Expert: Joanne Chang - 10/21/2007

Question
Hi

I am looking for understanding into my "bipolar" illness which i have battled with for many years.

Are you someone who thinks that it is a chemical balance or not?

I have always tried to combat my condition without drugs but now am trying st. johns wart to try and stop me having all these very negative thoughts.

Could you maybe advice me on how to treat this?

Thanks

Toby

Answer
Hi Toby,

In your letter, you asked specifically about whether I think a chemical imbalance is implicated in the negative symptoms that patients with bipolar disorder experience.

Personally, I do think there is a chemical imbalance if the symptoms are severe.  At that point, whether the imbalance is caused by the environment or genes, or the decline in the patient's mental state due to the illness, to me, does not seem to be the most consequential.  The nature (environment) vs nurture (genes) debate will rage on for all eternity.

Of greatest concern is the management of the symptoms.
I learned from your letter that you have tried combatting your condition without drugs and are now trying St. John's wort.
It is good that you are taking proactive measures to manage your negative thoughts and you should give yourself a pat on the back for that.

In the subject heading of your letter, however, you wrote "depression and suicidal thoughts".
You also stated that you have battled "bipolar" illness for many years, but are only now trying an alternative remedy.  Is it that you feel that your negative thoughts have increased or worsened recently?

You asked for advice on how to treat your condition.
Ultimately, the decision is up to you, but if your symptoms are such that suicidal thoughts are prevalent, you should consider speaking to a mental health professional (a psychiatrist or a psychologist) and consult him / her on the different measures you could take, given your specific life circumstances.
These include, but are not exclusive to, the following:
- psychotherapy* alone
- medication alone
- psychotherapy and medication combined

* CBT (Cognitive Behavioural Therapy), in particular, has been found to be effective in helping patients to reframe their negative thoughts, but as I always believe - one man's meat is another man's poison.  Hence, some patients do prefer (and work better with) certain types of therapy over another.

If the symptoms are severe (what is termed as the acute phase), e.g. with prevalent suicidal thoughts, combination therapy might be recommended.
Once the individual's mood is stabilised, the treatment regimen may be reviewed and revised.
It is also recommended that you look into maintaining a healthy lifestyle overall as part of self-care, e.g. regulating dietary, sleep and exercise habits.

Stay hopeful and do write back if you have further questions or need clarification on any of the above.

Best wishes,
Joanne