As I mentioned, people with bipolar type II spend almost four times 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’s 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 the treatment of bipolar disorder and depression. And yes, other dietary issues are being studied (more carbohydrates and fewer 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.

New Bipolar Depression Research AreasN-Acetylcysteine for Bipolar Disorder Depression – The Good and The Bad

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 trying it on your own. It means talking 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.

Information Reference

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.

Notes

* 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 changes 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.

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