Bipolar Depression and Amino Acids

[Aspen]

Hello. I have a diagnosis of Bipolar II but the depressive end of the cycle is by far the most common and usually the most debilitating. I have tried a number of pharmaceutical treatments but with very limited results and high number of side-effects. I currently take no medication and attend CBT.

Seasonal Affective Disorder appears to interact with my bipolar condition and I am now suffering hypersomnia, loss of motivation and physical aches and fatigue.

The amino acid Tryptophan is cited as having a reasonable degree of evidence for efficacy in the treatment of depression, especially that which is seasonally related, and given my lack of success with conventional treatments I have some incentive to consider it.

My question is twofold: in part regarding the safety of trying this substance in the light of my (albeit rarer) propensity for hypomania, and also wishing to know whether GPs or Psychiatrists will be able to write a prescription for this given that I want full supervision and cannot really afford to purchase the supplement myself. If so, how might I best approach my Psychiatrist with this in mind?

Thanks and regards

[Dr Johanna Herrod]

Dear Aspen,

Just to check that your definition Bipolar II is the same as mine! My definition is one or more Severe Depressive Episodes accompanied by at least one Hypomanic Episode.
Bipolar Depression is challenging to treat as the episodes tend to be longer and careful management of the Depression is needed so not to precipitate a Hypomanic Episode.
Tryptophan is a naturally occurring amino acid and precursor to Serotonin. It is usually prescribed in combination with an antidepressant. HOWEVER due to previous association with Eosinophil Myalgia Syndrome it is now only licensed in the UK for Resistant Depression prescribed by a Specialist.
For the SADS you could try a Light Box?
My advice is to ask your GP for an assessment by a Psychiatrist who could fully assess and advise.

Kind regards Dr Johanna Herrod

[Aspen]

Thanks. Correct definition, yes. I have experienced numerous deep and some not so deep depressions throughout my life. I recall at least three episodes of hypomania but only one has been observed clinically.

Light box coming in the post this week, so fingers crossed.

I was aware of the tryptophan/myalgia association but, as I understood it, this was only associated with one faulty manufacturing source. I had hoped that, with the problem isolated to a particular contaminated batch, it may now be more widely prescribed again. Not so? I can pick up a bottle in several shops in town but, as I say, I want proper monitoring and can barely afford to.

I'll take your advice and talk to my psychiatrist, of course. If I understand you correctly, it is possible for him to prescribe but and only if he believes it is necessary when other treatments have failed (which they have)?

Thanks and regards

[Dr Johanna Herrod]

Yes you are correct about the contamination issue and Yes discuss with your Psychiatrist. I would want to discuss Mood Stabilisers before prescribing antidepressants. I expect this has been discussed?
If you are keen to consider alternatives to the standard pharmacotherapy then consider Omega-Fatty-Acids. However studies that demonstrated efficacy needed high doses (I think about 10 tablets of the usual supplement dose!)

Kind regards Dr Johanna Herrod

[Aspen]

Gosh. I hadn't realised the therapeutic dose for Omega 3 oils in Bioplar disorder was so very high (I am careful to ensure dietary sources for myself). Might I trouble you to ask, is this considered speculative only, or does the evidence base equal say, that of St. John's Wort for moderate depression? I should try to read abstracts on some of these studies, I think.

Thanks ever so much.

[Dr Johanna Herrod]

For information on Omega-3-Fatty Acids in Bipolar Disorder. A good article is by Stoll A L. This suggests a dose of 5g daily calculated based on the concentration of Omega-3-Fatty Acid, which is a lot of Health Food shop capsules! However your GP may agree to prescribe a trial?

As for St John’s Wort (SJW) the Cochrane Study concludes that it does work in Depression. However you do need to ensure that the supplier is reputable and the dose is consistent. And not really to be taken in addition to prescribed psychotropic medication.

Kind regards Dr Johanna J Herrod

[stuckmum]

Very interested in the recommendation Omega 3, appreciate the suggestion. Have very ill son, refusing to recognise and ask for help, very defensive, hearing voices daily, and reacting angrily to them. Failed to get help for him, especially out of hours and at weekends. Keep being told, that it's not that Gp denies he has problem, but that he has to ask for it. His brother and sister too, have had to deal with his severe Bi-polar, and the effects it has had on us, it is now alienating them. Financial and work stress making him desparate at the moment, and angry that he can't afford a home of his own, but had to move back with me. Also that he struggles to keep car on road( often dangerous driving it when stressed and anxious) and can't afford a holiday.Anger usually results him hitting walls etc and being in denial. If the crisis team came out to him, out of hours, they would see how ill he is, confused, angry, with little control at times, on daily basis. Had to call police and ambulance recently. Was hopeful they would recognise how fragile he is, but although they realised he was very anxious, his perception warped and confused, making his emotions brittle, I thought they might persuade him to go and talk to someone in hospitol. He was shocked they were there,not aware his behaviour was so extreme, bordering on dangerous, and refused to discuss what was wrong.They left, being unable to make him go, but at least I got a written report, from the ambulance medic, confirming his confusion. I was fearful that his lack of control, would cause him to harm me or himself. His awareness of his actions, blinded by fear and danger.Always the rights of an individual are used as excuse to not get involved, leaving family and friends to take the brunt, of such a horribly damaging condition.We so love and want to help him, but I fear he is alienating everone close to him, as my mother did.When sectioned in the past, he should have had Aftercare to support him and us; then there would have been no question all these years, that it was a problem that needed to be managed, he might have acheived the goals he strives so hard for. Getting an education, he believed was the way out, of his "difficulies", he was not made to realiseit is his thought processes that need rethinking. Any suggestions gratefully received.

[Aspen]

Thank you, Dr. Harrod,

That is encouraging. I no longer eat animal products but could make an exception in this case. My research so far suggests there is very little data on vegetable sources of Omega 3 regarding mental health, but that levels of absorption vary hugely according to individual and the rest of his or her diet, making it (possibly) too unreliable for medical purposes. I will now examine the article you suggested.

Something else I came across in the past few days: Magnesium as mood stabiliser. It seems to have been abandoned by most research after a brief period of investigation though its physical similarity to lithium (binding to, indeed competing for, same receptors) is interesting. Why the loss of interest, I wonder; perhaps found to be ineffective or simply superseded by lithium therapy?

If you have any thoughts on that I would be interested to hear them.

Regards

[Wendy Green]

Hi Aspen,

I have some understanding of your suffering, as my brother has suffered from rapid cycling bipolar II for the past 40 years.

With regard to your original query about Tryptophan, you can obtain this quite cheaply in the form of the supplement 5HTP - which is derived from the seeds of the Griffonia plant. However, you would need to use it with caution, as although it could help to boost your mood during a depressive phase, it could aslo precipitate or worsen a hypomanic phase. The same caution applies to St. John's Wort.

Like Dr. Harrod, I think it might be worth supplementing your diet with up to 5g of omega 3 oils daily.

With regard to your final query about magnesium - according to the nutritional therapist Patrick Holford, this was widely used as a mood stabiliser before the 2nd World War. To boost your levels of this mineral make sure you eat plent of fruit, vegetables, wholegrains, nuts and seeds. Also, you might consider taking a magnesium supplement of 300mg - 500mg. You might consider obtaining this from a good multivitamin and mineral supplement, as this would also ensure you obtain sufficient vitamin B complex, which is vital for good mental health. Also, B vitamins help to lower homocysteine levels - high levels of which are associated with depression and other mental and physical health problems.

Finally, I recommend that you read Patrick Holford's excellent book on nutrition for mental health called:'Optimum Nutrition for Mental Health'.

Good luck.

Wendy

[Aspen]

Thank you kindly, Wendy.

I am aware of Holford, and although I think his books contain a wealth of potential I do find he has a tendency to exaggerate efficacy and leap to assumptions where the evidence is not really borne out. On the one hand it is right we should consider these things but on the other, this is my health we're talking about and I happen to know Holford is as deep in the supplement industry as GSK are in pharmaceuticals. His pooling of limited evidence does little to set my mind at rest, I need to see quality research backed up by real analysis. Holford is notoriously slapdash and overzealous in his approach. It would be nice if he would put his efforts into some proper trials rather than his expensive courses, books and supplements. I have seen him lecture in the past and he has more charisma than expertise. Sorry, if that seems harsh.

The work of A L Stoll appears solid, it showed such promise but it is astonishing that it was 1999 when it was carried out and some 13 years later we still do not have any quality follow up work! What is up with that? I intend to try omega oils as I think the basis is there and, importantly, no risk is attached. Sadly, I really wanted to avoid animal produce and once again, the evidence for using vegetable sources of omega oils is lacking. This is frustrating.

I have done some research into magnesium now, and the promise is there but confounded by some studies suggesting links with an increase in depression. Dosage has not really been established either. It is so hard for someone with no medical training such as me to really ascertain the state of consensus on magnesium even being a safe thing to try using, hence my asking here for an objective opinion from someone outside either the pharmaceutical or the supplement industry.

You thoughts and advice are of course most welcome and I appreciate your time and concern.

Very best,