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Augmenting Treatment for Bipolar Disorder with Supplements (Including Fish Oil)

In addition to medication and talk therapy for treating bipolar disorder it is worth considering augmenting your treatment with nutritional supplements. Many supplements are unproven and potentially harmful in treating bipolar disorder, so it is worth researching the actual scientific studies to determine which ones provide benefit. The only supplements mentioned in this article are harmless at the levels recommended in this article. Nevertheless, any supplements that you choose to make part of your regimen should be discussed with your psychiatrist and noted in your medication list at your physician’s office (primary care provider).

I’m serious. Treat supplements taken at higher than normal doses as medications. They may have interactions with the meds you already take. Your doctor(s) need to know about them.

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Fish Oil

The focus of this article is fish oil. Fish oil has the greatest number of scientific studies showing a proven benefit for bipolar disorder (and depression). It appears to have the benefits of decreasing depressive symptoms, preventing psychosis (manic symptoms), as well as preventing relapse. These benefits have been shown in a large number of studies, many of which are noted in the table in this article on PsychEducation.org:

http://www.psycheducation.org/depression/meds/Omega-3.htm

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The highlights of those studies are that 1-2 grams of EPA are shown to have an effect on Bipolar Disorder in 3 out of 4 studies. In one study, in 2005, a very impressive 8 out of 10 patients responded.

Patients with Major Depressive Disorder improved in 7 out of 9 studies. In one of those studies, 62% of depressed patients improved versus 27% on placebo, a very significant response rate.

EPA has also been shown to prevent psychosis among patients with Schizophrenia. 2 out of 41 developed psychosis on 1.2 grams of fish oil versus 11 of 40 in the control group in one study. The implications of this for schizophrenia and manic psychosis require further research.

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Fish oil contains both EPA and DHA, as well as other Omega-3s. EPA is the most studied for bipolar disorder and depression. A dose of typically 1-2 grams and up to 6 grams of EPA has been shown to have proven benefit for bipolar disorder and major depressive disorder.

Up to 2 grams of DHA has also been studied for depression, although no studies for bipolar disorder seem to be available. Regardless, it does not seem to hurt. Its presence does not interfere with the benefits of EPA, and it may have some benefit of its own.

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Recommended Best Value Fish Oil:

Amazon: Carlson Labs Fish Oil (says 200 ml but choose 16.9 oz size for best value)

Carlson Labs Fish Oil Nutrition Facts

Take 3 teaspoons a day to equal 2400 mg EPA. This gives you a little over 30 days in the 16.9 oz (500 ml) size. The number of servings in the nutrition facts is for the 200 ml size, not the 16.9 oz (500 ml) size.

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Folic Acid

Folic acid is another important supplement to complement medication and therapy in treating bipolar disorder. While it is possible to receive the Recommended Daily Intake (RDI) of 400 mcg of folic acid in your diet by eating leafy green vegetables and cereals, some people still suffer from a deficiency and there may be some benefit in receiving more than that for those with a mental disorder. Amounts that have been studied range from 800 mcg to 2500 mcg (2.5 mg).

Folic acid alternatively may be obtained through a proper diet, but perhaps not at the most beneficial levels unless you double up your cereal intake to get more than 100%.

Recommended dosage for bipolar disorder and major depressive disorder to start is 800 mcg.

More information is available on BipolarLives.com:

http://www.bipolar-lives.com/benefits-of-folic-acid.html

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Recommended Folic Acid Supplement:

Amazon: Carlson Labs Folic Acid, 800 mcg, 300-Tablet Bottle

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Supplements Worthy of Consideration

Additional supplements that may show statistically significant improvement for patients with bipolar disorder (generally at higher than normal doses) include inositol, vitamins B1, B2, B6, B9 (folic acid, mentioned previously) and B12, vitamin C, magnesium, SAM-e, and tryptophan.

These deficiencies are discussed on McManWeb.com at:

http://mcmanweb.com/nutritional.html

Amino acid deficiencies may also play a role, but because of the potential harm of taking too much of any of them, you should discuss which ones to take with your doctor.

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There are many supplements which have no proven efficacy in treating bipolar disorder and many of them are harmful to individuals with this disorder. It is worth looking at the published studies and deciding for yourself which ones are worth taking. And of course, discuss these with your doctor before starting your regimen.

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This article may be updated as I research these supplements further and find more studies. Additional supplements may be added if they are found to be safe and beneficial. I will note the updates here.

My wonderful collection of pills

My wonderful collection of pills

About my manic driving

I’ve already posted my introduction speech, so here’s my object speech too:

The bright sunlight reflecting off the snow on the ground and in the air is almost blinding. The air is thin and snow is thick on the roads, the result of an incoming blizzard in the early morning. Out of the crest of the mountain comes a speeding green object, hugging the road and straddling the center line. The car is the solitary moving object on the road, on a day where the rest of the commuters decided to stay home.

The car is my Volkswagen Jetta—lowered with a tight suspension, custom rims and tires that are rated for up to 90 mph in the snow. The car roars past the trees and over the mountains of Vermont, deftly maneuvering the bends and turns of the winding Green Mountain roads as if the snow didn’t exist. The Goodyear Ultra Grip Ice tires rapidly pushing the snow out the sides with a modern compound rubber sticking almost an inch out of each tire’s radius, providing the same ice-gripping power of a stud-less tire with the handling characteristics of a performance tire. The results are astounding. The car roars along at 85 miles per hour on the centerline of 3 inches of unplowed, untracked highway—alone!

The car is perfect for the conditions, as it was intended to be. A Jetta is a European-style car, designed for winding roads and small parking spaces. It is fuel-efficient but fun to drive, on the heavier side of compact cars, a great balance for handling. The steering is tight, the stick-shift is tight, and the custom springs and struts are tight. Everything about it screams “Drive me, fast!” Redlining at 6000 revolutions per minute with a peak torque of 5500 rpm, the engine is meant to be pushed through the full range of the tachometer, and to be kept in the high rpm range for the best acceleration. Meanwhile, with a peak horsepower at 3000 rpm, it is a fuel efficient car at highway speeds, maintaining roughly 30 miles per gallon at 70-80 miles per hour.

With an $8000 price tag and $2000 in custom modifications, it was my first real investment after graduating high school and starting a career in information technology. The monthly cost being rather exorbitant at $200 for loan payments and another $200 for full-coverage insurance, the car was a big part of my paycheck, and a big part of my life. Driving was, simply, extremely fun. It was also costly. You can imagine that driving to work at almost 90 miles per hour every day earns more than a few speeding tickets over time.

But there’s something to be said for driving between 50 to 70 miles per hour on dirt roads—it provides a vivid example of “leaving in the dust.”

I sound cocky, but whatever.

My self-introduction speech about music

I wrote a speech about music to introduce myself for my public speaking class. Here it is reproduced for you, my faithful readers:

Music has played a strong role in my life since my childhood. Both my father and my mother have encouraged my family to have an appreciation of music.

Early in my life, my dad played his 8-track tapes on his hi-fi and vinyl records. He played everything from Led Zeppelin to the Monkeys, including The Rolling Stones, The Beatles, Jefferson Airplane, and everything in between. Later, my mother got involved with music, becoming a singer/songwriter, playing guitar, and encouraging my brother and I to take up music ourselves. Our family reunions are a chance for a very musical family to get together in somewhat of a music festival.

My brother and I liked a lot of the same music throughout our teens, eventually settling on punk rock as my brother learned to play guitar and started his own band in high school. He would practice the same songs for months while my girlfriend and I would hang out with the band, whose members were all best friends at the time. They played concerts locally, often followed by a big party afterwards. We had great times together.

Beginning in that same time period, I started going to shows from big names in music. I made 311 concerts and Warped Tour annual events. I also got to see as diverse bands as Eminem and Sick of It All. I will never forget the time I saw Phish’s last show in Coventry, Vermont, getting within 3 miles of the show rather than 20, and sneaking in twice. I also won’t forget the NOFX show that the stage collapsed and speakers would have broken my back if 10 or more fans didn’t catch them.

The story doesn’t end there, as I am looking to pursue a career in online media, and may get the chance to put my appreciation of music to use.

You’re going to do what?!? where?!? oh my!!

You’re going to do what?!? where?!? oh my!!

The golden years (episode 1)

There was once a period of time in my life where everything effortlessly just fell into place. It followed a brief period of treatment of depression with Prozac and counseling, which lasted only a matter of weeks. Triggered by a breakup, but likely persisting for years before that, I was finally getting the treatment I thought I needed. It was very low dose Prozac and likely did nothing more than a placebo effect.

I had just graduated high school, with grades my Junior and Senior year that were low enough that I missed a chance to attend my first choice of college. I had no second choice. I decided to start improving my transcript at a community college in my hometown, hoping to eventually transfer to a “real” college (with dorms and such). That goal may not yet have come to fruition, but it still began the best times of my life.

I had only attended a semester of full-time college when I visited a classmate’s home and met the girl who would become the most serious girlfriend I would have for years, almost marrying her at one point. I stopped Prozac. My girlfriend and her 2 sisters and I basically partied all the time, but I kept up with my studies and spent the rest of my time with buddies who were still around after graduating high school. I had a lot of friends.

One buddy whom I did not expect to reappear in my life, and whom I had once played baseball with in 7th grade (I used to make his hand sting everyday playing catch), looked me up in the phone book and offered me a job opportunity. It just fell in my lap. The company he worked for were, at the time, hiring 11 new employees per week, starting from about 300. They were a tech business, providing maps to companies like Google and GPS data for in-car navigation systems. They were very successful, offered great benefits, and paid well for the area.

I excelled. I used to show up for work stoned and draw maps while bobbing my head to my walkman and watching people walk by. Piece of cake. I eventually began performing faster than most of my team. I began helping to train new team members. One day I used my self-taught knowledge of excel to begin tracking how fast work was performed in the team, and eventually to assign chunks of geography to rework.

Designing and administering databases became part of my job description, and eventually I was pulled away from being my team leader’s right-hand man to independent work on an MS Access database to catalog our library of paper maps. I spent the rest of my time at that company performing that type of work, doubling my salary over the course of 4 years and leading to many opportunities.

When the company was doing well, I was given the opportunity to teach mini-courses about building databases in MS Access. I learned MS SQL Server, and upgraded many of my databases to a (true) client-server model capable of being used by the whole company. I was pulled in many different directions, yet was productive and efficient with projects working with employees from all levels of the company.

When we began outsourcing the type of work I had started with at the company, I was glad not to be in risk of losing my job in that primarily entry-level department. Eventually, my bosses gave me a team, and later had me working with engineers from India, explaining how all of my systems tied into other systems within the company, looking to improve efficiency of those systems. In reality, they were looking for every opportunity to transfer even high-level work to India. My job was at stake.

I had bought a VW Jetta and moved out of my dad’s house to an apartment closer to work during my time at the company. My best friend had moved away. I had chosen not my best remaining friend as roommate, but a younger guy who seemed very lively and outgoing, who I thought would fit right in with my fast-paced partying lifestyle.

It was around this time that things started to go downhill. My roommate did not like my partying and set me up to be evicted, so he would not violate his lease and could stay with that landlord, moving into a nearby studio apartment. I moved back into my dad’s house.

This whole event triggered a depression. It became harder to get up and go to work. My job performance suffered. I skipped many days of work when my girlfriend had snow days to stay home with her. I eventually came down with bronchitis and had to take unpaid leave. I was fired for missing too many days of work, though as I said before, they also planned to outsource my job to India. I just gave them a convenient excuse to get rid of me.

All of this led to a period of months where I lived off my 401k savings and laid around in bed a lot. Reasonably depressed. My dad was not working after his divorce from my mother and the death of both of his parents the same year. It had been ongoing for years, but he had the inheritance to support us. But it led to two depressed adults, out of work, having depressing conversations and too much contact, with plenty of fighting.

I would spend a couple years in this state before moving back in with who were, at the time, my ex-girlfriend and her mom. I would not work until that time, when I started delivering newspapers with her mom and step-father. My car fell into disrepair during that time period. I spent a large amount of time on my computer I had bought with my 401k savings when I was fired.

I would never again in my life, as of yet, see a euphoric mania like that lasting for any noticeable period of time. What had been easy is no longer a breeze. I can neither think nor act as quickly or efficiently as I had during that time period.

It wasn’t all perfect though. I had spent thousands and thousands on weed and booze. I drove to work at 80-95 mph every day, risking my life and those around me on a 40 mile commute. I regularly practiced unsafe sex, though it was monogamous. I drank and partied with underage drinkers. I risked getting caught for marijuana and occasionally did get caught, taking diversion instead of it appearing on my record. I had been manic.

I had no idea of the extent of my mania until I received proper treatment for bipolar disorder type II (not depression) 6 years later. Perhaps the mania had been triggered by Prozac. Perhaps, instead, it had been triggered by positive events in my life. Or just my particular physiology led to such an occurrence. It’s pointless to analyze, as it is impossible to recreate the circumstances and trigger another euphoric mania. But quite probably, negative events triggered the following depression.

That depression appears to be what I am still fighting now.

My baby (puppy)!

My baby (puppy)!

My step-nephew enjoyed his first birthday today.
He would have been happy with just this one toy!

My step-nephew enjoyed his first birthday today.

He would have been happy with just this one toy!

This cocktail tastes gross

What meds am I taking now?

  • Lamictal (lamotrigine) - 300mg (200mg morning, 100mg night)
  • mirtazapine (Remeron) - 30mg (30mg, once a day taken at night)
  • Abilify (aripiprazole) - 2mg (2mg, once a day taken in the morning)

What meds have I tried in the past?

  • Prozac (fluoxetine) Sometime in 1998 - Took low dose for 6 weeks then started 4 year euphoric mania. Again in 2003 - High dose caused agitation
  • Effexor XR (venlafaxine) Sometime in 2003 - made me terribly agitated
  • hydroxyzine (Vistaril) March 2009 to October 2009 - dropped in favor of clonazepam due to needing something more effective in treating anxiety
  • Seroquel (quetiapine) March 2009 to October 2009 - stopped due to serious weight gain and cognitive side effects, specifically short term memory loss and difficulty remembering directions
  • clonazepam (Klonopin) September 2009 to December 2009 - stopped due to cognitive and depressive side effects, including sedation, lethargy, and fatigue.
  • valproic acid (Depakene) January 2010 to March 2010 - stopped due to psychotic vivid waking dream states, severe debilitating depression
  • risperidone (Risperdal) - October 2009 to April 2010 - stopped due to increased prolactin levels, possible hormone-related weight gain

More information about all of these medications can be found at CrazyMeds.us.

This blog post will be kept up-to-date with my current meds and history of previously-tried medications.

  • 2009 Dec 28 - increased lamotrigine from 150mg to 200mg
  • 2009 Dec 22 - stopped clonazepam, increased lamotrigine from 100mg to 150mg
  • 2010 Jan 14 - increased lamotrigine from 150mg to 200mg
  • 2010 Jan 28 - added valproic acid (500mg)
  • 2010 Mar 18 - stopped valproic acid
  • 2010 Mar 18 - increased lamotrigine from 200mg to 300mg
  • 2010 Apr 5 - stopped risperidone
  • 2010 Apr 5 - reduced mirtazapine from 45mg to 30mg
  • 2010 May 4 - added Abilify (2mg)
Disclaimer: I am not a mental health expert

This blog is intended to provide insight into my specific flavor of Bipolar II and Generalized Anxiety Disorder. I have no medical training, and the majority of my learning has been for my own benefit, looking at my diagnosed disorders as well as any possible comorbid disorders of which I have not (yet) been diagnosed, or that fit some of my symptoms.

I do not contend to be an expert in the psychiatric field. While I may be able to spread some new information that I have gleaned from straight news sources and studies, included in that mix may be some personal opinion and interpretations of formal psychological diagnoses and concepts. For more consistently reliable information, seek out medical journals, synopses, and read the studies themselves.

While I am neither a medical professional, nor a prolific writer, I am an avid learner. Most of my understanding of my disorder comes not from 15 minute monthly sessions with a Psychiatrist, but from researching my disorder and looking at my own history on my own time. This means that I have much more knowledge about the intricacies of my conditions, but it also means that some of what I state as fact is a best guess limited by my own capacities for retention and understanding of psychiatry.

Those capacities are, in turn, limited by my mental state relating to my disorder. While hypomanic, I am likely to be more thorough in my learning and explanations. While depressed, manic, or mixed state, those facilities may not be there. All of this must be taken into consideration when weighing whether or not to trust the information provided here. Corrections are always welcome, but should not detract from a diary of one man’s interpretation and experience suffering from a serious mental disorder. That is the intent of my tweets and the blog you are reading now.

Where am I on the spectrum?

"Spectrum" is a pleasant word. For many people, the first thing that comes to mind might be a rainbow—a wonderful display of Nature’s beauty that comes when it stops raining and the Sun comes out. What could be better than that?

Well we’re not talking about rainbows here. So what else can we come up with? The spectrum of one’s sexual preference? Again, many find this pleasant—the idea of sexual freedom and liberation. Politics? Freedom to choose your leader is always nice, assuming the system works properly. Religion? Certainly deciding how much of yourself you want to devote to your religion may feel liberating to some.

But not all spectrums are pleasant. Within the mental health community, many psychological disorders (DSM-IV) are now looked at as segments within a spectrum—the broader, abstract set of umbrella terms that help us understand how the disorders relate to each other. Asperger’s, High-Functioning Autism, and Autism are segments of the Autism Spectrum Disorders. Everything from Borderline Personality Disorder to Schizoaffective Disorder to Schizophrenia are parts of the Schizophenia Spectrum Disorders.

Likewise, the Bipolar Spectrum Disorders include a range from either the old classifications of Bipolar I (manic-dominant) to Bipolar II (depressive-dominant) or the new classifications of anything from mania with mild depression to depression with hypomania (see above link for more info).

Cyclothymia, Rapid Cycling, and Ultradian Rapid Cycling (within a single day) may be another axis upon which to place an individual within the spectrum. Typically, episodes are marked with a period of Euthymia (normal mood) in between episodes, but that is not always the case. Some individuals cycle directly from one mood episode to the next, and the longer one goes untreated, the more likely this is to happen, through a process known as “kindling” within the psychiatric community.

In my case, I happen to have strong factors of Depression and Generalized Anxiety (all day), along with a fairly heaping dose of Psychosis. Many of my mood episodes are of the Psychotic Depression, Dysphoric Mania, and Mixed State variety. I also have Rapid Cycling, which I strongly suspect to be Ultradian. This part of the spectrum is a rather gray area, a mix of symptoms from both sides of the spectrum, often during the same episode. This is also a hard set of symptoms to treat, and I’m certainly not holding my breath for a cure.

The current state of psychiatry is such that the best Bipolar individuals can hope for is enough stabilization of their symptoms to function in everyday life—their job, their education, their relationships, and everything else down to basic daily functions required to live independently. Bipolar individuals must take their meds. Furthermore, with the current state of medical science, they must take their meds for the rest of their lives. Counseling alone is not enough, and in fact often barely scratches the surface of the disorder. But don’t get me wrong—counseling is very effective in treating comorbid conditions, such as anxiety.

That happens to be what I’m struggling with now—to find the right balance of mood stablizers and anti-psychotics, combined with counseling for anxiety, irritability, depression, and sometimes even paranoia.

I have a long road ahead, but even receiving the proper diagnosis of Bipolar II puts me way ahead of the curve of most Bipolar individuals. Many go for years with an incorrect Major Depressive Disorder diagnosis or don’t any receive treatment at all. That’s where I was for over 10 years, but I’m further along now. And truly, up until very recently, I have only myself (and later my Psychiatrist) to congratulate for getting this far.

But I’m starting to reach out more and more to find others like me, on Twitter and hopefully soon in real life, to provide some of the extra emotional support I need to truly stabilize. I sincerely appreciate every word of support they have given me.

Hello (cruel) World!

I’ve got this nice blog all setup. Now comes the hard part: writing in it.

I should mention first off that much of the inspiration for my online bipolar existence (as well as much of my knowledge about bipolar medications) comes from crazymeds.us. I have great admiration for the webmaster of the site, Jerod Poore, and his obsessive compulsion for detail, especially considering he, himself, requires the meds he writes about for his epilepsy, bipolar disorder, and attention-deficit disorder. That prolific writing style is not likely to grace the blog you are reading now. But we’ll do the best we can with what we have to work with.

While Jerod seems compelled to write mountains of humorous, well-informed prose for his site, my current addiction is my twitter @benpolar, a barrage of quick status updates limited to 140 characters. You may want to stop over there (or look to the right of this blog) to dip into my stream of consciousness. Many more nuggets of wisdom can be obtained by sifting through my tweets, and you can easily track the progression of my treatment by perusing the tweets in my list of Favorites.

By no means am I the only tweeple on Twitter to tweet about #mentalhealth and #bipolar issues. My lists, @benpolar/bipolar-friends, and @benpolar/mental-health-news may be good starting points for finding more tweeple and mental health organizations to follow. We are gradually building up quite a support group on Twitter. I have to thank my friends for all of their support, especially during times when I have no other form of counseling. It’s been rather incredible.

With that I shall end my introduction. The world may be cruel, but many of the people who inhabit it aren’t—they are amazingly supportive and altruistic friends, and I <3 them.