Thursday, October 29, 2020

Bipolar Disorder Without medication

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People ask me if they can treat their bipolar disorder without medication all the time. They think that I have some secret answer to give them. Like I secretly know something that doctors don’t. Like there is a giantconspiracy to keep non-medication treatments away from people with bipolar disorder.

Well there isn’t.

So let me answer the question: Can you treat bipolar disorder without medication?

The quick answer is: no, not really. The long answer is: sort of, a bit.

So here I outline the treatments I’m aware of that treat bipolar disorder without prescription medication (or neuromodulation, like electroconvulsive therapy or repetitive transcranaial magnetic stimulation).

Psychotherapies for Bipolar Disorder

The number one way to treat bipolar disorder without drugs is psychotherapy. And this treatment does work. In my opinion, it won’t work nearly enough unless you’re also stabilizing your mood using medication, but that’s me. (And the research supports this.)

Nevertheless, therapy is a valuable tool in fighting bipolar disorder. Many types of therapy have been shown to work for bipolar disorder including:

  • Cognitive behavioral therapy
  • Interpersonal/social rhythm therapy
  • Psychoeducation
  • Prodrome detection therapy – particularly useful for preventing mania relapses
  • Family-focused therapy

Supplements for Bipolar Disorder

There are supplements that people say work and there are ones that studies say might be beneficial. Here are the supplements that actually have some evidence behind them:

  • Omega-3 – generally accepted as being able to help with bipolar depression (you need a lot of this stuff for it to work so eating fish isn’t going to do it, FYI)
  • N-Acetylcysteine – may help with bipolar depression
  • L-Methylfolate – may help some people with a specific deficiency with depression (actually, you need a prescription for this but it is a supplement so I’m including it)

Then there is the one that I, personally, don’t believe in and think people throw ridiculous sums of money away on and that’s micronutrient supplements for bipolar disorder. There is one big company (I won’t name them) that sells this stuff with wild promises and sly marketing. I don’t like them but it’s your call.

You’ll note that none of these are mania treatments. I don’t know of a single supplement that has any evidence in helping mania.

Light Therapy for Bipolar Disorder

There are two types of light therapy for bipolar disorder:

  • Light therapy – can be useful for bipolar depression (but can also induce mania, so never use it without a doctor’s advice)
  • Dark therapy – may help with rapid cycling (based on only one study, but still very interesting)

Diets for Bipolar Disorder

There are two diets I hear thrown around for bipolar disorder:

  • A ketogenic diet
  • A gluten-free diet

There are two case reports (single cases) of aketogentic diet working. I don’t know of any reports saying that a gluten-free diet works (unless, of course, you have celiac disease).

Lifestyle Changes for Bipolar

And one should not forget that lifestyle changes can effectively help stabilize mood in bipolar disorder. I find lifestyle changes tend to be individual specific but ones that we know have a positive effect in bipolar disorder include:

  • A strict sleep schedule and good sleep hygiene
  • A daily routine (this is part of social rhythm therapy)
  • Exercise (shown to be somewhat of an antidepressant)
  • Mindfulness meditation or relaxation techniques

Non-Medication Therapies for Bipolar Disorder

I suspect that some of these have their place, alongside medication, as useful treatments, but standalone, I highly doubt you’ll see nearly enough effect to truly keep bipolar disorder at bay. Typically what I see is people going off their medication, feeling good for a relatively short period of time and then ending up in the hospital with an extremely bad episode to deal with.

That being said, the odd person (I’ve met exactly one) can get stabilized and stay that way even without the aid of medication. I strongly stress that this is the extreme exception, but it does happen. But even the person that I know that is without medication freely admits that he got stabilized on medication first and may need medication again in the future. He just doesn’t know (as none of us do).

So my best advice is to get yourself stabilized using mediation, therapy and lifestyle changes and then if you want to try one of these other non-medication bipolar treatments as an add-on, talk to your doctor about it.

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