Serious medical problems frequently accompany bipolar disorder

Many individuals diagnosed with bipolar disorder have serious medical problems including diabetes and cardiovascular disease which significantly increase their risk of dying. In fact cardiovascular disease is the leading cause of death in individuals diagnosed with bipolar disorder resulting in an average life expectancy that is 10 to 25 years shorter than the population at large. Bipolar patients are diagnosed with cardiovascular disease 14 years earlier on average compared to individuals who do not have mood disorders. Furthermore, bipolar individuals with cardiovascular disease have more frequent and more severe mood symptoms compared to medically healthy bipolar individuals. The association between increased risk of cardiovascular disease and bipolar disorder has not been adequately explained and may be due to chronic unhealthy lifestyle choices, the psychological stress of dealing with bipolar mood swings, or genetic and biological factors.

In addition to the above factors adverse effects of medications also significantly increase cardiovascular risk by causing weight gain. It is estimated that approximately two thirds of individuals diagnosed with bipolar disorder are overweight and one third are obese. In general individuals diagnosed with bipolar disorder exercise less and are more sedentary compared to individuals who are not diagnosed with serious psychiatric disorders. High rates of obesity, smoking, drug and alcohol use in bipolar patients lead to high rates of diabetes, hypertension, and heart disease resulting in increased overall mortality compared to the general population.

Available pharmacologic approaches used to treat bipolar disorder are limited because of safety problems and efficacy problems. Several emerging non-pharmacologic treatments are supported by research evidence. To read about safe and effective uses of natural supplements and other complementary and alternative treatments of bipolar disorder read “Bipolar Disorder: The Integrative Mental Health Solution,” by James Lake M.D.

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Many individuals diagnosed with bipolar disorder do not respond to treatment

It is estimated that fewer than one half of individuals who take prescription medications following a first manic episode have good long-term control of their symptoms. To make matters more complicated, as many as 40% of bipolar patients who are taking one or more medications at recommended doses continue to have manic or depressive mood swings. As many as 1 in 4 of individuals who have the more severe form of bipolar disorder (so-called ‘bipolar I’) attempt suicide, and a significant percent eventually succeed. Stressful work, family or relationship situations, changes in the season, not getting enough sleep and the use or abuse of stimulants or recreational drugs significantly increase the risk of a manic episode. Regular exercise, good nutrition, a strong social support network and a predictable, low-stress environment help reduce relapse risk.

In the context of widely shared concerns about the effectiveness of conventional pharmacologic treatments of bipolar disorder emerging research findings suggest that select natural supplements may help alleviate symptoms of bipolar disorder and other mood disorders. To read more about safe and effective uses of natural supplements and other complementary and alternative treatments of bipolar disorder read “Bipolar Disorder: The Integrative Mental Health Solution,” by James Lake M.D.

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Challenges in diagnosing bipolar disorder

Distinguishing between mania and acute agitation caused by another mental health problem or a medical disorder, medication side effects or a substance of abuse can be challenging. A careful history helps to clarify whether a person is experiencing mood changes fluctuating between depression and mania or hypomania. Laboratory tests and functional brain imaging studies are sometimes helpful for determining whether a neurologic or other medical disorder is causing symptoms of depressed mood or mania. Medical problems that sometimes manifest as mania or depression include thyroid disease, strokes (especially in the right frontal area of the brain), multiple sclerosis, and (rarely) seizure disorders. Chronic abuse of stimulants such as methamphetamine (‘speed’) and cocaine, marijuana and other drugs sometimes causes mood swings such as irritability or feelings of intense euphoria alternating with depressed mood.

It is sometimes difficult to diagnose bipolar disorder even after other psychiatric or medical problems have been excluded because of the great variability in symptoms of mania. For example, irritability, agitation and rapid and intense ‘swings’ in emotions often take place in individuals who chronically abuse drugs or alcohol, as well as in individuals who struggle with schizophrenia or severe personality disorders such as borderline personality disorder. The diagnosis of bipolar disorder is made more complicated by the fact that acutely manic individuals often experience auditory hallucinations, delusions, paranoia and grossly confused thinking, making it difficult to distinguish bipolar mania from symptoms of schizophrenia or other psychotic disorders especially when limited information is available about a patient’s history.

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Limitations of conventional psychiatric treatments of anxiety

Conventional treatments anxiety in Western culture include a specialized kind of therapy called cognitive-behavioral therapy (CBT), supportive psychotherapy, and medications. Studies have confirmed that certain medications such as benzodiazepines (e.g. lorazepam, clonazepam and others) and serotonin reuptake inhibitors (SRIs) are effective for the short-term management of both panic attacks and generalized anxiety. Some medications are beneficial for symptoms of social phobia however available medications are not effective against fear of spiders (‘arachnophobia’), fear of heights, fear of flying and other so-called specific phobias. Certain kinds of behavioral therapies including graded exposure and flooding sometimes reduce the severity of social anxiety and performance anxiety. Conventional Western approaches used to treat symptoms of obsessive-compulsive disorder and post-traumatic stress disorder (PTSD) often combine psychotherapy and prescription medications.

A review of the medical research literature confirms that most currently available conventional treatments of anxiety are sometimes beneficial but have limited efficacy overall. A meta-analysis of several high-quality studies concluded that the efficacy of conventional treatments varies widely depending on the core symptom being treated. Panic attacks tend to improve and remain improved in response to sedative-hypnotic medications like lorazepam and clonazepam, but patients who use these and related medications for a period of time to control panic symptoms are at significant risk of benzodiazepine dependence and withdrawal. Furthermore, most individuals who experience generalized anxiety initially respond well to such conventional treatments but continue to have anxiety problems over the long-term. Phobias, obsessions and compulsions, and symptoms of post-traumatic stress are often poorly responsive to conventional pharmacologic treatments. Furthermore, many patients who have these problems are too impaired to seek treatment and often have other mental health problems such as depressed mood, insomnia and are at risk of abusing alcohol or drugs. Finally, anxiety is difficult to treat because of differences in the type and severity of symptoms in different people as well as medical, psychological, social and cultural factors that often cause anxiety or make a pre-existing anxiety problem worse.

In view of the limitations of available conventional treatments of anxiety research finding support the use of a variety of complementary and alternative approaches. To learn about safe and effective complementary and alternative treatments of anxiety read “Anxiety: The Integrative Mental Health Solution,” by James Lake M.D.

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Recent advances in understanding of bipolar disorder

There are probably many causes of bipolar disorder including genetic, neurobiological, and immunologic factors. One recently proposed theory suggests that a problem that takes place at the level of RNA may lead to dysfunction of mitochondria, the ‘power houses’ of cells, resulting in dysregulation of brain energy metabolism and increased free radical damage in the brain which in turn increase the risk of developing bipolar disorder. There is emerging evidence that N-acetyl-cysteine and other supplements address this problem and may prove to be effective non-pharmacologic treatments of bipolar disorder. Acute symptoms of mania may be associated with abnormal immune activation as evidenced by abnormal high levels of several molecules that play a role in inflammation such as TNF-?, and the production of antibodies to certain foods and brain proteins. Advances in understanding of the relationships between immune function and bipolar disorder may lead to a new class of medications preventing and treating bipolar disorder by regulating the immune system.

To read more about safe and effective uses of natural supplements and other complementary and alternative treatments of bipolar disorder read “Bipolar Disorder: The Integrative Mental Health Solution,” by James Lake M.D.

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QiGong and Tai-chi may reduce the severity of generalized anxiety and promote emotional well-being

Qigong and Tai-chi are ancient Chinese practices used for maintaining emotional well-being and promoting mind-body balance. A review of QiGong in mental health care identified five studies on QiGong in the treatment of anxiety but only one small uncontrolled study reported consistent anxiety-reducing benefits of regular QiGong practice. Other small studies suggest that regular QiGong practice results in decreased subjective feelings of anxiety possibly related to changes in central nervous system activity following prolonged practice.

Tai-chi is a highly evolved mind-body practice that is similar to QiGong. Tai-chi probably has beneficial stress-reducing effects that are comparable to meditation or brisk walking. In a pilot study compared Tai-chi to progressive muscle relaxation in combat veterans diagnosed with PTSD individuals in the Tai-chi group reported significantly greater decreases in subjective measures of stress compared to the group performing progressive muscle relaxation. Rare cases of agitation, hysteria and psychosis have been reported following intensive or “unskillful” qigong practice. Individuals diagnosed with schizophrenia or severe personality disorders should practice qigong only under the guidance of a skillful instructor who can advise them about avoiding practices that may worsen their mental health.

You can find out more about the benefits of qigong and tai-chi for generalized anxiety and promoting well-being, and other safe and effective complementary and alternative treatments of anxiety, and learn practical tips for using them in “Anxiety: the Integrative Mental Health Solution,” by James Lake M.D.

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The essential oils of Lavender and Rosemary reduce symptoms of generalized anxiety

Essential oils derived from lavender and other fragrant herbs are widely used to treat anxiety in the form of aromatherapy or massage oil. Limited research findings suggest that certain essential oils, especially lavender, have moderate anti-anxiety effects. Findings from one study suggest that that lavender aromatherapy promotes a relaxed drowsy state, while Rosemary aromatherapy promotes a relaxed alert state. Although other essential oil preparations made from other herbals are sometimes used to treat anxiety, there is not enough evidence to support their use.

You can find out more about the benefits of the essential oils of lavender and rosemary for generalized anxiety and other safe and effective complementary and alternative treatments of anxiety, and learn practical tips for using them in “Anxiety: the Integrative Mental Health Solution,” by James Lake M.D.

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Passion flower extract may reduce the severity of generalized anxiety

Passion flower (Passiflora incarnata) contains an active ingredient called chrysin that has been demonstrated to bind to benzodiazepine receptors in the brain. In one small study, Passion flower extract 45 drops/day and oxazepam (a benzodiazepine) were equally effective in reducing symptoms of generalized anxiety. Importantly, individuals taking oxazepam reported significant impairments in job performance at doses needed to lower anxiety and no one taking the Passion flower extract had problems working. Important benefits of Passion flower extract compared to benzodiazepines include the absence of excessive daytime sedation and no risk of addiction with prolonged use.

You can find out more about the benefits of Passion flower extract for generalized anxiety and other safe and effective complementary and alternative treatments of anxiety, and learn practical tips for using them in “Anxiety: the Integrative Mental Health Solution,” by James Lake M.D.

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Acupuncture and electro-acupuncture are beneficial for generalized anxiety

Acupuncture and acupressure are widely used to treat anxiety. Different acupuncture points are beneficial in generalized anxiety and panic attacks. A review of controlled studies and published case reports on acupuncture as a treatment of anxiety and depressed mood found consistent improvements in anxiety with both regular acupuncture and electro-acupuncture. Positive findings of most studies point to a general anxiety-reducing effect of acupuncture. In one double-blind study 55 adults randomized to receive ear acupuncture at a specific point called the “shenmen” point—(the so-called “relaxation” point)—were significantly less anxious than adults who were treated at a sham acupuncture point. Acupuncture is generally very safe when practiced by a well-trained clinician and infrequently causes bruising, fatigue and nausea.

You can find out more about the benefits of acupuncture and electro-acupuncture for anxiety and other safe and effective complementary and alternative treatments of anxiety, and learn practical tips for using them in “Anxiety: the Integrative Mental Health Solution,” by James Lake M.D.

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Regular massage reduces the severity of chronic generalized anxiety

Massage is widely used to achieve feelings of deep relaxation and reduced anxiety. The subjective physical and psychological benefits of massage are difficult to quantify in controlled trials however anecdotal evidence, a long-standing history of the widespread use of massage for stress reduction suggest that regular massage therapy reduces the severity of chronic moderate anxiety and be especially beneficial when anxiety that is related to test-taking, work stress or the anticipation of invasive medical procedures. In general, regular massage therapy effectively reduces anxiety, improves emotional resilience and enhances feelings of general well-being in anxious individuals.

You can find out more about the benefits of regular massage for anxiety and other safe and effective complementary and alternative treatments of anxiety, and learn practical tips for using them in “Anxiety: the Integrative Mental Health Solution,” by James Lake M.D.

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