New Treatments for Bipolar Depression—Options for Treatment Resistance – Bipolar Burble Blog

Recently, Psychiatric Times did a comprehensive piece on new or unusual bipolar depression treatments, treatments that may be an option for treatment-resistant bipolar depression. They are thinking outside the standard bipolar depression treatments. This is critical because many people just aren’t being helped or aren’t being helped enough by standard bipolar depression treatments. These novel bipolar depression treatments come in two flavors: medication-based and non-medication-based. If you’re at a place in your bipolar depression treatment where you’re not getting better, you may want to consider discussing these unique treatments with your psychiatrist.

New and Unique Non-Medication Treatments for Treatment-Resistant Bipolar Depression

Admittedly, some of these options I have talked about before, but some of them I have not. All of them are worth noting. It’s important to realize when it comes to these treatments for bipolar depression, they aren’t shown to lead to remission, typically, but are useful in conjunction with other treatments.

Light and Time-Based Treatments for Bipolar Depression

These treatments together are known as chronotherapeutic treatments. These treatments involve the use of a lightbox to control exposure to light. Sometimes, also controlling exposure to darkness is needed. This is in combination with control of the sleep cycle.

Controlling exactly when you sleep, how much you sleep, and when you get light and darkness are things people just don’t want to do. I say over and over that if you control your sleep through good sleep hygiene, you’ve come a good way to controlling your mood. Chronotherapy takes these recommendations seriously, and even the International Society for Bipolar Disorder recommends the use of chronotherapeutic treatments. If you have treatment-resistant bipolar depression, I think the effort is worth it. I’ve written about one chronotherapy protocol here.

Physical Exercise for Bipolar Depression

According to Psychiatric Times,

“exercise has been shown to reduce inflammatory markers, and physical activity may be beneficial in bipolar depression . . . Exercise improves depressive symptoms, reduces stress, decreases inflammatory markers, and promotes the synthesis of monoamine neurotransmitters in patients with bipolar disorder.”

And as I’ve said before, while most research has been done on higher-intensity exercise, any exercise is good exercise. Try walking. Read more about exercise and bipolar disorder here.

Smoking Cessation for Bipolar Depression

No one thinks that smoking is good for you; that’s true, but did you know that it can worsen the symptoms of bipolar depression? It’s important to stop smoking to set the best foundation you can for the treatment of bipolar depression. Keep in mind you may be able to do this by using medications like bupropion (Wellbutrin, Zyban) that may not interfere with your bipolar medications. Ask your psychiatrist for options.

Diet to Treat Bipolar Depression

As I’ve said before, no diet actually treats bipolar disorder, but certain diets can improve overall health and reduce inflammation, and this can help with mental illness. Studies into this field are limited, but options for diets include the Mediterranean diet, the MIND diet (MIND: Mediterranean-Dietary Approaches to Stop Hypertension [DASH] Intervention for Neurodegenerative Delay), and a ketogenic diet. The MIND diet has the best empirical support. When implementing a diet, consider making one small change at a time instead of trying to overhaul an entire way of eating. No diet should be undertaken without a doctor’s supervision. (See here for more about the MIND diet.)

Supplements and Nutriceuticals to Treat Bipolar Disorder

Some supplements and nutriceuticals may benefit people with bipolar depression. It’s important to note, again, that these should be used adjunctively. These are not replacements for actual medication. Do not start the use of anything — even an over-the-counter supplement — without a doctor’s supervision. Bipolar disorder is more sensitive than you think.

Choices here include:

• Probiotics — Probiotics modulate stress hormones, increase brain-derived neurotrophic factor (BDNF) and serotonin levels, and reduce inflammation, but study into their use is extremely limited.
• Omega-3 fatty acids — Omega-3 fatty acids have anti-inflammatory properties and may be effective in supporting bipolar depression treatment. They are the most well-studied supplement for use in depression and bipolar depression. It’s important to note that you can’t get the amount of omega-3 fatty acids you need for treatment in your diet. As per Psychiatric Times, “If using fish oil supplements, patients should ensure that the eicosapentaenoic acid (EPA) content is 1.5 times the amount of docosahexaenoic acid (DHA). In addition, patients should take between 1000 to 3000 mg per day.”
• L-methylfolate — L-methylfolate has limited evidence but may be useful, plus there are no known drug interactions with it. (See more about l-methylfolate here.)

Brain Stimulation in the Treatment of Bipolar Depression

Most people are aware that electroconvulsive therapy (ECT) is available to treat bipolar depression, particularly treatment-resistant bipolar depression. This treatment is considered one of the “most potent interventions” for depressive disorders, including bipolar depression. Some people even suggest that it should be used earlier in the course of treatment rather than as a treatment of last resort. (See here for more on the plusses and minuses of ECT.)

Transcranial magnetic stimulation (TMS) may also be an option for treatment. This is not a new treatment for bipolar depression, per se, but it is newer in the bipolar population as opposed to the unipolar depressive population. (See here for information on TMS vs. ECT.)

Finally, deep brain stimulation (DBS) is a new treatment for bipolar depression. It is showing promising results, but it is a surgically invasive and costly procedure that includes an implant in the brain that must be removed if the treatment is unsuccessful. There are many unknowns with this procedure, and it is not commonly used.

New and Unique Medications for the Treatment of Bipolar Depression

There are a whole host of medications that can be used to treat bipolar depression that don’t show up on typical treatment algorithms. Everything from medication for narcolepsy to medication for Parkinson’s disease is on this list for the treatment of treatment-resistant bipolar depression. A few of the common ones include modafinil (Provigil)/armodafinil (Nuvigil), n-acetylcysteine, and ketamine/esketamine (Sprovato). The full list of medications in this category, along with their common side effects, as written by Psychiatric Times, can be found here.

Note that these medications are not without risk, and they are often without specific evidence in the bipolar population. Psychiatric Times puts it well by saying,

“Studies of off-label medications may show inconsistent findings due to smaller sample sizes and methodological variation. In addition, the majority of the systematic reviews and meta-analyses of these studies do not include information about the dosing ranges used, which limits their generalizability and clinical utility. When considering these novel medications, clinicians should consider them to be second-, third-, or fourth-line options, at best.”

Take these medications seriously, but don’t hesitate to discuss these options with your psychiatrist if there is a chance they may help you, especially if are experiencing treatment-resistant bipolar depression.

To read the whole article at Psychiatric Times, see here.

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