Bipolar Disorder (manic depression)

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In addition to the various treatments available to individuals with bipolar disorder, there are hundreds of bipolar awareness groups that have been organized over the past several years. These bipolar awareness groups help people diagnosed with bipolar disorder cope with the illness and function in their community.

Additional Information About Bipolar

The following information details some of the research that has been done on Bipolar (and other depressive disorders) and specific micro-nutrients.

(1) Abnormal frontal lobe phosphorous metabolism in Bipolar disorder.

Am J Psychiatry 1995 Jun;152(6):915-8

Deicken RF, Fein G, Weiner MW.

Magnetic Resonance Unit, Department of Veterans Affairs Medical Center, San Francisco, CA, USA.

OBJECTIVE: Abnormalities in frontal lobe phosphorous metabolism in patients with Bipolar disorder have been reported, but many of the patients studied were receiving lithium. In this study, medication-free Bipolar patients were examined to determine abnormalities in frontal lobe high-energy phosphorous metabolism. METHOD: In vivo phosphorous-31 magnetic resonance spectroscopic imaging was performed on 12 un-medicated, euthymic Bipolar patients and 16 healthy comparison subjects. The percentages of total phosphorous signal for phosphomonoesters, inorganic phosphate, phosphodiesters, phosphocreatine, and beta-ATP were calculated. RESULTS: In relation to the comparison group, the patients with Bipolar disorder had significantly lower phosphomonoester values and higher phosphodiester values in both the left and right frontal lobes. The patients also had a significantly higher right-to-left ratio of frontal lobe phosphocreatine. No other differences in phosphorous metabolites or lateralized asymmetries were noted. CONCLUSIONS: This preliminary study provides support for abnormal frontal lobe phosphorous metabolism in Bipolar disorder.

(2) Alterations in brain phosphorous metabolism in Bipolar disorder detected by in vivo 31P and 7Li magnetic resonance spectroscopy.

J Affect Disorder 1993 Jan;27(1):53-9

Kato T, Takahashi S, Shioiri T, Inubushi T.

Department of Psychiatry, Shiga University of Medical Science, Japan.

Phosphorus-31 magnetic resonance spectroscopy (MRS), able to detect membrane metabolism and intracellular pH as well as energy metabolism in vivo, was applied to 17 Bipolar patients in the manic state and the euthymic state. In nine of these patients, brain lithium concentration was simultaneously determined by means of lithium-7 MRS in order to clarify the effect of treatment with lithium on brain phosphorous metabolism. Both phosphomonoester (PME) peak area and intracellular pH were found to be higher in the manic state than in the euthymic state. These values in the euthymic state were lower than those in normal controls whose ages and sexes were matched with the patients. However, PME and intracellular pH did not correlate to brain lithium concentration. These findings coincide with a hypothesis that patients with Bipolar disorder may have membrane abnormality in their euthymic state and state-dependent alteration of catecholaminergic activity may be a secondary phenomenon.

(3) Brain phosphorous metabolism in depressive disorders detected by phosphorus-31 magnetic resonance spectroscopy.

J Affect Disorder 1992 Dec;26(4):223-30

Kato T, Takahashi S, Shioiri T, Inubushi T.

Department of Psychiatry, Shiga University of Medical Science, Japan.

Brain phosphorus metabolism was measured in 22 patients with depressive disorders. Ten of them had DSM-III-R Bipolar disorder, and 12 had major depression. In Bipolar patients, phosphomonoester (PME) and intracellular pH were significantly increased in the depressive state than in the euthymic state, while those values in the euthymic state were significantly low as compared to age-matched normal controls. Phosphocreatine (PCr) was significantly decreased in severely depressed patients compared to mild depressives. These findings suggest that high energy phosphate metabolism, intracellular pH and membrane phospho-lipid metabolism are altered in depressive disorders.

(4) Lithium, sodium and potassium transport in erythrocytes of manic-depressive patients.

Acta Psychiatric Scand 1984 Jan;69(1):24-36

Dagher G, Gay C, Brossard M, Feray JC, Olie JP, Garay RP, Loo H, Meyer P.

Different Li, Na and K transport pathways were assessed in erythrocytes from manic-depressive patients. No alteration in the Li-Na countertransport, Na, K cotransport or passive permeabilities was observed in either uni-polar or Bipolar manic-depressive patients. In addition, acute or chronic lithium treatment did not alter the maximal velocity of either the Li-Na counter-transport or the Na, K cotransport. A two-fold reduction of the ouabain-sensitive Na efflux was observed among manic-depressive patients without alteration in the affinity of the Na pump for internal Na.

(5) The management of resistant depression.

Acta Psychiatric Belg 1986 Mar-Apr;86(2):141-51

Levine S.

Between 10 and 30% of depressed patients, mostly Bipolar, develop a therapy-resistant illness. The known causes of such chronic evolutions are discussed: misdiagnosis (underlying schizophrenia, personality disorder or dementia), drug-induced depression (neuroleptics), systemic disease (hypothyroidism, multiple sclerosis, cardiovascular or neo-plastic disease etc.), or lack of efficacy (drug compliance, insufficient dosage). Remedies are suggested: adequate dosage, drug combination (Newcastle cocktail. tricyclic antidepressant + MAOI, imipramine + T3), carbamazepine in lithium-resistant cases, alprazolam, reduction in vanadium intake, sleep deprivation, psychosurgery.

(6) B complex vitamin patterns in geriatric and young adult inpatients with major depression.

J Am Geriatric Soc 1991 Mar;39(3):252-7

Bell IR, Edman JS, Morrow FD, Marby DW, Mirages S, Perrone G, Kayne HL, Cole JO.

McLean Hospital Geriatric Service, Harvard Medical School, Belmont, Massachusetts.

This study compared the B complex vitamin status at time of admission of 20 geriatric and 16 young adult non-alcoholic inpatients with major depression. Twenty-eight percent of all subjects were deficient in B2 (riboflavin), B6 (pyridoxine), and/or B12 (cobalamin), but none in B1 (thiamine) or folate. The geriatric sample had significantly higher serum folate levels. Psychotic depressives had lower B12 than did non-psychotic depressives. Poorer blood vitamin status was not associated with higher scores on the Hamilton Depression Rating Scale or lower scores on the Mini-Mental State Examination in either age group. The data support the hypothesis that poorer status in certain B vitamins is present in major depression, but blood measures may not reflect central nervous system vitamin function or severity of affective syndromes as measured by the assays and scales in the present study.

(7) Relationship of normal serum vitamin B12 and Folate levels to cognitive test performance in subtypes of geriatric major depression.

J Geriatr Psychiatry Neurol 1990 Apr-Jun;3(2):98-105

Bell IR, Edman JS, Miller J, Hebben N, Linn RT, Ray D, Kayne HL.

McLean Hospital, Department of Psychiatry (Geriatric Inpatient Service), Belmont, MA 02178.

This retrospective study evaluated the relationships between normal serum vitamin B12 and folate levels and neuropsychologic measures in a sample of 60 geriatric inpatients with psychotic depression, nonpsychotic depression, Bipolar disorder, and dementia--all consecutively referred for cognitive testing. The psychotic depression subgroup demonstrated numerous significant positive correlations between B12 and cognitive subtests not seen in other diagnostic subgroups, especially those of IQ, and verbal and visual memory. Metabolic factors including vitamin B12 may play specific roles in the cognitive dysfunctions of different geropsychiatric disorders.

(8) Nutritional practices, knowledge, and attitudes of psychiatric healthcare professionals: unexpected results
Psychiatr Hosp 1990 Summer;21(3):125-7

Ryan VC, Rao LO, Rekers G.

University of South Carolina School of Medicine.

This study investigated inter-relationships among nutrition knowledge, habits, and attitudes of psychiatric healthcare providers. Data of nutritional intake was compared with that of the general population of the state of South Carolina, obtained from a previous public health study. Nutritional habits were determined from both a 24-hour recall and a separate three-day recall of dietary intake. Nutrition knowledge and attitudes were determined by validated questionnaires. The knowledge questionnaire consisted of 50 multiple-choice questions. Attitudes were determined using a semantic differential instrument consisting of phrases of descriptive Bipolar adjectives. Dietary intake was analyzed using the Food Processor software and compared with the RDAs and with the intake of the general population. Nutrition knowledge was measured by the number of correct responses. Nutrition attitudes were assigned numerical scores and measured by a Likert scale. Only 3 of the subjects met 70% of indicator nutrients (iron, calcium, vitamin B6, and vitamin C). No significant relationships were established among attitudes, habits, and knowledge. Sixty-three percent of subjects perceived themselves as role models to patients, yet 90% of them practiced poor nutrition habits as compared with 97% of the general population. The higher the education level, the more likely that subjects felt nutrition is important for health. A comprehensive nutrition education program is essential for health care providers to promote successful nutrition education for the patients they serve.

For even more information about Bipolar disorder, please visit our research library.