A recent article in the American Journal of Psychiatry sheds light on the vexing challenge of treating depression in individuals who have an underlying bipolar disorder: For many people with bipolar disorder, depression occurs more frequently and damages function more severely than mania, but treating bipolar depression with antidepressants carries the risk of triggering manic symptoms.
Please check out Suelain Moy’s excellent interview of Dr. Fink, “Treating Bipolar Disorder: A Q & A with Dr. Candida Fink, Part 2.” Dr. Fink’s answers cover medication, therapy, self-help, and the benefits of having a strong support network. After reading the interview, please return here and let us know what you think.
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.
My son was diagnosed with bipolar disorder in the 5th grade. He is now about to turn 21. He cuts and he cannot hold a job or finish a class at the local community college.
His bipolar disorder seems to be more depression-based than manic, or maybe the lithium and Abilify he takes helps the mania but doesn’t treat the depression.
Are there any medications recently developed which can help the depression? I know there is a study underway looking at this problem, but I can’t find out much about it. Sam took the initial test and they said that he qualified, but is no longer interested in participating in the research.
If you’re taking a selective serotonin reuptake inhibitor (an SSRI antidepressant) that doesn’t seem to be working very well and you take nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, to relieve pain, that NSAID may be the reason why your SSRI isn’t working.
Recently Paul Greengard PhD published a report in an online journal that strongly suggests that treatment with NSAIDs may reduce the antidepressant activity of SSRIs. Their research is based on the theory that depression is at least partially related to the body’s inflammatory responses. This is called the cytokine hypothesis and is based on observations that some chemicals released as part of inflammation – cytokines – are involved in regulating neurotransmitters such as serotonin.
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.
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?
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.
One of the problems with using traditional anti-depressants, especially selective serotonin reuptake inhibitors (SSRI’s) to treat bipolar depression is the potential risk of triggering a switch from depression to mania. Another issue is that traditional anti-depressants may not be effective in treating depression in some patients.
SSRI’s work by inhibiting the reabsorption of the neurotransmitter serotonin, effectively increasing the level of serotonin in the synapses of the brain – the space between the brain cells (neurons). This reduces the symptoms of depression and anxiety in many people.
While insufficient serotonin may be one cause of depression, researchers are exploring another possible cause – dysregulation of glutamate. Glutamate is the most abundant excitatory neurotransmitter in the body. Riluzole (Rilutek), a prescription drug commonly used to treat Lou Gehrig’s disease, amyotrophic lateral sclerosis (ALS), reduces the release of glutamate while increasing its uptake. Some studies have shown that Riluzole is effective in treating acute bipolar depression alone or in combination with other anti-depressants.
Rejection sensitivity is a psychological condition that causes a person to feel oversensitive to rejection or perceived rejection in relationships and social interactions. An individual with rejection sensitivity may perceive an unintentional snub or even being made to wait as deliberate rejection and feel severe, painful anxiety and perhaps even anger as a result. Appearance-based rejection sensitivity may contribute to eating disorders (see “Sensitivity to Rejection Can Be Dangerous” on PsychCentral).
What drew my attention recently to rejection sensitivity was an article in this month’s edition of the journal Bipolar Disorder based on a study entitled “Pain during depression and relationship to rejection sensitivity” (Ehnvall A, Mitchell PB, Hadzi-Pavlovic D, Malhi GS, Parker G.). These researchers looked into the relationship between severe, treatment-resistant bipolar depression, pain, and rejection sensitivity.
A recent study published in the Archives of General Psychiatry by researchers at National Institute of Mental Health showed that the medication Ketamine, given intravenously to a small group of people with bipolar depression, caused a rapid antidepressant response in a high percentage of those patients. Their responses were much better than patients given a placebo IV solution.