Bipolar4LifeSupport

Recent studies suggest that about half of anxiety and depression sufferers use some kind of integrative therapy for their symptoms.

Part of the reason people might be attracted to integrative carefor depression or anxiety is the holistic perspective found in most integrative approaches. This perspective takes into account the complex nature of depressive disorders and the numerous reasons why people experience them.

Mind Body Practices

There have been more studies in the past several years looking at relaxation training, meditation, hypnosis or imageryin the treatment of depression. These practices have been an important part of traditional healing approaches for millennia (e.g. Ayurvedic, Traditional Chinese Medicine, Tibetan Medicine). In addition, hypnosis is used by conventional psychotherapists, dentists, and other health professionals.

Research on yoga, stress reduction, and relaxation therapy shows positive outcomes for anxiety and depression. There is an especially large body of research showing that the practice of mindfulness can have a profound impact on mood.

Mindfulness meditation has been shown to improve symptoms of anxiety and depression after just 8 weeks. Mindful movement practices, such as yoga, tai chi, and qigong, may also offer relief. Given that it costs little to learn these practices and there is little risk, they are worth pursuing. In addition to evidence of effectiveness, these practices can provide a sense of control over at least one aspect of life.

Nutritional Supplements

The uniqueness of each person’s biochemical processes is only just beginning to be appreciated. The evolving field of Functional Medicine attempts to take into account both the genetic information and the unique differences that occur in each person’s metabolism, including their extra need for certain nutrients. Current recommendations, as follows, come from a generalized understanding of human brain chemistry, without these individual considerations.Note: The best source of nutrients for the body-mind is from nutrition-dense organic foods.

CAUTION: When taking prescription medication for depression or anxiety, basic nutritional supplementation is useful, although some supplements should NOT BE USED while taking some prescription medications. Note individual cautions.

Basic Nutritional Supplementation

The following is often recommended daily for people with mood concerns:

• Multiple Vitamin with B6 and minerals

• Omega-3 fatty acids EPA/DHA totaling 1,000-3000 mg daily

• Vitamin D-3 (Dosage dependent on the vitamin D blood level and season of the year, with higher dosage in the winter months.)

• Probiotics with two or more live cultures

Omega-3 fatty acid deficiency, or an imbalance with omega-6, correlates with an increased rate of both anxiety and depression. Dosage range has not yet been clearly established, but studies have shown improvement in depressive symptoms with as little as 1 gram, or as much as 6 grams a day. (This is the total of the EPA and DHA.) Begin with 1 gram a day of fish oil and increase slowly up to 3000-4000 mg per day. It is wise to work with a health professional in integrative health with higher doses. Flaxseed oil, or ground flaxseed meal, (2 tbsp daily) is a vegetarian alternative.

Other Nutrients

• B-Vitamins are necessary for the production and regulation of neurotransmitters connected to depression. B-vitamin deficiency has been linked with mood disorders, including depression and anxiety. Elderly patients are at particular risk of B12 deficiency; and women on oral contraception or estrogen replacement are at increased risk of B6 deficiency. Thus, although long-term prospective studies have not been completed, it seems beneficial to take Vitamin B complex, with 100 mg each of the major B vitamins.

• Folic Acid is low in one-third of depressed adults. Depression is also the most common symptom of folate deficiency. If there is a deficiency, some depression medications (i.e. SSRIs) are not as effective. Take 0.8-1 mg daily of folic acid.

• S-Adenosylmethionine (SAMe) is a naturally occurring chemical substance intimately involved in the production, regulation, and action of many brain neurotransmitters. While some research has hinted that SAMe may be helpful in the management of depression, the National Center for Complementary and Integrative Health (NCCIH) states that the scientific evidence on SAMe is inconclusive because many of these studies were small and short-term. An initial dose may start at a low dose (200 mg) and gradually increase to 800 to 1,600 mg per day, dividing into two doses. Note that, because of gastrointestinal side effects, it is important to start gradually at a lower dose, and only increase gradually. It is best to use this with the guidance of a professional, especially if combined with an antidepressant. It should not be used in bipolar disorders.

• Magnesium Glycinate (citrate, or oxide), a mineral, is known to be a relaxant and may help reduce muscle tension and anxiety and promote sleep. Data in this area is limited, but many studies have found it to be promising. Dosage range is 200-800 mg per day. The oxide and citrate forms may potentially cause loose stools.

• NAC (N-Acetyl-Cysteine) is a potent antioxidant that acts in the brain and body and may be helpful for anxiety, depression, and addictions. It has a calming effect and may be used with medication. Dosage range is 600-1200 mg twice daily.

• Inositol is considered a B Vitamin, although technically it is not a vitamin because the body can produce it. When taken as a supplement, it may be helpful in reducing anxiety, panic, and OCD.  The dosage ranges are usually 1500 mg per day, although much higher doses have been used under supervision. It is contraindicated in bipolar disorder.

• GABA is the neurotransmitter most responsible for calming down an overactive brain. When taken as a nutritional supplement it may have a calming effect and help with muscle relaxation, although it is not thought to be absorbed in the brain well. Some people have found taking it at bedtime helps relax the body.  The dosage range is from 100 mg twice a day and up to 750 mg three times a day.

Amino Acids

Caution: 5HTP & L-Tryptophan should not be used with medications unless you are working with a professional, due to the danger of Serotonin Syndrome, which is too much serotonin, a very serious complication.

• 5HTP is extracted from an African plant called Griffonia simplificolia and is converted into serotonin in the brain. (By the way, foods containing tryptophan convert into 5 HTP in the brain and likewise boost serotonin levels.) The increase in serotonin, sometimes called the “feel-good” neurotransmitter, may help calm anxiety and soothe agitation, and help with anxious depression. It may also be helpful for those with sleep disturbances, and some women have found it helpful for PMS. Dosage range is 50-100 mg up to 3 times per day.
• L Tryptophan is an amino acid, a protein building block that can be found in many plant and animal proteins. L-tryptophan is called an “essential” amino acid because the body can’t make it. It must be acquired from food. In the body L-tryptophan has been used as an aid to treat sleep problems (insomnia), anxiety, depression and premenstrual syndrome.
• L-Theonine is an amino acid found in green tea that may provide a useful support for anxiety and depression. It works with several of the neurotransmitters that help increase focus and also have a calming effect. Dosage range is 100-200 mg 2 times per day.
• Taurine is an amino acid that replenishes GABA and neurotransmitters that calm
• the brain. It may help protect the brain from some of the harmful effects of stress and may be helpful for anxiety and mood instability for some people. Dosage range: 500 mg one to three times a day.
• L-Tyrosine and DL-Phenylalanine are amino acids that convert into the more  energizing neurotransmitters, dopamine and norepinephrine. They are found in protein-rich foods, and may be helpful for people who experience a low energy depression. Taken as nutritional supplements, these amino acids may boost mood, motivation and energy. The dosage range is from 500 mg to 1500 mg per day.

Botanical Medicines

• St. John’s Wort is an herb/plant that impacts several neurochemical pathways in the brain and has been shown in numerous studies of mild to moderate depression to be as effective as conventional antidepressants. Begin slowly with 300 mg, 2 or 3 times daily, using a product standardized to a minimum of 2-5 percent hyperforin or 0.3 percent hypericum. There are potential side effects to this botanical, although the side effect rate is lower than that of prescription drugs. There are also potential herb/drug interactions, especially with blood thinners. St. John’s Wort should not be used in combination with SSRIs, and may interfere with oral contraceptives. Do not take for bipolar depression

• Valerian is another botanical that has been used in Europe as a calmative agent and tranquilizer, especially for sleep disturbances. The research in this area is small and inconsistent, so while some studies suggest benefits, there is no conclusive evidence that valerian may help with anxiety or depression. Valerian may be tried clinically, at doses of 150 to 300 mg in the morning and 300 to 600 mg in the evening for at least a six-week trial.

• Rhodiola is an herbal adaptogen that may be helpful for stress, anxiety, or depression. Some have found it to be helpful for Seasonal Affective Disorder (SAD). A typical dose is 200 mg per day.

Essential Oils

Essential oils (aromatherapy) are safe and can be effective for anxiety and depression.  Individual preferences of scent may guide self-care. The essential oils of lavender, chamomile, basil, Frankincense, are generally found to have a calming effect (for those with anxiety), while bergamot and peppermint oil are stimulating and can help those with depression.

Nature-Based Therapies

As the new field of nature-based therapies shows, being in nature can reduce anxiety and depression and increase pleasant feelings. Looking at a scene of natural beauty, people describe their feelings with words like calm, beauty, happiness, hope, and aliveness. Being connected to nature not only makes people feel better emotionally, it reduces blood pressure, heart rate, muscle tension, and the production of stress hormones—all signals of stress and fear.

So when you are fighting anxiety or feeling down, find a park or greenspace and go for a walk or go outside and work in your garden.

Animal-Assisted and Pet Therapies

Pets may play a major role as a therapeutic intervention for people with anxiety and depression. Equine (horse) Assisted therapists have also been very helpful for people with anxiety and depression.

Music Therapy

Music therapy involves actively listening to or performing music to promote health and healing. Experts recommend listening to music regularly, either daily or weekly, to begin to see a reduction in depressive symptoms. More and larger studies are needed before recommendations are clear, but given the low cost and risks, this may be a helpful approach for those individuals who have interest in this area.

Naturopathic Medicine

Naturopathy includes diet, exercise, natural botanicals and supplements, mind/body practice, hydrotherapy, and other tools. For those preferring natural approaches, treatment with a naturopath can be partnered with psychotherapy of some kind.

Traditional Chinese Medicine

Traditional Chinese Medicine practitioners work with an individual to optimize their nutrition, activity, and internal energetic balance, using herbs, acupuncture, movement practices (qi gong and tai chi), massage (Tui Na), and other techniques. Acupuncture for mild to moderate depression has been found to be promising in early studies, although larger reviews have not come to a consensus about whether or not it is effective in relieving anxiety and depression.

Disclaimer: The information in this website page is not to be used in place of medical treatment by a health or mental health provider.
References

Lifestyle changes are simple but powerful tools in treating depression and anxiety, and they are an essential component of an integrated approach to treatment. In some cases, lifestyle changes alone can lift depression or relieve anxiety, so it makes sense to start with them right away. But if you are suffering from moderate to severe depression or anxiety, also seek professional help right away. And if you don’t see relief from symptoms of mild depression in a few months, likewise seek professional help.

Lifestyle changes that can help include the following.

Exercise

Exercise is the most important place to start. Numerous well-designed studies have found exercise to be effective in elevating mood and reducing symptoms of depression. As for anxiety, many research studies have also found an improvement in anxiety symptoms with increased physical activity, especially mindful movement, such as yoga, tai chi, and qigong.

Exercise stimulates the body to produce serotonin and endorphins, which are chemicals in the brain (neurotransmitters) that alleviate depression. But that only partially explains the positive impacts of exercise on depression.

Participating in an exercise program can increase self-esteem, self-confidence, and sense of empowerment, as well as improve social connection and enhance relationships. All of these things have a positive impact on a depressed or anxious individual.

Diet

The brain is one of the most metabolically active parts of the body and needs a steady stream of nutrients to function. A poor diet may not provide the nutrients necessary to produce neurotransmitters and may provoke symptoms of anxiety or depression. The science of Functional Medicine provides specific guidelines on foods for brain health.

In addition to eating a healthy diet that provides adequate nutrients, it is also important to make sure your gut is healthy so you can absorb those nutrients. This means paying attention to the health of your intestinal flora—the bacteria that break down foods. Taking supplemental probiotics with two or more live cultures (for example lactobacillus and bifidobacerium) and eating fermented foods, such as yogurt and miso, help support a healthy digestive system.

Sweetened beverages, such as sweetened tea, soda, and fruit punch may also contribute to depression. A recent study found that people who drink four or more cups or cans of soda every day are 30% more likely to be depressed than people who did not drink soda. The same study reported that those who drank unsweetened coffee each day (either regular or decaf) reported less depression than non-coffee drinkers. Because other studies show that long-term use of caffeine has been linked with anxiety, decaffeinated coffee may be the best choice for some.

Longer term studies in this area are needed, but minimizing refined sugars and caffeine is currently an easy and logical recommendation. If you are a regular caffeine user, cutting back gradually will be best tolerated.

Alcohol

Depressed populations have more problems with alcohol use even though alcohol itself is a depressant. Alcohol use may be a way that individuals ‘self-medicate,’ trying to numb the pain of their depression. People suffering from depression should stop drinking alcohol. If alcohol abuse underlies the depression, it is critical that it be addressed directly.

Sleep

Poor sleep has a strong effect on mood, in part because the neurotransmitters needed to support mood are replenished with sleep. Thus we need restorative sleep to maintain a balanced brain and mental health.

People who don’t get adequate sleep, in length or quality, each night are more likely to develop major depression than those who sleep through the night. In addition, research shows that sleep-deprived people have a much stronger tendency to classify neutral images as “negative,” so that even everyday items can seem more menacing and contribute to anxiety.

Make getting the amount of good quality sleep you need a priority

Thoughts and Emotions

Negative attitudes and feelings of helplessness and hopelessness can upset the body’s hormone balance and deplete the brain chemicals required for feelings of happiness or calm, as well as have a damaging impact on the immune system and other parts of our body.

We tend to believe that our emotions are part of who we are and can’t be changed. Research has shown that this isn’t so: emotions can be changed by altering the situation (leaving a depleting job), shifting our attention (noticing the beauty of the day instead of the traffic), and by re-framing our perspective (“that person is under stress,” rather than “he doesn’t like me”).

How we choose to live our lives impacts the way we feel every day. Certain types of mental training, such as meditation or positive thinking, can affect our perceptions of the world and make us feel calmer, more resilient, and happier. Other researchers have identified many other helpful attitudes—such as forgiveness, gratitude, and kindness—that can be developed with practice.

Stress Reduction

Too much stress exacerbates depression and anxiety. Begin by identifying what creates stress for you (your stressors) and see if you can make changes in your life to reduce these stressors.Learn relaxation techniques to help reduce your reaction to stressors, and cultivate intentional, helpful responses. Cultivate resilience so that you can best handle life stressors that are not avoidable. For relaxation and other mind-body techniques to try, see the section entitled What Integrative Therapies and Healing Practices Might Help for Anxiety and Depression?

Social Support

Strong relationships and social support networks reduce isolation and loneliness, both key risk factors for depression.

Anxiety can also cause us to avoid other people and become isolated. But reaching out to friends and family can help us deal with our anxiety. Our friends can help us make realistic assessments of threat and their support can bolster our confidence in dealing with issues. Pets can also be wonderful for helping us to feel support and companionship.  Physically, having a loved one (two or four-legged) close calms us and reduces the fight or flight response.

So keep in regular contact with friends and family, or consider joining a class or group. Volunteering is a wonderful way to get social support and help others while also helping yourself.

Purpose

Extensive research has found that people with a strong sense of purpose are better able to handle the ups and downs of life. Purpose can offer a psychological buffer against obstacles—thus, a person with a strong sense of purpose remains satisfied with life even while experiencing a difficult day. According to researcher Barbara Fredrickson, this kind of long-term resilience can lead to less worry and greater happiness over time.

Spirituality also helps people meet challenges and continue. Having a strong spiritual outlookmay help you find meaning in life’s difficult circumstances.

Disclaimer: The information in this website page is not to be used in place of medical treatment by a health or mental health provider.
References