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Bipolar? Need Advice.
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I had my first visit with a psychiatrist today, and was underwhelmed with her for several reasons. After the list of questions she went through, and the issues she highlighted and asked me to elaborate on, I wasn't surprised when she dx'd bipolar. She seems to think I've had bpII my whole life. I do have a strong family history of mental illness, and I've actually been out of work for almost 2 months because of anxiety and depression.

The doc wants me to start taking Lamictal ASAP. Why did this rx not surprise me, after I saw promo materials for the stuff all over her desk? Hm...

I do NOT like drugs of any kind, and this stuff is expensive (even the generic) and has some nasty side effects. But I do need to do something. I really can't continue like I am. I need to go back to work and I need to be stable for my family.

We've established a clear connection with gluten and my son's behavior, however I haven't see much improvement in my mood since we went gluten-free. I have had a HUGE improvement in my arthritis symptoms, but I'm having MORE GI symptoms (which I never really had before) and my moods are still pretty erratic. I do notice a distinct feeling of either gloom or anxiety or both if I eat gluten, plus I seem to have DH, and I did the iodine test so I'm still feeling like it's likely Celiac. At any rate, I won't let gluten into my house after I've seen how DS and DH react to it now. It's literally like poison to them.

I'm still eating dairy, we've increased corn quite a bit, small increase in rice, and I do use some of the baking mixes from time to time (we have pancakes about once a week.) Otherwise we usually eat whole foods - I try to make meals that consist of a meat, starch and green veggie, plus sometimes fruit.

I must be missing something. Should I try eliminating corn or dairy? Should I supplement? What supps would be indicated here?

I'm currently on short-term disability because of my anxiety and depression. They (the insurance company) want me back at work, and the doc seems to think meds are the quickest way to get me back to work, and back to normal (whatever that is.) The doc wants me to do a thyroid panel. At this point (gluten-free for 2+ months) there would be no point in trying to test for Celiac, right? I'm wondering, if I could actually present a diagnosis, if they'd let me work on healing and supplementing rather than medicating. (and by "let me" I mean, continue to approve my disability and continue paying me.)

Lastly... is medication the answer until I heal? Should I just get on the meds and work from there?

Please help me sort this out!

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I was bipolar. Gluten gave me depression, I was not diagnosed celiac and treated with SSRIs, and the SSRIs started causing manic episodes. I've been on a laundry list of psych meds including Lamictal. It didn't do much. None of the meds did much, as gluten was part of the underlying problem. I still get anxious and tired if I'm glutened.

Gluten-free was not enough to fix my mood though. I think the years of malabsorptoin and SSRIs caused permanent damage. After a year gluten-free, I finally gave up in the midst of a horrible mixed manic episode, took a huge risk, went off all my meds and onto a supplement called EMPowerPlus. It is expensive, but I was paying almost as much if not more for the lamictal, lithium, trazodone, and shrink visit copays. My psychiatrist watched me to be sure I stayed safe.

I started on EMPowerPlus in early summer and by early fall, all the depression had lifted and my mind cleared. I had the energy to pick up a consulting job while I was finishing school, and affording it stopped being an issue. EMPowerPlus is a high potency nutritional supplement, chelated in a way that is supposed to target it to the central nervous system. A naturopathic psychiatrist told me about it, and she was not getting comparable results with more typical supplements. Starting on it can be a rough ride if you go off meds and onto the full dose as I did, but it interacts oddly with meds and I didn't want to risk a severe depression tapering on. You may be able to taper on more gradually.

I'm still on EMPowerPlus. Whenever I try to taper off it, I start getting insomnia and depression so I know it's still stabilizing my mood. You can get it from http://www.truehope.com.

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I am one who also would refuse drugs. I know they aren't the right answer. But everyone is different in their personal beliefs, and I think it would be ill-advised to simply take anyone's word on the issue, even that of a doctor. Having multiple opinions and perspectives should be helpful.

That said, I can attest to the value of supplements on neurological functioning. At least for me, they were the right answer. The sublingual methylcobalamin (active form of vitamin B12) and magnesium have done wonders for so many aspect of my health, as has the multivitamin. I therefore recommend these to anyone suffering from the sorts of problems you describe.

Anyway, I'd have to say, try avoiding dairy. Many on this board have found it to be quite problematic. In fact, I'd recommend avoiding all the top allergens, which include not just wheat and dairy, but soy, corn, eggs, tree nuts, peanuts, and shellfish. There may be other foods which trigger your symptoms though, so you might try keeping a food journal, to track what you eat and how you feel throughout each day.

The supplement Skylark mentioned also sounds worth looking into.

Some other things which are known to cause neurological problems include artificial sweeteners and MSG, food dyes, yeasts and molds, and even fumes from household chemicals, and products such as upholstery and carpeting. One of the benefits of magnesium is that it helps reinforce the blood/brain barrier, thus reducing the effects of neurotoxic compounds.

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First off, it's perfectly okay to go on medication! I'm like you, I'm not keen on it, and I never took it, but I also didn't have to deal with being a parent, spouse, getting the bipolar diagnoses, and trying to go gluten free all at once. You've got a LOT on your plate. If the meds help even you out and get you through the worst of it, then you should try them. You can always go off them later once you feel like you've got more things under control.

Like others, I've noticed my mood swings have tapered off since going gluten free. However, I'm still at risk for major mood episodes. One thing about being bipolar is that you have to learn a lot--there are lifestyle changes you have to go through to keep yourself healthy. It's not as in-depth as going gluten free--but there's a whole range of topics you'll need to address and understand--like what your mood triggers are, what changes you can make to minimize them, what your earliest warning signs of a mood episode are, what to eat and do to stay healthy, what behavior, cognitive, and physical exercises you can do to limit your chances of another major episode.

You should pick up a book, like "Taking Charge of Bipolar Disorder," something that gives you a comprehensive approach to dealing with it.

Now, all that said, you've only been gluten-free for a couple of months. Your intestines are still healing--the bloating and so forth is likely secondary intolerances popping up. Generally, six months is the minimum for intestinal damage to reverse itself. I felt my moods soften out within a couple of months, but I was still making improvements afterward too.

If I were, I'd strongly consider the medication to get over the hump of all of this happening at once--to get yourself functional and more able to deal with things. In the meantime, your intestine will sort themselves out--it's

not a choice between medication and healing--your body can do both at once, and you absolutely need to be educating yourself about bipolar disorder and dealing with it, so that if you do go off the medications (or don't go on them) you'll have everything you need already in place to deal with that.

As for supplements--for the moods definitely take flax seed or fish oil.

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You may want to ask if you can try one of the older meds first. IMHO doctors push the newer meds to often and they often have risks that are not even known yet. There is also nothing wrong with trying supplements and behavioral therapy for a time first while the gluten reaction gets out of your system.

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Thanks for responding Skylark. I've seen you talk about bipolar and I was hoping you'd provide your insight. :)

I'm not currently on any meds, is EPP effective enough to start on it and expect results fairly quickly? With the Lamictal it's basically a 30+ day ramping up process, with me watching out for a rash, and side effects which include anxiety and depression. (srsly??)

So is the EPP itself a chelator? Should I expect detox symptoms?

Interestingly when I googled the EPP, a local naturopathic doctor that a friend highly recommends came up as a retailer. Unfortunately I'd have to pay out of pocket to see him but I'm leaning towards it.

About testing for Celiac - are there any tests that will bring a positive after I've been gluten-free for 2+ months? My DH rash has been clear for a couple weeks now, but is even one lesion is enough to biopsy? I've mentioned on here before that I really do not care about a diagnosis for myself. I see the effect gluten has on my son and me and that's enough for me. However if it will help with my leave situation I could definitely pursue it.

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Thanks RiceGuy. Your input is also very valuable. :)

We moved into a house with brand new carpeting (installed about 2 weeks before we moved in and man it stank!) but my depression predates the move by quite a bit. The anxiety did kick in full force about 6 weeks after we moved though. I avoid msg and artificial sweeteners like the poisons they are. I recognized a very profound effect on my mood from aspartame many years ago and cut my diet coke habit quickly. :)

I was hoping/afraid someone would say to go off dairy and other allergens lol. I love my ice cream and we eat a lot of cheese around here.

So, mag & b12 + a multi might be a good place to start if I can't get the EPP right away?

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Thanks starrytrekchic! One of my big concerns here is the risks associated with quitting a med once I've started.

This whole "bipolar" concept is new and a really big blow. I'm just not sure about it... both my mom and hubby agree that I fit the profile, but I'm having some trouble embracing it. I'm almost going through a grieving process (which isn't helping my mood.)

I'll definitely check out that book.

Fish oil - ok add that one to the list. :)

I've read varying things about dosage on omega3 for mental health. One midwife I saw recommended up to 20k mg per day for post-partum depression, but taking TWENTY of those huge pills each day is not fun. The most I can usually manage is 5-6 (though I suppose I could do that 3-4x per day, but ugh.)

First off, it's perfectly okay to go on medication! I'm like you, I'm not keen on it, and I never took it, but I also didn't have to deal with being a parent, spouse, getting the bipolar diagnoses, and trying to go gluten free all at once. You've got a LOT on your plate. If the meds help even you out and get you through the worst of it, then you should try them. You can always go off them later once you feel like you've got more things under control.

Like others, I've noticed my mood swings have tapered off since going gluten free. However, I'm still at risk for major mood episodes. One thing about being bipolar is that you have to learn a lot--there are lifestyle changes you have to go through to keep yourself healthy. It's not as in-depth as going gluten free--but there's a whole range of topics you'll need to address and understand--like what your mood triggers are, what changes you can make to minimize them, what your earliest warning signs of a mood episode are, what to eat and do to stay healthy, what behavior, cognitive, and physical exercises you can do to limit your chances of another major episode.

You should pick up a book, like "Taking Charge of Bipolar Disorder," something that gives you a comprehensive approach to dealing with it.

Now, all that said, you've only been gluten-free for a couple of months. Your intestines are still healing--the bloating and so forth is likely secondary intolerances popping up. Generally, six months is the minimum for intestinal damage to reverse itself. I felt my moods soften out within a couple of months, but I was still making improvements afterward too.

If I were, I'd strongly consider the medication to get over the hump of all of this happening at once--to get yourself functional and more able to deal with things. In the meantime, your intestine will sort themselves out--it's

not a choice between medication and healing--your body can do both at once, and you absolutely need to be educating yourself about bipolar disorder and dealing with it, so that if you do go off the medications (or don't go on them) you'll have everything you need already in place to deal with that.

As for supplements--for the moods definitely take flax seed or fish oil.

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You may want to ask if you can try one of the older meds first. IMHO doctors push the newer meds to often and they often have risks that are not even known yet. There is also nothing wrong with trying supplements and behavioral therapy for a time first while the gluten reaction gets out of your system.

What are some of the older meds? I know of Lithium, but that's the only one I'm familiar with. The doc mentioned a few even newer meds but mentioned that since I've only ever taken Celexa that Lamictal would probably work well.

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I also noticed that the pdoc really wasn't impressed by my thoughts on gluten. She asked me why we went off gluten and then as I was explaining my reasoning, she interrupted me at one point and said "You're jumping around a lot here." Um, no I'm explaining a history that led to my eliminating gluten 2 months ago...

I would love to find a pdoc who would actually appreciate the implications of diet and nutrition on my mental state...

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I was hoping/afraid someone would say to go off dairy and other allergens lol. I love my ice cream and we eat a lot of cheese around here.

So, mag & b12 + a multi might be a good place to start if I can't get the EPP right away?

You won't have to give up ice cream. Just the ones made with dairy. Try coconut milk ice cream, such as Purely Decadent or Coconut Bliss.

The supplements are something you can begin right away. Whether you'll still need them if you start the EPP may depend on what that product contains, and what you're deficient in.

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I also noticed that the pdoc really wasn't impressed by my thoughts on gluten. She asked me why we went off gluten and then as I was explaining my reasoning, she interrupted me at one point and said "You're jumping around a lot here." Um, no I'm explaining a history that led to my eliminating gluten 2 months ago...

I would love to find a pdoc who would actually appreciate the implications of diet and nutrition on my mental state...

Naturopathic shrinks can be really good about that. My HMO shrinks just shook their heads and didn't know what to make of my fairly impressive recovery. They were happy for me and asked for info on Truehope. LOL! Oh, by the way take extra fish oil if you're feeling a little manic. That's the one tip I got from an MD/PhD shrink that was long-term useful.

The EMPowerPlus can do odd things when you start abruptly on it. It seems to be quite active and it's not like taking a normal vitamin pill. TrueHope has a call center that can help you get going. If you start on the full dose without tapering, there seems to be a cortisol spike (I tried to get a grant to study this but no luck). The cortisol can actually make you feel more emotional, some people get flus or colds, and others have trouble with candida. Truehope sells phosphatidyl choline to take at first, as it helps with the cortisol. In a couple months your body normalizes again and you feel a lot better in general. I was a mess getting started, as I was detoxing from meds and ended up with candida problems on top of it all. I felt flat-out awful for probably three months because I cross-tapered off meds and onto EMPowerPlus as fast as I could for fear of an untreated depressive episode. I stuck to it with encouragement from my naturopathic psychiatrist friend and it was SO worthwhile!

Typical response time once you're onto the loading dose of 15 capsules a day is 4-8 weeks. (Yes, with that and the fish oil I take gobs of pills. It still beats lithium/lamictal.) I very strongly recommend you taper onto the loading dose unless you're suicidal and need the EMPowerPlus to kick in fast. That means you're looking at a couple months at least to feel better. If you prefer not to visit the naturopathic doctor, call the Truehope call center and ask them how to taper on to minimize side effects. The people in the call center are kind and very experienced in getting people stable on EMPowerPlus.

In general, psych meds will kick in faster but if EMPowerPlus works for you, you will feel better on the EMPowerPlus. Psych meds are like a mental straight jacket. You're not having mood swings, but you're brain fogged, slightly stoned, and don't always feel completely engaged in life. That's why bipolars are always trying to go off their meds. It's not that we like mania, it's that the meds are awful. Really. On EMPowerPlus I just feel like myself, without all the mood problems and irritability. My family says it changed my personality, making me friendlier, more relaxed, and much better company. For me, it has been a real "cure" for the bipolar.

I hope this helps. It's turning into a wall of text. If you're seriously considering EMPowerPlus and need help beyond what you can get from Truehope, feel free to PM me.

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What are some of the older meds? I know of Lithium, but that's the only one I'm familiar with. The doc mentioned a few even newer meds but mentioned that since I've only ever taken Celexa that Lamictal would probably work well.

Older meds = lithium, possibly with depakote

Lithium is a very good medicine, probably still the best we have for bipolar in people who tolerate it well. Doctors don't use it much these days because people complain about the blood draws to monitor levels. It is not without side effects, but the anticonvulsants have side effects too and the antipsychotics carry a small but scary risk of tardive dyskinesia.

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The supplements are something you can begin right away. Whether you'll still need them if you start the EPP may depend on what that product contains, and what you're deficient in.

EPP has lots of soluble vitamins, and they've balanced the calcium, phosphate, and magnesium pretty carefully. The thing it has that's unusual is a lot of Ashmead chelates of trace elements. It's a little light on A and D for safety reasons and my doctor prescribed 2000 IU of Vitamin D along with the EPP. If you're thinking celiacs need extra B12, the loading dose has 900ug of cyanocobalamin so there is room to take a methylcobalamin sublingual. Some people also need methylfolate, as EPP has only normal folate.

If you can't get EPP right away (or don't choose to try it) a good multi with trace elements, Solgar's methylfolate, sublingual B12 and some D in a gelcap wouldn't be a bad place to start.

Methylfolate because some people cannot process folate into the active form and it can cause psych symptoms in those folks.

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I also noticed that the pdoc really wasn't impressed by my thoughts on gluten. She asked me why we went off gluten and then as I was explaining my reasoning, she interrupted me at one point and said "You're jumping around a lot here." Um, no I'm explaining a history that led to my eliminating gluten 2 months ago...

I would love to find a pdoc who would actually appreciate the implications of diet and nutrition on my mental state...

Good luck finding a psychiatrist who understands that celiac can impact us psychologically. Here are a couple articles to share with the psychiatrist. Whether she will read them and then do some more research I can't say. But celiac can definately be a direct cause of mental illness and many times, but not always, those psychiatric disorders will resolve or become much more controlable with strict adherence to the diet and vitamin supplementation. If you do a search using neurological and celiac or bipolar and celiac I am sure you will find many more articles. I have inclosed a link to a couple of abstracts that are on Pubmed (NIH articles). I have educated my own psychiatrist and therapist who now often screen some patients that have both GI symptoms and psychological issues. The bold was added by me.

http://www.ncbi.nlm.nih.gov/pubmed/12298186

Psychiatric symptoms and psychological behavioral pathologies are common in patients with untreated coeliac disease. There are several case reports of coexistence of coeliac sprue and depression, schizophrenia and anxiety. Views on association between coeliac disease and psychiatric disturbances and results of the most important studies are discussed. Biological background is referred. Malabsorption and deficiency of aminoacids and vitamins implicate reduction of synthesis of neurotransmitters in the central nervous system. Psychiatric symptoms could also be linked to immunological disregulation in coeliac patients. Psychological pathologies do appear in treated and untreated coeliacs, the need of psychological support is stressed. Coeliac disease should be taken into consideration in patients with psychiatric disorders, particularly if they are not responsive to psychopharmacological therapy, because withdrawal of gluten from the diet usually results in disappearance of symptoms. In recent years, an increased incidence of subclinical/silent coeliac disease has been reported. Psychiatric symptoms and psychological behavioral pathologies could be the only clinical manifestation of coeliac disease, but the epidemiological aspects need further investigation.

http://www.ncbi.nlm.nih.gov/pubmed/18431064?dopt=AbstractPlus

Several extraintestinal clinical manifestations have been reported in celiac disease (celiac disease). Among them, growing evidence suggests the association between celiac disease and affective and psychiatric disorders. In this review the most frequent affective and psychiatric disorders associated with celiac disease and the possible mechanisms involved in these associations were analyzed. The available data suggest that screening for celiac disease in patients with affective and/or psychiatric symptoms may be useful since these disorders could be the expression of an organic disease rather than primary psychiatric illnesses

http://www.ncbi.nlm.nih.gov/pubmed/16922014

CONCLUSION: These cases represent atypical forms of celiac disease manifested in childhood only by neuropsychological disorders. To make an early diagnosis and to improve the disease prognosis, the literature and our clinic experience shown that is useful screen the celiac disease in all patients with neuropsychological disorders such as epileptics foci in the parietal-occipital region and/or occipital calcification, headache (mostly if there isn't familiarity), spinocerebellar ataxia, neuromuscular disease of unknown aetiology, Down syndrome, behavioural disorders and some psychiatric troubles.

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Wow. Again thanks for so much info Skylark. I'm feeling a bit overwhelmed by it all. (In a good way.) :)

Off to ponder...

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I'm happy to offer whatever I know that can help you. Bipolar is pretty awful, but you can beat it. Whatever direction you choose, I wish you the best of luck.

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I want to try to do things more naturally but I need immediate relief, so I decided to start on the lamictal. I took my first 25mg dose this evening, and noticed an almost immediate improvement in my mood.

Hopefully once I maintain a stable mood I can head in a different direction.

I did also start taking magnesium, b12, a multi-vitamin, D and fish oil. I plan to quit dairy, but I need to wean myself off of it.

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Good luck finding a psychiatrist who understands that celiac can impact us psychologically. Here are a couple articles to share with the psychiatrist. Whether she will read them and then do some more research I can't say. But celiac can definately be a direct cause of mental illness and many times, but not always, those psychiatric disorders will resolve or become much more controlable with strict adherence to the diet and vitamin supplementation. If you do a search using neurological and celiac or bipolar and celiac I am sure you will find many more articles. I have inclosed a link to a couple of abstracts that are on Pubmed (NIH articles). I have educated my own psychiatrist and therapist who now often screen some patients that have both GI symptoms and psychological issues. The bold was added by me.

http://www.ncbi.nlm....pubmed/12298186

Psychiatric symptoms and psychological behavioral pathologies are common in patients with untreated coeliac disease. There are several case reports of coexistence of coeliac sprue and depression, schizophrenia and anxiety. Views on association between coeliac disease and psychiatric disturbances and results of the most important studies are discussed. Biological background is referred. Malabsorption and deficiency of aminoacids and vitamins implicate reduction of synthesis of neurotransmitters in the central nervous system. Psychiatric symptoms could also be linked to immunological disregulation in coeliac patients. Psychological pathologies do appear in treated and untreated coeliacs, the need of psychological support is stressed. Coeliac disease should be taken into consideration in patients with psychiatric disorders, particularly if they are not responsive to psychopharmacological therapy, because withdrawal of gluten from the diet usually results in disappearance of symptoms. In recent years, an increased incidence of subclinical/silent coeliac disease has been reported. Psychiatric symptoms and psychological behavioral pathologies could be the only clinical manifestation of coeliac disease, but the epidemiological aspects need further investigation.

http://www.ncbi.nlm....pt=AbstractPlus

Several extraintestinal clinical manifestations have been reported in celiac disease (celiac disease). Among them, growing evidence suggests the association between celiac disease and affective and psychiatric disorders. In this review the most frequent affective and psychiatric disorders associated with celiac disease and the possible mechanisms involved in these associations were analyzed. The available data suggest that screening for celiac disease in patients with affective and/or psychiatric symptoms may be useful since these disorders could be the expression of an organic disease rather than primary psychiatric illnesses

http://www.ncbi.nlm....pubmed/16922014

CONCLUSION: These cases represent atypical forms of celiac disease manifested in childhood only by neuropsychological disorders. To make an early diagnosis and to improve the disease prognosis, the literature and our clinic experience shown that is useful screen the celiac disease in all patients with neuropsychological disorders such as epileptics foci in the parietal-occipital region and/or occipital calcification, headache (mostly if there isn't familiarity), spinocerebellar ataxia, neuromuscular disease of unknown aetiology, Down syndrome, behavioural disorders and some psychiatric troubles.

I am not bipolar but have dealt with depression. The psychiatrict that i was seeing was very supportive of the diagnosis of celiac especially when the connection is made between gluten actually blocking the absorption of vitamins, particularly vitamin D which has a lot to do with depression and mood swings. The neurologist i work with also put me on topapmax (topiramate) which in some ways helped headaches and some other things but my vitamin was still extremely low while all the other levels were more normal ( after following Gluten-Free diet). I am now taking lamictal and the combination is working. KLOW

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