Turmeric (curcumin) may be a new, inexpensive depression and anxiety treatment. It’s early days on this one, but it’s worth noting because it is so available and inexpensive. Here is where the research is on turmeric as a treatment for depression and anxiety.
Those of you who follow me know that I’m not a big fan of Truehope/EMPowerplus, in spite of having tried EMPowerplus myself. And one of the things I complained about is the lack of double-blind, controlled studies of the supplement. Well, one scientific study has now been published and I figured I should mention it to be fair. This new study indicates preliminary evidence for Truehope/EMPowerplus (a micronutrient formula) in the treatment of attention-deficit/hyperactivity disorder (ADHD).
It’s been quite a while since I’ve done a Truehope/EMPowerplus update. I had planned on more of them, initially, but when nothing major happened, I didn’t have much to report. I have come to some conclusions about my Truehope/EMPowerplus (what is Truehope/EMPowerplus) experience at five weeks, however, so I’ll share them below.
I was really nervous to have to tell my doctor that I had decided to take the Truehope product EMPowerplus. I was pretty sure he was going to either laugh or chastise me out of his office. My anxiety about it was so bad that I didn’t want to mention it at all. Of course, that would have been a poor decision. Allowing anxiety to override your logic is never the right call.
So I told him and surprisingly, he was nonplussed. He just sort of said, “Alright then.”
- I started on half a dose – that’s two pills in the morning and two in the evening.
- Pretty much as soon as I started taking the EMPowerplus I started feeling giddy. Not quite hypomanic but notably elevated and different, although not better.
- On day five I experienced an official rapid cycle from hypomania one day to serious debilitating depression the next day.
I have been known to lament that there’s nothing new under the sun when it comes to depression treatment, and thus, there is little hope for people with true treatment-resistant depression. (And by treatment-resistant depression I mean people who really have tried everything, and there are few in this category.)
But I forget how far we’ve come and how fast. It isn’t fair to say there aren’t new approaches to treatment-resistant depression because there are new approaches being researched and approved every year. Here are a few noted by Current Psychiatry article Innovative approaches to treatment-resistant depression:
N-acetylcysteine, also known as N-acetyl-L-cysteine or just acetylcysteine is a supplement that shows promise in the treatment of bipolar depression. This is really big news because there are very few drugs, supplements or anything else that show promise in the area of bipolar depression. But N-acetylcysteine (NAC) is even better than most because:
- N-acetylcysteine is an over-the-counter supplement
- N-acetylcysteine is cheap
- N-acetylcysteine has very few known side effects
What is N-Acetylcysteine (NAC)?
Don’t be scared by the fancy name, just think of NAC as a supplement like omega-3 or vitamin D.
N-acetylcysteine is the N-acetyl derivative of the amino acid cysteine, and cysteine is an amino acid required for you to live. Your body uses it in your brain, for digestion and many other things.
And more interesting for people with bipolar disorder, cysteine is a precursor to glutathione, which is a precursor to glutamate – a neurotransmitter in the brain. Like the neurotransmitter serotonin is made more effective by using selective-serotonin reuptake inhibitor (SSRI) antidepressants, glutamate is increased by taking NAC.
The Research on N-Acetylcysteine (NAC) and Bipolar Disorder
I have been watching the research on NAC and bipolar depression for a while and it looks very promising.
Note that NAC is always used as an add-on medication for bipolar depression and is not used alone.
- A recent open-label trial found statistically significant reductions in bipolar depression scores over the course of eight weeks. Improvements in functioning and quality of life were also seen.
- A randomized double-blind placebo-controlled study found significant reductions in bipolar depression scores. Reduction in depression was seen by week eight but further (“medium to high”) benefits were seen by week 20.
N-acetylcysteine has also been used to treat compulsive behavior (like hair-pulling, trichotillomania and gambling), cocaine craving and cigarette smoking.
How is N-Acetylcysteine (NAC) Dosed? What is the Cost of NAC?
This is always a call for your doctor but the double-blind placebo-controlled study mentioned above dosed at 1000 mg twice daily. Some studies have gone higher than this.
I pay about $25.00 per month for NAC and I get it from a vitamin shop.
What are the Side Effects of N-Acetylcysteine (NAC)?
This depends on who you ask. In the double-blind placebo-controlled study no side effects were noted as statistically significant but side effects are, of course, possible with any medication. Long-term data is not available on NAC’s safety.
It’s worth noting that in very high doses (much higher than is used in humans) mice were found to develop damage to the heart and lungs.
Natasha Tracy’s Opinion on N-Acetylcysteine (NAC)
In my non-medical opinion, this medication is worth a try for people who have unresolved bipolar depression. Again in my opinion, it is a low-risk option for treatment that really appears to have no downsides.
And on a personal note, I, personally, have found it effective.
Learning More About N-Acetylcysteine
If you’re interested in NAC I encourage you to click on the studies I have linked to and read Dr. Phelps’ write-up on NAC as it contains more detail than I have provided. You may need to provide this information to your doctor as many doctors don’t know about NAC and bipolar depression.
This is an informational article and nothing is intended as medical advice. All medications, including supplements should be taken under the care of a doctor only. Please and thank you.
This week’s three new things include:
- A new supplement that may help brain health and mental illness: l-theanine
- A poor comparison between rapid cycling bipolar disorder and the financial markets
- A new discussion of antipsychiatry
1. New to Me: L-Theanine as an Antidepressant
Maurya, a commenter, asked if I knew anything about l-theanine. Well, I didn’t. Every once in a while even I run across something of which I haven’t heard.
So, for those of you in my boat, here’s a bit about l-theanine:
- L-theanine is derived from green tea although we’re not sure of the best way to extract it.
- L-theanine has been studied on mice and seems to exert antipsychotic- or even antidepressant-like qualities.
- L-theanine is a glutamate derivative and loyal readers will know that I think glutamate will be a big player in mental illness treatment in the next few years. (N-acetylcysteine (NAC) also works with glutamate.)
- There is very little conclusive research on l-theanine, we really just have ideas about what it does; it may possibly be a stress-reducer
- L-theanine may improve cognitive impairment (a human study)
As always, as this is a supplement it is not FDA-controlled and there is no guarantee as to what you will get in the bottle and you should never take any supplement without first checking with your doctor.
More studies on l-theanine can be found here.
I’m a writer so questionable metaphors irk me. And rapid cycling bipolar disorder as a metaphor for the financial marketplace? Really? That’s a whole new level of irk.
If you really want to make that comparison then the bulk of the article should be on the markets and not mental illness, and not the other way around like Lloyd I. Sederer M. D. did in Rapid Cycling Bipolar Disorder: In the Office and On ‘The Street.’
Comments of Mental Illness Stigma
All this poorly-written article did was confuse people and elicit a bunch of anti-bipolar comments like:
“The foundation of the Bi-Polar epidemic is based in suppressed biochemistry, outdated understanding of genetics and a complete misunderstanding of our true spiritual nature.”
“So how exactly is this different from saying some people dramatically over-react to external circumstances?
Sorry folks, but this one goes into the notebook for the next philosophical discussion of “medicalization” as a way of discussing deviance.”
Seems to me he just wanted to use mental illness as an eyeball-grabber, tricking readers onto a topic they would never otherwise read – with the extra bonus of eliciting remarks of stigma.
3. What I Find Interesting – New Discussion of Antipsychiatry
As you might know, I’m not a fan of antipsychiatry folks. I have written a lot on this topic and I’m sure I will write much more in times to come. But I can across this article, Getting It From Both Sides: Foundational and Antifoundational Critiques of Psychiatry which has an interesting discussion of antipsychiatry viewpoints.
Two Sides to Antipsychiatry
It astutely notes there are two sides of antipsychiatry – those who feel that nothing can be defined and thus no mental illness can be defined; and those who feel illness is rigidly defined and mental illness doesn’t meet that definition.
Both sides, as the author says,
“. . . have had the effect of discrediting and marginalizing psychiatry and of delegitimizing psychiatric diagnosis and nosology.”
It’s a very intelligent view of antipsychiatry criticism that is elevated far beyond what we normally see online. Check it out.
Until next week: Smarter and Better.
As I mentioned, people with bipolar type II spend 35X more time depressed than hypomanic, and yet there are very few treatments available.
As we discussed last time, the neurotransmitter glutamate and the inflammatory complex are two new, badly-needed areas of bipolar depression treatment research. Here are three additional bipolar depression treatment areas you probably don’t know about: diet, antioxidants and modafinil.
Diet, Insulin and Bipolar Disorder
There are quite a few people talking about diet and bipolar disorder, and diet and depression. And for all the words they say, the one thing we actually know through study is: no diet is known to treat bipolar disorder. Period. We know an unhealthy diet will possibly make you worse, but the only thing science can recommend is to eat a healthy, balanced diet.
Diet and Insulin
[push]The only thing science can currently recommend is to eat a healthy, balanced diet.[/push]
That being said, insulin interacts with many parts of the body responsible for much of the brain functioning. For example, insulin regulates the concentration of neurotransmitters and monoamines in the central nervous system; and these chemicals are thought to impact mood disorders, Alzheimer’s and schizophrenia. It appears a lack of insulin can produce mental illness symptoms.
This area is in extremely early development but there is currently testing of insulin increasing drugs in treatment of bipolar disorder and depression. And yes, other dietary issues are being studied (more carbohydrates and less carbohydrates are being studied) but as of yet, there is nothing concrete.
Antioxidants and Bipolar Depression (N-acetylcysteine (NAC))
We know something unfortunate about the brain and mental illness: mental illness shrinks the brain. (Mental illness decreases neuroplasticity, technically.) And we know that some drugs protect or reverse this effect (SSRI antidepressants, lithium, electroconvulsive therapy (ECT)). [pull]We know something unfortunate about the brain and mental illness: mental illness shrinks the brain.[/pull]
And one of the possible causes of brain shrinkage currently being considered is oxidative stress. Oxidative stress represents an imbalance that prevents detoxification and repair within tissues. (It’s complicated. See Wikipedia.) Some amount of oxidative stress is normal (and important) but this stress combined with cell abnormalities is implicated in bipolar disorder. Evidence suggests lithium and valproic acid protect neurons against oxidative stress.
(Still with me? Good. It’s going to get easier. Just hang on a bit longer.)
This oxidative stress can be caused due to decreased levels of antioxidants. One in particular, glutathione, is known to have abnormal levels in bipolar disorder. And in order to make enough glutathione, a body must have enough of an amino acid, cysteine.
Increasing cysteine levels using N-acetylcysteine (NAC) has been reported to be neuroprotective and impact glutamate (which we think is good, see here). NAC has been able to alleviate depressive symptoms in people with bipolar disorder in a double-blind placebo-controlled study as an add-on medication.
The good? NAC is cheap, over-the-counter, and from what we know, safe.* The bad news? NAC can take up to five months to work and study on it is limited. (See bipolar disorder type 2 depression and NAC notes by Dr. Jim Phelps.)
In a completely non-medical, Natasha-only-based opinion, NAC seems like something you could talk to your doctor about adding. There doesn’t seem to be a downside other than waiting for five months to see if it works. This doesn’t mean try it on your own. It means talk to your doctor.^
Modafinil and Bipolar Depression
Last, but not least, is the research into modafinil treatment of bipolar depression. Modafinil is a “wakefulness promoting agent” prescribed to people “with excessive sleepiness.” This is not an amphetamine but is a stimulant. Basically, we don’t understand this medication but it increases monoamines like norepinephrine and dopamine, which we generally like.
Modafinil has been shown effective in treating bipolar depression (without inducing mania or hypomania) by week two of treatment. In the study, modafinil decreased depressive symptoms and increased remission rates.
This medication is one some doctors are already using off label for the treatment of bipolar depression.
Summary of Bipolar Depression Treatments You Didn’t Know About
Basically, under all of this, the message is: we’re working on it. It’s long and slow and frustrating for us crazies but the doctors have their lab coats out and they’re thinking up stuff all the time. Will any of these help you? I don’t know. But what I do know is these five areas should be a reason to hold onto hope, even if what you’re doing right now isn’t working.
The information in this article is primarily from: Novel Treatment Avenues for Bipolar Depression By Roger S. McIntyre, MD and Danielle S. Cha. Clinical Psychopharmacology. April 19, 2011.
See the article for all the nitty gritty details about the above.
* Safe in this case means no known drug interactions (to the best of my knowledge and according to a doctor). In the drug database used by doctors up here in Canada it reports no side effects. In the study they note it as “safe” but report change in energy, headaches, heartburn and joint pain as possible side effects – these being basically the same in the placebo and NAC group. Keep in mind though, so little study has been done on this there may be all sorts of gotchas we haven’t seen.
^ Remember: your doctor should know about all medications, vitamins and supplements you take. Just because it’s over-the counter doesn’t mean it’s harmless.
Long (long) time readers will recall that once-upon-a-time I took the atypical antipsychotic Geodon. I found this to be an unbearably painful and side effect laden psych med. I hated Geodon. I wouldn’t wish Geodon on my worst enemy. I lost touch with reality on Geodon. I passed out at work on Geodon. I got sick constantly on Geodon.
You know, that being said, Geodon works for a lot of people.
I gather my reaction to this antipsychotic was fairly atypical. And if I had known what to eat when taking Geodon that might have helped.
Geodon (generic ziprasidone, also marketed as Zeldox by Pfizer) was the fifth atypical antipsychotic to receive FDA approval, in 2001. Geodon is approved to treat schizophrenia, bipolar disorder mixed-states and bipolar mania. And, of course, Geodon is prescribed off label in other cases of bipolar disorder or for depression.
Facts about the Atypical Antipsychotic Geodon
Interesting facts about atypical antipsychotic Geodon:
- Has a very short half-life – a mean of 2-5 hours
- Geodon should always be taken with food (see below)
- It slightly increases the QTc interval (heart rhythm)
- Geodon can occasionally cause mania in people with bipolar disorder
It has all the other nasty effects that atypical antipsychotics do like weight gain, diabetes, tardive dyskinesia and the like.
Geodon Must be Taken with Food
One of the nasty problems I had with Geodon is that I found unless I ate exactly the right thing (red meat, I found, but results were variable) I would get really sick after taking the drug. I would feel nauseated, dizzy, crazy and basically so sick I had to go to sleep. And it was really hard to predict exactly when this would happen. It was a bitch.
Food with Geodon Affects Bioavailability
What I didn’t know is what really matters is the number of calories consumed with Geodon.
I had thought taking the Geodon was making me sick but actually it was the withdrawal from Geodon making me sick. Due to the short half-life, if I didn’t get the correct dose of Geodon, I went through withdrawal. (I took it once a day, increasing the problem.)
And as it turns out, if you don’t eat the right food, Geodon isn’t properly absorbed into your bloodstream. This is known as bioavailability. If you take Geodon without food its bioavailability may only be 50%. So 200mg becomes 100mg.
What to Eat with Geodon
While psychiatrists generally tell people to take Geodon with food, I doubt anyone mentions that if you don’t, it is only half as useful.
Luckily, there’s a study. According to The impact of calories and fat content of meals on oral Ziprasidone [Geodon] absorption: a randomized, open-label, crossover trial:
- Maximum Geodon absorption was seen with meals of 1000 calories
- Low-calorie meals of 250 calories had only a 60% – 90% absorption rate, highly variable
- Meals of 500 calories were close to the absorption rate of the 1000 calorie meals
- Meals of 500 – 1000 calories had much less variable Geodon absorption rates
- Fat content of the meal had no bearing on outcome
So, in short, if you’re taking Geodon, you should eat a meal of 500 calories or more when you take your Geodon.
Isn’t That a Lot of Calories?
I’d say so, yes. Seeing as dosage instructions for Geodon are to take Geodon twice daily with food, that’s at least 1000 calories right there. Kind of nutty, but there it is.
Do Doctors Know about Calories, Diet and Geodon?
Honestly, I have no idea. I wouldn’t be surprised if they didn’t know the magic formula was 500 calorie meals with Geodon. You might want to ask your doctor about it.
 In case you’re curious, Geodon is one of four drugs Pfizer plead guilty to illegally promoting for disorders for which it was not FDA approved.
 By the way, you could get around this problem with intramuscular injections. If, you know, that were an option for you.
 And by “should” I mean according to the study and after talking to your doctor. Of course.
I’ve been “living the bipolar lifestyle” for over a decade now, and due to my general obsession over all things factual, I’ve done lots and lots and lots of research on bipolar treatments. Lots of research on lots of psychotropic pharmaceuticals specifically, but I’ve looked at, and tried bipolar disorder treatments too. I’ve written about unusual mental illness treatments here from time to time but I decided to put together the top 5 list of bipolar / depression treatments you might not know about for HealthyPlace.
Unusual Bipolar Disorder / Depression Treatments
- L-methylfolate: A Burbled Article – L-methylfolate as Antidepressant Enhancing Agent
- Omega-3: My Burble Article – Diet and Depression / Bipolar
- Calcium Channel Blockers – Burblicious – Anticonvulsants as Calcium Antagonists in Mood Stabilization
- Thyroid Hormones – I was on Levoxyl, oddly I didn’t write about it.
- Light Therapy – somehow I can’t find anything on this either. Which is weird, because I actually like this one.
It’s probably that I just didn’t get the chance to write about the last two. Sometimes I really mean to say something but I don’t get around to actually doing it. Anyway, you can check out the HealthyPlace article for more.