Statistics indicate that approximately 2.6% of U.S. adults experience bipolar disorder each year, and within this group, about 82.9% of cases are classified as severe. What many people may not realize is that bipolar disorder is further divided into distinct subtypes, the most common being bipolar 1 and bipolar 2. This discussion centers around bipolar 1 disorder, a subtype marked by heightened manic episodes and intervening depressive episodes, both of which significantly alter everyday life. While managing bipolar 1 can present challenges, embracing integrative approaches can provide a more comprehensive and balanced pathway to address the condition effectively.

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What is Bipolar 1 Disorder?

Bipolar 1 disorder, sometimes referred to as manic-depressive disorder or simply manic depression, is a form of mental illness characterized by distinct episodes of manic and depressive symptoms. Individuals experiencing this condition have at least one manic episode in their life, which is a period characterized by a noticeably elevated or irritable mood, heightened energy, and behavior patterns that significantly interfere with everyday activities.

It's worth noting that these manic episodes usually last for a minimum of seven days or present with such severity that immediate medical attention becomes a necessity. Depression episodes also occur and typically persist for at least two weeks. Interestingly, the manifestation of both depressive and manic symptoms concurrently is possible and is referred to as a mixed features episode. When individuals experience four or more episodes of mania or depression within one year, the term 'rapid cycling' is employed. In the periods between these extreme episodes of mania and depression, many people with bipolar 1 disorder can lead normal lives (3).

Bipolar 1 Disorder  Symptoms
During a bipolar 1 manic episode, individuals may experience (3):

• Euphoria or heightened irritability
• Rapid, loud speech and jumping between ideas
• Hyperactivity and less need for sleep
• Excessive spending, hypersexuality, or substance abuse
• Delusional thinking at severe stages

Untreated manic episodes can last a few days to several months, often followed by depression. Some individuals may have "rapid-cycling" symptoms or "mixed features" where manic and depressive symptoms co-occur or alternate rapidly. Depressive episodes, resembling clinical depression, involve feelings of sadness, loss of pleasure, low energy, guilt, and possibly suicidal thoughts (3).

What Causes Bipolar 1 Disorder?

Bipolar 1 disorder can develop in virtually anyone, although some groups have a higher risk. It most commonly manifests in the teens or early 20s, with nearly all cases appearing before the age of 50. Individuals with an immediate family member diagnosed with bipolar disorder face an elevated risk (3).

The precise cause of bipolar disorder remains undetermined. However, experts concur that multiple elements likely interact to increase a person's susceptibility to the disorder. These elements represent a multifaceted blend of physical, environmental, and social factors. One consideration is genetics. Bipolar disorder seems to have a hereditary component, as it tends to run in families. Family members of those with the disorder face an increased risk of developing it themselves. Despite this, no single gene has been identified as being directly responsible. Instead, a combination of genetic and environmental influences are believed to act as triggers.

Stressful situations or circumstances often ignite the symptoms of bipolar disorder. These stressors could include the end of a relationship, experiences of physical, sexual, or emotional abuse, or the death of a loved one. Even physical illness, sleep disturbances, and overwhelming problems in daily life, like issues with money, work, or relationships, can trigger bipolar disorder (5).

Another proposed factor is a chemical imbalance in the brain. Some evidence suggests bipolar disorder may be linked with imbalances in brain chemicals or neurotransmitters, which include noradrenaline, serotonin, and dopamine. If these neurotransmitters are imbalanced, a person may develop some symptoms of bipolar disorder. For instance, mania episodes might occur when noradrenaline levels are excessively high, while depressive episodes could result from decreased noradrenaline levels (5).

How is Bipolar 1 Disorder Diagnosed?

Diagnosing bipolar 1 disorder begins with a health care provider conducting a physical exam and medical tests to rule out other causes. If needed, they may refer the individual to a mental health professional for a more specialized assessment. This might involve a thorough discussion about the individual's symptoms, life history, and family background. Physical and psychological evaluations, as well as mood charting, can provide valuable insights. Finally, the individual's symptoms may be compared to the established criteria for bipolar disorders in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) (2,5).

What is the Difference Between Bipolar 1 and Bipolar 2?

Bipolar 1 and 2 are the most common types of bipolar disorder, marked by extreme shifts in mood and energy. Both types feature depressive episodes, but the manic episodes differentiate them. In bipolar 1, individuals experience severe episodes of depression and mania, with some returning to a baseline mood state between these episodes. Manic episodes can involve elevated mood, high energy, impulsivity, and sometimes psychosis, leading to risky behaviors and potential hospitalization.

Bipolar 2, differentiated from bipolar 1 in 1994, also involves depressive episodes but replaces full mania with less intense hypomanic episodes. The presence of hypomania, which may be less obvious and burdensome, sometimes leads to initial misdiagnoses of depression. Unlike mania, hypomania doesn't involve psychosis, and the risks taken during hypomanic episodes are generally less extreme. Individuals with bipolar 2 are often able to maintain steady employment and healthy relationships more consistently than those with bipolar 1 (6).

Functional Medicine Labs That Can Help Individualize Treatment Options for Bipolar 1 Disorder

Functional medicine labs offer a variety of tests that can help tailor treatment to patients, allowing providers to optimize management strategies.

Stool Testing for Bipolar 1 Disorder

The gut microbiome helps produce neurotransmitters like serotonin, GABA, and dopamine. Changes to the gut microbiota composition have been observed in mental health conditions, including bipolar disorder. Therefore, the GI-MAP + Zonulin test by Diagnostic Solutions and the GI Effects® Comprehensive Profile from Genova Diagnostics could provide insights into the gut-brain axis, potentially uncovering imbalances contributing to bipolar symptoms.

Neurotransmitters & Micronutrients Testing for Bipolar 1 Disorder

As discussed above, chemical imbalances in the brain, including these neurotransmitters, are associated with bipolar disorder. Specifically, excessive levels of noradrenaline can contribute to manic episodes, while decreased levels can lead to depressive episodes. Neurotransmitter and Micronutrient Test results can be used to develop a personalized treatment approach, including nutritional supplementation or dietary adjustments to correct identified deficiencies or imbalances.

Hormone and Stress Testing for Bipolar 1 Disorder

The DUTCH Complete is a dried urine test providing an in-depth analysis of stress and sex hormones. It reveals cortisol patterns, a cornerstone in understanding stress response, which is often a trigger in bipolar 1 disorder. It also gauges estrogen and progesterone levels which are vital since studies suggest a relationship between hormonal fluctuations and bipolar 1, particularly in women, discussed further in the treatment section below (24,25).

Environmental Toxins Testing for Bipolar 1 Disorder

Toxin exposure can lead to oxidative stress, impairing both gut function and mental health. This relationship is particularly relevant as the gut microbiome plays a critical role in producing mood-related neurotransmitters. Furthermore, toxin-induced oxidative stress could interfere with the balance of neurotransmitters in the brain, potentially contributing to bipolar episodes.

Conventional Treatment for Bipolar 1 Disorder

Bipolar 1 disorder treatment primarily centers around the use of medications, including mood stabilizers like Lithium and Valproate, as well as antipsychotics such as Cariprazine and Aripiprazole. In certain cases, Benzodiazepines might be employed for short-term symptom control. In instances where medication proves insufficient, Electroconvulsive Therapy (ECT) can be considered a safe and effective treatment option for both manic and depressive symptoms.

Functional Medicine Treatment for Bipolar 1 Disorder

Integrative medicine is commonly used in conjunction with conventional therapies to support overall health and well-being in individuals with bipolar 1 disorder. It's important to note that bipolar disorder is a complex psychiatric condition that typically requires a comprehensive treatment plan involving medication, psychotherapy, and lifestyle modifications.

Here are some aspects of integrative medicine that can complement traditional treatments for bipolar 1 disorder:

Integrative Nutrition for Bipolar 1 Disorder

Bipolar 1 disorder can potentially be managed more effectively with integrative nutritional approaches. Among these, gut health optimization stands out, reflecting the strong evidence for a connection between gut and mental health.

Research has indicated a significant relationship between diet and mental health. Studies suggest that certain nutrients may influence the symptoms of bipolar disorder and may even play a role in its development. For instance, unsaturated fatty acids like omega-3, commonly found in seafood, along with micronutrients such as folic acid and zinc, are associated with improved symptoms of bipolar disorder. There are also promising results linked to Coenzyme Q10 (Coq10) and probiotics, further underlining the potential benefits of a gut health-focused approach.

The Microbiome Diet provides a potential roadmap to improving gut health. This three-phase program promotes an organic, plant-based diet rich in 'Microbiome Superfoods.' These include prebiotic foods like artichokes, onions, and garlic, which feed and nourish healthy intestinal bacteria, and probiotic foods like kimchi and sauerkraut, which help build a healthy intestinal mucosa layer and enhance the immune system. By eliminating foods that interfere with a healthy microbiome and encouraging the consumption of nutrient-dense superfoods, this diet may support optimal gut health and potentially enhance mental health outcomes in bipolar 1 disorder.

Supplements and Herbs for Bipolar 1 Disorder

Various supplements can potentially help reduce the symptomatology in patients with bipolar 1 disorder.

Omega-3 Fatty Acids for Bipolar 1 Disorder

Omega-3 fatty acids, found to inhibit neuronal pathways similar to conventional bipolar treatments, have shown potential in improving the short-term course and extending remission periods in bipolar 1 disorder.

Dose: About 9.6 grams/day

Duration: Evaluate response after 4 months

Probiotics for Bipolar 1 Disorder

Evidence suggests that probiotics, sometimes referred to as 'psychobiotics' when associated with mental health benefits, could potentially improve outcomes for individuals with bipolar 1 disorder. Probiotics could possibly influence mental health through various mechanisms such as neurotransmitter synthesis, inflammation regulation, and enhancing stress response.

Dose: 10-20 CFU (colony forming units) per day

Duration: Ongoing

Coenzyme Q10 (CoQ10) for Bipolar 1 Disorder

Coenzyme Q10 (CoQ10), an antioxidant naturally produced in our bodies, is catching attention as a potential supplement for individuals grappling with bipolar 1 disorder. Beyond its reported improvement in mental health, CoQ10's pivotal role in cellular energy production and its defense against oxidative stress positions it as an intriguing area of study. New research reveals that when CoQ10 is administered alongside mood stabilizers and antidepressants, it may yield better outcomes in managing bipolar 1 disorder (22,23).

Dose: 200 mg/day

Duration: Evaluate response after 8 weeks

Hormonal Balance for Bipolar 1 Disorder

Bipolar 1 disorder may be influenced by hormonal factors, particularly in women. Research indicates that female hormones may contribute to the development and severity of bipolar disorder, with instances such as menopause and premenstrual symptoms potentially affecting its course. Notably, pregnant women or those in the postpartum period with bipolar disorder are at a heightened risk of symptom recurrence and hospital admission, suggesting a significant hormonal association during these periods. Balancing hormonal fluctuations might be a critical aspect of managing this disorder, though further research is required to fully understand this relationship (24).

Estrogen may play an especially key role in the condition. Studies have shown low levels of estrogen are associated with postpartum psychosis in women with bipolar disorder and that symptoms improve with estrogen treatment. Additionally, tamoxifen, a selective estrogen receptor modulator, has demonstrated antimanic effects, further suggesting the impact of estrogen levels on bipolar disorder. However, as these results are preliminary, more research is needed to conclusively understand the role of estrogen and other sex hormones in bipolar disorder (25).

Detoxification Support for Bipolar 1 Disorder

The importance of detoxification in managing bipolar 1 disorder cannot be overstated, despite it not being a cure but a supportive measure to improve overall health status. Research suggests an association between environmental pollution and an increased risk of psychiatric disorders, with environmental influences contributing to a 32% risk for bipolar disorder. Supporting the body's inherent detoxification capabilities, largely centered on liver function, can be a viable approach to mitigate these risks.

Various strategies can be employed to enhance the body's detoxification system. These include reducing exposure to toxins through the use of air purifiers, water filters, eating organic food, and using less toxic personal care products. Ensuring optimal liver functionality by providing it with the necessary vitamins and minerals it requires for detoxification is also a good choice. Incorporation of a healthy diet, which includes foods such as cruciferous vegetables, berries, rooibos tea, celery, and grapefruit, among others, can significantly enhance liver detoxification. Moreover, supplements like Resveratrol, Quercetin, and Lycopene, along with herbs like Milk Thistle and Turmeric, have properties that aid in liver detoxification. Finally, certain lifestyle changes, such as avoiding smoking and alcohol, incorporating dry brushing, sauna use, adequate exercise, and hydration, can significantly aid in detoxification.

Lifestyle Modifications for Bipolar 1 Disorder

Living with bipolar 1 disorder requires careful lifestyle modifications, which include managing sleep patterns, staying active, and managing stress. Adherence to a consistent daily schedule can significantly aid mood control. Importantly, maintaining a regular sleep cycle is critical; any deviations in sleep quantity, such as sleeping less or more than usual, may indicate impending manic or depressive episodes, respectively. Therefore, creating calming bedtime rituals and maintaining a soothing sleeping environment can promote healthy sleep patterns. Regular exercise can also improve mood and enhance sleep quality; beginning with simple activities like walking and gradually increasing intensity can be beneficial.

In addition to these, it's essential to manage stress levels. Activities such as yoga, exercise, and meditation can provide focused relaxation and anxiety relief. Adjustments in personal and professional life that help reduce stress should also be considered. Moreover, limiting caffeine intake, which can disrupt sleep and affect mood, is advisable. It's equally important to abstain from alcohol and drugs as they can exacerbate bipolar disorder symptoms and interfere with medications. If issues with substance abuse exist, seeking immediate help is necessary since the treatment for bipolar disorder may not be sufficient to address substance abuse. Engaging with support groups or professional services can be of significant help in these instances (27).

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Summary

In conclusion, bipolar 1 disorder is a complex condition requiring a multifaceted approach to care. While conventional treatments are indispensable, integrative strategies like those provided through functional medicine can enhance treatment outcomes and improve overall health. Ultimately, a good choice for individuals with bipolar 1 disorder is to work closely with their healthcare team to create a personalized, comprehensive treatment plan.