Q: Psychotherapy & Nutritional Support
My daughter was diagnosed with bi-polar disease as a result of prednisone taken
for her chrohn's disease, or so they say. The first year
was hell figuring out medication. I felt the year was wasted on her
because nothing else was discussed such as support groups, therapy to help her
concentrate. To make a long story short, she switched doctors. He is
treating her with neurotin, zyprexa and paxil. It seems to help her.
He says that he can get her 90% better. My daughter who is 25 feels that
she is about 60%. With her chrohn's and bi polar, I feel she needs
nutritional support but noone gives it to her. Am I wrong? She is
bone-thin. Who can help her with this problem or how does she insist that
she needs therapy? This girl was a straight A nursing student, with one
semester left to graduate when this bi-polar came to visit. I'm at whit's
end, I don't know how to help her. Can you make any suggestions.
Dear Ms. R' --
To my knowledge no one has shown (with reliable scientific technique, anyway)
how to treat bipolar disorder, or even to augment its treatment, with a
nutritional approach -- unless you count fish oil for the
therein; or using zinc and/or selenium to counteract Depakote side effects; that
kind of thing.
Conversely, it's pretty clearly an uphill battle, i.e.
more so than usual in bipolar disorder, treating it when prednisone is still in
the picture. That does not seem to be true in every case, but in most cases in
my experience, where I've had a few folks who had to continue it,
including for inflammatory bowel diseases. Certainly we see it trigger bipolar
disorder fairly frequently (although the doc's who use it, e.g. oncologists, say
they see really bad reactions to prednisone relatively rarely -- so I'm trying
not to judge the drug on the basis of what I see, which obviously is selected
for quite severely negative reactions).
Now psychotherapy, as opposed to nutritional
therapy, as an adjunct to medications for bipolar disorder, has recently been
shown to be of value, including in bipolar II (here's a recent summary of those
psychotherapies for bipolar disorder; you'll note that only some of them, or
some pieces of several, are appropriate in bipolar II, but still, the results
Finally, I would note that the use of Neurontin may
mark this new doc' as one who does not practice solely on the basis of a
"data-based" approach, as there are several studies showing that Neurontin does
not work, at least in large groups of patients compared to a placebo, as a mood
stabilizer. But, it is a pretty good antidepressant and antianxiety
medication. It also has been, in my experience, capable of inducing cycling and
mixed-state symptoms just like antidepressants -- such as Paxil -- can do.
However, if she's doing well and continuing to improve, that's hard to fault,
eh? There is still an art to this business of bipolar treatment. He may be
very good at it. I just note these things in case things are not continuing to
improve; then, getting back on the usual path (e.g. adding an additional
stabilizer to the Zyprexa, and perhaps tapering out either Neurontin or
Paxil or both), might be worth considering.
Published November, 2003