Successful management of bipolar disorder is largely dependent on having a well-thought-out plan and talking over any changes with your support team first.
Since first being diagnosed with bipolar disorder at age 17, Kristin Finn has gone off her mood-stabilizing medications only twice — during each of her two pregnancies.
Both times, Finn worked carefully with her health care team to develop a plan for managing bipolar disorder without the assistance of medications. The plan included journaling, exercise, stress management, and avoidance and awareness of the things she knew might trigger her depression or mania.
Finn chronicled her journey in the book Bipolar and Pregnant, written because it was so difficult for her to find the information she needed to manage her condition during pregnancy anywhere else. And as a speaker for the Depression and Bipolar Support Alliance, she continues to share her experiences as a woman living with bipolar disorder.
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Bipolar Treatment Plan: Why Compliance Matters
According to Ken Duckworth, M.D., medical director of the National Alliance on Mental Illness (NAMI), Finn’s compliance with her treatment plan year after year is not the norm. A majority of people with the disorder — as many as 64 percent, according to some estimates — don’t stay with their treatment plan throughout their lives, for various reasons.
“For one, nobody wants to take medications for a long period of time,” Dr. Duckworth says. “And people with bipolar disorder can go years between episodes, making taking the medication seem unnecessary.” Other reasons that people report for discontinuing their bipolar treatment plan include missing the “highs” associated with mania, denial that they have the condition, a poor doctor-patient relationship, co-existing personality disorder, drug or alcohol abuse, and medication side effects.
Unfortunately, Duckworth says that he’s seen patients discontinue their treatments without a plan or support and then suffer great personal setbacks when their untreated bipolar disorder reemerges — including job loss, trouble with the law, broken relationships, financial catastrophes, and suicide attempts.
Bipolar Treatment Plan: Plan Carefully for Changes
Duckworth recommends that anyone considering a change to his or her approach to managing bipolar disorder follow Finn’s lead; that is, make any modifications with the knowledge and assistance of their healthcare team, and be sure to have a well-thought-out plan of action.
“Be in a dialogue with your doctor,” he says. “Weigh the pros and cons that all the effects [of changing your treatment] will likely have on your life, and have a plan for managing that.”
According to Finn, there were two keys to her success. The first was writing her plan down on paper before discontinuing her medication. When she struggled with symptoms of her untreated bipolar disorder, like the inability to stop talking incessantly, she could refer back to her written plan and refresh her memory about what steps she had decided to take when they occurred. “I could look back on that, and reel myself in,” she says.
The second key component of Finn’s plan was asking certain people in her life to be on the lookout for signs of a relapse. In fact, Finn actually signed agreements with her support team to resume taking her medication again if they thought she needed it.
“When you’re depressed or hypomanic, you can’t see yourself clearly,” she notes. “You can’t see how you are behaving clearly.”
In short, the best way to managing bipolar disorder over a lifetime is to have a well- thought-out plan for managing bipolar disorder, to communicate it to those around you, to work with your support and health care teams to put it into play, and to be ready to make changes as needed. Duckworth says, “Whether or not taking a mood-stabilizing medication is better or worse than the effects of not taking one is a decision each person with bipolar disorder must decide for themselves. Doctors can’t make people take their meds, we can only try to help them understand the consequences of not taking them.”
Minerals are naturally occurring substances that are basic building blocks for cells and chemical processes in the body. Most of them are needed in relatively small amounts, amounts that are covered through the combination of a reasonably decent diet and a regular multivitamin with minerals.
Supplementing with specific minerals can be helpful for alleviating bipolar symptoms, however. Minerals that are sometimes suggested include:
Teenagers need between 8 to 10 hours of sleep, while adults should get 7 to 9 hours.
Key Takeaways
Sleep is important for your physical and mental health. How many hours of sleep you need depends on your age.
Sleep protects your health and keeps you active and alert. In addition, it revs up your metabolism and regulates your hunger hormones so it helps you maintain a healthy weight.
Sure, you’re eating your vegetables and fruits and squeezing in exercise at least 20 minutes a day, but are you getting enough sleep, too? The latest sleep recommendations from the National Sleep Foundation may make you want to think twice about skimping on essential shut-eye. Sleep is key to your physical health and emotional vitality, but just how many hours of sleep you need depends on your age and stage of development.
“Sleep is important for mental function: alertness, memory consolidation, mood regulation, and physical health,” says Phyllis C. Zee, MD, PhD, professor of neurology and director of the Sleep Disorders Center at the Northwestern University Feinberg School of Medicine in Chicago.
Too few hours of sleep or poor sleep could pave the way to a myriad of emotional and physical problems, from diabetes to obesity, explains Dr. Zee. “In fact, data shows that with sleep loss, there are changes in the way the body handles glucose, which could lead to a state of insulin resistance (pre-diabetes),” says Zee. “There is also evidence that lack of sleep alters appetite regulation, which may lead to overeating or food choices that can also contribute to overweight and obesity.”
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Your Sleep Needs Change Over the Years
How much sleep you need to stay healthy, alert, and active depends on your age and varies from person to person — most adults need at least seven or more hours of sleep each night.
The National Sleep Foundation and a panel of 18 experts combed through more than 300 studies to identify the ideal amount of time a person needs to sleep according to their age:
Newborns (0 to 3 months): 14 to 17 hours of sleep
Infants (4 to 11 months): 12 to 15 hours of sleep
Toddlers (1 to 2 years): 11 to 14 hours of sleep
Preschoolers (3 to 5 years): 10 to 13 hours of sleep
School-aged children (6 to 13 years): 9 to 11 hours of sleep
Teenagers (14 to 17 years): 8 to 10 hours of sleep
Young adults (18 to 25 years): 7 to 9 hours of sleep
Adults (26 to 64 years): 7 to 9 hours of sleep
Older adults (65 years or older): 7 to 8 hours of sleep
Gender Affects Sleep Patterns
Although most men and women need about 7 to 8 hours of sleep per night, their sleep patterns are generally different. Women often sleep more than men and experience a lighter sleep that is more easily disrupted. Many women have undiagnosed sleep disorders.
Problems that can disrupt women’s sleep include depression, major life events (such as divorce), pregnancy, hormonal changes related to menopause, sleep disorders (i.e., obstructive sleep apnea and restless legs syndrome), and medical problems like arthritis, back pain, and fibromyalgia.
Research shows that men often lose sleep over job-related stress. Men also tend to take sleep for granted and stay up longer than they should. Today, helping take care of the kids and keeping up with the household chores only adds to the pressure on men.
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Additional stressors that cause men to lose sleep include life issues (regarding marriage/divorce, children, employment, money), medical problems like epilepsy and heart disease, sleep disorders, substance abuse, and depression.
If you believe you need professional advice about your lack of sleep, a good idea is to maintain a sleep diary for about a week. This will help your doctor get an accurate picture of your sleep history. Your doctor might recommend prescription medication, a device to keep your air passageways open, or a weight-loss plan, based on your individual symptoms and needs.
Last Updated: 2/22/2016
When combined with prescribed medication, these alternative approaches may help you better manage the symptoms of bipolar disorder.
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St. John’s wort, meditation, light therapy, and fish oil supplements may help relieve some bipolar depression symptoms.
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Key Takeaways
Talk to your doctor about any complementary or integrative health therapy you want to try to make sure you’re doing so safely.
Managing bipolar disorder may require multiple strategies, including medication and complementary therapies.
Consider adding approaches with some science behind them, like St. John’s wort, SAMe, or fish oil supplements, or traditional Chinese medicine.
Bipolar disorder requires managing two distinct categories of symptoms. Manic symptoms may include impulsive behavior, excessive irritability, and anxiety, while depressive symptoms may include a low mood, poor appetite, and emotional indifference, according to the National Institute of Mental Health. Though there aren’t many complementary or alternative medicine (CAM) remedies for manic behavior, a few non-prescription therapies may help alleviate depression. Most people who have bipolar disorder spend the majority of their time depressed rather than manic, notes the National Institutes of Health.
But just because CAM therapies exist doesn’t mean that people with bipolar disorder should throw away their antidepressants. “Bipolar is a very serious, lifelong disorder,” says Philip Muskin, MD, professor of psychiatry at Columbia University Medical Center in New York City. “If you need an antidepressant, you should take it. These other types of therapies are additional or complementary rather than alternative.”
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The complementary and non-pharmacological treatments that have shown some benefit for the depressive side of bipolar disorder are:
1. Rhodiola
Officially known as rhodiola rosea, this herb has been used for years to help manage stress and has also demonstrated positive effects on people struggling with depression. While rhodiola doesn’t ease depression to the extent that an antidepressant will, it has fewer side effects, according to a study published in 2015 in Phytomedicine. “Rhodiola is mildly stimulating,” Dr. Muskin notes. “I wouldn’t use it as a solo therapy, but it is a good adjunct for someone who is on antidepressants and feels like they [still] don’t have a lot of energy.”
2. SAMe
SAMe, or S-adenosylmethionine, is a coenzyme found naturally in the body that has been extensively researched and shown to reduce symptoms in people with major depressive disorder, according to a review of research published in 2015 in CNS & Neurological Disorders – Drug Targets. But SAMe should be used with caution in people with bipolar disorder who are suffering from depression because it can actually provoke mania, according to the National Center for Complementary and Integrative Health (NCCIH). It should be used only under the direct supervision of a physician.
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“Anything that is a real antidepressant can cause mania in bipolar people,” Muskin says, “so there is some risk that a patient taking SAMe might become manic.” Several clinical trials are now underway to determine the best way to use SAMe in people with depression-related disorders as well as bipolar disorder.
3. St. John’s Wort
This herb, which is often used in Europe for mood management, is one of the better-known natural mood enhancers. Even so, evidence is mixed on whether St. John’s wort actually has a positive effect on major depression or bipolar disorder. The NCCIH states that St. John’s wort may help with depression but can also cause psychosis, and the agency warns that it could interact with many other medications people with bipolar disorder may be taking. St John’s wort has been shown to have similar side effects to some antidepressant medications because it appears to affect the body in a similar way, according to 2015 research published in the journal Clinical and Experimental Pharmacology and Physiology.
4. Meditation
People who meditate using a supervised mindfulness-based cognitive therapy approach may see a reduction in depression that directly correlates to how many days they meditate. The more they meditated, the fewer symptoms they had, according to a study published in 2013 in Behaviour Research and Therapy.
5. Omega-3 Fatty Acids
People with bipolar disorder may have extra motivation to start eating more fish that are heavy in omega-3s, such as salmon, mackerel, and sardines, or they may want to consider taking omega-3 supplements. That’s because the anti-inflammatory effects of omega-3 fatty acids could help regulate mood, according to research published in 2015 in the Journal of the American College of Nutrition. Adding about 300 milligrams of omega-3s each day to a depression treatment plan can enhance results, according to research published in 2012 in the journal Polish Psychiatry. “If you look at countries where they eat a lot of fish, they have a relatively low incidence of bipolar disorder,” Muskin says. “In the brain, we think omega-3s might help with moving neurotransmitters in and out, which may help stabilize moods.”
6. Light Therapy
People with bipolar disorder may have interrupted circadian rhythms, which means their daily biological clock isn’t working well. A number of strategies may help to reset this internal clock and improve bipolar management, according to a 2012 research review published in Dialogues in Clinical Neuroscience. These include timed exposure to periods of light and darkness and a forced change in sleep times. Be sure to discuss these or other similar strategies with your doctor before you try them on your own.
7. Traditional Chinese Medicine
This approach relies on certain herbal combinations and comprehensive changes in diet and daily habits. There is not enough evidence yet to support or rule out Chinese herbal preparations, concludes a review published in 2013 in Evidence-Based Complementary and Alternative Medicine. But some combinations may benefit mood disorders. Work with a practitioner trained in the field in collaboration with your doctors.
8. Interpersonal and Social Rhythm Therapy
This technique teaches people with bipolar disorder to maintain a more regular schedule in all aspects of life, including sleeping, waking, eating, and exercise. It has been shown to improve daily functioning, according to a study published in 2015 in Bipolar Disorders.
9. Eye Movement Desensitization and Reprocessing Therapy
EMDR uses a supervised program of eye movements, combined with actively remembering traumatic experiences, to improve symptoms. This approach can be helpful to people who have bipolar disorder and a history of trauma, according to research published in 2014 in the journal Psychiatry Research.
Complementary Bipolar Treatments: A Few Words of Caution
“The reality is that there is not a lot of data on complementary therapies for bipolar disorder,” Muskin says. “That doesn’t mean these products shouldn’t be used, but when patients try to find out about them, they shouldn’t expect to be able to go to [websites] like The New England Journal of Medicine and download a lot of articles.”
Muskin recommends ConsumerLab as a reputable site where people can go to research complementary therapies. “You can find out whether or not the product you’re buying really contains the product you think it does, as well as what it’s indicated for and whether it has contaminants,” he says. The National Institutes of Health Office of Dietary Supplements also provides an extensive online database of dietary supplements that includes detailed product and manufacturer information.
Most of these therapies are safe, and there is limited evidence of negative interactions with prescription medications. Regardless, patients and their family members should actively research these products and discuss options with a psychiatrist before taking them, especially because complementary therapies do not undergo the same strict review process as pharmaceutical medications.
Additional Reporting by Madeline Vann, MPH.
Last Updated: 1/15/2016
