Bipolar

Bipolar Disorder, Manic Depressive

The conventional psychiatric drug approach

The most common treatment for bipolar is a combination of psychiatric drugs (called polypharmacy) that may include antipsychotics, lithium, anticonvulsants, antidepressants, and benzodiazepines. One study found that 72% of bipolar patients were taking 2 or more drugs, 55% were on 3 or more, and 36% were on 4 or more. [1] 

 

Bipolar drugs have been well-studied in hundreds of gold standard trials. They have been shown to reduce bipolar symptoms and may be a vital option for those in severe psychiatric crisis. 

 

However, these benefits should be viewed in a broader context that considers the drugs' risks and limitations as well as the many evidence-based nondrug options available. This full view helps individuals and their practitioners make the most informed choices about care. 

In that spirit, the following infographic summarizes statistics on the challenges of bipolar drugs extracted from a number of gold-standard scientific studies

 

Your health, your choice

The risks and limitations of bipolar drugs make their risk/reward profile less favorable than most people think.

 

Doctors and patients alike want the transparent sharing of the pros and cons of drugs so people can make informed trade-off decisions on their care. Too often however, the information flow is inadequate.

Over 60% of people with bipolar feel improperly informed about the drugs they take, especially regarding drug side effects and the impact they can have on their sex lives. [2]

 

But as this information becomes clarified in research and used to inform clinical care, both doctors and patients are becoming more cautious in using bipolar drugs, especially for the developing brain and personhood of children.

 

With no game changing drugs on the horizon, it's fortunate that there are a growing number of evidence-based non-drug options that show promise. Nearly all can be used with drugs, they typically have far fewer and milder side effects than drugs, and their use can often help reduce - and in some cases eliminate - the need for drugs. 

 

This is an important step forward since our mind, body, and emotions require a more holistic, integrated, and complete solution than pills can provide. 

Work with trusted integrative practitioners

Your doctors and practitioners are your trusted guides. Work closely with them as you evaluate and choose your options of care. Many are joining the paradigm shift to Integrative Mental Health, a discipline with a much larger menu of recovery options that spans the best of conventional and non-drug treatments.

 

Leading voices in mainstream psychiatry speak to the benefits of this paradigm shift. Dr. Kenneth Duckworth, Medical Director of the National Alliance on Mental Illness (NAMI), is clear: "... psychiatric medications... are rarely enough to promote recovery alone... Use of non-medication strategies is crucial for most clinical situations." [3] 

Unfortunately, your current doctors may not offer the full combination of treatments you need. In that case, consider expanding your team with integrative practitioners.

 

Instead of looking only at symptoms and drugs that can reduce them, integrative practitioners often probe to find markers of known causative factors of bipolar distress. This results in personalized treatment customized to your unique bio-individuality and needs. 

Even though Integrative Mental Health shows great promise, non-drug options aren't a panacea. But the expanded menu of options of integrative care offers you many more avenues of recovery and much stronger reasons for hope.

An integrated wellness approach

Thousands of studies show that non-drug approaches help mental health recovery. In fact, there are 27 broad non-drug approaches that have proven effective. Many are useful for bipolar (download free monograph).

There are many non-drug options for bipolar, separated into four categories of care.

The "higher" in this diagram we operate (toward Preventive), the better, since these are the approaches that help us sustain mental wellness. However, once we develop symptoms, it may be helpful to use techniques in multiple categories simultaneously to maximize recovery. 

 

Preventive care

Preventive approaches include a number of common sense practices we can adopt that often have a significant impact on mental health. Often called wellness basics, many of these approaches have been proven very helpful for bipolar including a safe home, proper diet, mindfulness, regulating our "body clock" (with light and darkness), restful sleep, ensuring gut-health, mind-body disciplines (like yoga) and more.

 

Restorative care

Restorative approaches address root-causes and direct influencers of mental health symptoms. They come in two varieties: biomedical and psychosocial. Since our body and mind interact so deeply, it is often helpful to address both simultaneously.

 

Biomedical practitioners help identify your unique bio-individuality through blood/urine and other testing, using detailed biomedical test panels. These tests can uncover nutrient imbalances, hormonal issues, amino acid irregularities, food allergies, pathogens, inflammation, toxicities, or other causative factors. To help you locate integrative biomedical practitioners, review our practitioner finder

 

Biomedical testing is important since over 25% of the time, mental health symptoms are caused by or significantly influenced by physical issues. [4] This figure rises to about 50% for those of lower socioeconomic status.

Walsh-protocol nutrient therapy has been shown in open label trials to be a particularly effective biomedical treatment for bipolar: 75%-80% of people with bipolar who undergo 6 months of nutrient therapy report significant symptom improvement and the ability to reduce medication, while about 5% can eliminate medication altogether. [5] Funding is being sought to build the evidence-base for this approach in randomized controlled trials. 

Nutrient Therapy for Bipolar with Dr. William Walsh, PhD  

Courtesy Walsh Institute.  www.WalshInstitute.org.

Psychosocial practitioners can help identify and address an individual's past trauma, stress, social challenges, emotional difficulties and unhelpful thinking patterns that can cause or influence bipolar symptoms. This is important since assistance is often helpful to work through issues that may be difficult to overcome alone. 

 

Cognitive Behavioral Therapy and Interpersonal & Social Rhythm Therapy have proven to be effective for bipolar symptoms. A variety of trauma-informed therapies are also available, since childhood trauma is much more common in those with bipolar. Directories of therapists, psychologists, peer specialists and other psychosocial practitioners are usually available in your community.

 

Symptom relief care

Symptom relief approaches seek to address residual symptoms not removed by preventive and restorative care. 

 

Prescription lithium (lithium carbonate) is one of the most common symptom relief therapies for bipolar mania. It can reduce bipolar mania symptoms and the likelihood of suicide. But, it is also intolerable to some people and can cause kidney damage with long-term use.  Non-prescription lithium (lithium orotate), although not well-studied, is showing promise at low dosages and appears to avoid the kidney damage of prescription lithium. 

 

There are also a variety of herbs, sensory therapies and very low charge electrical stimulation approaches that have also been shown effective for bipolar symptoms.

 

Over-care avoidance

Over-care avoidance limits the use of medical interventions to only what is necessary. Not only is over-care expensive, it can also be harmful.


Polypharmacy (using more than one psychiatric drug at the same time) is one potential form of over-care. It is associated with increased risk of suicide [6] and worsening outcomes [7] for those with bipolar. It can also lead to a prescribing cascade where new drugs are increasingly added to address side effects created by previous ones.

 

The highest risk form of polypharmacy is using multiple antipsychotics, drugs that are very commonly used in bipolar care. The American Psychiatric Association and American Board of Internal Medicine are actively working to curb this practice.[8] 

 

Over-care avoidance is often achieved by experimenting to find "minimum effective dosages" - the smallest number of drugs used in the smallest amounts for the shortest duration to gain significant symptom relief. This helps minimize drug side effects, risks, and withdrawal difficulties.

 

In addition, some leading psychiatrists are developing de-prescribing plans to help clients reduce and sometimes eliminate psychiatric drugs as they gain sustainable benefit from non-drug options.[9]  

Resources

Footnote references are removed in the mobile version of this page to respect small screen sizes. They can be found in the desktop version.

 

Please see disclaimer.

Bipolar Drug Therapy Infographic References:

Under revision. Coming soon.

References:

[1]  Weinstock LM et al, Medication burden in bipolar disorder: a chart review of patients at psychiatric hospital admission. Psychiatry Res. 2014, PMCID: PMC3968952

[2]  Bowskill R et al,Patients' perceptions of information received about medication prescribed for bipolar disorder: implications for informed choice,  J Affect Disord. 2007, PMID: 17174406https://goo.gl/2gtRT4

[3]  Duckworth K, The Sensible Use of Psychiatric Medications, NAMI Advocate Magazine, Winter 2013,  https://goo.gl/GMIuSU.

[4]  Koranyi EK et al, Physical illnesses underlying psychiatric symptoms, Psycho Psychosom. 1992, PMID: 1488499, http://goo.gl/V9Wi23.; Koran L, MEDICAL EVALUATION FIELD MANUAL, 1991, http://goo.gl/TPNL9t, copied 10/30/2013.; Hall RC, Physical illness manifesting as psychiatric disease. II. Analysis of a state hospital inpatient population, Arch Gen Psychiatry. 1980, PMID: 7416911.

[5]  Walsh W, Nutrient Power Heal Your Biochemistry and Heal your Brain, Skyhorse Publishing, 2014, http://goo.gl/DxoIvQ

[6]  Gazalle FK et al, Polypharmacy and suicide attempts in bipolar disorder, Rev Bras Psiquiat, 2007, PMID: 17435926, https://goo.gl/4nC2S1.

[7]  Kingsbury S, Psychopharmacology: Rational and Irrational Polypharmacy, Psychiatric Services, Aug 2001, PMID: 11474046http://goo.gl/PFE3Rk.; Kingsbury S, Psychiatric Polypharmacy: The Good, the Bad, and the Ugly, Psychiatric Times, 1007, http://goo.gl/KIIsId.; Akici A, Rational pharmacotherapy and pharmacovigilance, Curr Drug Saf. 2007, PMID: 18690951.

[8]  American Psychiatric Association, Five Things Physicians and Patients Should Question, Choosing Wisely, 2015, http://goo.gl/t3blZ8

[9] Gupta S, A Prescription for "Deprescribing" in Psychiatry, Psychiatr Serv. 2016 PMID: 26975524.  Ontario Pharmacy Evidence Network, Deprescribing Guidelines, https://goo.gl/8VpYFx. Grudnikoff E et al, Deprescribing in Child and Adolescent Psychiatry—A Sorely Needed Intervention, Am J Therapeutics, 2017, PMID: 28059976. Gupta, S et al, Deprescribing antipsychotic medications in psychotic disorders: How and why? Betham Science, 2018, https://goo.gl/mR9jJ1. 

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