Psychotherapy & Nutritional Support
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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.  Thank you

 

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
omega-3's 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 are impressive.)

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 mood stabilizer to the Zyprexa, and perhaps tapering out either Neurontin or Paxil or both), might be worth considering.  

Dr. Phelps


Published November, 2003 

 

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