Contact me now at (255) 352-6258 or complete my booking form to secure your appointment today.
As I mentioned, people with bipolar type II spend almost four times more time depressed than hypomanic, and yet there are very few treatments available.
As we discussed last time, the neurotransmitter glutamate and the inflammatory complex are two new, badly-needed areas of bipolar depression treatment research. Here are three additional bipolar depression treatment areas you probably don’t know about: diet, antioxidants, and modafinil.
There are quite a few people talking about diet and bipolar disorder and diet and depression. And for all the words they say, the one thing we actually know through study is: no diet is known to treat bipolar disorder. Period. We know an unhealthy diet will possibly make you worse, but the only thing science can recommend is to eat a healthy, balanced diet.
[push]The only thing science can currently recommend is to eat a healthy, balanced diet.[/push]
That being said, insulin interacts with many parts of the body responsible for much of the brain’s functioning. For example, insulin regulates the concentration of neurotransmitters and monoamines in the central nervous system; and these chemicals are thought to impact mood disorders, Alzheimer’s, and schizophrenia. It appears a lack of insulin can produce mental illness symptoms.
This area is in extremely early development, but there is currently testing of insulin-increasing drugs in the treatment of bipolar disorder and depression. And yes, other dietary issues are being studied (more carbohydrates and fewer carbohydrates are being studied), but as of yet, there is nothing concrete.
We know something unfortunate about the brain and mental illness: mental illness shrinks the brain. (Mental illness decreases neuroplasticity, technically.) And we know that some drugs protect or reverse this effect (SSRI antidepressants, lithium, electroconvulsive therapy (ECT)). [pull]We know something unfortunate about the brain and mental illness: mental illness shrinks the brain.[/pull]
And one of the possible causes of brain shrinkage currently being considered is oxidative stress. Oxidative stress represents an imbalance that prevents detoxification and repair within tissues. (It’s complicated. See Wikipedia.) Some amount of oxidative stress is normal (and important), but this stress, combined with cell abnormalities, is implicated in bipolar disorder. Evidence suggests lithium and valproic acid protect neurons against oxidative stress.
(Still with me? Good. It’s going to get easier. Just hang on a bit longer.)
This oxidative stress can be caused due to decreased levels of antioxidants. One, in particular, glutathione, is known to have abnormal levels in bipolar disorder. And in order to make enough glutathione, a body must have enough of an amino acid, cysteine.
Increasing cysteine levels using N-acetylcysteine (NAC) has been reported to be neuroprotective and impact glutamate (which we think is good, see here). NAC has been able to alleviate depressive symptoms in people with bipolar disorder in a double-blind placebo-controlled study as an add-on medication.
N-Acetylcysteine for Bipolar Disorder Depression – The Good and The BadThe good? NAC is cheap, over-the-counter, and from what we know, safe.* The bad news? NAC can take up to five months to work, and study on it is limited. (See bipolar disorder type 2 depression and NAC notes by Dr. Jim Phelps.)
In a completely non-medical, Natasha-only-based opinion, NAC seems like something you could talk to your doctor about adding. There doesn’t seem to be a downside other than waiting for five months to see if it works. This doesn’t mean trying it on your own. It means talking to your doctor.^
Last but not least is the research into modafinil treatment of bipolar depression. Modafinil is a “wakefulness promoting agent” prescribed to people “with excessive sleepiness.” This is not an amphetamine but is a stimulant. Basically, we don’t understand this medication, but it increases monoamines like norepinephrine and dopamine, which we generally like.
Modafinil has been shown effective in treating bipolar depression (without inducing mania or hypomania) by week two of treatment. In the study, modafinil decreased depressive symptoms and increased remission rates.
This medication is one some doctors are already using off label for the treatment of bipolar depression.
Basically, under all of this, the message is: we’re working on it. It’s long and slow and frustrating for us crazies, but the doctors have their lab coats out, and they’re thinking up stuff all the time. Will any of these help you? I don’t know. But what I do know is these five areas should be a reason to hold onto hope, even if what you’re doing right now isn’t working.
The information in this article is primarily from Novel Treatment Avenues for Bipolar Depression By Roger S. McIntyre, MD, and Danielle S. Cha. Clinical Psychopharmacology. April 19, 2011.
See the article for all the nitty gritty details about the above.
* Safe, in this case, means no known drug interactions (to the best of my knowledge and according to a doctor). In the drug database used by doctors up here in Canada, it reports no side effects. In the study, they note it as “safe” but report changes in energy, headaches, heartburn, and joint pain as possible side effects – these being basically the same in the placebo and NAC group. Keep in mind, though, so little study has been done on this there may be all sorts of gotchas we haven’t seen.
^ Remember: your doctor should know about all medications, vitamins, and supplements you take. Just because it’s over the counter doesn’t mean it’s harmless.
Natasha Tracy is an award-winning writer, speaker, advocate, and consultant from the Pacific Northwest. She has been living with bipolar disorder for 26 years and has written more than 2000 articles on the subject.
Find more of Natasha’s work in her acclaimed book: "Lost Marbles: Insights into My Life with Depression & Bipolar" on Amazon.
Connect with Natasha at the social media links below.
Shopping for someone with a mental illness can feel tricky—you want a gift that actually helps, not just more clutter. This guide walks you through 15 thoughtful, low-pressure mental health gifts that offer real comfort, reduce stress, and say, “I see you and I’m here,” during the holidays and all year.
I’m never going to call bipolar pain a “gift.” Most days, I just want it to stop. But emotional and even physical pain aren’t always random torture—they’re often trying to tell us something. This piece digs into what your pain might be saying, how to listen, and how that can make living with it just a little easier.
After 24 of 30 TMS sessions with no meaningful improvement, I wrote the guide I needed: why failed treatment hurts, how to get through the next 72 hours, and what to ask your clinician now.
Subscribe to my monthly newsletter to get the latest from Bipolar Burble, Breaking Bipolar, my vlogs at bpHope, my masterclasses, and other useful tidbits -- plus get a FREE eBook on coping skills.
Hello. What you are saying is false. Diet IS the cause of Bipolar and most all mental illness. The real problem is that people are too lazy to do what they need to do for their mental health. They think a pill will cure it. NOPE! You’re being poisoned with the modern diet and fed a pill to “cure” the problem, If you want to cure your bipolar you must completely eliminate refined sugar, gluten, alcohol, corn, caffeine, and any processed foods from your diet. If you have not done this, you have no leg to stand on when it comes to claims about diet not curing bipolar disorder. I have seen it work in many people over and over, but very few are able to muster the control and self-discipline necessary to see it happen.
Stop being a lazy pig and eat only whole meats, vegetables, and fruit. You can thank me later.
Provigil was a wonder drug for me. I suffered for most of my life with severe depression, mixed diagnoses on whether I am actually bipolar… and for me Wellbutrin and Depakote were what worked. However, I was drowsy from the Depakote, so my doctor gave me this wonder drug! 200 mg in the morning and I was good to go! Great times were had by all! Then my husband and I considered trying for kids, and weaning off the Provigil was the first thing on my list.
Then the NIGHTMARE BEGAN. We have yet to try to conceive because merely cutting my dose in half left me in tears every day. I was severely depressed, nearly hospitalized. My doctor about ran away from me, since he was theone pprescribing the drug off label. Luckily I had my husband, because without his support I dread the thought of what would have happened.
Now I know my dopamine plummeted. As a person with prior alcohol addiction, I also was never informed that possibly this drug could cause me more problems.
Mania? What is mania by definition? Just because I wasn’t arrested or found running down the street naked doesn’t mean I wasn’t manic. It just wasn’t as severe. Sleepless nights, up all night with creative projects, extremely talkative… it was just more controlled.
So live it up on your Provigil high, so long as you don’t intend on stopping. I don’t mean to be hurtful
I blame physicians for thinking this is no different than a ‘non stimulant cup of coffee.’ Then when you’re withdrawing hard, that same caring physician is nowhere to be found. MDs dealing with mental disorders that they lack the experience to treat.
For me it was one of the most dangerous, painful withdrawals I have ever had.
modafinil definitely helps my anergic depression. i also use stablon and these two are truly wonder drugs.
ill be reducing my lithium to see if i can function on the above two.
Modafilin
I been taking this medication for 2 months now, and for me it been a huge improvment in mood, function and stresstolerance as well as reducing Seroquel related sleepyness. The improvement came quickly, too. The side effects I experienced is so light headaches, and feeling less hungry, but still with a normal apatite and a ability to appreciate food. During the first days I felt like i had too much caffeine (a bit restless, etc), but that feeling passed.
Do you know if it applies to Nuvigil (Armodafinil) as well as Provigil?
Do you know of any studies related to long term use of Provigil/Modafinil?
My psych encouraged me to try it due to daytime tiredness from psych meds as well as residual fatigue from cancer treatment, and I have wanted to add another med to my 6 med regimen (plus I get jittery from Provigil/Nuvigil). And, I am concerned about longterm effects.
Hi Jenn,
Armodafinil (Nuvigil) is the active component of modafinil (Provigil). I’m not a chemistry expert, but I believe for treatment uses, they are considered the same: http://en.wikipedia.org/wiki/Armodafinil
(Ar)Modafinil is a non-amphetamine, wakefullness-promoting agent. I know that sounds vague, but that’s because it is vague. In spite of much study, we don’t know exactly how the drug works. The reason it’s used in psychiatry, yes, is because it promotes wakefullness, but also because it’s thought to increase the dopamine and norepinephrine. Modafinil has been shown in studies to be a useful antidepressant add-on.
There is a study on its use >12 months. It’s considered safe and effective. http://www.ncbi.nlm.nih.gov/pubmed/20957846 (treatment of sleep disorders) There are actually quite a few interesting studies: http://www.ncbi.nlm.nih.gov/pubmed?term=modafinil%20long-term
My, personal, non-medical opinion, is that I wouldn’t be worried about it long-term any more than any other medication. It’s not an amphetamine, but even those (like Ritalin) can be used effectively long-term. I see nothing to worry about. (I’ve taken it for years, but that’s just me.)
But as always, medication is a personal decision so knowing how you feel best and working with your doctor is what matters most.
– Natasha Tracy
Im bipolar and adhd for many years and with the conventional treatment life is not easy so i started to look for not conventional things after reading a lot and i found that antioxidants are very important in the brain so i am using theanine from the green tea and helps a lot also alpha lipoic acid and maqui berry and some other ones and they help me a lot in memory concentration depresion and all the symptoms we all know using lithium Carlos