Bipolar disorder is characterised by episodes of deep depression followed by mania. The set of symptoms and their severity varies considerably from person to person, and in many cases, the person may not have any symptoms for long periods of time. No one knows the cause(s) of bipolar disorder although it is thought to be an interaction between multiple genes and the environment. Common triggers include using cannabis or other illegal drugs, tobacco, alcohol, taking drugs not prescribed for you, staying up all night, lack of regular and adequate sleep, poor diet and higher levels of stress.
The name ‘bipolar disorder’ has come to replace the name ‘manic depression’.In bipolar symptoms vary between two poles, mania being one and depression being the other. Usually, when symptoms are severe enough to cause problems in the person’s life, work or relationships, the person is said to be in an ‘episode’ of depression or an ‘episode’ of mania. Some psychiatrists call these episodes ‘states’, as in manic state or depressive state. Individuals with bipolar have been indicated to have poorer diets, and also be at a higher risk of developing type II diabetes and becoming obese (Beyer and Payne, 2015).
Symptoms of depression include:
- Feelings of sadness;
- Loss of interest in things that used to give pleasure;
- Difficulty sleeping or sleeping too much: eating too little or too much;
- Losing or gaining weight quickly and
- Extreme feelings of guilt.
Symptoms of mania include:
- Feeling very good and powerful, and special and important;
- Inability to sleep or needing very little sleep;
- Planning or starting many new projects;
- Racing ideas and thoughts where one thought flows into another quickly and this then leads to another and another;
- Speaking very quickly and continuously;
- Being involved in activities which may lead to problems, such as spending a lot of money or making financial decisions about large amounts of money or gambling or engaging in risky or inappropriate sexual activities.
The set of symptoms and their severity varies considerably from person to person, and in many cases, the person may not have any symptoms for long periods of time.
For a diagnosis of bipolar disorder, psychiatrists look for certain symptoms occurring over certain periods of time. Many people with bipolar disorder go to the doctor when they have symptoms of depression rather than when they have symptoms of mania. This is one reason that so many people with bipolar disorder report being diagnosed first with clinical depression instead of bipolar disorder. The symptoms of clinical depression and bipolar depression can be very similar. Often, some time goes by until the doctor, the patient or others notice that the person is showing symptoms of mania in addition to the depressive symptoms. For some people, use of antidepressant drugs and/or stimulants can be linked to the onset of manic symptoms.
Although symptoms of mania get the most attention and the most research, the newest studies about the long-term life course of people with bipolar disorder suggest that people with bipolar disorder actually spend much more time in a depressive episode than in a manic episode (time spent depressed is 2 or 3 times more common than that spent in a manic state).
Conventional treatment of bipolar disorder typically involves the long-term use of mood-stabilisers such as lithium or anti-depressants.
What causes Bipolar Disorder?
No one knows the cause (or causes) of bipolar disorder. In general, it is true to say that researchers believe that bipolar disorder, like almost all illnesses, results from interactions of ‘genes’ and the ‘environment’. The latest information from researchers about genes suggests that there is NOT one gene that causes all the symptoms of bipolar disorder. Rather it is the interaction of many genes, all contributing small effects and all interacting with the ‘environment’. The ‘environment’ includes the physical environment (food, pollutants etc) as well as psychological, social and cultural influences.
While the causes of bipolar disorder are not known, the triggers for symptoms and episodes have been studied more thoroughly. There are many possible triggers for episodes in different people. Some of the research shows that common triggers are: using cannabis or other illegal drugs, tobacco, alcohol, taking drugs not prescribed for you, staying up all night, lack of regular and adequate sleep, poor diet and higher levels of stress. The problem of sleep is an important and common one in bipolar disorder. Sleep problems may vary and can include problems going to sleep, staying asleep, waking up very early before light or in the middle of the night, waking up many times during the night, sleeping during the day for long periods.
People who have unusual job schedules (like shift work or work starting at different times of the day on various days) may also have problems adjusting to these stressors.
Nutrition and Bipolar Disorder
Increase your omega-3 fats
The richest dietary source is from fish, specifically carnivorous cold water fish, such as salmon, mackerel and herring. Surveys have shown that the more fish the population of a country eats the lower is their incidence of depression. In one study estimating the various illnesses linked with low levels of omega-3 fatty acids, bipolar disorder came out on top as the number one illness most associated with lack of omega-3 essential fatty acids.
There have been six double-blind placebo controlled trials of omega-3s and depression to date, five of which show significant improvement. The first trial by Dr Andrew Stoll from Harvard Medical School, published in the Archives of General Psychiatry, gave 40 depressed patients either omega-3 supplements versus placebo and found a highly significant improvement. The next, published in the American Journal of Psychiatry, tested the effects of giving twenty people suffering from severe depression, who were already on anti-depressants but still depressed, a highly concentrated form of omega-3 fat, called ethyl-EPA versus a placebo. By the third week the depressed patients were showing major improvement in their mood, while those on placebo were not. The latest trial by Dr Sophia Frangou from the Institute of Psychiatry in London gave a concentrated form of EPA, versus placebo, to 26 depressed people with bipolar disorder and again found a significant improvement. This may be because omega-3s help to build your brain’s neuronal connections, as well as the receptor sites for neurotransmitters. Therefore, the more omega-3s in your blood, the more serotonin you are likely to make and the more responsive you become to its effects.
Where’s the evidence? Search our evidence database for a list of scientific studies on omega 3, bipolar and depression.
Side effects? In some earlier studies which gave 14 fish oil capsules a day mild gastrointestinal discomfort, mainly loose bowels. However, nowadays you can buy more concentrated EPA rich fish oils so the amount of actual fish oil required is less. Supplementing fish oils also reduces risk for heart disease, reduces arthritic pain and may improve memory and concentration.
Key Action:
Eat fish at least twice a week, seeds on most days and supplementing omega 3 fish oils. Look for a supplement that contains EPA, DHA and GLA.
The best fish for EPA, the type of omega 3 fat that’s been most thoroughly researched are: mackerel (1,400mg per 100g/3oz), herring/kipper (1,000mg), sardines (1,000mg), fresh (not tinned) tuna (900mg), anchovy (900mg), salmon(800mg), trout (500mg). Tuna, being high in mercury is best eaten not more than twice a month.
The best seeds are flax seeds and pumpkin seeds. Flax seeds are so small they are best ground and sprinkled on cereal. Alternatively, use flax seed oil, for example in salad dressings. While technically providing omega 3 only about 5% of the type of omega 3 (alpha linolenic acid) in these seeds is converted in your body into EPA.
Balance your blood sugar
There is a direct link between mood and blood sugar balance. All carbohydrate foods are broken down into glucose and your brain runs on glucose. The more uneven your blood sugar supply the more uneven your mood.
Eating lots of sugar is going to give you sudden peaks and troughs in the amount of glucose in your blood; symptoms that this is going on include fatigue, irritability, dizziness, insomnia, excessive sweating (especially at night), poor concentration and forgetfulness, excessive thirst, depression and crying spells, digestive disturbances and blurred vision. Since the brain depends on an even supply of glucose it is no surprise to find that sugar has been implicated in aggressive behaviour, anxiety, and depression, and fatigue.
Lots of refined sugar and refined carbohydrates (meaning white bread, pasta, rice and most processed foods,) is also linked with depression because these foods not only supply very little in the way of nutrients but they also use up the mood enhancing B vitamins; turning each teaspoon of sugar into energy needs B vitamins. Sugar also uses up other important nutrients.
The best way to keep your blood sugar level even is to eat what is called a low Glycemic Load (GL) diet and avoid, as much as you can, refined sugar and refined foods, eating instead whole foods, fruits, vegetables, and regular meals. Caffeine also has a direct effect on your blood sugar and your mood and is best kept to a minimum, as is alcohol.
Where’s the evidence? Search our evidence database for a list of scientific studies on sugar, caffeine and bipolar.
Side effects? If you are diabetic and taking medication to help your blood glucose control, you should keep a close eye on your blood glucose levels as your need for medication may reduce.
Key Action:
Cut out sugar and all sources of sugar. Eat only unrefined carbohydrates and ensure these are combined with protein and plenty of fibre to further slow the sugar release. Avoid stimulants, even apparently ‘natural’ ones.
Up your magnesium
Magnesium is a mineral that helps maintain normal muscle and nerve function, keep heart rhythm steady, support a healthy immune system and keep bones strong. Some indications of deficiency of magnesium are: muscle tremors or spasm, muscle weakness, insomnia or nervousness, high blood pressure, irregular heartbeat, constipation, fits or convulsions, hyperactivity, depression, confusion and lack of appetite. Magnesium is interesting in bipolar disorder because of its chemical similarity to lithium (lithium being the drug most commonly used as a mood stabiliser). In fact, there is some evidence that the drug lithium may attach to the places inside the cell where magnesium is supposed to attach. In studies (Chouinard, Giannini), some people with bipolar disorder or other psychiatric illnesses had differences in the amounts of magnesium in their blood. There have been some studies where magnesium was added to other treatments to stop symptoms of mania or rapid cycling. Magnesium can block the entry of too much calcium into cells (it is a natural calcium channel blocker) which may explain why it is helpful with some symptoms of illnesses. Magnesium’s role in supporting good sleep may also be quite important here, since many people with bipolar disorder experience increasingly poor sleep patterns preceding a manic episode.
Key Action:
Foods high in magnesium are: whole grains, legumes and especially dark green leafy vegetables. Pumpkin seeds and salmon also have magnesium. It is worth supplementing magnesium, particularly if you have some of the other indications of insufficiency. Try 400mg daily. Magnesium works in conjunction with many other nutrients so an all-round multi-vitamin and mineral formula is a good idea.
Avoid or reduce caffeine, sugar, refined carbohydrates and alcohol
Eat a diet that will stabilise your blood sugar (known as a Low GL diet). This means avoiding sugar and refined carbohydrates, eating at regular intervals, including protein with every meal and snack.
Key Action:
Keep alcohol to a minimum, for example, one unit per day, three to four times per week.
Avoid strong stimulants such as coffee, tea and energy drinks and drink mild stimulants such as green tea only occasionally.
References
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