 |
 |
|
|
|
|
BASIC INFORMATION
DESCRIPTION
Manic-depressive disorder, also medically termed bipolar mood disorder, is a variant of classic depression. It typically begins as depression and then develops into alternating periods of depression and mania. A person with severe manic-depressive disorder may go from feeling unrealistically (and dangerously) invincible and elated to being over-whelmed with misery and despair, even suicidal.
Bipolar disorder is considered to be a serious mental illness. It is estimated that about 5.7 million adults or about 2.6 to 3 percent of the population, aged 18 and older, of the United States suffers from some form of this disorder in any given year.
Bipolar disorder can run in families. It usually starts in late adolescence or early adulthood. However, some develop them late in life. It is often not recognized as an illness, and people may suffer for years before it is properly diagnosed and treated. Untreated, bipolar disorder can result in damaged relationships, poor job or school performance, or even suicide. However, there are effective treatments, medications and "talk therapy". A combination of therapies usually works best. Like other diseases such as heart disease or diabetes, bipolar disorder is a long-term illness that must be carefully managed throughout a person's life.
CAUSES
The cause of this disorder is not well understood, but there are several theories as to its origin. It may be triggered by extreme stress. Heredity may be a factor in some cases. Some researchers believe that early experiences, such as the loss of a parent or other early childhood trauma, play an important role. Others believe that the manic phase is used (unconsciously) as a kind of psychological compensation for the depression that otherwise engulfs the individual. Biological factors are also possible. There is evidence that intracellular sodium increases during the mood swings of manic-depressive disorder, then returns to normal after recovery. It is also known that in depressed individuals, brain chemicals called monoamines are depleted.
MoonDragon's ObGyn Information: Depression
SYMPTOMS
Some of the symptoms of manic-depressive disorder are:
- Changes in sleep pattern.
- Withdrawal from society.
- Extreme pessimism.
- A sudden loss of interest in and failure to finish projects that were started with enthusiasm.
- Chronic irritability.
- Sudden attacks of rage when crossed.
- Loss of inhibition.
- Changes in sexual behavior that may range from a complete loss of sex drive to sexual excess.
The course of manic-depressive disorder is highly variable. Both mania and depression can vary in severity, and the length of the cycles, from depression to mania and back again, can occur over the course of a few days or over many months - even in some cases, years.
Self-esteem and feelings of hopelessness characterize the depressive phase.
A person experiencing depression may lack motivation to do anything, even get out of bed. Some people simply sleep for weeks, withdraw from social activities, avoid relationships with others, and become unable to work.
Others may seem to be living normal lives - going to work, interacting with others - but inwardly feel a deadening sadness and are unable to experience genuine pleasure.
The periods of mania often start suddenly and without warning. Some people experience what is called hypomania, excitement that does not necessarily appear to be a sign of mental illness - just great enthusiasm and energy. Others experience full-blown manic psychosis, in which they have seemingly boundless energy and are ceaselessly active and easily distracted. They may not want to rest or sleep for 24 hours or more. Mental activity is sharply accelerated, and delusions of grandeur, persecution, or invincibility are not uncommon. Most people in this condition seem to be utterly elated for no apparent reason, but some become unreasonably irritable and hostile. They may even have hallucinations. Despite all this, a person experiencing full-blown mania generally believes that he or she is functioning at peak efficiency.
Bipolar disorder causes dramatic mood swings - from overly "high" and/or irritable to sad and hopeless, and then back again, often with periods of normal mood in between. Severe changes in energy and behavior go along with these changes in mood. The periods of highs and lows are called episodes of mania and depression.
Signs and symptoms of mania (or a manic episode) include:
- Increased energy, activity, and restlessness.
- Excessively "high," overly good, euphoric mood.
- Extreme irritability.
- Racing thoughts and talking very fast, jumping from one idea to another.
- Distractibility, cannot concentrate well.
- Little sleep needed.
- Unrealistic beliefs in one's abilities and powers.
- Poor judgment.
- Spending sprees.
- A lasting period of behavior that is different from usual.
- Increased sexual drive.
- Abuse of drugs, particularly cocaine, alcohol, and sleeping medications.
- Provocative, intrusive, or aggressive behavior.
- Denial that anything is wrong.
A manic episode is diagnosed if elevated mood occurs with three or more of the other symptoms most of the day, nearly every day, for 1 week or longer. If the mood is irritable, four additional symptoms must be present.
Signs and symptoms of depression (or a depressive episode) include:
- Lasting sad, anxious, or empty mood.
- Feelings of hopelessness or pessimism.
- Feelings of guilt, worthlessness, or helplessness.
- Loss of interest or pleasure in activities once enjoyed, including sex.
- Decreased energy, a feeling of fatigue or of being "slowed down".
- Difficulty concentrating, remembering, making decisions.
- Restlessness or irritability.
- Sleeping too much, or cannot sleep.
- Change in appetite and/or unintended weight loss or gain.
- Chronic pain or other persistent bodily symptoms that are not caused by physical illness or injury.
- Thoughts of death or suicide, or suicide attempts.
A depressive episode is diagnosed if five or more of these symptoms last most of the day, nearly every day, for a period of 2 weeks or longer.
A mild to moderate level of mania is called hypomania. Hypomania may feel good to the person who experiences it and may even be associated with good functioning and enhanced productivity. Thus even when family and friends learn to recognize the mood swings as possible bipolar disorder, the person may deny that anything is wrong. Without proper treatment, however, hypomania can become severe mania in some people or can switch into depression.
Sometimes, severe episodes of mania or depression include symptoms of psychosis (or psychotic symptoms). Common psychotic symptoms are hallucinations (hearing, seeing, or otherwise sensing the presence of things not actually there) and delusions (false, strongly held beliefs not influenced by logical reasoning or explained by a person's usual cultural concepts). Psychotic symptoms in bipolar disorder tend to reflect the extreme mood state at the time. For example, delusions of grandiosity, such as believing one is the President or has special powers or wealth, may occur during mania; delusions of guilt or worthlessness, such as believing that one is ruined and penniless or has committed some terrible crime, may appear during depression. People with bipolar disorder who have these symptoms are sometimes incorrectly diagnosed as having schizophrenia, another severe mental illness.
It may be helpful to think of the various mood states in bipolar disorder as a spectrum or continuous range. At one end is severe depression, above which is moderate depression and then mild low mood, which many people call "the blues" when it is short-lived but is termed "dysthymia" when it is chronic. Then there is normal or balanced mood, above which comes hypomania (mild to moderate mania), and then severe mania.
In some people, however, symptoms of mania and depression may occur together in what is called a mixed bipolar state. Symptoms of a mixed state often include agitation, trouble sleeping, significant change in appetite, psychosis, and suicidal thinking. A person may have a very sad, hopeless mood while at the same time feeling extremely energized.
Bipolar disorder may appear to be a problem other than mental illness - for instance, alcohol or drug abuse, poor school or work performance, or strained interpersonal relationships. Such problems in fact may be signs of an underlying mood disorder.
SUICIDE
Some people with bipolar disorder become suicidal. Anyone who is thinking about committing suicide needs immediate attention, preferably from a mental health professional or a health care provider. Anyone who talks about suicide should be taken seriously. Risk for suicide appears to be higher earlier in the course of the illness. Therefore, recognizing bipolar disorder early and learning how best to manage it may decrease the risk of death by suicide.
Signs and symptoms that may accompany suicidal feelings include:
- Talking about feeling suicidal or wanting to die.
- Feeling hopeless, that nothing will ever change or get better.
- Feeling helpless, that nothing one does makes any difference.
- Feeling like a burden to family and friends.
- Abusing alcohol or drugs.
- Putting affairs in order (e.g., organizing finances or giving away possessions to prepare for one's death).
- Writing a suicide note.
- Putting oneself in harm's way, or in situations where there is a danger of being killed.
If you are feeling suicidal or know someone who is:
- Call a health care provider, emergency room, or 9-1-1 right away to get immediate help.
- Make sure you, or the suicidal person, are not left alone.
- Make sure that access is prevented to large amounts of medication, weapons, or other items that could be used for self-harm.
While some suicide attempts are carefully planned over time, others are impulsive acts that have not been well thought out; thus, the final point in the box above may be a valuable long-term strategy for people with bipolar disorder. Either way, it is important to understand that suicidal feelings and actions are symptoms of an illness that can be treated. With proper treatment, suicidal feelings can be overcome.
THE COURSE OF BIPOLAR DISORDER
Episodes of mania and depression typically recur across the life span. Between episodes, most people with bipolar disorder are free of symptoms, but as many as one-third of people have some residual symptoms. A small percentage of people experience chronic unremitting symptoms despite treatment.
The classic form of the illness, which involves recurrent episodes of mania and depression, is called bipolar I disorder. Some people, however, never develop severe mania but instead experience milder episodes of hypomania that alternate with depression; this form of the illness is called bipolar II disorder. When four or more episodes of illness occur within a 12-month period, a person is said to have rapid-cycling bipolar disorder. Some people experience multiple episodes within a single week, or even within a single day. Rapid cycling tends to develop later in the course of illness and is more common among women than among men.
People with bipolar disorder can lead healthy and productive lives when the illness is effectively treated (see "Conventional Medical Treatment" below). Without treatment, however, the natural course of bipolar disorder tends to worsen. Over time a person may suffer more frequent (more rapid-cycling) and more severe manic and depressive episodes than those experienced when the illness first appeared. But in most cases, proper treatment can help reduce the frequency and severity of episodes and can help people with bipolar disorder maintain good quality of life.
DIAGNOSIS & TREATMENT
DIAGNOSIS
The symptoms of some childhood psychological disorders such as attention deficit disorder (ADD), attention deficit hyperactivity disorder (ADHD), conduct disorder, and schizophrenia can be similar to those of mania, so a thorough examination is needed to avoid misdiagnosis. It is not uncommon for children who are diagnosed with psychotic depression to be diagnosed with bipolar disorder as adults.
CONVENTIONAL MEDICAL TREATMENT
Both children and adolescents can develop bipolar disorder. It is more likely to affect the children of parents who have the illness. Unlike many adults with bipolar disorder, whose episodes tend to be more clearly defined, children and young adolescents with the illness often experience very fast mood swings between depression and mania many times within a day. Children with mania are more likely to be irritable and prone to destructive tantrums than to be overly happy and elated. Mixed symptoms also are common in youths with bipolar disorder. Older adolescents who develop the illness may have more classic, adult-type episodes and symptoms. Bipolar disorder in children and adolescents can be hard to tell apart from other problems that may occur in these age groups. For example, while irritability and aggressiveness can indicate bipolar disorder, they also can be symptoms of attention deficit hyperactivity disorder, conduct disorder, oppositional defiant disorder, or other types of mental disorders more common among adults such as major depression or schizophrenia. Drug abuse also may lead to such symptoms.
For any illness, however, effective treatment depends on appropriate diagnosis. Children or adolescents with emotional and behavioral symptoms should be carefully evaluated by a mental health professional. Any child or adolescent who has suicidal feelings, talks about suicide, or attempts suicide should be taken seriously and should receive immediate help from a mental health specialist.
Scientists are learning about the possible causes of bipolar disorder through several kinds of studies. Most scientists now agree that there is no single cause for bipolar disorder - rather, many factors act together to produce the illness. Because bipolar disorder tends to run in families, researchers have been searching for specific genes - the microscopic "building blocks" of DNA inside all cells that influence how the body and mind work and grow - passed down through generations that may increase a person's chance of developing the illness. But genes are not the whole story. Studies of identical twins, who share all the same genes, indicate that both genes and other factors play a role in bipolar disorder. If bipolar disorder were caused entirely by genes, then the identical twin of someone with the illness would always develop the illness, and research has shown that this is not the case. But if one twin has bipolar disorder, the other twin is more likely to develop the illness than is another sibling.6
In addition, findings from gene research suggest that bipolar disorder, like other mental illnesses, does not occur because of a single gene. It appears likely that many different genes act together, and in combination with other factors of the person or the person's environment, to cause bipolar disorder. Finding these genes, each of which contributes only a small amount toward the vulnerability to bipolar disorder, has been extremely difficult. But scientists expect that the advanced research tools now being used will lead to these discoveries and to new and better treatments for bipolar disorder.
Brain-imaging studies are helping scientists learn what goes wrong in the brain to produce bipolar disorder and other mental illnesses. New brain-imaging techniques allow researchers to take pictures of the living brain at work, to examine its structure and activity, without the need for surgery or other invasive procedures. These techniques include magnetic resonance imaging (MRI), positron emission tomography (PET), and functional magnetic resonance imaging (fMRI). There is evidence from imaging studies that the brains of people with bipolar disorder may differ from the brains of healthy individuals. As the differences are more clearly identified and defined through research, scientists will gain a better understanding of the underlying causes of the illness, and eventually may be able to predict which types of treatment will work most effectively.
Most people with bipolar disorder - even those with the most severe forms - can achieve substantial stabilization of their mood swings and related symptoms with proper treatment. Because bipolar disorder is a recurrent illness, long-term preventive treatment is strongly recommended and almost always indicated. A strategy that combines medication and psychosocial treatment is optimal for managing the disorder over time.
In most cases, bipolar disorder is much better controlled if treatment is continuous than if it is on and off. But even when there are no breaks in treatment, mood changes can occur and should be reported immediately to your health care provider. The health care provider may be able to prevent a full-blown episode by making adjustments to the treatment plan. Working closely with the health care provider and communicating openly about treatment concerns and options can make a difference in treatment effectiveness.
In addition, keeping a chart of daily mood symptoms, treatments, sleep patterns, and life events may help people with bipolar disorder and their families to better understand the illness. This chart also can help the health care provider track and treat the illness most effectively.
MEDICATIONS
Medications for bipolar disorder are prescribed by psychiatrists and medical practitioners with expertise in the diagnosis and treatment of mental disorders. While primary care practitioners who do not specialize in psychiatry also may prescribe these medications, it is recommended that people with bipolar disorder see a psychiatrist for treatment.
Medications known as "mood stabilizers" usually are prescribed to help control bipolar disorder. Several different types of mood stabilizers are available. In general, people with bipolar disorder continue treatment with mood stabilizers for extended periods of time (years). Other medications are added when necessary, typically for shorter periods, to treat episodes of mania or depression that break through despite the mood stabilizer.
Lithium, the first mood-stabilizing medication approved by the U.S. Food and Drug Administration (FDA) for treatment of mania, is often very effective in controlling mania and preventing the recurrence of both manic and depressive episodes.
Anticonvulsant medications, such as valproate (Depakote®) or carbamazepine (Tegretol®), also can have mood-stabilizing effects and may be especially useful for difficult-to-treat bipolar episodes. Valproate was FDA-approved in 1995 for treatment of mania.
Newer anticonvulsant medications, including lamotrigine (Lamictal®), gabapentin (Neurontin®), and topiramate (Topamax®), are being studied to determine how well they work in stabilizing mood cycles.
Anticonvulsant medications may be combined with lithium, or with each other, for maximum effect.
Children and adolescents with bipolar disorder generally are treated with lithium, but valproate and carbamazepine also are used. Researchers are evaluating the safety and efficacy of these and other psychotropic medications in children and adolescents. There is some evidence that valproate may lead to adverse hormone changes in teenage girls and polycystic ovary syndrome in women who began taking the medication before age 20. Therefore, young female patients taking valproate should be monitored carefully by a health care provider.
Women with bipolar disorder who wish to conceive, or who become pregnant, face special challenges due to the possible harmful effects of existing mood stabilizing medications on the developing fetus and the nursing infant. Therefore, the benefits and risks of all available treatment options should be discussed with a practitioner skilled in this area. New treatments with reduced risks during pregnancy and lactation are under study.
TREATMENT OF BIPOLAR DEPRESSION
Research has shown that people with bipolar disorder are at risk of switching into mania or hypomania, or of developing rapid cycling, during treatment with antidepressant medication. Therefore, "mood-stabilizing" medications generally are required, alone or in combination with antidepressants, to protect people with bipolar disorder from this switch. Lithium and valproate are the most commonly used mood-stabilizing drugs today. However, research studies continue to evaluate the potential mood-stabilizing effects of newer medications.
Atypical antipsychotic medications, including clozapine (Clozaril®), olanzapine (Zyprexa®), risperidone (Risperdal®), quetiapine (Seroquel®), and ziprasidone (Geodon®), are being studied as possible treatments for bipolar disorder. Evidence suggests clozapine may be helpful as a mood stabilizer for people who do not respond to lithium or anticonvulsants.16 Other research has supported the efficacy of olanzapine for acute mania, an indication that has recently received FDA approval.17 Olanzapine may also help relieve psychotic depression. If insomnia is a problem, a high-potency benzodiazepine medication such as clonazepam (Klonopin®) or lorazepam (Ativan®) may be helpful to promote better sleep. However, since these medications may be habit-forming, they are best prescribed on a short-term basis. Other types of sedative medications, such as zolpidem (Ambien®), are sometimes used instead. Changes to the treatment plan may be needed at various times during the course of bipolar disorder to manage the illness most effectively. A psychiatrist should guide any changes in type or dose of medication. Be sure to tell the psychiatrist about all other prescription drugs, over-the-counter medications, or natural supplements you may be taking. This is important because certain medications and supplements taken together may cause adverse reactions. To reduce the chance of relapse or of developing a new episode, it is important to stick to the treatment plan. Talk to your health care provider if you have any concerns about the medications.
THYROID FUNCTION
People with bipolar disorder often have abnormal thyroid gland function. Because too much or too little thyroid hormone alone can lead to mood and energy changes, it is important that thyroid levels are carefully monitored by a health care provider.
People with rapid cycling tend to have co-occurring thyroid problems and may need to take thyroid pills in addition to their medications for bipolar disorder. Also, lithium treatment may cause low thyroid levels in some people, resulting in the need for thyroid supplementation.
MEDICATION SIDE EFFECTS
Before starting a new medication for bipolar disorder, always talk with your psychiatrist and/or pharmacist about possible side effects. Depending on the medication, side effects may include weight gain, nausea, tremor, reduced sexual drive or performance, anxiety, hair loss, movement problems, or dry mouth. Be sure to tell the practitioner about all side effects you notice during treatment. He or she may be able to change the dose or offer a different medication to relieve them. Your medication should not be changed or stopped without the psychiatrist's guidance.
PSYCHOSOCIAL TREATMENTS
As an addition to medication, psychosocial treatments - including certain forms of psychotherapy (or "talk" therapy) - are helpful in providing support, education, and guidance to people with bipolar disorder and their families. Studies have shown that psychosocial interventions can lead to increased mood stability, fewer hospitalizations, and improved functioning in several areas. A licensed psychologist, social worker, or counselor typically provides these therapies and often works together with the psychiatrist to monitor a patient's progress. The number, frequency, and type of sessions should be based on the treatment needs of each person.
Psychosocial interventions commonly used for bipolar disorder are cognitive behavioral therapy, psychoeducation, family therapy, and a newer technique, interpersonal and social rhythm therapy. National Institute of Mental Health (NIMH) researchers are studying how these interventions compare to one another when added to medication treatment for bipolar disorder.
Cognitive behavioral therapy helps people with bipolar disorder learn to change inappropriate or negative thought patterns and behaviors associated with the illness.
Psychoeducation involves teaching people with bipolar disorder about the illness and its treatment, and how to recognize signs of relapse so that early intervention can be sought before a full-blown illness episode occurs. Psychoeducation also may be helpful for family members.
Family therapy uses strategies to reduce the level of distress within the family that may either contribute to or result from the ill person's symptoms.
Interpersonal and social rhythm therapy helps people with bipolar disorder both to improve interpersonal relationships and to regularize their daily routines. Regular daily routines and sleep schedules may help protect against manic episodes.
As with medication, it is important to follow the treatment plan for any psychosocial intervention to achieve the greatest benefit.
OTHER TREATMENTS
In situations where medication, psychosocial treatment, and the combination of these interventions prove ineffective, or work too slowly to relieve severe symptoms such as psychosis or suicidality, electroconvulsive therapy (ECT) may be considered. ECT may also be considered to treat acute episodes when medical conditions, including pregnancy, make the use of medications too risky. ECT is a highly effective treatment for severe depressive, manic, and/or mixed episodes. The possibility of long-lasting memory problems, although a concern in the past, has been significantly reduced with modern ECT techniques. However, the potential benefits and risks of ECT, and of available alternative interventions, should be carefully reviewed and discussed with individuals considering this treatment and, where appropriate, with family or friends.
Herbal or natural supplements, such as St. John's wort (Hypericum perforatum), have not been well studied, and little is known about their effects on bipolar disorder. Because the FDA does not regulate their production, different brands of these supplements can contain different amounts of active ingredient. Before trying herbal or natural supplements, it is important to discuss them with your health care provider. There is evidence that St. John's wort can reduce the effectiveness of certain medications. In addition, like prescription antidepressants, St. John's wort may cause a switch into mania in some individuals with bipolar disorder, especially if no mood stabilizer is being taken.
Omega-3 fatty acids found in fish oil are being studied to determine their usefulness, alone and when added to conventional medications, for long-term treatment of bipolar disorder.
Even though episodes of mania and depression naturally come and go, it is important to understand that bipolar disorder is a long-term illness that currently has no cure. Staying on treatment, even during well times, can help keep the disease under control and reduce the chance of having recurrent, worsening episodes.
OTHER ILLNESSES & BIPOLAR DISORDER
Alcohol and drug abuse are very common among people with bipolar disorder. Research findings suggest that many factors may contribute to these substance abuse problems, including self-medication of symptoms, mood symptoms either brought on or perpetuated by substance abuse, and risk factors that may influence the occurrence of both bipolar disorder and substance use disorders. Treatment for co-occurring substance abuse, when present, is an important part of the overall treatment plan.
Anxiety disorders, such as post-traumatic stress disorder and obsessive-compulsive disorder, also may be common in people with bipolar disorder. Co-occurring anxiety disorders may respond to the treatments used for bipolar disorder, or they may require separate treatment.
GETTING HELP FOR BIPOLAR DISORDER
Anyone with bipolar disorder should be under the care of a psychiatrist skilled in the diagnosis and treatment of this disease. Other mental health professionals, such as psychologists, psychiatric social workers, and psychiatric nurses, can assist in providing the person and family with additional approaches to treatment.
Help can be found at:
- University or medical school affiliated programs.
- Hospital departments of psychiatry.
- Private psychiatric offices and clinics.
- Health maintenance organizations (HMOs).
- Offices of family health care providers, internists, and pediatricians.
- Public community mental health centers.
People with bipolar disorder may need help to get help. Often people with bipolar disorder do not realize how impaired they are, or they blame their problems on some cause other than mental illness. A person with bipolar disorder may need strong encouragement from family and friends to seek treatment. Family health care providers can play an important role in providing referral to a mental health professional. Sometimes a family member or friend may need to take the person with bipolar disorder for proper mental health evaluation and treatment. A person who is in the midst of a severe episode may need to be hospitalized for his or her own protection and for much-needed treatment. There may be times when the person must be hospitalized against his or her wishes. Ongoing encouragement and support are needed after a person obtains treatment, because it may take a while to find the best treatment plan for each individual. In some cases, individuals with bipolar disorder may agree, when the disorder is under good control, to a preferred course of action in the event of a future manic or depressive relapse. Like other serious illnesses, bipolar disorder is also hard on spouses, family members, friends, and employers. Family members of someone with bipolar disorder often have to cope with the person's serious behavioral problems, such as wild spending sprees during mania or extreme withdrawal from others during depression, and the lasting consequences of these behaviors. Many people with bipolar disorder benefit from joining support groups such as those sponsored by the National Depressive and Manic Depressive Association (NDMDA), the National Alliance for the Mentally Ill (NAMI), and the National Mental Health Association (NMHA). Families and friends can also benefit from support groups offered by these organizations.
BIPOLAR DISORDER CLINICAL STUDIES
Some people with bipolar disorder receive medication and/or psychosocial therapy by volunteering to participate in clinical studies (clinical trials). Clinical studies involve the scientific investigation of illness and treatment of illness in humans. Clinical studies in mental health can yield information about the efficacy of a medication or a combination of treatments, the usefulness of a behavioral intervention or type of psychotherapy, the reliability of a diagnostic procedure, or the success of a prevention method. Clinical studies also guide scientists in learning how illness develops, progresses, lessens, and affects both mind and body. Millions of Americans diagnosed with mental illness lead healthy, productive lives because of information discovered through clinical studies. These studies are not always right for everyone, however. It is important for each individual to consider carefully the possible risks and benefits of a clinical study before making a decision to participate.
In recent years, NIMH has introduced a new generation of "real-world" clinical studies. They are called "real-world" studies for several reasons. Unlike traditional clinical trials, they offer multiple different treatments and treatment combinations. In addition, they aim to include large numbers of people with mental disorders living in communities throughout the U.S. and receiving treatment across a wide variety of settings. Individuals with more than one mental disorder, as well as those with co-occurring physical illnesses, are encouraged to consider participating in these new studies. The main goal of the real-world studies is to improve treatment strategies and outcomes for all people with these disorders. In addition to measuring improvement in illness symptoms, the studies will evaluate how treatments influence other important, real-world issues such as quality of life, ability to work, and social functioning. They also will assess the cost-effectiveness of different treatments and factors that affect how well people stay on their treatment plans.
The Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) is seeking participants for the largest-ever, "real-world" study of treatments for bipolar disorder. To learn more about STEP-BD or other clinical studies, see Clinical Trials, visit the National Library of Medicine's Clinical Trials Database, or contact NIMH.
FOR MORE INFORMATION
REFERENCES
1. Kessler RC, Chiu WT, Demler O, Walters EE. Prevalence, severity, and comorbidity of twelve-month DSM-IV disorders in the National Comorbidity Survey Replication (NCS-R). Archives of General Psychiatry, 2005 Jun;62(6):617-27.
2. American Psychiatric Association. Diagnostic and Statistical Manual for Mental Disorders, fourth edition (DSM-IV). Washington, DC: American Psychiatric Press, 1994.
3. Hyman SE, Rudorfer MV. Depressive and bipolar mood disorders. In: Dale DC, Federman DD, eds. Scientific American. Medicine. Vol. 3. New York: Healtheon/WebMD Corp., 2000; Sect. 13, Subsect. II, p. 1.
4. Goodwin FK, Jamison KR. Manic-depressive illness. New York: Oxford University Press, 1990.
5. Geller B, Luby J. Child and adolescent bipolar disorder: a review of the past 10 years. Journal of the American Academy of Child and Adolescent Psychiatry, 1997; 36(9): 1168-76.
6. NIMH Genetics Workgroup. Genetics and mental disorders. NIH Publication No. 98-4268. Rockville, MD: National Institute of Mental Health, 1998.
7. Hyman SE. Introduction to the complex genetics of mental disorders. Biological Psychiatry, 1999; 45(5): 518-21.
8. Soares JC, Mann JJ. The anatomy of mood disorders - review of structural neuroimaging studies. Biological Psychiatry, 1997; 41(1): 86-106.
9. Soares JC, Mann JJ. The functional neuroanatomy of mood disorders. Journal of Psychiatric Research, 1997; 31(4): 393-432.
10. Sachs GS, Printz DJ, Kahn DA, Carpenter D, Docherty JP. Medication treatment of bipolar disorder 2000. Postgraduate Medicine, 2000; Spec No:1-104.
11. Sachs GS, Thase ME. Bipolar disorder therapeutics: maintenance treatment. Biological Psychiatry, 2000; 48(6): 573-81.
12. Huxley NA, Parikh SV, Baldessarini RJ. Effectiveness of psychosocial treatments in bipolar disorder: state of the evidence. Harvard Review of Psychiatry, 2000; 8(3): 126-40.
13. Vainionpaa LK, Rattya J, Knip M, Tapanainen JS, Pakarinen AJ, Lanning P, Tekay A, Myllyla VV, Isojarvi JI. Valproate-induced hyperandrogenism during pubertal maturation in girls with epilepsy. Annals of Neurology, 1999; 45(4): 444-50.
14. Llewellyn A, Stowe ZN, Strader JR Jr. The use of lithium and management of women with bipolar disorder during pregnancy and lactation. Journal of Clinical Psychiatry, 1998; 59(Suppl 6): 57-64; discussion 65.
15. Thase ME, Sachs GS. Bipolar depression: pharmacotherapy and related therapeutic strategies. Biological Psychiatry, 2000; 48(6): 558-72.
16. Suppes T, Webb A, Paul B, Carmody T, Kraemer H, Rush AJ. Clinical outcome in a randomized 1-year trial of clozapine versus treatment as usual for patients with treatment-resistant illness and a history of mania. American Journal of Psychiatry, 1999; 156(8): 1164-9.
17. Tohen M, Sanger TM, McElroy SL, Tollefson GD, Chengappa KN, Daniel DG, Petty F, Centorrino F, Wang R, Grundy SL, Greaney MG, Jacobs TG, David SR, Toma V. Olanzapine versus placebo in the treatment of acute mania. Olanzapine HGEH Study Group. American Journal of Psychiatry, 1999; 156(5): 702-9.
18. Rothschild AJ, Bates KS, Boehringer KL, Syed A. Olanzapine response in psychotic depression. Journal of Clinical Psychiatry, 1999; 60(2): 116-8.
19. U.S. Department of Health and Human Services. Mental health: a report of the Surgeon General. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, National Institutes of Health, National Institute of Mental Health, 1999.
20. Henney JE. Risk of drug interactions with St. John's wort. From the Food and Drug Administration. Journal of the American Medical Association, 2000; 283(13): 1679.
21. Nierenberg AA, Burt T, Matthews J, Weiss AP. Mania associated with St. John's wort. Biological Psychiatry, 1999; 46(12): 1707-8.
22. Stoll AL, Severus WE, Freeman MP, Rueter S, Zboyan HA, Diamond E, Cress KK, Marangell LB. Omega 3 fatty acids in bipolar disorder: a preliminary double-blind, placebo-controlled trial. Archives of General Psychiatry, 1999; 56(5): 407-12.
23. Strakowski SM, DelBello MP. The co-occurrence of bipolar and substance use disorders. Clinical Psychology Review, 2000; 20(2): 191-206.
24. Mueser KT, Goodman LB, Trumbetta SL, Rosenberg SD, Osher FC, Vidaver R, Auciello P, Foy DW. Trauma and posttraumatic stress disorder in severe mental illness. Journal of Consulting and Clinical Psychology, 1998; 66(3): 493-9.
25. Strakowski SM, Sax KW, McElroy SL, Keck PE Jr, Hawkins JM, West SA. Course of psychiatric and substance abuse syndromes co-occurring with bipolar disorder after a first psychiatric hospitalization. Journal of Clinical Psychiatry, 1998; 59(9): 465-71.
DIETARY & HOLISTIC RECOMMENDATIONS
CONSIDERATIONS
Injections of vitamin B-12 and megadoses of the B vitamins often bring about an improvement. The B vitamins have a lithium-like effect on the brain.
Amino acids, especially taurine and tyrosine, are important in the treatment of this disorder.
The trace minerals lithium carbonate and lithium citrate are known to alter the period of the rhythmic cycling of the brain, and help to even out the moods in persons with manic-depressive disorder. Lithium drugs' most important role is to prevent and decrease the occurrence of manic episodes. It is usually taken by mouth in capsule, tablet, or liquid form. The side effects of lithium drugs can include diarrhea, edema, frequent urination, kidney dysfunction, nausea, slight hand tremors, stomach cramps, thirst, thyroid enlargement, weight gain, and worsening of skin conditions such as acne and psoriasis. Toxic levels of lithium in the blood can cause blurred vision, confusion, muscle twitching, nausea, slurred speech, tremors, and vomiting. Lithium levels can be elevated to dangerous levels by changes in the diet, strenuous exercise, surgery, or illness, especially influenza. If you must take lithium drugs, try to keep your weight at a regular level and avoid crash dieting, as lithium levels are elevated by sudden weight loss. Keep your health care provider informed of any of the above-mentioned circumstances to avoid an imbalance in your dosage. Lithium drugs should not be taken by people with severely impaired kidney function.
Lithium orotate is an organic form of lithium that is sold in health food stores.
Information from: OtisPregnancy.org: Lithium & Pregnancy (October 2007)
This article contains information about the risks that exposure to lithium can have during pregnancy. With each pregnancy, all women have a 3-5 percent chance of having a baby with a birth defect. This information should not take the place of medical care and advice from your health care provider or midwife.
LITHIUM DESCRIPTION & USE
Lithium is a medication used for the long-term treatment of bipolar disorder, which is also called manic-depression. Lithium helps prevent "highs and lows" and therefore, lithium is referred to as a "mood stabilizer." Lithium may also be used to treat other psychiatric and medical conditions. Lithium is sold under many brand name preparations. Some of these include Cibalith-S, Eskalith, Lithane, Lithobid and Lithonate.
STOPPING LITHIUM BEFORE PREGNANCY
Women should not stop taking lithium without first talking to their health care provider. If you are taking lithium and you are trying to become pregnant, discuss your options with your practitioner. Your health care provider may recommend that you continue taking lithium throughout your pregnancy, discontinue it at certain points during pregnancy, or discontinue taking lithium completely during pregnancy. The recommendation will be based on a variety of factors, such as the type and severity of the condition being treated, the likelihood you may relapse without medication, the stage of pregnancy you are in and other risk and benefit considerations. Stopping lithium abruptly has been associated with relapse of symptoms in individuals with bipolar disorder and is not recommended.
If you and your health care provider decide you should stop taking lithium before you become pregnant, it takes about 20 hours for half of the drug to be cleared from your body. Studies have shown that the longer an individual has been on lithium, the longer it may take for the body to clear it completely after it has been discontinued. Generally, the lithium that is taken up by your system is cleared from the body over a 3 to 4 day period.
Studies have not shown that taking lithium makes it more difficult for women to become pregnant. There is no increased risk for miscarriage that has been reported.
PREGNANCY & FATHERS-TO-BE TAKING LITHIUM
One study found that men who were treated with lithium had reduced quality and movement of their sperm. Decreased sex drive was also reported in another study, but this is a common side effect of depression and may not be due to the lithium use. While these effects may make it harder to become pregnant, more studies need to be done in this area before it is known if lithium use in men really decrease fertility. There are no reports in the literature that suggest the use of lithium in men is associated with an increased risk of birth defects.
LITHIUM AND BIRTH DEFECTS
Although not very often, there is an increased chance for heart defects when lithium is used when the heart is forming during the first trimester. One very rare heart defect called Ebstein's anomaly has been seen in addition to other more common types of heart defects. Ebstein's anomaly is the abnormal placement of one of the valves that controls blood flow in the heart. This heart defect can vary from a mild medical problem to a life-threatening problem. Studies have suggested the rate of heart defects with lithium exposure to be in the range of 1-5 percent. This range is similar to the background rate for heart defects in the general population, 0.5-1 percent. No other birth defects have been linked to lithium use in pregnancy.
LITHIUM CONCERNS IN THE SECOND OR THIRD TRIMESTER
There are case reports of lithium use during pregnancy and the development of a goiter (enlarged thyroid gland in the neck) in the mother. If untreated in the mother, this can lead to a goiter in the baby, a serious problem. The mother's thyroid function should be monitored throughout pregnancy, so she can be treated before the baby develops any problems. In addition, there have been individual reports of reversible thyroid and kidney toxicity in the newborn when lithium was used near delivery. with careful treatment, the baby should fully recover in 2-10 days. Because the risk for relapse and postpartum depression is often of great concern, pregnant women who need to take lithium in late pregnancy are not usually weaned off early in the 3rd trimester. Instead, lithium can be stopped 24 to 48 hours prior to a planned delivery or at the start of labor. Once the baby is delivered, lithium can be restarted at the dosage that was used before the pregnancy began. You should be sure your health care provider and your baby's pediatrician are aware of your lithium use, so the baby is monitored after delivery.
MONITORING FETAL HEALTH DURING PREGNANCY
If you were taking lithium during the first 10 weeks of pregnancy, it is recommended that you have a level II ultrasound, around the 18th week of pregnancy, to examine the baby's growth and development. It is also recommended that you have a fetal echocardiogram, a special ultrasound of the baby's heart, at 21-22 weeks of pregnancy. These two tests are only used for screening and do not pick up all problems. However, heart defects are the concern with lithium use during pregnancy, and these tests are very good at finding the heart problems which are of most concern. Based on what is seen, your health care provider may recommend more follow-up testing.
LITHIUM & BREASTFEEDING
Lithium passes into the breast milk and is absorbed by the baby. While the amount of lithium found in a nursing baby's blood is less than what is in the mother's blood, there are some reports of adverse effects on the breastfed baby. If a women takes lithium while breastfeeding, the amount of lithium in her baby's blood can be measured by a health care provider. Be sure to discuss options concerning breastfeeding with your health care provider or midwife.
LITHIUM EXPOSURE & CHILD DEVELOPMENT
Studies on children up to 5 years of age who were exposed to lithium during pregnancy did not find significant physical, mental, or behavioral problems when compared to children who were not exposed to lithium during pregnancy.
For those who cannot tolerate lithium, health care providers may prescribe an anticonvulsant drug such as divalproex (Depakote). An antidepressant, such as Paroxetine (Paxil) or buproprion (Wellbutrin), may be prescribed for depressive episodes. To control acute manic episodes, the antipsychotic medications resperidone (Risperdal) and olanzapine (Zyprexa). Stronger medications such as haloperidol (Haldol) or chlorpromazine (Thorazine) are prescribed in rare situations, but these medications can interfere with normal cognitive functioning and have many side effects.
Electroconvulsive therapy (ECT) is sometimes used as a final choice to treat manic-depressive disorder. It is not recommended, as it is traumatic, highly invasive, and can cause identity confusion and memory loss.
Psychotherapy and self-help support groups are very helpful in the treatment of manic-depressive disorder.
According to an article in The New England Journal of Medicine, individuals with depression and manic-depressive disorder appear to be hypersensitive to the neurotransmitter acetylcholine. Therefore, choline should not be taken in a dose that exceeds the amount in a multiple vitamin.
Manic-depressive disorder may be aggravated by an overgrowth of yeast in the intestinal tract and by nutritional deficiencies. Food allergies, such as an allergy to wheat products, and the consumption of large amount of caffeine and/or refined sugar, can make symptoms worse.
According to Richard S. Wilkinson, M.D., of Yakima, Washington, an expert in environmental medicine, environmental sensitivities or allergies may cause manic-depressive disorder.
Certain systemic disorders can cause depression, including Alzheimer's disease, diabetes mellitus, encephalitis, hyperthyroidism, hypothyroidism, multiple sclerosis, and Parkinson's disease. Any depression diagnosis should be made only after a thorough physical examination to rule out an underlying illness.
RECOMMENDATIONS
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, which should be consumed in moderation only. Eat white fish and turkey twice a week. See the links below for more information on a gluten-restricted diet.
Eat fish that are high in omega-3 fatty acids. Tuna, salmon, mackerel, and herring are good choices. Omega-3 fatty acids may stabilize mood swings and have effects similar to those of the medication lithium.
Consume no sugar or products containing sugar (read food product labels carefully). Also avoid alcohol, dairy products, caffeine, carbonated beverages, and all foods with colorings, flavorings, preservatives, and other additives.
Be aware that food allergies may aggravate mood swings. Use an elimination diet to find which foods may be causing problems, and eliminate them from the diet.
Take high doses of B-complex vitamins, approximately 100 mg of each major B vitamin 3 times daily (amounts of individual vitamins in a complex will vary). The B complex is very important for all mood disorders. Use injections (under a health care provider's supervision) or a sublingual form for best absorption. Persons with manic-depressive disorder do not absorb the B-complex vitamins easily, and often have deficiencies of these vitamins.
Avoid choline and the amino acids ornithine and arginine. These substances may make symptoms worse.
Do not take any drugs except for those prescribed by your health care provider.
Establish and maintain a regular routine for your daily activities. A lack of sleep can trigger a relapse.
As much as possible, avoid situations that cause stress, such as a turbulent relationship or a difficult working environment. Stress is a major contributor to serious problems for people with manic-depressive disorder.
NUTRITIONAL SUPPLEMENTS
Unless otherwise specified, the dosages recommended here are for adults. For a child between the ages of 12 and 17 years, reduce the dose to 3/4 the recommended amount. For a child between the ages of 6 and 12, use 1/2 the recommended dose, and for a child under the age of 6, use 1/4 the recommended amount.
NUTRIENTS Supplement Suggested Dosage Comments Very Important Free-Form Amino Acid Complex As directed on label twice daily, on an empty stomach. To supply protein, needed for normal brain function and to combat depression.
Amino 1000 Complete, NOW Foods, 120 Caps,
Amino 1500, Chewable Blend of 20 Amino Acids, Predigested, NOW Foods, 150 TabsL-Tyrosine 500 mg twice during the day and again at bedtime. Take with water or juice. Do not take with milk. Take with 50 mg vitamin-6 and 100 mg vitamin C for better absorption. Important for treating depression. Stabilizes mood swings. See Amino Acids for more information.
L-Tyrosine, Pharmaceutical Grade, Free Form, NOW Foods, 500 mg, 120 Caps,
L-Tyrosine Powder, Vegetarian, Free Form, NOW Foods, 4 oz.Taurine 500 mg 3 times daily on empty stomach. Take with water or juice. Do not take with milk. Take with 50 mg vitamin-6 and 100 mg vitamin C for better absorption. Deficiency can result in hyperactivity, anxiety, and poor brain function. See Amino Acids for more information.
Taurine, Free Form, NOW Foods, 500 mg, 100 Caps,
Taurine, Double Strength, Free Form Amino Acid, NOW Foods, 1000 mg, 100 Caps,
Taurine Powder, 100% Pure Free Form, NOW Foods, 1000 mg, 8 oz.Vitamin B Complex 100 mg of each major B vitamin 3 times daily (amounts of individual vitamins in a complex will vary) or as directed on label. Injections: 2 cc twice weekly or as prescribed by a health care provider. To supply B vitamins essential for normal brain function and a healthy nervous system. Injections (under a health care provider's supervision) are best and can be combined in a single injection. If injections are not available, use a hypoallergenic formula. A lozenge, sublingual, or spray form is best.
Ultimate B (Vitamin B Complex), Nature's Secret, 60 Tabs,
Vitamin B-100 Complex, w/ Coenzyme B-2, Nature's Way, 631 mg, 100 Caps,
PABA / Para-Aminobenzoic Acid, NOW Foods, 500 mg, 100 CapsPlus
Vitamin B-6 (Pyridoxine)50 mg 3 times daily. Injections: 1/2 cc twice a week or as prescribed by a health care provider. To correct deficiencies and essential for normal brain function and healthy nervous system. B Vitamins must be replenished daily. All injectables can be combined in a single injection.
Vitamin B-6 (Pyridoxine), 100 mg, 100 CapsPlus
Vitamin B-121,000-2,000 mcg daily on an empty stomach. Injections: 1 cc twice weekly, or as prescribed by a health care provider. Important in making myelin, the substance of which the sheaths covering the nerves are made. Injections (under a health care provider's supervision) are best. All injectables can be combined in a single injection. If injections are not available, use a lozenge, sublingual, or spray form.
Vitamin B-12 Complex Liquid, NOW Foods, 2 fl. oz.,
Vitamin B-12, Nature's Way, 2000 mcg, 100 Sublingual Lozenges,
Vitamin B-12 Liquid Supplement, 50 mcg, With Vitamin B-9 (Folic Acid), 400 mcg, 1 oz.
Vitamin B-12, California Natural, 1000 mcg, 60 Tabs,
Vitamin B-12 LipoSpray, NOW Foods, 2 fl. oz.,Plus
Raw Liver ExtractAs directed on label. A good source of B vitamins and iron. Consider injections (under a health care provider's supervision). All injections can be combined in a single injection. Liquid Liver Extract
(Enzymatic Therapy)As directed on label. Helps to prevent anemia and supplies necessary B vitamins in natural form. Zinc 50 mg daily. Do not exceed a total of 100 mg daily from all supplements. Protects the brain cells. Use zinc gluconate lozenges or OptiZinc for best absorption.
Zinc Ionic Mineral Supplement, Fully Absorbable, 100 +/- ppm, 16 fl. oz.,
Colloidal Silver & Zinc Lozenges, Silva Solution, 90 Lozenges,
Zinc Lozenges W/ Echinacea & Vitamin C, Nature's Way, 23 mg, 60 Lozenges,
Zinc (Chelated), 100% Natural, Nature's Way, 30 mg, 100 CapsCopper 3 mg daily. Needed to balance with zinc.
Copper Ionic Mineral Supplement, Fully Absorbable, 50 +/- ppm, 16 fl. oz.,Important Lithium As prescribed by a health care provider. A trace mineral that alters the manic-depressive cycles, producing greater mood stability. Available by prescription only.
Lithium Supplement as a Trace Mineral,Helpful Essential Fatty Acids As directed on label. Important for improved cerebral circulation and blood pressure stability.
Ultimate Oil, Essential Fatty Acids Supplement, Nature's Secret, 90 SoftGels,
Essential Fatty Acids For Baby & Children, Organic, 8 fl oz.,5-Hydroxytryptophan (5-HTP) As directed on label. Increases the body's production of serotonin. Note: Do not use this supplement with other antidepressants.
Natural Mood Stabilizer, 5-HTP Optimum Mood Support, 50 mg, 60 Caps,
5-HTP Hydroxy Tryptophan, Vegetarian, NOW Foods, 100 mg, 120 VCaps,
5-HTP Hydroxy Tryptophan Supplement, Natural Serotonin With Vitamin B-6 & C, Nature's Way, 50 mg, 60 TabsMulti-Vitamin & Mineral Complex As directed on label. Mineral imbalances may cause depression. Use a high potency formula.
Super Multi-Vitamin & Multi-Mineral, Pure Vital Earth, 32 fl. oz. (98% Bio-Available for Absorption),
Damage Control Master Formula, High Potency, Multi-Vitamin & Mineral, 60 Packets (30 Day Supply)
Calcium
And
MagnesiumCalcium: 1,500 mg daily.
Magnesium: 750 mg daily.Has a calming effect. Enhances sleep if taken at bedtime.
Calcium Ionic Mineral Supplement, Fully Absorbable, 700 +/- ppm, 16 fl. oz.,
Magnesium Ionic Mineral Supplement, Fully Absorbable, 350 +/- ppm, 16 fl. oz.,
Liquid Calcium W/ConcenTrace, Orange Vanilla, Trace Minerals, 1000 mg, 32 fl. oz.,
Cal-Mag Pre-Chelated Calcium & Magnesium, Vital Earth, 240 Gelcaps,
Magnesium Ionic Mineral Supplement, Fully Absorbable, 350 +/- ppm, 16 fl. oz.,
Just An Ounce Calcium & Magnesium Liquid, Almond Flavor, 16 fl. oz.,
Calcium & Magnesium Mineral Complex, 100% Natural, Nature's Way, 500 mg / 250 mg, 250 CapsNicotinamide Adenine Dinucleotide (NADH) As directed on label. Enhances production of dopamine and serotonin.
ENADAlert ENADA NADH Supplement, Source Naturals, 5 mg, 30 Tabs,
NAD (Niacin), NOW Foods, 25 mg, 60 Lozenges,Vitamin C With Bioflavonoids 3,000-6,000 mg daily. To aid in brain function and to protect the immune and nervous systems.
Vitamin C Liquid w/ Rose Hips & Bioflavonoids, Kosher, Natural Citrus Flavor, Dynamic Health, 1000 mg, 16 fl. oz.,
The Right C, Vitamin C Powder, Nature's Way, 120 grams,
Ester C With Bioflavonoids, Nature's Way, 1000 mg, 90 Tabs,
Vitamin C 1000 With Bioflavonoids, Nature's Way, 100% Natural, 1000 mg, 250 VCaps,
The Right C, Nature's Way, 1000 mg, 120 Tabs
MANIC-DEPRESSIVE / BIPOLAR MOOD DISORDER SUPPLEMENTS
Information, supplements and products for bipolar disorder and manic depressive disorder, medical conditions that cause extreme mood swings that range from depression to mania.
Amino 1000 Complete, NOW Foods, 120 Caps.
Amino 1000 Complete contains a balanced blend of 20 essential and non-essential amino acids.Anti-Anxiety Herbal Formula, 100% Natural, 2 fl. oz.
Use this anti-anxiety herbal formula daily to reduce the occurrence of anxiety attacks.Ashwagandha Root (Withania Somnifera) Powder, 4 oz. Bulk
Ashwagandha Root (Withania somnifera) is also known as Indian ginseng. Ashwagandha is useful for coughs, infertility, impotence and more.Ashwagandha Root (Withania Somnifera) Tincture, 100% Organic, 2 fl. oz.
Ashwagandha Root (Withania somnifera) is said to improve physical energy, strengthen immunity and increase sexual activity.Avea Mood Liquid Extract, 30 ml.
Via the proprietary extraction and enhancement process utilized to produce Avea, the product has been enhanced to address the majority of the causes of endogenous depression.Blue Scullcap (Scutellaria Lateriflora), Standardized, Nature's Way, 100 mg, 60 VCaps
Scullcap is most commonly used as a sedative and it can take the edge off anxiety and promote sleep for those who struggle with insomnia.Chromium Ionic Mineral Supplement, Fully Absorbable, 50 +/- ppm, 16 fl. oz.
WaterOz Ionic Chromium is a pure liquid chromium supplement. Chromium helps the body regulate metabolism, regulate insulin and blood sugar levels, helps the body lose weight by stimulating enzymes that metabolize glucose, burns fat. Chromium deficiencies may contribute to Infertility and decreased sperm count.Emotional Balance Wellness Oil, Nature's Inventory, 2 fl. oz.
Not only does Emotional Balance Wellness Oil smell incredible, it also calms and centers those who use it.5-HTP Supplement, Hydroxy Tryptophan Natural Serotonin With Vitamin B-6 & C, Nature's Way, 50 mg, 60 Tabs
Nature's Way 5-HTP Supplement is available in an easy to swallow enteric coated tablet.GABA (Gamma Aminobutyric Acid) Supplement, NOW Foods, 500 mg, Plus B-6, 2 mg, 100 Caps
GABA is a non-essential amino acid found mainly in the human brain and eyes. It is considered an inhibitory neurotransmitter, which means it regulates brain and nerve cell activity by inhibiting the number of neurons firing in the brain. GABA is referred to as the brain's natural calming agent.GABA Powder (Gamma Aminobutyric Acid), NOW Foods, 100% Pure, Vegetarian, 500 mg, 6 oz.
GABA is a non-essential amino acid found mainly in the human brain and eyes and it is considered an inhibitory neurotransmitter, which means it regulates brain and nerve cell activity by inhibiting the number of neurons firing in the brain - GABA is referred to as the brain's natural calming agent.Irwin Naturals Advanced Ginza Plus, Multi-Adaptogen, 75 Gelcaps
Irwin Naturals Advanced Ginza-Plus is a balanced formula combining five powerful adaptogens, including one of the highest potency ginseng extracts on the market.Just An Ounce Calcium & Magnesium Liquid, Almond Flavor, 16 fl. oz.
Just An Ounce, Calcium and Magnesium Liquid can help with the development of strong bones and teeth, also prevents muscle cramping, risk of colon cancer, maintain regular heart beat, protects against osteoporosis and helps relax the central nervous system.Lemon Balm Tincture, 100% Organic, 2 fl. oz.
Lemon Balm is a sedative that elevates the mood an antidepressant.NerveEase, Balanceuticals, TCM Stress Formula, 100% Natural, 60 Caps
Chinese medicine uses this time-honored formula to strengthen and pacify the nervous system, inhibit spontaneous activities of the brain, enhance memory, eliminate stress, nurture and maintain healthy functions of the heart, supplement the blood and nourish the Yin.Omega 3 Fish Oil Supplement, Mood Aid, EFA Gold, Enteric Coated, Nature's Way, 60 Softgels
Mood Aid Fish Oil Supplement is a highly concentrated source of EPA (Eicosapentaenoic acid) from pure cold water fish oil.St. John's Wort, Perika, 200 mg, 60 Tabs
Nature's Way St. John's Wort is scientifically advanced to maintain a healthy emotional outlook.St. John's Wort Tonic (Formerly Depression Tincture), 2 fl. oz.
St. John's Wort Supplement is found to help alleviate depression and strengthen the nervous system.Super Omega 3-6-9, NOW Foods, 1200 mg, 90 Softgels
Super Omega 3-6-9 Softgels are a blend of Fish, Borage and Organic Flax Seed Oils.The Journal To The Sacred Garden Includes Experiential CD, By Hank Wesselman, Ph.D.
The Journey to the Sacred Garden by Hank Wesselman, Ph.D. is a Guide to Traveling in the Spiritual Realms.Vitamin C 1000 With Bioflavonoids, Nature's Way, 100% Natural, 1000 mg, 250 VCaps
Nature's Way Vitamin C with Bioflavonoids provides antioxidant protection for many of the body's important enzyme systems.
HerbalRemedies: Manic-Depressive / Bipolar Mood Disorder Information
HerbalRemedies: Manic-Depressive / Bipolar Mood Disorder Supplements & Products
HerbalRemedies: Generalized Anxiety Disorder (GAD) Supplements & Products
NOTIFY YOUR MIDWIFE OR HEALTH CARE PROVIDER IF...
You or a family member have any symptoms or an increase of symptoms or other signs of depression, manic depressive disorder / bipolar mood disorder.
You are pregnant or trying to become pregnant and you are taking medications for treatment of bipolar / manic depressive disorder. Some medications are associated with certain types of birth defects and need to be evaluated, adjusted, changed or discontinued during your pregnancy. Pregnant women on medications are usually considered risky and should not consider a home birth delivery unless her midwife and her health care provider are working closely together in the management of her condition during her pregnancy and is given a medical "go ahead" by her prescribing health care provider.
You have any unexpected or unusual symptoms. Medications prescribed for this disorder often have side effects and the medication or dosage may need to be evaluated, changed or adjusted. Some people may have sensitivity, allergies, or other health conditions which would prevent them from using certain drugs or other treatments.
If you are feeling suicidal or know someone who is:
- Call a health care provider, emergency room, or 9-1-1 right away to get immediate help.
- Make sure you, or the suicidal person, are not left alone.
- Make sure that access is prevented to large amounts of medication, weapons, or other items that could be used for self-harm.
For a full list of available products from Mountain Rose Herbs, click on banner below:
HELPFUL PRODUCTS & FURTHER EDUCATION
Prescription for Nutritional Healing: The A-To-Z Guide To Supplements
-- by Phyllis A. Balch, James F. Balch - 2nd Edition
Prescription for Nutritional Healing: The A-To-Z Guide To Supplements
-- by Phyllis A. Balch, James F. Balch - 4th Edition
Prescription for Herbal Healing: The A-To-Z Reference To Common Disorders
-- by Phyllis A. Balch
The Complete Guide to Natural Healing
If you see a suggested Amazon product "not there" as indicated by an orange box with the Amazon logo, this only means the specific product link has been changed by Amazon.com. Use the "click here" icon on the orange box and it will bring you to Amazon.com and you can do a search for a specific product using keywords and a new list of available products and prices will show. Their product and resource links are constantly changing and being upgraded. Many times there are more than one link to a specific product. Prices will vary between product distributors so it pays to shop around and do price comparisons.
Educational materials and health products are available through Amazon.com. Use the search box provided below to search for a particular item.
HERBS, OILS, & SUPPLIES
Mountain Rose Bulk Herbs
Mountain Rose Aromatherapy Oils
Click Here To Visit Herbal Remedies Product Page
A Source For Medicinal & Ritual Herbs & Supplies
Aphrodisiacs Aromatherapy Bath & Body Care Bulk Herbs By The Pound Capsules, Tablets & Extracts Chinese Herbals Electronics Extracts First Aid Products Food Products, Mixes, Seeds, Snacks & More! Hair Care Products & Supplies Herbs & Oils, Kilo & Ton Hydroponics & Gardening Kava Products Kitchen & Housewares Mushrooms Musical Instruments Oral Care & Dental Products PC & IT - Computer Supplies & Assessories Skin Care, Cosmetics, & Gift Sets Smokes, Seeds, Cacti Spices, Salts, Sweeteners, & Seasonings Sports, Toys & Games Sweets, Candy, Chips & Snacks Stimulants Sedatives Teas & Coffees
Shaman Shop Home Page
