Michael I. Gurevich
Private Psychiatric Practice, Glen Head, New York
Cassandra L. Robinson
Helfgott Research Institute, National College of Natural Medicine, Portland, Oregon
Abstract
Psychopharmacological treatment has been the mainstay in long-term maintenance of bipolar disorder (BD) patients for the last 60 years. Conventionally accepted treatment options are primarily based on expert opinion rather than on well-executed, independently funded research. Investigation of maintaining patients without medications using treatment alternatives has been neglected. This clinical case series examines the outcomes of 7 BD patients who experienced a poor response or significant side effects with conventional treatment modalities. Patients were gradually and safely withdrawn from all medications. Treatment strategies were based on an individualized holistic approach using herbs, nutritional supplements, vitamins, amino acids, acupuncture, dietary recommendations, and behavioral modifications. Multiple treatment modalities were combined addressing the etiological causes for BD symptoms. Upon withdrawal from psychotropic medications, patients were free of medication-induced side effects and obtained psychiatric stability for at least 10 months. Further research is needed to investigate the long-term outcomes of BD treatment modalities based on well-defined successful outcome criteria, such as reduction in symptoms, improvement in quality of life, overall health outcomes, and cost effectiveness.
Abstract
El tratamiento psicofarmacológico ha sido el pilar fundamental en el mantenimiento a largo plazo de los pacientes con trastorno bipolar durante los últimos 60 años. Las opciones terapéuticas aceptadas convencionalmente se basan principal-mente en la opinión de los expertos y no en investigaciones bien realizadas y financiadas de forma independiente. La investigación del mantenimiento de pacientes sin medica-mentos usando tratamientos alternativos no ha recibido mucha atención. Esta serie de casos clínicos examina los resultados de 7 pacientes con trastorno bipolar que experimen-taron una respuesta escasa o efectos secundarios significativos con modalidades de tratamiento conven-cionales. A los pacientes se les retiró toda la medicación de forma gradual y segura. Las estrategias terapéuticas se basaron en un enfoque individual holístico, utilizando productos de herboristería, suplementos nutricio-nales, vitaminas, aminoácidos, acupuntura, recomendaciones dieté-ticas y modifcaciones del comportamiento. Se combinaron múltiples modalidades terapéuticas para abordar las causas etiológicas de los sínto-mas de trastorno bipolar. Tras la reti-rada de la medicación psicotrópica, los pacientes no tenían efectos secundarios inducidos por los fárma-cos y habían conseguido estabilidad psiquiátrica durante al menos 10 meses. Es necesaria más investig-ación para averiguar los resultados a largo plazo de las modalidades tera-péuticas del trastorno bipolar basa-dos en criterios de resultados positivos bien definidos, tales como la reducción de los síntomas, la mejora de la calidad de vida, los resultados generales de salud, y la rentabilidad.
References
Practice guideline for the treatment of patients with bipolar disorder. In: American Psychiatric Association, editor. American Psychiatric Association practice guidelines for the treatment of psychiatric disorders.
Washington, DC: American Psychiatric Association; 2002: 547–634. [Google Scholar]
Electroconvulsive therapy of acute manic episodes: a review of 50 years’ experience.
Am J Psychiatry.
1994; 151(2): 169–76. [PubMed] [Google Scholar]
Combined chlorpromazine and electroconvulsive therapy in mania.
Br J Psychiatry.
1994; 164(6): 806–10. [PubMed] [Google Scholar]
Electroconvulsive treatment compared with lithium in the management of manic states.
Arch Gen Psychiatry.
1988; 45(8): 727–32. [PubMed] [Google Scholar]
Psychotropic medications for patients with bipolar disorder in the United States: polytherapy and adherence.
Psychiatr Serv.
2008; 59(10): 1175–83. [PubMed] [Google Scholar]
Mood stabilizer combinations: a review of safety and efficacy.
Am J Psychiatry.
1998; 155(1): 12–21. [PubMed] [Google Scholar]
Antipsychotic prescribing trends: a review of pharmaco-epidemiological studies.
Acta Psychiatr Scand.
2010; 121(1): 4–10. [PubMed] [Google Scholar]
Prevalence and correlates of antipsychotic polypharmacy: a systematic review and metaregression of global and regional trends from the 1970s to 2009.
Schizophr Res.
2012; 138(1): 18–28. [PMC free article] [PubMed] [Google Scholar]
National trends in the office-based treatment of children, adolescents, and adults with antipsychotics.
Arch Gen Psychiatry.
2012; 69(12): 1247–56. [PubMed] [Google Scholar]
Trends in the utilisation of psychotropic medications in Australia from 2000 to 2011.
Aust N Z J Psychiatry.
2013; 47(1): 74–87. [PubMed] [ Google Scholar]
Is the combination of a mood stabilizer plus an antipsychotic more effective than mono-therapies in long-term treatment of bipolar disorder? A systematic review.
J Affect Disord.
2013: 1–7. [PubMed] [Google Scholar]
A placebo-controlled 18-month trial of lamotrigine and lithium maintenance treatment in recently manic or hypomanic patients with bipolar I disorder.
Arch Gen Psychiatry.
2003; 60(4): 392–400. [PubMed] [Google Scholar]
Treatment of bipolar depression: current status, continued challenges, and the STEP-BD approach.
Psychiatr Clin North Am.
2003; 26(2): 495–518. [PubMed] [Google Scholar]
Discontinuing lithium maintenance treatment in bipolar disorders: risks and implications.
Bipolar Disord.
1999; 1(1): 17–24. [PubMed] [Google Scholar]
Discontinuation of maintenance treatment in bipolar disorder: risks and implications.
Harv Rev Psychiatry.
1993; 1(3): 131–44. [PubMed] [Google Scholar]
Recurrence risk in bipolar manic-depressive disorders after discontinuing lithium maintenance treatment: an overview.
Clin Drug Investig.
1998; 15(4): 337–51. [PubMed] [Google Scholar]
Risk of recurrence following discontinuation of lithium treatment in bipolar disorder.
Arch Gen Psychiatry.
1991; 48(12): 1082–8. [PubMed] [Google Scholar]
Bipolar disorder therapeutics: maintenance treatment.
Biol Psychiatry.
2000; 48(6): 573–81. [PubMed] [Google Scholar]
The long-term natural history of the weekly symptomatic status of bipolar I disorder.
Arch Gen Psychiatry.
2002; 59(6): 530–7. [PubMed] [Google Scholar]
A prospective investigation of the natural history of the long-term weekly symptomatic status of bipolar II disorder.
Arch Gen Psychiatry.
2003; 60(3): 261–9. [PubMed] [Google Scholar]
Lithium prophylaxis of bipolar illness. The value of combination treatment.
Br J Psychiatry.
1994; 164(2): 208–14. [PubMed] [Google Scholar]
New York, NY: Farrar, Straus and Giroux; 2011. [Google Scholar]
Judgement under uncertainty: heuristics and biases.
Science.
1974; 185(4157): 1124–31. [PubMed] [Google Scholar]
The promise and reality of pharmacogenetics in psychiatry.
Psychiatr Clin North Am.
2010; 33(1): 181–224. [PMC free article] [PubMed] [Google Scholar]
Treatment adherence among patients with bipolar or manic disorder taking atypical and typical antipsychotics.
J Clin Psychiatry.
2006; 67(2): 222–32. [PubMed] [Google Scholar]
Antipsychotic drug side effect issues in bipolar manic patients.
J Clin Psychiatry.
2000;61(suppl 8):52–61. [PubMed] [Google Scholar]
Effective mood stabilization with a chelated mineral supplement: an open-label trial in bipolar disorder.
J Clin Psychiatry.
2001; 62(12): 936–44. [PubMed] [Google Scholar]
The potential of nutritional therapy.
Science.
2010; 327(5963): 268. [PubMed] [Google Scholar]
Nutrients for prevention and treatment of mental health disorders.
Psychiatr Clin North Am.
2013; 36(1): 25–36. [PubMed] [Google Scholar]
Nutritional therapies for mental disorders.
Nutr J.
2008; 7: 2. [PMC free article] [PubMed] [Google Scholar]
Feasibility of a nutritional supplement as treatment for pediatric bipolar spectrum disorders.
J Altern Complement Med.
2012; 18(7): 678–85. [PubMed] [Google Scholar]
Database analysis of adults with bipolar disorder consuming a micronutrient formula.
Clin Med Psychiatry.
2009; 4: 3–16. [Google Scholar]
Do vitamins or minerals (apart from lithium) have mood-stabilizing effects?
J Clin Psychiatry.
2001;62(12):933–5. [PubMed] [Google Scholar]
Nutrient-based therapies for bipolar disorder: a systematic review.
Psychother Psychosom.
2013; 82(1): 10–9. [PubMed] [Google Scholar]
Adjunctive nutraceuticals with standard pharmacotherapies in bipolar disorder: a systematic review of clinical trials.
Bipolar Disord.
2011;13(5-6):454–65. [PubMed] [ Google Scholar]
The Clinical Global Impressions Scale: applying a research tool in clinical practice.
Psychiatry.
2007; 4(7): 28–37. [PMC free article] [PubMed] [Google Scholar]
Baltimore, ON: Kirkton Press; 1994. [Google Scholar]
The treatment of celiac disease with the specific carbohydrate diet; report on 191 additional cases.
Am J Gastroenterol.
1955; 23(4): 344–60. [PubMed] [Google Scholar]
Heidelberg, Germany: Carl Auer International; 2008. [Google Scholar]
Assessment of the emotional freedom technique.
Sci Rev Ment Health Pract.
2003; 2(1): 1–10. [Google Scholar]
The immediate effect of a brief energy psychology intervention (Emotional Freedom Techniques) on specific phobias: a pilot study.
Explore.
2011; 7(3): 155–61. [PubMed] [Google Scholar]
Eye movement desensitization and reprocessing (EMDR): a meta-analysis.
J Consult Clin Psychol.
2001; 69(2): 305–16. [PubMed] [Google Scholar]
Eye movement desensitization and reprocessing. In: Weiner IB, editor; , Craighead WE, editor. , editors. Corsini encyclopedia of psychology.
Hoboken, NJ: John Wiley & Sons, Inc.; 2010. [Google Scholar]
Redmond, WA: Klinghardt Academy; 2012. [Google Scholar]
Louisville, CO: Sounds True (Audio CD); 2004. [Google Scholar]
New York, NY: Thieme; 2007. [Google Scholar]
New York, NY: Thieme; 2012. [Google Scholar]
New York, NY: William Morrow Paperbacks; 2012. [Google Scholar]
How many psychiatric diagnoses fit on the head of a pin?
Aust N Z J Psychiatry.
2014;48(11):1067–8. [PubMed] [Google Scholar]
ICD, DSM and the Tower of Babel.
Aust N Z J Psychiatry.
2014; 48(4): 371–3. [PubMed] [Google Scholar]
The new crisis of confidence in psychiatric diagnosis.
Ann Intern Med.
2013; 159(10): 720. [PubMed] [Google Scholar]
Oakland, CA: University of California Press; 2013. [Google Scholar]
A review of the clinical, economic and social burden of treatment-resistant depression: 1996-2013.
Psychiatr Serv.
2014; 65(8): 977–87. [PubMed] [Google Scholar]
Broad-spectrum micronutrient formulas for the treatment of psychiatric symptoms: a systematic review.
Expert Rev Neurother.
2013; 13(1): 49–73. [PubMed] [Google Scholar]
Effects of a branched-chain amino acid drink in mania.
Br J Psychiatry.
2003; 182: 210–3. [PubMed] [Google Scholar]
Choline in the treatment of rapid-cycling bipolar disorder: clinical and neurochemical findings in lithium-treated patients.
Biol Psychiatry.
1996; 40(5): 382–8. [PubMed] [Google Scholar]
Lithium orotate in the treatment of alcoholism and related conditions.
Alcohol.
1986; 3(2): 97–100. [PubMed] [Google Scholar]
Bipolar disorder and complementary medicine: current evidence, safety issues, and clinical considerations.
J Altern Comp Med.
2011; 17(10): 881–90. [PubMed] [Google Scholar]