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There is a vast amount of data from traditional psychiatry, that opines Bipolar Disorder to be a genetic disorder, but that doesn't explain what causes it. 

The inability to break down Norepinephrine due to a deficiency in an enzyme called COMT is one objective finding I have found useful in explaining to patients why they behave or react certain ways. (And this one is a genetic find) 

Pfeiffer reported that those who have daily or day-to-day mood swings have food allergies or hypoglycemia. In addition, he said they are pyroluric and are easily treated with adequate doses of B6 and Zinc. (do you know about pyroluria?) 

Pfeiffer recommends 

1. Adequate B6 for dream recall (NTE 2gms qd) 
2. Zinc (as gluconate) 30mg am &pm 
3. Manganese (as gluconate) 10mg am &pm 
4. if B6 produces numbness in extremities. Shift to pyridoxal phosphate at 1/10th dose of normal B6 

I found it interesting that I have been trained in traditional psychiatry to medicate manic-depressives. Personally, I find this dreadful, as I think we lose a lot of great minds and creations when we do. Just think of all the historical geniuses who would fit the bipolar mold, and if they were living today, they would be medicated out of creating. (Not to offend anyone, but this would probably also include Jesus Christ, as he would certainly fit the bill for a Bipolar Psychotic, by today's standards, just think about it). And all the actors, and others today who are strange and bizarre, well, some are getting medicated and they aren't doing too much anymore. 

As I just treat kids, I have found that many of them can be controlled with a sugar free diet. It takes a long time (average is about 2 years) for the family to make this adjustment, but it does work. So are they still Bipolar? (I have other opinions about this area as well). 

Furthermore, there is now a Bipolar IV Disorder. That is, a patient who has an adverse reaction to a medication, such as an antidepressant and exhibits signs of mania, therefore, is labeled Bipolar. If this person never had this medication, they would never had this experience, nor would they have the diagnosis. 

Treatments: 

The latest psychiatry journals have finally published info about EFAs (essential fatty acids) and how patients taking those have relieved their symptoms of depression and Bipolar Disorder, and many of these patients have stopped using meds completely. So are these people still Bipolar? 

Phenylalanine (in dosages of up to 4,000 mg per day) alleviates many (approximately 75% of) cases of Manic Depression. 

[Sabelli, H. C., et al. Clinical studies on the phenylethylamine hypothesis of affective disorder: Urine and blood phenylacetic acid and phenylalanine dietary supplements. J Clin Psychiat. 47(2):66-70, 1986. 

To test the hypothesis that 2-phenylethylamine (PEA) modulates affective disorders, plasma levels and urinary excretion of its main metabolite, phenylacetic acid (PAA), were studied in depressed and manic subjects, and the mood-elevating effects of its precursor, L-phenylalanine, were studied in depressed subjects. Mean total plasma PAA concentrations were 491.83 +/- 232.84 ng/ml in 12 healthy volunteers and 300.33 +/- 197.44 ng/ml in 23 drug-free patients with major depression. The 24-hour urinary PAA excretion was also measured in 48 healthy volunteers (141.1 +/- 10.2 mg PAA/24 hr) and in 144 patients with major depression (78.2 +/- 41.0 mg PAA/24 hr). The results suggest that low plasma and urinary PAA may be state markers for depression and are compatible with the PEA hypothesis. In further support, phenylalanine elevated mood in 31 of 40 depressives.] 

Triiodothyronine (25 - 30 micrograms per day) alleviates Manic Depression Arem, R. The Thyroid Solution. Ballantine Books, New York, USA 1999:114-117. 

The author recommends the use of triiodothyronine (25 - 30 micrograms per day) for the treatment of manic depression. It is particularly useful for rapid-cycling manic depression. 

Manic Depression patients are generally found to have low endogenous production of Glutathione. Altschule, M. D., et al. Blood glutathione level in mental disease before and after treatment. Arch Psych. 71:69, 1955. 

The authors observed low blood glutathione levels in manic depression patients. 

Braverman, Eric R. The Healing Nutrients Within. Keats Publishing, New Canaan, Connecticut, USA. 1997:152. 

The author has experienced occasional positive results using supplemental L-cysteine in the treatment of manic depression. The underlying mechanism for the success of L-cysteine in some manic depression patients is believed to be via its role as a precursor for glutathione. 

Folic Acid is the most common deficiency found in Manic Depression patients. .Coppen, A., et al. Folic acid enhances lithium prophylaxis. Journal of Affective Disorders. 10(1):9-13, 1986. 

Supplemental folic acid may positively effect morbidity in some patients placed on lithium prophylaxis. .Hasanah, C. I., et al. Reduced red-cell folate in mania. Journal of  Affective Disorders. 46:95-99, 1997. 

This study found that reduced red-cell folate occurs in both phases of bipolar disorders. 

Lee, S., et al. Folate concentration in Chinese psychiatric outpatients on long-term lithium treatment. Journal of Affective Disorders; 24(4):265-270, 1992. 

Manic Depression patients have impaired metabolism of Inositol and supplemental Inositol may help to overcome this impaired metabolism. Banks, R. E., et al. Incorporation of inositol into the phosphoinositides of lymphoblastoid cell lines established from bipolar manic-depressive patients. Journal of Affective Disorders. 19(1):1-8, 1990. 

Lymphoblastoid cell lines established from patients suffering from bipolar manic-depressive psychosis or from a control group have been used to study the metabolism of the polyphosphoinositides in these cells. Cells were incubated for up to 6 h in [3H]inositol and the extent of inositol incorporation into the mono-, di- and triphosphoinositides was measured after extracting the water- and lipid-soluble inositol-containing pools. Although both the uptake of inositol and the 'free' intracellular inositol pool sizes were similar in the two cell groups, the incorporation of [3H]inositol into the phosphoinositides of the cells derived from bipolar manic-depressives was significantly less (by around 50-60%) than that which occurred in the control cells. 

Vitamin B12 deficiency can cause Mania. Goggans, F. C. A case of mania secondary to vitamin B12 deficiency. American Journal of Psychiatry. 141(2):300-301, 1984. 

A case of mania apparently secondary to vitamin B12 deficiency appeared without other overt clinical features of pernicious anemia and resolved with B12 replacement. Six months later, the patient was receiving monthly B12 injections and his mental status remained normal. 

Human case study demonstrated that mania can occur in conjunction with vitamin B12 deficiency and that vitamin B12 injections reversed this mania. 

Since this study it has been demonstrated that oral vitamin B12 is as effective as injections for restoring vitamin B12 levels in cases of vitamin B12 deficiency. 

Vitamin C (3,000 mg per day) improves the condition of Manic Depression patients. Naylor, G. J., et al. Vanadium: A possible aetiological factor in manic-depressive illness. Psychol Med. 11(2):249-256, 1981. 

Preliminary results of a double-blind, crossover comparison of normal vanadium intake with reduced intake in manic and depressed subjects are reported. Both manic and depressed patients were significantly better on reduced intake. These results are in keeping with the suggestion that vanadium may be an aetiological factor in manic depressive illness. 

Tryptophan alleviates Manic Depression and is beneficial when suicidal tendencies exist in Manic Depression patients: Chouinard, G., et al. Tryptophan in the treatment of depression and mania. Adv. Biol. Psychiat;10:47-66, 1983. 

.Murphy, D. L., et al. Tryptophan in affective disorders: Indoleamine changes and differential clinical effects. Psychopharmacologia. 34:11-20, 1974. 

Tryptophan (9,000 mg per day) potentiates the beneficial effects of Lithium in the treatment of Manic Depression. 

Stoll, A. L., et al Omega 3 fatty acids in bipolar disorder: a preliminary double-blind, placebo-controlled trial. Archives of General Psychiatry; 56(5):407-412, 1999. 

This double-blind, placebo-controlled study involved manic depression patients (aged 18 - 65 years). All patients had experienced at least one manic or hypomanic episode during the preceding year. Patients were permitted to continue using an existing medication (e.g. lithium carbonate or valproate). Subjects were administered either docosahexaenoic acid (DHA, 3,400 mg per day) together with eicosapentaenoic acid (EPA, 6,200 mg per day) (30 patients received this combination) or placebo for four months. Improvement was significantly greater in the DHA + EPA group compared to the placebo group on almost every assessment measure. The significant difference in relapse rate and response was highly clinically significant. After the study had been completed, almost all patients receiving DHA + EPA opted to continue using this therapy as part of their long-term treatment.. Stoll, A. L. Comment. Arch Gen Psychiatry. 56(5):413-416, 1999. 

A comment on the above study: "this study may represent the first demonstration of an effective therapy for bipolar disorder."  Segala, M. (editor). Disease Prevention and Treatment 3rd Edition. Life Extension Media. Florida, USA. 2000:233-234. 

The means via which fish oils benefit manic depression patients may involve 
their ability to increase serotonin levels in the brain. Omega-3 fish oil for mood swings. Life Enhancement. July 1999. 

Fish oil supplement reduces bipolar symptoms and improves outcomes in pilot 
study. Reuters Healthwire service. 7 May 1999. 

Human double-blind trial has found that 6,200 mg EPA + 3,400 mg DHA (used in 
conjunction with normal manic depression medication) improved almost all symptoms of manic depression and reduced the relapse rate. Fish oil is high in both EPA and DHA and could therefore be expected to produce similar results.

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