Depression Archives – Page 2 of 2 – A Healthy State of Mind

Micronutrients in Mental Health Series III Folic acid has been widely researched for the treatment of depression. In this post we will continue our Micronutrients in Mental Health Series, covering the 3rd nutrient implicated in depression and anemia with our discussion of folate. The name ‘folate’ is derived from the Latin ‘folium’ which means foliage, […]

May is National Physical Fitness and Sports month, and with the warmer days and more sun, it hopefully is easier for people to get motivated to move! Doctors have a tendency to overlook or understate the value of exercise in being busy to find the best treatment(s) for a patient’s ills, but the effects of […]

Antidepressant-induced hypomania or mania is defined as a short-term reaction to medication. This phenomenon, referred to as “switching”, occurs within 2 months of treatment initiation (if it occurs).1  Antidepressants can also cause long-term mood destabilization in bipolar treatment even in the absence of a short-term manic or bipolar switch.1,2  Properly diagnosing bipolar disorder is challenging […]

Circadian rhythm imbalances are at the root of Seasonal Affective Disorder (S.A.D.), a number of sleep disorders, jet lag, some cases of Attention Deficit /Hyperactivity Disorder and Shift Work Disorder (a circadian rhythm sleep disorder). (For more on how to address S.A.D, see my blog post  entitled ‘How to keep the Winter Blues at Bay‘. ) […]

Blog – Holistic Medicine for Stress,Trauma & Chronic Illness – Portland,OR

Well the time for spreading holiday cheer has come! To keep the holidays spirited and healthy, I thought that I would share some tips and counsel about how to indulge healthily this season (limiting the ill effects of alcohol and exploring bitters, verjus, non alcoholic mocktails). And in case you overdo it, I discuss the […]

Micronutrients in Mental Health Series III Folic acid has been widely researched for the treatment of depression. In this post we will continue our Micronutrients in Mental Health Series, covering the 3rd nutrient implicated in depression and anemia with our discussion of folate. The name ‘folate’ is derived from the Latin ‘folium’ which means foliage, […]

May is National Physical Fitness and Sports month, and with the warmer days and more sun, it hopefully is easier for people to get motivated to move! Doctors have a tendency to overlook or understate the value of exercise in being busy to find the best treatment(s) for a patient’s ills, but the effects of […]

Antidepressant-induced hypomania or mania is defined as a short-term reaction to medication. This phenomenon, referred to as “switching”, occurs within 2 months of treatment initiation (if it occurs).1  Antidepressants can also cause long-term mood destabilization in bipolar treatment even in the absence of a short-term manic or bipolar switch.1,2  Properly diagnosing bipolar disorder is challenging […]

Signs of spring are starting to show – with bulbs pushing through the soil and buds on trees forming. With the first day of spring still a few weeks away, now is the time to plan for a spring cleanse. Cleansing has been performed for centuries, but is perhaps all the more important in our […]

Circadian rhythm imbalances are at the root of Seasonal Affective Disorder (S.A.D.), a number of sleep disorders, jet lag, some cases of Attention Deficit /Hyperactivity Disorder and Shift Work Disorder (a circadian rhythm sleep disorder). (For more on how to address S.A.D, see my blog post  entitled ‘How to keep the Winter Blues at Bay‘. ) […]

How herbs & supplements may trigger mania & hypomania | A Healthy State of Mind

Posted by Mary R. Fry, N.D. on Thursday, November 17, 2011

Antidepressant-induced hypomania or mania is defined as a short-term reaction to medication. This phenomenon, referred to as “switching”, occurs within 2 months of treatment initiation (if it occurs).1  Antidepressants can also cause long-term mood destabilization even in the absence of a short-term manic switch.1,2  Properly diagnosing bipolar disorder is challenging and can take time.  It may take up to 8 years for a depressed patient to manifest manic symptoms and/or receive a proper diagnosis.3

Herbal and natural supplements can induce hypomania or mania in those with bipolar disorder.  St. John’s Wort, SAMe (S-adenosyl methionine) and Omega 3 fatty acids can cause switching in bipolar.4,5,6,7,8,9,10  Ephedra sinica, Rhodiola rosea, Gingko biloba, Ginseng and Inositol are also implicated in antidepressant-induced hypomania/mania.6,7,10

There is insufficient evidence to support long-term use of antidepressant herbs in bipolar disorder.  Studies with antidepressant medications generally do not support long-term use of antidepressant agents in bipolar disorder. Current recommendations are to use these herbs as adjuvant treatments with mood stabilizers in bipolar disorder.6,7,8,10  Cautious, selected use of antidepressants, as opposed to routine use, is advised in bipolar disorder.11,12,13

There are a number of predictors of antidepressant-induced hypomania and mania.  Patients with bipolar I subtype, mixed episodes or past antidepressant-induced hypomania/mania are prone to switching.  Comorbid substance use increases the risk of switching.  Rapid cycling is strongly associated with increased risks of antidepressant-induced hypomania/mania.2,14

Patients with bipolar disorder are advised to consult a licensed physician to safely use herbal supplements.4  Avoid abrupt withdrawal of antidepressant medications and/or herbs.14  Herbal antidepressants are not recommended in those with a higher likelihood of antidepressant-induced hypomania or mania.

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References:

1Ghaemi SN. Treatment of Rapid–Cycling Bipolar Disorder: Are Antidepressants Mood Destabilizers? Am J Psychiatry 2008;165:300-1.

2Ghaemi SN, Hsu DJ, Soldani F, etal. Antidepressants in bipolar disorder: a case for caution. Bipolar Disord 2003;5:421-33.

3Holma KM, Melartin TK, Holma IA, etal. Predictors for switch from unipolar majord epressive disorder type I or II: a 5-year prospective study. J Clin Psychiatry 2008;69:1267-75.

4Nierenberg AA,  Burt T, Matthews J, etal. Mania associated with St. John’s Wort.  Biol Psychiatry 1999;46:1707-8.

5Sarris J, Kavanagh DJ, Byrne G. Adjuvant use of nutritional and herbal medicines with antidepressants, mood stabilizers and benzodiazepines.  J Psychiatr Res 2010;44:32-41.

6Iovieno N, Dalton ED, Fava M, etal. Second–tier natural antidepressants: Review  and critique.  J Affect Disord 2010; doi:10.1016/j.jad.2010.06.010

7Sarris J. Herbal medicines in the treatment of psychiatric disorders: a systematic review. Phytother Res 2007;21:703-16.

8Mischoulon D. Updatea nd Critique of Natural Remedies as Antidepressant Treatments. Psychiatr Clin N Am 2007;30:51-68.

9Parker G, Gibson NA, Brotchie H, etal. Omega-3 fatty acids and mood disorders. Am J Psychiatry 2006;163:99-978.

10Andreescu C, Mulsant BH, Emanuel JE. Complementary and alternative medicine in the treatment of bipolar disorder – a review of the evidence. J Affect Disord 2008;110:16-26.

11Ghaemi SN, Goodwin FK. Antidepressants for Bipolar Depression. Am J Psychiatry 2005;162:1545-5.

12Ghaemi SN, Ostacher MM, El–Mallakh RS, etal. Antidepressant Discontinuationin Bipolar Depression: A Systematic Treatment Enhancement Program for Bipola rDisorder (STEP–BD) Randomized Clinical Trial of Long–Term Effectiveness and Safety. J Clin Psychiatr 2010;71;372-80.

13Viet aE. Cause for caution, case for action.  Bipolar Disord 2003;5:434-5.

14Goldberg JF. Antidepressants in bipolar disorder: 7 myths and realities. Current Psychiatry 2010;9:41-9.

Categories: Bipolar Disorder, Herbal Medicine, Psychiatric Medications Tags: Ephedra, Gingko, Ginseng, Hypomania, Inositol, Mania, Mood Stabilizers, Omega 3 Fatty Acids, Rhodiola, Self-Medication