicum: Difficulty remembering names; cries with self pity; anxiety at night. Mercurius solubilis: Hastiness; slow to understand or grasp concepts; stammering; perception that time is passing by too slowly; muttering delirium; introverted, closed, emotionally intense and suspicious; internal impulses which are often violent or involve destructive ideas (stabbing, etc.); impulse to scream, hurriedness and irritability; anxiety and panic attacks with a great fear of insanity; withdrawn and depressed; suicidal. Psorinum: Trembling from moral emotion; hypochondriasis; depression during menopause; anxiety and hopelessness about the future or pessimism; suicidal thoughts and feelings; deep anxiety states with restlessness and anguish; feelings of abandonment or isolation. Staphysagria: Acute state of symptoms; generally unhappy and dissatisfied about everything; low-self-esteem; tendency to throw things when angry, talks to himself out loud; constant and often distressingly frequent sexual fantasies; history of incest or alcoholic parents. Stramonium: Excessive speaking; praying; beseeching; entreating; worse solitude and darkness; jealousy, destructive forms of mania where the patient throws objects across the room; shrieks; curses; hits or strikes others; bites himself or others and the repressed unconscious violently erupts; rage and violence with the capacity to commit murder; violent behaviour of any type; mania with red face, dilated pupils and superhuman strength. Fears of: death (especially violent death or murder), the dark, of being alone, of animals. Syphilinum: Loss of memory; sensation or fear of going insane; dread of night; alcoholism; compulsive checking and handwashing. Veratrum album: Person wants to help many people; delusions; lying without realizing it; jealousy; argumentative and harshly critical; sadness with a lot of crying; violent and destructive; nymphomania; religious mania; sensation of ice on the top of the head; philosophical; arrogant; mania involves acute or chronic psychosis (violence, excessive spending, et cetera).
Minerals Chromium GTF can prove useful in situations of abnormal glucose metabolism, i.e., hypoglycemia. Take 200 to 400mcg daily. Zinc functions to protect the brain cells. Take 30 to 50mg daily with meals. Do not exceed a total of 100mg daily from all supplements.
Vitamins High potency B vitamins are very important for all mood disorders. B vitamins are vital in any type of nervous system dysfunction, and during mood swings and periods of prolonged stress. Take approximately 100mg of each B vitamin three times daily. Folate is indicated for symptoms associated with depression. It also enhances the effects of lithium. Take 1 to 5mg daily. People who have manic-depression disorder often have deficiencies of the B-vitamins and therefore do not absorb them well. This is particularly true for Vitamin B12. Consider an intra-muscular injection protocol (under the supervision of your naturopath or other health practitioner) for enhanced absorption. Injections of B12 and megadoses of the B vitamins have a lithium-like effect on the brain. Take 1,000mcg every day and work up to 3 to 4g. Vitamin B6 (pyridoxine) is indicated for mood swings, irritability, and depression. Pyridoxine has been found to raise serotonin levels, which are often decreased in depressed people. Also, pyridoxine may reverse the effects of toxic substances associated with hyperactivity and aggressive behaviour in mania. Take 100mg daily. Vitamin C aids in brain function. Take 3,000 to 5,000mg or more daily. Start at the lower dosage and increase up to bowel tolerance.
Actions and Remedy Listings
For More Information ... Centre for Addiction and Mental Health
33 Russell Street
Toronto, Ontario
M5S 2S1 Tel.: 416.535.8501
Fax: 416.595.5017 Web: www.camh.net
Mood Disorders Association of Ontario
40 Orchard View Boulevard, Suite 222
Toronto, Ontario
M4R 1B9 Tel.: 416.486.8046
Toll-Free: 1.888.486.8236
Fax: 416.486.8127 Web: www3.sympatico.ca/mdamt
Email: mdamt@sympatico.ca
American Psychological Association
750 First St., N.E.
Washington, DC
20002-4242
USA Tel.: 202.336.5500
National Depressive Manic Depressive Association (DMDA)
730 Franklin St., #501
Chicago, IL
60610
USA Toll-Free: 1.800.826.3632
National Foundation for Depressive Illness
20 Charles Street
New York, NY
10014
USA
National Mental Health Association
1021 Prince Street
Alexandria, VA
22304-297
USA
Stanley Center for the Innovative Treatment of Bipolar Disorder
3811 O'Hara Street, Suite 279
Pittsburgh, PA
15213
USA
Toll-Free: 1.800.424.7657
Fax: 412.624.0493
See also Depression, Food Allergies/Intolerances, Hypoglycemia
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