Bipolar4LifeSupport

Serotonin precursors are compounds used in the production of serotonin, dopamine, and norepinephrine, brain chemicals responsible for mood. A subset of people with bipolar disorder will respond to serotonin precursor treatment, but this intervention is still considered experimental. Both 5-hydorxytryptophan (5-HTP) and S-adenosyl-L-methionine (SAMe, pronounced “Sammy”) are serotonin precursors that can be used in the treatment of bipolar disorder.

5-HTP is a compound made from the amino acid (protein) tryptophan and is primarily found in the brain. 5-HTP is one of the basic building blocks for serotonin, one of the neurotransmitters (brain chemical) responsible for mood regulation. Individuals who experience depression have reduced levels of serotonin in their brains.

Serotonin itself can be manufactured in the laboratory, but when taken as a supplement, it cannot reach the brain (it does not have the ability to cross from general blood circulation into brain circulation, because of a selective membrane that only allows certain chemicals into the brain). 5-HTP came into use in an effort to find a natural way to increase brain serotonin levels. Multiple research studies have demonstrated 5-HTP’s ability to increase serotonin levels when taken as a supplement.

SAMe is a compound produced by the liver and used throughout the body in a chemical process called methylation. Methylation, essential to many chemical reactions in the body, is one of the last steps in the production of the brain chemicals serotonin, dopamine and norepinephrine (which regulate mood).

Because there are no foods that have high SAMe levels, our bodies must make this substance. Our liver usually creates SAMe from the amino acid (protein) methionine, which is found in many foods. Interestingly, supplementing with methionine does not work as well as supplementing with SAMe, because creating SAMe takes multiple steps and requires many co-factors (other nutrients, such as vitamin B12, folate and others) to ensure that the process is successful.

While the use of SAMe in your body is diverse (it participates in over 35 biochemical processes), the process of interest in bipolar disorder is the creation of the brain chemicals mentioned above (dopamine, serotonin and norepinephrine). SAMe slows the breakdown of these brain chemicals, allowing them to work longer. In addition, SAMe speeds production of the receptors which receive these neurotransmitters. The presence of additional receptors allows the neurotransmitters that are present to work more effectively. Some research suggests that SAMe may also make the existing receptors more responsive (better able to receive messages from neurotransmitters). All of these functions combine to create increased levels of neurotransmitters, which can decrease the symptoms of bipolar disorder.

Both 5-HTP and SAMe have a few research studies to support their use as treatment for bipolar disorder. However, no one should use either supplement without consulting with a health care professional because both of these compounds may induce a manic state. They can also interfere with the functioning of standard antidepressant medications and lithium (commonly used to treat bipolar disorder). Again, the use of these supplements should not be attempted without the support of a qualified health care professional.

Safety and Dosing for 5-HTP

A typical dose of 5-HTP is between 150-300 mg a day. 5-HTP should not be used with any other antidepressant medication due to the risk of a rare condition called serotonin syndrome (or serotonin toxicity) that produces mental confusion, agitation, headache, shivering, sweating, hypertension (high blood pressure), tachycardia (fast heart rate), and other symptoms. As mentioned above, 5-HTP may also interfere with lithium.

Side Effects of 5-HTP

There is a small risk of developing liver toxicity when using 5-HTP. L-tryptophan, a closely related chemical, was pulled from shelves in 1989 when it was associated with liver failure in a few people taking the supplement. While it appears that 5-HTP does not have this problem, it is best to check with your health practitioner before starting any new medication, especially if you currently have (or have a history of) liver problems.

Any substance that increases serotonin carries with it the risk of causing a manic episode. Consult your health care provider before taking 5-HTP.

Safety and Dosing for SAMe

Dosing is typically between 800mg/day and 1600mg/day for SAMe.

Side Effects of SAMe

SAMe is very safe at recommended dosages. Because it is essentially a protein, it has no real side effects other than gastrointestinal upset (see box) and the possibility of causing mania in people with bipolar disorder. Supplementing with SAMe should not be undertaken without the support of your health care provider.

Bipolar disorder (formerly called manic depression) is a mood disorder that causes drastic changes in mood from high manic phases to depressive low phases. The manic phase is characterized by feelings of elated mood and exaggerated self-importance, talkativeness, little need for sleep, increased sociability, racing thoughts, risky or inappropriate behavior, and increased sexual appetite. This period of mania is often followed by a period of depression, with the symptoms mentioned previously (loss of interest or pleasure in previously enjoyable activities; major changes in appetite; sleep problems; fatigue, a feeling of worthlessness or hopelessness; problems with concentration and making decisions; and thoughts of suicide). The change from the manic phase to the depressive phase is called “cycling”. Some people with Bipolar Disorder cycle quickly, while others cycle more slowly. The cycling can be “deep” with very severe manic and very severe depressive phases, or the cycling can be less severe with mild depression and manic phases.

The term “Bipolar Disorder” actually describes four different disorders which range in phase severity and how quickly someone’s mood cycles between phases.

Complementary and Alternative Therapies for Bipolar Disorder

There are no CAM therapies that can take the place of conventional medical therapies for the treatment of bipolar disorder based on current research understandings. Many of the supplements that have been studied for the treatment of bipolar disorder were selected on the basis of how well they treat unipolar or general depression. This is unfortunate, because depression and bipolar disorder are very different diseases which typically require separate interventions.

Even though there are no stand-alone CAM remedies for bipolar disorder, some preliminary studies suggest that many of the supplements suggested below will provide some benefit as adjunctive (complementary) treatments. The most convincing evidence suggests that Omega-3 fatty acids are helpful, but again, this supplement is not recommended as a solo treatment.

The following chart summarizes the common natural treatments for bipolar disorder and the degree of scientific study to support their use:

(A) Well Supported Integrative Therapies for Bipolar Disorder

The only true stand-alone CAM therapy for depression is St. John’s Wort. All other CAM therapies are typically considered adjuncts (additions) to other treatments. The following therapies are currently being studied to determine whether they benefit people with depression. These therapies are generally not harmful, but it unclear whether they are truly helpful. There is some limited research on the effectiveness of these therapies, but study results do not allow us to suggest them as stand-alone treatments for depression.

B-Vitamins

B-vitamins, especially B1 (thiamin), B6 (pyridoxine), B9 (folic acid), and B12 (cobalamin) have all been examined for their contribution to depression. These B-vitamins play many important roles in the body and are necessary to manufacture brain chemicals (GABA, Serotonin, Dopamine, and others) responsible for regulating mood.

Many studies on effectiveness of using B-vitamins for treating depression are promising. However, many more studies must be conducted before concluding that these vitamins are effective in treating all types of depression. Research suggests that the B-vitamins tend to work well for depression related to a deficiency state (such as with alcoholics, or other people with poor nutrition) or for depression associated with premenstrual syndrome.

B-vitamins enhance the effects of many of the standard treatments for depression. Trials of standard antidepressant medications combined with B-vitamins indicated that people recover from depression more rapidly and often with fewer side effects when taking this combination.

The B-vitamins are water-soluble (dissolvable in water) and are easily removed from the body in the urine. They are generally considered safe, with little to no side-effects. However, megadoses (very high doses) of B6 (pyridoxine) have been associated with liver inflammation and nerve damage. It is best to take a multivitamin that contains many B-vitamins (such as a multi-B vitamin combination) or a separate B-complex supplement. Follow the dosing instructions on the vitamin label or consult with your health care practitioner.

Homeopathy

Homeopathy is the use of very small amounts of substances (sometimes an infinitesimal amount of the active ingredient) for the treatment of disease. Homeopathy is based on the principle of analogy; that “like-treats-like”. With this principle in mind, a homeopathic practitioner might give a homeopathic medication that would normally cause a fever to someone who has a fever already. The thought is that the body seeks a “balance” with a disease and if it is pushed further, then the body will push back. If someone who has a fever is “given more fever”, the body will react by reducing the fever.

Homeopathy is very difficult to study due to the varied treatments that practitioners use across different patients. Most homeopathic remedies are individualized to the patient; therefore, 10 patients with depression might get 10 different remedies. While a few studies have shown that homeopathy can be used to treat depression, these studies were not large or well-designed.

The mechanisms by which homeopathy achieves treatment effects is unclear. Many scientists suggest that when homeopathy works, benefits are caused by the so-called placebo effect (patients taking inactive medications show symptom improvement because they think they are receiving active drugs). This has not been established definitively, however. Some clinical trials have shown that homeopathy works better than a placebo (medication without an active ingredient) for treating depression, but other studies have not shown this result. In any event, most homeopathic preparations are so diluted that there is very little chance that an active ingredient (in the conventional sense) is present.

While there are many self-help books on homeopathy, it is best to go to a practitioner and have them personalize a remedy for you. Because homeopathy uses such small amounts of substances, it can be said that homeopathy has no side effects or drug interactions.

Yoga

Similar to exercise, yoga has shown some promise as a treatment for depression. Many yoga practices incorporate deep breathing, stretching, and strengthening exercises along with a mild cardiovascular workout in a class atmosphere.

Yoga is difficult to study in a clinical setting because there are several different factors that can impact its effectiveness. For example, there are many different types of yoga (with varied levels of relaxation or activity), and individual levels of effort during classes may vary. In addition, only certain people are willing to try this form of exercise, so study results may not apply to every group of people who are depressed. There are a few studies that suggest that regular yoga sessions improve depressive symptoms, but their design makes it difficult to draw broad conclusions about the type of person who would benefit most from this therapy.

Yoga can be practiced at home, or you can find a class at a local community/recreation center, gym, or yoga studio. There are forms of yoga that incorporate slow stretching and others that are more active. If you are thinking of trying yoga, visit a class a few times to determine which teacher and style will best meet your needs.

Acupuncture

Acupuncture literally means ‘needle piercing” and is the practice of inserting very fine needles into the skin to stimulate specific anatomic (body) points for therapeutic purposes. In addition to needles, acupuncturists can also use heat, pressure, friction, suction, or electromagnetic energy impulses to stimulate acupuncture points. Treatment is designed to to balance the movement of energy (called qi) in the body to restore health.

Acupuncture has been shown some promise as a treatment for depression. Once again, the varied treatments (how the needles are used) and selection bias (only certain types of people are willing to try acupuncture) affect research trials, making it difficult to determine if acupuncture is helpful for all types of people with with depression. Further study is required.

The specific course and duration of acupuncture treatment depends on the nature and severity of depressive symptoms. A typical course of treatment might involve ten to twelve weekly sessions.

5-hydorxytryptophan (5-HTP) is a compound made from the amino acid (protein) tryptophan and is primarily found in the brain. 5-HTP is one of the basic building blocks for serotonin, a neurotransmitter (brain chemical) thought to be responsible for mood regulation. Individuals who experience depression and anxiety have reduced levels of serotonin in their brains.

Antidepressant medications such as the selective serotonin reuptake inhibitors (SSRI) and monoamine oxidase inhibitors (MAOI) are commonly used to treat depression. These medications work by increasing the total amount of serotonin in the brain or by allowing the serotonin that is already there to work longer.

Serotonin itself can be manufactured in the laboratory, but when taken as a supplement, it cannot reach the brain (it does not have the ability to cross from general blood circulation into brain circulation, because of a selective membrane that only allows certain chemicals into the brain). Multiple research studies support the use of 5-HTP as a natural way to increase brain serotonin levels. Some research has also supported the use of 5-HTP for treating depression, but the studies are based on small groups of people, limiting the conclusions that can be drawn about the potential benefits of 5-HTP for all types of depressed individuals.

Safety and Dosing

A typical dose of 5-HTP is between 150-300 mg a day. 5-HTP must not be used with any other antidepressant medication because of the risk of a rare condition called serotonin syndrome (or serotonin toxicity) that produces mental confusion, agitation, headache, shivering, sweating, hypertension (high blood pressure), tachycardia (fast heart rate), and other symptoms. 5-HTP also may interfere with lithium (a medication typically used for bipolar disorder).

Side Effects of 5-HTP

There is a small risk of developing liver toxicity when using 5-HTP. L-tryptophan, a closely related chemical, was pulled from shelves in 1989 when it was associated with liver failure in a few people taking the supplement. While it appears that 5-HTP does not cause this problem, it is best to check with your health practitioner before starting any new medication, especially if you currently have (or have a history of) liver problems.

WARNING: Any substance that increases serotonin carries with it the risk of causing a manic episode in people with bipolar disorder (manic depression). A manic episode, the high energy component of bipolar disorder, is characterized by a euphoric (joyful, energetic) mood, hyperactivity, a positive and expansive or agitated outlook on life, a hyper-inflated inflated sense of self-esteem, impulsive and risky behavior, and a reduced need for sleep. While the use of 5-HTP hasn’t been linked to manic episodes, caution is still warranted. Consult your health care provider before taking 5-HTP if you have bipolar disorder.

SAMe (pronounced “Sammy”) stands for S-adenosyl-L-methionine. SAMe is a compound produced by the liver and used throughout the body in a chemical process called methylation. Methylation, essential to many chemical reactions in the body, is one of the last steps in the production of the brain chemicals serotonin, dopamine and norepinephrine (which regulate mood).

Because there are no foods that have high SAMe levels, our bodies must make this substance. Our liver usually creates SAMe from the amino acid (protein) methionine, which is found in many foods. Interestingly, supplementing with methionine does not work as well as supplementing with SAMe, because creating SAMe takes multiple steps and requires many co-factors (other nutrients, such as vitamin B12, folate and others) to ensure that the process is successful.

While the use of SAMe in your body is diverse (it participates in over 35 biochemical processes), the process of interest in depression is the creation of the brain chemicals mentioned above (dopamine, serotonin and norepinephrine). People with depression often have low levels of these brain chemicals, and SAMe affects these neurotransmitters in different ways. SAMe slows the breakdown of these brain chemicals, allowing them to work longer. In addition, SAMe speeds production of the receptors which receive these neurotransmitters. The presence of additional receptors allows the neurotransmitters that are present to work more effectively. Some research suggests that SAMe may also make the existing receptors more responsive (better able to receive messages from neurotransmitters). All of these functions combine to create increased levels of neurotransmitters, which decreases depressive symptoms. Research confirms that both depressed and non-depressed people who supplement with SAMe have higher overall levels of serotonin, dopamine, and norepinephrine. In research on treating depression, the positive effects of SAMe have been impressive. These studies, however, have been small, so it is difficult to determine which groups of people will benefit most from this supplement.

It appears that SAMe works well for people with mild depressive symptoms (with no risk for or indication of suicidal behavior), rather than individuals with more severe major depression. SAMe may also benefit people who cannot take standard antidepressant medications due to their side effects. SAMe could also be used in conjunction with other (standard) anti-depressants, but only under the supervision of a qualified practitioner. Scientists need additional research on SAMe to determine its effectiveness, interactions with other medications, and place within the family of depression therapies.

Safety and Dosing

Dosing for SAMe is typically between 800mg/day and 1600mg/day.

SAMe is very safe at recommended dosages. Because it is essentially a protein, it has no real side effects other than gastrointestinal upset (see box) and the possibility of triggering mania in people with bipolar disorder (see box).

Side Effects of SAMe

SAMe increases the risk of developing a rare condition called serotonin syndrome (or serotonin toxicity) that produces mental confusion, agitation, headache, shivering, sweating, hypertension, tachycardia (fast heart rate), and other symptoms. Check with your health care provider before incorporating SAMe into your therapy.

WARNING: SAMe has been suspected to cause manic episodes in people with bipolar disorder (manic depression). A manic episode, the high energy component of bipolar disorder, is characterized by a euphoric (joyful, energetic) mood, hyperactivity, a positive, expansive outlook on life, a hyper-inflated sense of self-esteem, impulsive and risky behavior, and a reduced need for sleep. While the number of these cases is low, it is best to avoid SAMe if you suffer from bipolar disorder, or if you aren’t sure if you have bipolar disorder vs. conventional unipolar depression. If you use SAMe, begin treatment only with the support of a licensed health care professional.