Managing Bipolar Mania Without Drugs

© www.PeterSmithUK.com (updated March 13)

WARNING

Learn how control your mania first BEFORE you start using antidepressant treatments.
Whilst I encourage you to learn about and take control of your health you must be safe when self-medicating. 
Do not suddenly stop taking your prescribed medication without professional support or at least a lot of research and knowledge. 
Do not take antidepressant remedies and antidepressants drugs at the same time without expert supervision. 
 
Before you self-medicate with natural therapies to adjust your brain chemistry you should read the previous section Introduction to Bipolar Neurotransmitters and Treatment


 

Page Summary

On this page I discuss non-drug treatment options to antidote bipolar mania and prevent or reduce its’ recurrence in the future including:-
  • Darkness Therapy: you probably heard that bright light therapy can be used as an antidepressant did you know that total darkness therapy can be used to treat mania. This is a cheap, non-toxic and side-effect free technique you can use on a daily basis to dampen down and prevent mania even hard to treat rapid cycling bipolar syndrome. I think this is the most innovative and exciting new developments in bipolar syndrome treatment in years, everyone with bipolar syndrome should routinely include this simple method to live well with bipolar syndrome. 
  • Taking control of your biological clock to normalize out of balance manic sleep cycles. Disturbances in the biological clock causing delayed and diminished sleep cycles is one of the central features of bipolar syndrome especially bipolar mania. We can take control of the timing of our sleep cycles by combining blue light therapy in the morning, blue-light blocking techniques in the evening and specific nutritional supplements.
  • Amino acids that reduce dopamine production.
  • Amino acids that produce fast acting calmative effectson the brain and antidote mania.
  • Detoxifying vanadium build-up which can occur during times of mania.
  • Supplementing choline/lecithin (together with detoxifying vanadium) to make non-toxic very low doses of lithium (as orotate) an effective and viable option.
First I’ll explain each of the options in detail and then put them all together into two prescriptions one that you could use day-to-day to as a preventative prescription and the second what you might do during periods of runaway hyper-mania.


Controlling Mania with Darkness Therapy



You’ve probably already heard that bright light can produce an antidepressant effect (see Bright Light Antidepressant Therapy); but what you may not have heard of is that immersion in total darkness (mainly while you sleep) can produce an anti-mania affect. Studies have shown that exposure to bright light has a stimulatingeffect and wakes us up both bipolar and non-bipolar people alike.
 
When you’re manic obviously the last thing you need is more stimulation so you should avoid bright light especially in the evening prior to bedtime, but darkness therapy is much more than just avoiding stimulation in the evening it somehow seems to actively treat mania and rapid cycling.  

 

What Darkness Therapy May Be Able to Do for You



Before I learned how to incorporate darkness therapy on a daily basis into my wellness regime several times a year my bipolar syndrome would try to hijack my brain, my thoughts would speed up and I would start to experience anxiety and paranoia, left untreated my brain would then burn out and I would crash into a serious depression. The moment I saw this cycle restarting I would aggressively shut my whole system down to stop it, I would cancel all non-essential engagements and force myself to sleep for several days with high doses of glycine, taurine, melatonin, tryptophan, zinc, lecithin and fish oils washed down with a large glasses of wine. This combination, especially flooding the brain with high doses of fish oils would switch off the mania and induce an unpleasant but manageable depression lasting several days. It felt like I was doing to my brain was rebooting it just like you do with a computer when it freezes and you have to switch it off and re-started it, it wasn’t the most pleasant or refined technique but I could carry on working through it and make myself well again within a week or so.



I have rapid cycling bipolar syndrome which would attempt to quickly hijack my brain with runaway mania about 6 times a year or once every 2 months, since introducing darkness therapy into my regime the mania comes on less quickly and I am able to efficiently nip it in the bud simply by upping the amount of darkness therapy I use together with lecithin and a very low dose lithium supplement, none of which produce any unpleasant side-effects. You may be surprised to see the use of lithium recommended on a site dedicated to natural therapy approaches but bear with me and read this section, I am talking about tiny doses of lithium quite unlike anything used in conventional medicine and as I’ll discuss lithium, bright light, darkness, the functioning of our biological clock and bipolar syndrome are all intimately intertwined.
 
Another benefit the darkness therapy gives me is because I am better able to control the manic side of my condition I’m able to treat the depression side of my condition more effectively, taking full advantage of more powerful natural antidepressant treatments.  I can now use several very effective natural antidepressant treatments that were previously unavailable to me because they would precipitate mania. I now take 1000 mg of the amino acid tyrosine first thing in the morning, without tyrosine my brain would tend to be slow, groggy, demotivated and depressed first thing in the morning i.e. dopamine deficient and taking the amino acid precursor to dopamine (tyrosine) on a daily basis eliminate starting the day feeling depressed; before I used darkness therapy daily tyrosine could make me manic within as little as 5 days. I can now also take advantage of a daily dose of bright light therapy which I at least for me is powerfully antidepressant but also powerfully mania inducing without the counterbalancing effect of darkness therapy.
 
In between manic hijacks my default position would be pretty much continuous fairly severe depression, most of the time I could hold it at a low grade depression level with natural remedies but when I would try to completely prevent it with more aggressive treatment it would result in me becoming first manically high then crashing down into a suicidal depression. Sometimes I would just put up with a low grade depression, sometimes I would get fed up, treat it more aggressively then deal with the fallout and fairly regularly I would come across some new approach or think up a new way of combining the remedies I already had and try that. People used to think I was a bit crazy always trying new therapies but they didn’t have to live with continuous mental illness and anyway with rapid cycling bipolar syndrome the condition is rarely if ever static, it’s constantly moving itself and you can’t just take the same prescription every day and expect to be the best you can be. 


Since introducing darkness therapy I no longer have to put up with the burden of low grade depression for a couple of months several times a year. In fact I think most if not all of the attempted manic hijackings I now experience are probably self inflicted from over treating the depression side of things. It feels great to be free of depression and obviously sometimes it’s tempting to overdo the treatment; this seems to be happening less and less as I gain experience at stabilising my mood by simultaneously combining anti-mania and antidepression techniques at the same time. I hope that you will be able to learn how to do this in a fraction of the time it’s taking me by benefiting from my experience.


How Does Darkness Therapy Work

Initially the suggestion that immersion in total darkness can is may sound too bizarre to be believable but there is a part of our brain called the called the biological clock or suprachiasmatic nucleus that is directly controlled by external light. The biological clock controls the timing of our body’s daily cycles including our sleep cycles and research has consistently shown is an imbalance in the biological clock in bipolar brains. This is why sleep cycle disturbances are so common in bipolar syndrome. 


As far as I can tell darkness therapy does not produce a rebound over treatment that results in depression in the same way that antidepressant treatments including BLT can cause an over shoot into mania. For people with bipolar syndrome that need help with depression one possible solution is to combine BLT with darkness therapy on a daily basis to treat the depression and keep a lid on the mania.
 
 
One would like to think that when a new potentially very effective and totally safe way of treating a serious medical condition is discovered it would attract lots of further research and attention because medical research is all about finding solutions to problems right? Unfortunately medical research is incredibly expensive and serious financial investment is generally never put into researching techniques unless there is the possibility of recovering the financial investment and making a profit. You couldn’t patent darkness therapy and make it profitable so who is going to invest enormous sums of money in researching it. It’s a sad fact but effective treatment and remedies do not get developed in medicine just because there are effective, they have to also be potentially patentable and profitable before they will attract significant research funding. 
 
Its interesting that Li plays a central role in the workings of the clock because it is needed as a cofactor for on of the central enzymes that runs the clock. This is one of the few known essential functions of lithium in the body. Let me just restate this lithium is needed to run the clock that goes out of balance in bipolar syndrome. Below I’ll talk about low safe doses of li which I now believe should be part of drug free treatment regime for bipolar
 
Lets look at how does light and darkness affect the brain: light +li sets the clock, darkness and   
 
UNDER CONSTRUCTION
 
I WISH IT WAS THAT EASY THE SOLUTION WAS JUST BLT AAND TDT BUT BLEY IS HARD TO CONTROLE
 
ITS NOT THAT EASEY AS JUST USING BLT/TDT
WHAT I THINK TDT GIVES US IS 1 IT MAKES AMTI MANIA TX MORE EFFECTIVE
2/ IT MAKES ATIDEPRESSANTS MORE USEBLE AND SAFER WHICHIS VERY HELPFUL FOR MANY PPEOPRE.
 
BLT IS STRONG FOR ME AT LEAST
Compared to herbal remedies and amino acid supplements I would say that bright light and total darkness therapy are powerful it but less precise and without the refined precision that one can achieve with supplements I think it would be difficult to maintain and even balance with these therapies alone. In my own case I use them on a daily basis to give me a big push in the right direction and then use the other remedies to finally adjust my levels either up or down as required.
 
There’s only been a couple of scientific trials on total darkness therapy but immersion in total darkness appears to be capable of effectively stopping hyper-mania including the very hard to treat ultra- rapid cycling bipolar mania. The treatment consists of at spending 12 or even 14 hours in total darkness at least in the early stages.  


Virtual Darkness:

It turns out that we can prevent the light signals from reaching the part of the brain that detects outside daylight (the suprachiasmatic nucleus our internal biological clock) with the lights still on so that we can still see to read, talk, watch TV etc. 
 
before we can go into the next section, Controlling Bipolar Sleep Cycles, we need to understand how the biological clock works and how bluelight affects it.

 

Understanding the Biological Clock and How to Influence It Is Central to Gaining Control of Your Bipolar Syndrome



When you learn how to influence your own internal biological clock with the use of bright light therapy, total darkness and virtual darkness you will gain control over the timing of your sleep cycles and have learnt another very useful and practical technique to live well with bipolar syndrome.
 
See: Darkness Therapy for Bipolar
 
There’s a tiny little structure inside the brain called the suprachiasmatic nucleus which works as an internal alarm clock sending out signals to other parts of the body to do things at the right time of day. For example it tells the bowels to be active in the morning and inactive in the night-time, it tells our adrenal glands to make a surge of cortisol in the morning giving us energy and drive, and it tells the body when to cool down and go to sleep. The timing of our biological clock is supposed to be coordinated with the outside daytime and nighttime and this coordination so often goes out with bipolar syndrome causing big and unhealthy shifts in our sleep-wake cycles. Our biological clock coordinates itself with daytime and nighttime by receiving signals from the eyes telling it when still light. Before the invention of artificial light this was completely coordinated by the presence or absence of sunlight, but today of course many of us are surrounded by bright light in the evening especially now from backlit LED TVs, computer screens, tablets and full-colour smart phone screens; as well as getting artificial bright light in the evening many of us are getting too little bright light in the morning by living and working in doors. Ideally we should be exposed to bright outdoor light during the morning and then virtually no light for several hours in the evening before sleeping in total darkness and our bodies evolved to receive this before the invention of the modern world.
The reason it’s possible to prevent light signals from reaching the brains internal biological clock (the suprachiasmatic nucleus) whilst still being able to use light to see with is because the biological clock gets all its information about daylight exclusively from special cells in the eyes and these cells only respond to blue coloured light.  
Therefore all we have to do is prevent just the blue wavelengths of light reaching the eyes and leave all the other colours (red, orange, yellow, green, indigo, violet) and the cells in the eyes that tell the biological clock when it still light outside see nothing, as far as they are concerned the sun has set and it is total darkness outside but the other cells in the eyes -the cells that give us vision- can still see the world around us. We call this virtual darkness.  
One of the things I really like about this technique is we’re not interfering with the suprachiasmatic nucleus, were not suppressing its function in any chemical way that could have side-effects, this is not just tricking or fooling the suprachiasmatic nucleus that the light has gone out, we really are removing the only external signal (blue-light) that it response to.
It seems that virtual darkness may work just as well is total darkness in helping to control bipolar mania which is really good news because it means simply by setting up your evening living area to be a low blue light environment you can clock up several hours of virtual darkness and then retire to a totally dark bedroom where you can sleep for 7 to 8 hours to make up the total of 12 or even 14 hours of combined with virtual and total darkness therapy. This provides us with an amazingly simple and totally side-effect free anti-manic treatment that we can do as part of our daily routine with very little effort to help us live well with bipolar syndrome.

There’s an initial cost to setting up a totally dark bedroom and a virtual darkness living room environment (instructions discussed elsewhere) but after that the treatment is free and I suggest everyone with bipolar syndrome should do it.


How to Use Darkness Therapy

There are two ways you can use total darkness therapy:

1/ On a daily basis to keep the manic side of your bipolar syndrome in check and prevent its recurrence. Let me assure you that it’s not going to be necessary that you spend 12-14 hours a day in total darkness every day on an ongoing basis to keep this therapy going, all you need to do is sleep in total darkness and dim down late-night bright-light exposure before that so you can easily turn this into a really practical technique every day technique.
2/ As a treatment for a hyper-manic crises, in which case you may well need to extend the treatment to a full 14 hours.
The obvious difficulty with applying this treatment is what to do for 12 hours shut away in a totally dark bedroom and the obvious solution is to sleep, however when I’m depressed I’ll gladly sleep 12-14 hours but when I’m manic 6 ½ is fine, so forcing oneself to stay asleep in a totally dark room when you hyper-manic may require assistance. The solution I use is a combination of tryptophan, very low dose magnesium and melatonin, alternatively use drugs. The main point here is do whatever you have to sleep for as long as you can in a totally dark room
As just mentioned above maintaining a regime of 12 hours total darkness therapy per day is quite challenging and frankly impractical. There is however an amazing new trick which appears to be able to get around the impractically long time total darkness treatment requires and that is the use of what is called virtual darkness discussed in the next section.
Just to be clear you can safely combine total darkness therapy with any other medication or treatment you’re currently using. 
To use darkness therapy as part of your daily regime to keep your hyper-mania in remission all you need to do is sleep in a completely dark bedroom for say 7 hours and supplement this with about 4 hours of “virtual darkness”.SEE BELOW
I use darkness therapy both personally for my own rapid cycling bipolar syndrome and in my practice, and I wholeheartedly believe it to be effective; I also believe it’s the most exciting new development in managing bipolar syndrome for decades. It is completely safe and non-toxic and after the initial setup costs of the blackout blinds and materials it’s free to receive a nightly mood-stabilising dose of darkness.   Everyone with bipolar syndrome should try it! The only potential problem with darkness therapy is that to be effective it may require 10 to 14 hours of immersion in darkness to be effective, as you can imagine this is on the one hand impractical as an ongoing preventative strategy and on the other hand retreating into a completely dark room for 14 hours when can’t sleep because your head is racing with hypomania presents an enormous challenge to say the least; but as I will explain below there’s an ingenious solution to this problem called ‘virtual darkness’. Briefly we can achieve the same benefits as say 10 hours of total darkness by sleeping in a totally dark bedroom for let’s say 7 hours and wearing blue light blocking amber coloured sunglasses for 3 hours before going to bed. As I’ll explain below preventing blue light from reaching the eyes mimics the effects of total darkness but we can still see to carry on reading, watching TV etc., so by supplementing the hours we spend asleep in a totally dark bedroom with virtual darkness we can use darkness therapy on a daily basis as a simple and practical technique to help prevent bipolar mania. As I’ll explain later to live well with bipolar syndrome you should adjust the number of hours you apply darkness therapy depending on the state of your condition. In the next chapter Treating Bipolar Depression we will look at using bright light therapy for its antidepressant effects and then in the chapter Putting it All Together we will look at how we can combine bright light therapy and darkness therapy to produce a safe, natural, mood stabilising effect.

 

Controlling Disturbed Bipolar Sleep Cycles 



I used to think of disturbed sleep cycles as an annoying symptom of bipolar syndrome that would stop once the bipolar syndrome was under control, but once I learned how control the biological clock and sleep cycles I discovered that targeting and treating disturbed sleep cycles offers another valuable approach to treating and living well with bipolar syndrome. 
It’s easy to do, free and totally without side effects so EVERYOINE with bipolar should use this technique as part of the foundation of their wellness regime.  
For detailed information and prescriptions on treating sleep cycles with the use of bright light, darkness and specific supplements see Sleep Better with Natural Therapies available from October 2013.
 
To induce and maintain sleep in a crisis I prescribe the combination of Lithinase (the very low dose lithium I prescribe), tryptophan, GABA, melatonin and extra omega-3 fish oil. This can help to precipitate sleep in the first place and then use multiple top-up doses of instant release (ideally sublingual) low dose melatonin to extend sleep every time you wake up. For this purpose I would recommend a low dose of 0.5 mg or even less or at least the minimal dose of melatonin that works for you. 
I’ve never tried it but potentially you could use sleeping pills if you have to. The problem with sleeping pills is that they suppress brain wave activity in a way that actually prevents the brain achieving the deep sleep state; you can also quickly become dependent on sleeping pills. I do not know at this time whether the disruption to one’s ability to achieve deep sleep that sleeping pills cause affects the effectiveness of total darkness therapy, although I suspect that they probably wouldn’t and that total darkness therapy works just as well even if you’re not asleep by influencing the light sensitive parts of the brain, but I’m just speculating and a lot more research needs to be done in this area. It’s interesting to note that not only does the amount of sleep we get and the timing of our sleep change when we become manic but also the amount of time we spend in the different stages of sleep changes. There are many different stages to sleep but they can be divided simply into two types: there’s REM sleep (REM stands for rapid eye movement) when we do most of our dreaming, and there’s non-REM sleep which includes phases of very deep unconsciousness, what is called deep sleep. It’s interesting to note that during times of bipolar mania the amount of time one spends in REM sleep is diminished and during times of bipolar depression the amount of time one spends in REM sleep is increased, in other words we spend more of our sleep dreaming were depressed and less when were manic. I’ve even seen suggestions that it could be helpful to use drugs to diminish the amount of time one spends in REM dreaming sleep to help treat bipolar depression. 
 
Melatonin on the other hand does not interfere with any normal sleep phases and promotes non-REM deep sleep and REM dreaming sleep. Melatonin is not only a very safe substance but actually possesses many positive health benefits. You can actually buy supper strong 10 mg melatonin supplements; the problem can be that doses over 3 mg quite often produce nightmares, I suggest you buy a very low dose melatonin to start with so that you have the flexibility to experiment with from very low to very high doses and see what works for you. Try and be open-minded and avoid the thinking that a higher or stronger dose would be better, some people find smaller doses (300 mcg or micrograms) are more effective than larger doses. The company Life Extension produce a 300 mcg capsule otherwise you can buy liquid melatonin and scaled-down the dosage. 
 
By combining sleeping in a totally dark bedroom with the virtual darkness techniques discussed in the next section anyone can increase the natural production of melatonin, from their pineal gland which has healthy antioxidant, cancer fighting and anti-ageing properties. However the potential health benefits for people with bipolar syndrome are even greater and well worth the initial time and effort it takes to set these techniques up. For more information on the multiple health benefits of melatonin see [INSERT LINK]
 
Ok let’s continue and look at other remedies you can use to treat and manage bipolar mania.

 

Natural Remedies for Bipolar Mania



Just to reiterate it’s useful to think of bipolar syndrome as primarily an imbalance in dopamine, it seems the bipolar brain at least sometimes cannot keep dopamine within a normal range. During a manic phase excessive dopamine activity intoxicates the brain in a similar way to the effects of cocaine, amphetamine and excessive coffee. See About Bipolar Syndrome for symptoms. One of the treatments we can use during a manic episode is to reduce dopamine levels with amino acids therapy. 
 
Bipolar Brains Seem to Lack the ability to Regulate Dopamine by Themselves
 
The problem is when you reduce dopamine levels in a bipolar brain the levels may not come back down to normal but keep going and you overshoot and cause low dopamine depression. As I’ve said elsewhere because bipolar depression typically involves deficient dopamine it is often not helped by boosting serotonin treatment including SSRIs. To resolve bipolar depression we often need to restore deficient dopamine levels to but boosting dopamine may cause an overshoot causing mania. 
 
Treating and stabilising bipolar syndrome is not simple, it’s acknowledged to be the most challenging conditions in mental health to treat. I hope that my site and books enable you to learn how to balance you’re your brain chemistry to prevent depression and mania.
As you probably already know antidepressant treatments sometimes cause the bipolar brain to come out of depression and swing up into mania, so when you need to bring mania under control you would stop of or at least reduce the dosage of your antidepressant treatments. Bright light therapy, tyrosine and SAMe are particularly prone to induce mania and may need to be stopped; omega-3 fish oil and serotonin boosting trypotophan 
 
If you are currently using antidepressand currently using bright light therapy to manage bipolar depression either omit it for a few days as you wrestle the mania down, or alternatively you may wish to continue with it to help maintain the regularity of your biological clock and sleep cycles but when you are manic at lease decrease the dosage of your bright light therapy to say 1/3 or 1/4 of your usual dose by decreasing the length of the bright light exposure.

 

Glycine



For a hyper-manic chrisis or any time you feel you are beginning to lose control yo can begin the crisis management treatment with a single dose of the amino acid Glycine. [In his book Healing Nutrients Within Dr Braverman says he tried 15 to 30 g of glycine with two manic individuals during acute attacks and it caused a cessation of the manic episode and calmness within one hour. As he says further clinical trials are warranted. I only recommend this very high dose during acute hyper-manic episodes.
Dosage: Take 15-30 g (15,000-30,000 mg) in water/juice on an empty stomach at least two and half hours after eating a protein.
Adjust the dosage according to your body weight; take 30 g if you're a big person and 15 g if you’re petite. To take this high dose would be a lot of pills to swallow, so instead you could either buy powder or open up capsules. I prefer capsules because they tend to have a better shelf-life and we can be precise with the dose.
Continue supplementing Glycine on subsequent days at the lower dose of 2-4 g (2000-4000 mg) on an empty stomach once or twice per day as needed.  If the glycine does not appear to be helping by then I would give it up.  

 

Taurine



1000 mg 30-40 minutes before each meal and optionally another dose before bed on the few days until thing begin to calm down, thereafter 500 mg. Taurine is a useful remedy to use as soon as you see the early warning signs that have previously told you you are heading towards mania. I recommend keeping glycine for occasional use when you need a heavy handed treatment to stop hyper-mania and use taurine on a more frequent basis in order to prevent you getting so bad that you need the glycine. 
 
DOPAMINE DEPLEATING DRINK
TRUEHOPE: not effective


·        Low dose Lithium, CHOLINE, LECITHIN AND VANADIUM DETOXIFICATION.

It’s easy to forget but lithium is of course not really a drug it’s a mineral like magnesium, zinc or selenium with some essential biological functions especially for healthy brain function. The amount of lithium we ingest from food and water varies considerably depending where you live however the French Total Diet Study suggests 50 mcg (0.05 mg) might be an average. Just for comparison the amount of elemental lithium in a typical prescription of lithium carbonate prescribed for bipolar syndrome would be 180 mg that’s 180,000 mcg compared to 50 mcg a day in the typical French diet.
 
A study in Texas showed that populations with drinking water containing less than 50 mcg per litre show significantly higher levels of suicide and violent crime than populations with drinking water containing 160 mcg per litre. Looking at the numbers it appears that the average diet doesn’t supply adequate levels of lithium for optimal mental health including the prevention of suicide.
 
There’s also some evidence that lithium may slow down and be protective against the ageing process particularly within the brain, so perhaps everybody not just people with bipolar syndrome should be supplementing their diet with low-dose lithium.
 
It’s not know why but it has been observed that the level of lithium in the blood decreases when we are in a manic phase, just to be clear the observation was not that when patients with bipolar forgot to take their lithium and became manic it was that our levels of lithium go down when we are manic. The implication of this observation is that during times of mania we should increase the amount of lithium will supplement. Up until now I only take lithium when I am or feel I’m about to become manic my sleep cycles become excessively delayed; however because of the apparent mental and physical health benefits derived from a diet containing higher levels of lithium I think I may begin to take a low dose lithium supplement on a daily basis.
 
One of the essential functions of lithium is it is required for proper functioning of the biological clock that runs our sleep cycles, something that is almost always out of balance in people with bipolar syndrome, particularly during phases of mania. 
 
Many people are put off lithium because the high doses used in psychiatric medicine can have both unpleasant and potentially dangerous side-effects, however lithium is potentially the best and ideal remedy for bipolar, if only we could get lithium is benefits without side effects. When I believe that we can, the Texas study showed us that as little as 80-160 mcg can significantly diminish suicide risk and I have observed that supplementing just 50-100 mg from a product called Lithinase is sufficient to normalise the function of the biological clock and sleep cycles, I actually recommend it in my book Sleep Better with Natural Therapies to everyone as part of the treatment for insomnia.
 
For people with bipolar type II Lithinase may provide sufficient lithium to stabilise the condition when combined with other remedies and techniques, with the option of occasionally increasing their lithium dosage by adding 5 mg of lithium orotate during periods of hypomania. For people with bipolar type I (i.e. their condition includes hyper-manic episodes) I recommend 5 to 10 mg of lithium orotate in combination with other remedies and techniques as a standard dose and up to 20 mg as needed during manic phases.
 
For many years it puzzles me how such small doses of lithium could produce therapeutic effects in myself and my patients and psychiatric medicine asserted that only much higher doses produce a therapeutic effect. I now believe the explanation for this may be that I always combine the low dose lithium I prescribe with other remedies that protect the lithium and enhance its effects.
 
Firstly studies have shown that when the mineral vanadium builds up in people with bipolar they are more likely to become manic and that administering 2000 to 4000 mg of vitamin C detoxifies the excess vanadium and speeds up the recovery from mania [reference]. I believe this is because vanadium and lithium are antagonistic minerals meaning that as vanadium levels go up it suppresses lithium levels, the very thing we need to control bipolar mania. So taking 2000 to 4000 mg of vitamin C a day prevents vanadium build up and protects our low dose of lithium from being suppressed.
 
Secondly I always prescribe lecithin or choline bitartrate along with the Lithinase or lithium orotate, this is because not only do these B vitamins demonstrate anti-mania properties but they have also been shown to enhance the effectiveness of lithium. In fact these may not be two independent effects, I think it’s quite possible that lecithin and choline have anti-mania effects because they enhance lithium activity within the brain. I have a separate page on this see Lecithin Choline & Bipolar Syndrome To prevent lecithin and choline causing depression which has been seen in some people I always add omega-3 fish oil, whats nice is that the lecithin/choline supplements also improve the effectiveness of the fish oil. 
 
There is some evidence that one of lithium’s actions is to reduce inflammation in the brain derived from excessive omega-6 metabolism [reference], another central component of my approach to treating bipolar syndrome is to eliminate inflammation in the brain by amongst other things following and anti-inflammatory diet, eliminating leaky gut syndrome and food sensitivities.
 
I believe that all these things put together make it possible for us to obtain therapeutic benefits from very low doses of lithium that are safe and side-effect free.


Low dose Chelated Lithium for Bipolar and Bipolar Type II


Pharmaceutical lithium has a bad reputation for toxicity and side-effects, when you take pharmaceutical lithium it can sedate your personality making one feel emotionally numb; sure this calms down the ups and downs of bipolar but sometimes it can be a case of using a sledge hammer to crack a nut. All this results in poor patient compliance with staying on lithium, however lithium is potentially so useful for bipolar treatment if only we could get the benefits without the side effects.  To get around the problem of side effects I try to optimise the effects of lithium within the body so that we can take a greatly reduced dose but still receive at least some of the benefits of Lithium. For example one can eliminate potential vanadium toxicity with 3 grams of vitamin C a day, one can also enhance lithium’s effects be supplementing folic acid etc. etc. when all these measures are combined on can use doses of lithium that have no disenable side effects but still deliver enough of the advantages to make lithium a usable friend. Personally I resisted even trying lithium for almost two decades having been indoctrinated very early on that it was a horrible medicine now I feel better from taking it a few days per month and have now side effects, I especially like being to take it at times and events that almost always would make me manic and just apply a gentle brake to my up mood swing as it tries to accelerate off. This means I can attend those events without being ill for several weeks afterwards [EXPAND]

Lithium has two useful properties:


Firstly it can effectively put the brakes on the manic phase of bipolar syndrome to bring down the hyper and elevated affect (mood).
Secondly it can help reset altered sleep-wake cycle, see Sleep Chapter. 
 
Pharmaceutical lithium (lithium carbonate) is not without its problems, firstly the therapeutic dose is only just below the toxic dose so regular monitoring through blood tests is required. Lithium can also cause an unpleasant excessive numbing of one’s emotions and feelings. Initially this effect may be desirable perhaps for a day or two to stop the heightened you could say exaggerated emotions experienced during mania. However to spend weeks and months or even years in a totally numb and I’m feeling state is a form of Purgatory. This emotionless state is certainly less dangerous than the hypomanic state, but many people with bipolar syndrome feel they would rather be a bit bonkers and experience intense highs and lows rather than go through life like a zombie. As a consequence of this problem many people go off their lithium medication. 
 
If you search online you will see that lithium orotate it is put forward as an alternative to the lithium carbonate typically prescribed by conventional medicine. It is claimed that lithium orotate is better absorbed from the intestines than lithium carbonate and therefore one can use a lower dose to achieve the same effect. However a scientific study comparing lithium orotate with lithium carbonate concluded that the significant difference between them is not a difference in absorption, but a difference in the rate of excretion. 
The non-prescription lithium orotate is excreted by the kidneys more slowly than the pharmaceutical lithium carbonate, it therefore can maintain a higher and more sustained concentration of lithium in the blood even when taken at a lower dose. This may be a good and bad, the slower excretion rate may result in a beneficial lingering and maintaining affect, however it may also result in a build-up of lithium in the body over time, potentially to toxic levels. I conclude that lithium orotate may be a superior choice to lithium carbonate, especially for a person with cyclomania (rapid up and down cycling), however for safety’s sake you should still have occasional blood tests with long-term use to prevent toxicity. 
 
What is useful about lithium orotate is that it’s fairly easy to buy without prescription enabling you to quickly self-medicating and stabilise a manic episode. Short term use -less than a month say- at an appropriate dose of your body weight is unlikely to cause toxicity. 
Having said that lithium is still potentially toxic and you should only use it if really necessary, say in a manic phase and at the minimal dose you can to achieve the effect you need.
 
The typical dose for lithium carbonate is 900 to 1800 mg per day, divided between two doses.
For lithium orotate is 150 mg per day, divided between two doses.
 
A much gentler and safer alternative to the above is a product called Lithinase.
It’s available from the US, I use the supplier www.iherb.com .
 
It is an amine no acid chelated form of lithium and each capsule provides 50 micrograms of elemental lithium. By comparison the 900 to 1800 mg of calcium carbonate used in conventional psychiatry would deliver 170 to 340 mg of elemental lithium. So even six capsules a day of Lithinase would only deliver 0.3 mg of lithium, less than a 500th of the conventional dose; a dose so low you could be mistaken for thinking it would be ineffective. However I have found Lithinase to be highly effective, even at doses less than six per day. I personally took six Lithinase per day for a while and experienced drowsiness and a numb emotionless state. I found I was able to achieve therapeutic effects with the extremely low doses of 1 to 3 capsules per day and at this dose I did not experience any unpleasant numbness. 
 
One of the really great things about the low-dose lithium derived from Lithinase is that you can start and stop it, or vary the dose as your needs dictate. This is in marked contrast to the high dose conventional lithium drugs that should not be stopped and started in the same way.
 
At this very low dose of lithium blood tests are not required, as there is no risk of toxicity. Conventional prescription lithium comes with several warnings including the importance of not becoming dehydrated and not eating a very low sodium diet, because lithium strongly antagonised sodium. 
 
The effectiveness of lithium is greatly enhanced by taking 200 mg per day of folic acid. 
Higher doses (of lithium) can cause drowsiness if taken during the day so you might try a low dose in the morning and the main dose with dinner. 
 
Even though Lithinase is only supplementing a very low dose of lithium I have still found there can be a problem with running low on sodium or becoming dehydrated. 
Take this seriously and ensure you drink adequate hydrating fluids and eat enough salt. If you do become dehydrated and feel faint the problem is you can’t just drink a lot of fluid on its own because doing so will further dilute sodium levels. In this scenario you must simultaneously rehydrate and consume sodium electrolytes. I would use a packet of instant miso soup or rehydrating electrolytes such as Dioralyte from your pharmacy or Alka-Clear by Higher Nature which can be mixed with fruit juice to produce a glucose three rehydrating electrolyte rich drink. Electrolyte mixtures can neutralise your stomachs hydrochloric acid and should not be used at the same time as consuming protein foods. Take them on an empty stomach and wait 30 minutes after drinking before eating protein to avoid indigestion. 
 
It is especially easy to become dehydrated and low in sodium during exercise particularly with long duration sports such as long-distance cycling or running and then experience awful headaches when taking Lithinase, especially if you’ve been drinking alcohol night before which dehydrates you. Avoiding this problem is very easy by consuming electrolyte drinks. I use Alka-Clear by Higher Nature, it provides magnesium, sodium and potassium. 
It is perfectly safe to consume alcohol with Lithinase, or other forms of lithium for that matter, as long as you maintain adequate hydration. Try alternating one alcoholic drink with one non-alcoholic drink such as fruit juice and water, then consume plenty fluids and electrolytes before going to bed and should have no problems at all.
 
Another great source of electrolytes and natural sodium is vegetable soup with celery or celeriac in it. Despite its inherent high sodium content celery soup contains compounds that can actually lower high blood pressure, making this a healthy choice for someone on lithium with hypertension. 
 
Lithinase can be taken just for a few days to nip a manic episode in the bud, or rebalance your sleep cycles and then stopped again. 
 
A personal anecdote of mine is that I always, quite predictably, would experience a few days of rapid cycling from depressed to hypomanic (cylomania with bipolar Type II if you’re into labels) within several days of going on holiday. With just one or two capsules per night for a few days before I am able to prevent this problem completely. Also exciting parties such as Hogmanay and the like would often induce this state and I am able to prevent this with sometimes as little as a single dose of Lithinase taken before going to sleep immediately after such a social engagement. 
 
Please let me know if you try Lithinase how you get on with it either way.
 
With trial and error it is possible to find the right dose. You want just enough to prevent insomnia or crazy sleep cycles and put a cap on your mania, but not so much that you feel ‘emotionally numb’ or drowsy during the day.


*CAUTION WITH LITHIUM:

Lithium can cause drowsiness so unless you are completely familiar with how it will affect you it is inadvisable to drive a car or do anything similar. Be safe.
You must not become dehydrated when taken lithium, drink at least 2 litres a day, see my tips on hydration on my lymph cleansing notes. 
Also you must not become depleted of sodium which the lithium antagonises. Most people’s diets are too high in sodium so this may well not be a problem, however a healthy eater may want to add a bowl of celery, celeriac or miso soup add day to prevent sodium depletion.
If you become depleted of sodium and dehydrated, say after sports, trying to re-hydrate by drinking lots of fluids will dilute you sodium so much you could collapse. The solution is if you have not eaten and drunk enough start with miso soup or even an 1/8 teaspoon salt in fruit juice. Just eat well and keep hydrated and you will be fine. 



Lithium should not be used by individuals by:-
·        With significant renal or cardiovascular diseases.
·        Who are taking diuretics or ACE inhibitors.
·        Consult your doctor before use if you are taking anti-hypertensive drugs, anti-inflammatory drugs, analgesic drugs or insulin.
·        Lithium should not be used by pregnant women and breast-feeding mothers.



Omega 3 with a high EPA content. 
At the right dose EPA has proven antidepressant properties for both unipolar and bipolar depression, for mania however results are mixed and when the results of many studies are combined together (meta analysis) EPA produced mixed results and overall does not show significant anti-mania affects, although it does appear to help moderate aggressive behaviour that is all too often exhibited during times of hyper-mania. It has been observed in some people that high doses of EPA actually make depression worse, so for example 500 mg EPA may be too little to have an antidepressant effect, 1000 mg may be just right and 1500 mg may make depression worse. The ideal dose varies from person to person and you have to experiment to find yours, usually the ideal maintenance dose is between 750-1500 mg, but it may be much higher. It has been my observation that that suddenly increasing (say doubling) the dosage of the omega-3 fish oil you take produces a sedated and sleep inducing effect and you can use this as an additional anti-mania treatment. However there may be a price to pay and that is a temporary rebound depression. Today I hardly ever use the technique of flooding the brain with omega-3 oil as an aid to controlling my bipolar mania, but before I discovered how to use darkness and virtual darkness techniques I would regularly take and excessive dose of omega-3 oils to help control my bipolar mania side and simply put up with three days of moderate depression as a side-effect.
 
I’ve also seen theories that omega-3 oils may assist the way lithium works in the body and if this does indeed turn out to be the case it may hypothetically explain why I appear to been able to obtain results with the very very low dose lithium (Lithinase ) I prescribe and take myself. Another related supplement is lecithin and its derivatives (choline, phosphatidilecholine etc.), these B vitamin like substances are used by the body and brain for the transportation and utilisation of oil molecules, think of these vitamins as a delivery service, they transport the essential EPA and DHA oils to your brain and elsewhere from our digestive system and liver. There are also studies that show high doses of supplemental lecithin or one of its derivatives choline reduces mania and can worsen depression. 
 
Let me put all of this together, I think a small daily dose of lecithin (not enough to promote depression) helps the brain use omega-3, and omega-3 helps lithium to work, so they work together as an antidepressants and anti-manic remedies. For maintenance for example I personally usually take a low dose (1/2 teaspoon) of lecithin, a miniscule dose of lithium (Lithinase 1-2 caps) and 800 mg EPA. If I become manic and need to apply the brakes I take 4 teaspoons of lecithin and 1500 mg EPA, this will flood my brain with omega-3 oils, this induces brings me down, helps sleep but typically induces a moderate depression which wears off 3 days after I stop and the EPA levels in the brain fall. Unpleasant as this is I’ve used it myself, deciding that suffering 3 days of depression was an acceptable side-effect for the anti-mania effects. Add this approach when you have to stop the mania at all costs. 
 
N.B. Omega-3 oils have to compete for absorption with other oils like omega-6 and nonessential oils like the saturated fats in meat and dairy. If you eat an unhealthy diet high in unnecessary fats you are setting up a hurdle that the omega-3 oils have to overcome and decrease their effectiveness a lot perhaps even rendering them ineffective. Minimise all oils and use only olive oil and supplements omega-3. See Omega-3 Fish Oils and Mental Health [under construction]. In fact all the effectiveness of all the remedies and techniques I use is predicated on you following a healthy diet. 
 
·        Melatonin   
Just to be clear melatonin does not in itself possess any anti-mania affects, but it can still be useful to us as a sleep aid. The correct dosage of melatonin varies considerably between individuals (typically between 0.3 to 5 mg) and you need to experiment to establish what dosage produces a strong sleep affect without simultaneously producing nightmares for you. Lower dose tablets and capsules are more useful and flexible than single high-dose pills. With very low dose products you can take additional doses if you wake up prematurely as many times as is needed to stay asleep, this is helpful for times when you want to do extended total darkness therapy.
 
·        L-tryptophan. 
Like melatonin, tryptophan does not have anti-mania affects however it can be a useful natural sleep aid.
Dosage: 1000-2000 (up to 3000) mg L-tryptophan taken 40 minutes before or two and half hours after dinner, will help induced sleep. Tryptophan firstly produces an antidepressant effect by increasing serotonin levels, but after dark serotonin is converted into melatonin and aids increased sleep.
 
Tryptophan > 5HTP > Serotonin > Melatonin
Serotonin is a calming or inhibitory neurotransmitter and unlike other antidepressants I have never known tryptophan to encourage the manic state.   
Caution do not take L-tryptophan if you are currently taking prescription antidepressants.
 
 
Managing Bipolar Sleep Cycles
 
There is mounting evidence suggesting that the genes that control our circadian rhythms are also involved in bipolar disorder. A model is emerging that a genetic variation in people with bipolar syndrome results in an abnormality in the suprachiasmatic nucleus’s’ ability to regulate the circadian rhythm and this has a wider impacts than previously understood, affecting serotonin and dopamine circuitry elsewhere in the brain, adversely affecting mood regulation. If this turns out to be an accurate model it may suggest that targeting sleep wake-cycles goes to the heart of the treating the bipolar condition.
 
 
Sleep disturbances almost always are part of the symptom picture or bipolar syndrome. It’s hard to emphasise strongly enough the importance of regulating ones sleep cycles in bipolar syndrome. Some medics consider sleep disorders to be a symptom of bipolar syndrome, others to be a separate cause or contributing disorder; either way lack of sleep badly affects your mood and contributes to mania. Whatever the cause of sleep deprivation, be it from shift work, independent insomnia or sleep cycle disorders etc. the highly strung-out state sleep deprivation can cause may worsen or even kick-start a manic episode. Not only may sleep deprivation kick-start a manic episode but it may be responsible for the psychotic symptoms associated with extreme mania. It has been observed from experiments and torture that severe sleep deprivation can induce psychotic states even in healthy subjects. In fact the effects of severe sleep deprivation can be so harmful that sleep deprivation experiments are no longer permitted in humans. I believe that sleep deprivation will not only worsen but may sometimes be the primary cause of the psychotic states that can occur with severe mania. Controlling sleep and eliminating this risk factor should therefore be given a central place in your recovery programme. 
 
Changes in your sleep-wake cycle can also be read as an early warning signal that you may be heading towards or already in a manic phase and running on lack of sleep for longer than a few days should be taken very seriously by anyone with a history of bipolar syndrome. 
 
Just to emphasise the point let me repeat it:Changes to your sleep-wake cycle should be a warning that you may be heading towards or are already in a manic episode. 
Getting too little sleep may bring on a manic episode or intensify a manic episode even inducing or intensifying psychotic symptoms such as delusional thinking, paranoia etc.  
Take this stuff seriously, for example if you stayed up all night with insomnia it may be better to phone in to work sick and sleep the whole day than go to work without sleep and end up manic by the end of the week, resulting in more time off work in the long run. 
 
I now see sleep disorders within bipolar syndrome in a completely different light. Rather than being an annoying symptom and sideshow, correcting sleep disorders can be so helpful at controlling the intensity and consequences of bipolar syndrome that I now see it as an opportunity to manage and improve the condition. 
Don’t just target the bipolar syndrome and hope your sleep cycle will sort itself out, target your sleep cycles directly as part of your treatment to manage bipolar syndrome. 
 
MOVE TO BIPOLAR
With bipolar syndrome it’s so important to avoid lack of sleep. During the manic phase of bipolar syndrome it is common to go for long periods of time with little or no sleep. Lack of sleep quickly diminishes the functional capacity of the frontal lobes of the brain that give us rational thought and control; this diminishes our capacity to inhibit impulsive behaviour. Alcohol also diminishes the functional capacity of the inhibiting (sensible) lobes. With less control one becomes more impulsive, agree, emotional and likely to make bad decisions.
 
During a manic phase the rational sensible part of the brain may be barely able to hold you back from carrying out bad, reckless and crazy behaviour. It may be the last line of defence left in the mind against every other part of you telling you that some crazy or reckless behaviour is an absolutely fantastic idea.   Lack of sleep will only worsen the risks of a manic phase turning bad, if you’ve had destructive mania in the past treat lack of sleep swiftly and aggressively. Knock yourself out with whatever works for you, max out on the natural sleep remedies or drugs if you need to, shut yourself in a totally dark room and sleep. Sleep for days if you have to, but that’s going to be rarely necessary. Stay away from bright light/sunshine, or wear sunglasses, (take vitamin D3 on days you don’t get any sunshine on your body). 
The trouble with using sleeping pills to do this is that many people find they become dependent upon them to get any sleep at all and often the sleeping pills stop working very well either.
 
This carries with it the very real risk of inducing psychotic symptoms. It is possible to induce psychotic symptoms in an otherwise healthy person just through sleep deprivation, but adding psychotic symptoms to hyper-mania is like jumping out of the frying pan into the fire. When you are hypomanic you must force yourself to sleep at least seven hours a day whatever it takes. 
 
 
REFERENCES
Montgomery et al 2003. Reduction of brain dopamine concentration with dietary tyrosine plus phenylalanine depletion: an [11C]raclopride PET study. American Journal of psychiatry 2003 October, 106 (10): 1887-9.
 
How to Treat an Acute Hyper-Manic Crisis
If you or someone you care for has a history of hyper-manic states I recommend keeping the following remedies at home ready for immediate use during a crisis. 
Store remedies in a dark cool cupboard, replacing them when they run out of date. In the middle of a crisis you don't want to be fumbling around to try to find the prescription, so I recommend writing down the dosages on a piece of card and keeping it with the remedies or some similar arrangement.
 
May I remind you that if you choose to not use conventional pharmaceutical medicine and instead or simultaneously take alternative remedies you are entirely responsible for the consequences of your decision. 
 
When extreme the manic state can be very destructive driving you to pursue risky, destructive and expensive behaviours with a diminished or non-existent capacity to sensibly assess the risks of what you are doing. This mental state must brought under control quickly and aggressively, if you are unable to gain at least significant control of the condition within say 48 hours of commencing the remedies below it may be time to bring out the big guns i.e. pharmaceuticals.
 
Hyper-Mania Crisis Prescription:-
 
You can get all the above remedies except Lithinase and L-tryptophan from:
www.nutricentre.com
and the rest from:
www.iherb.com
Putting It All Together
 
Managing the hypo-mania in bipolar type II when it becomes excessive should be doable by most people with these techniques, however managing the extreme hyper-mania in bipolar type I especially when it comes on very quickly with virtually little or no warning is very challenging. Let’s not forget that managing this type of bipolar syndrome is challenging even with conventional therapies, all too often the body adapts to the medication, or the symptom picture of changes, the ongoing side-effects become too intolerable and the person wants to take a break from their medication. 
 
If you’re interested in the scientific evidence for the use of darkness therapy I refer you to the excellent site on bipolar syndrome that first introduced me to this useful novel technique:http://www.psycheducation.org/index.html



 
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Hi my name is Peter Smith I specialise in treating and coaching people how to live well with mental health problems, digestive health problems/IBS, sleep problems and type II diabetes using natural therapies.
I used these techniques to overcome and live well with my own bipolar disorder and IBS. I've been in practice as a natural medicine practitioner since 1988.
 

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