Research has long shown an association between low folate levels and depression, particularly depression that’s more severe and less responsive to medical treatment. (Folate is a water-soluble B vitamin in its natural form. Folic acid is the synthetic version found in supplements.)

Folate is critical in the development of the human nervous system, so pregnant women must take folic acid supplements. People who abuse alcohol, people with certain illnesses, and those who take a number of different medications are at risk for folate deficiencies, which can present with a variety of cognitive, emotional, and behavioral symptoms. Doctors may check folate levels as part of an initial workup of depression.

Many people who experience a serious mood episode with psychosis often have cognitive impairments that continue long after they recover from the mood episode. The actual percentages vary from study to study, but approximately 50% of those with mania and 15% of those with major depression experience mood episodes with psychotic features, so recovery from cognitive impairment is a serious concern for those with bipolar disorder.

A study published in the American Journal of Psychiatry entitled “Two-Year Syndromal and Functional Recovery in 219 Cases of First-Episode Major Affective Disorder With Psychotic Features,” found that while most patients recovered from symptoms soon after hospitalization, only about one third with psychotic affective disorders recovered functionality by 24 months.

Medication is effective in treating acute bipolar mood episodes. Medication and psychoeducation are both effective in reducing recurrences in euthymic periods (when symptoms are not present). Unfortunately, neither treatment option has much effect on restoring cognitive facilities or one’s ability to function as they did prior to the episode. But there may be hope on the horizon.

A contributor to our Bipolar Blog recently shared her story of living with Bipolar II and how a vegan diet along with 5-HTP and exercise helps her maintain mood stability. That got me thinking that it might be interesting and helpful to hear from others about what works (and what hasn’t) for them.

We’re all on a bipolar journey, and everyone travels a different path. Hearing what works and what doesn’t can often keep others off dead-end roads and provide shortcuts to more effective treatments so they feel better sooner.

Please share. What’s your diagnosis? What works for you – medication and non-medication? What hasn’t worked in the past?

Note: This is just for people with bipolar disorder. On Thursday, family and friends of those with bipolar will have their chance to share.

Photo by Martin Cathrae, available under a Creative Commons attribution license.

In a recent study entitled “Postural Control in Bipolar Disorder: Increased Sway Area and Decreased Dynamical Complexity,” Indiana University researchers measured and compared the magnitude of postural sway between study participants with and without bipolar disorder. The study involved 32 participants, 16 of whom carried the bipolar diagnosis. The control group was made up of 16 age-matched non-psychiatric healthy participants. Participants were asked to stand as still as possible on a force platform for 2 minutes under 4 conditions: (1) eyes open-open base (feet apart); (2) eyes closed-open base; (3) eyes open-closed base (feet together); and (4) eyes closed-closed base.

The researchers postulated that because many of the structural, neurochemical, and functional abnormalities identified in the brains of those with bipolar disorder are also implicated in postural control, people with bipolar disorder would have less postural control and hence a greater magnitude of sway than those without a brain disorder. In other words, there’s a connection between motor and mood disorders. The results supported their hypothesis:

By Shamash Alidina, author of Mindfulness For Dummies

Mindfulness is a meditation therapy that uses self-control techniques to overcome negative thoughts and emotions and achieve a calmer, more focused state of mind – a moment-to-moment awareness with qualities of kindness, curiosity, and acceptance.

Mindfulness was originally an ancient eastern approach to wellbeing that has been found, through recent psychological research, to be a powerful way of managing a range of mental health conditions.

The great thing about mindfulness is that it’s not only a technique you practice now or then, but a way of living your whole life, moment by moment. People who practice mindfulness regularly find they are more focused, calm, and better able to cope with the challenges of life.

Observing thoughts instead of reacting to them

In mindfulness, you learn to see thoughts as just thoughts rather than as facts or situations you must react to. Thoughts commonly come and go in the mind, and if you treat all thoughts as true and assign them all the same level of importance, you’re more prone to feel down in the midst of negative or self-judgmental thoughts and highly elated in the midst of positive thoughts. This rollercoaster ride of emotions and energy often seems to trace the same path as bipolar disorder’s ups and downs.

If brain chemistry can affect thoughts and behaviors, can thoughts and behaviors affect brain chemistry and perhaps even rewire the brain?

Yes.

An accumulating body of evidence supports the notion that non-medical interventions – especially mindfulness – can create changes in the body and brain that help reduce distress and improve brain function in a variety of ways.

MindfulnessA mental state of heightened awareness, free of distraction, and more conducive to deliberate thought and action.

I recently read an interesting article by Kristy Foster on the Farm and Dairy website entitled “A healing place: Farming has a hand in recovery for those suffering from mental illness.” The article shines a spotlight on Hopewell Farm in Mesopotamia, Ohio – a unique 300-acre treatment center for adults with “schizophrenia, schizoaffective disorder, bipolar disorder, major depression, and other forms of serious mental illness.”

Hopewell has the capacity to serve 40 adults, each of whom is expected to work on a crew, when well enough to do so. Each work crew serves a specific need in the community: housekeeping, kitchen, maintenance and grounds, farm and garden. In addition to requiring residents to serve on a work crew, Hopewell’s program includes:

Just read an article out of Glasgow, Scotland entitled “Laughter’s the Best Medicine,” about an interesting supplemental treatment for bipolar disorder and other illnesses – comedy courses.

According to the article, a Glasgow-based charity organization won a three-year £62,500 (approximately $100,000) grant from the Esmee Fairbairn Foundation to “provide free comedy courses aimed at improving confidence and self-esteem, as well as reducing the social isolation and depression, that ill health – mental and physical – can cause.”

I’m not sure how effective this would be in treating acute bipolar symptoms, but it certainly sounds like a great way recover from the fallout and remove a major stressor – the social isolation that often rides the tail of a major mood episode.

What I wonder is, would insurance cover this? Maybe I’ll call just to hear them laugh.

Photo by Cristiano Betta, available under a Creative Commons attribution license.

Dialectical Behavioral Therapy (DBT for short) is a specific subtype of Cognitive Behavioral Therapy (CBT for short) originally developed by Dr. Marsha Linehan to treat individuals with borderline personality disorder. The program focuses on learning and practicing emotional and interpersonal skills that are usually not well developed in people suffering with this condition.

DBT’s Five Core Modules/Skills

DBT contains a number of modules for building specific skills both in an individual and group setting. Training targets the development of five core skills:

• Mindfulness
• Distress Tolerance
• Emotion Regulation
• Interpersonal Effectiveness
• Self Management

The Case for Using DBT to Treat Bipolar Disorder

Beyond its role in DBT, mindfulness has gained a great deal of attention recently as a tool for helping in the treatment of a number of psychiatric conditions including depression and ADHD. The strategies of mindfulness are actually ancient techniques, but we are increasingly able to study and prove the brain benefits of these practices.

Robert Asks…

Do you think a combination of different herbs can cure any form of bipolar disorder and if so what are those herbs?

Dr. Fink Answers…

In Chapter 9 of Bipolar Disorder For Dummies, we discuss a host of alternative treatments for bipolar disorder, including ECT (electroconvulsive therapy), light therapy, vitamins & minerals, and herbs, used alone and in conjunction with traditional forms of medicines and therapies. For example, some people claim that St. John’s Wort is useful for treating the depressive pole in bipolar disorder. (Of course, unfortunately, like most other antidepressants, St. John’s Wort also increases the risk of triggering mania, especially in someone who has bipolar disorder.)