Complaints & connections · borters.ch
Not moodiness but phases with a logic of their own — with treatment long stable times are possible.
Also known as: bipolar disorder · manic-depressive illness
Open in the tool — with search and all the links →This compilation is for information and replaces neither medical diagnosis nor treatment. If you have symptoms, see a doctor.
An alternation between depressive phases and phases of markedly elevated or irritable mood with reduced need for sleep, pressured speech, overconfidence and risky decisions (mania, or the milder hypomania). Phases last weeks to months, often with long balanced periods between. A common problem: depressive phases lead to the doctor, while elevated phases feel good at first and go unreported — so plain depression is treated for years, which can worsen the course. Anyone noticing phases of unusually high energy with little need for sleep should mention it. With mood-stabilising treatment and a reliable daily rhythm, the condition can be managed well.
Consistent times — even on weekends — stabilise the body clock and sleep quality most.
Bright morning light and dim evening light support the natural rise of melatonin.
Caffeine lingers for hours — in the afternoon/evening it disrupts sleep depth.
Lithium is still the agent with the strongest effect on relapses and the only one shown to lower the suicide rate. It needs regular blood checks, because the range between effect and too much is narrow. It smooths the swings; it does not take the person away.
About one to three in a hundred people are affected. From the first signs to the right classification, six to ten years pass on average, because the depressive phases are noticed first and the elevated ones are often not experienced as illness. A manic phase lasts weeks to months untreated, a depressive one longer. Lithium needs regular blood checks, because the effective and the harmful range lie close together — weekly at first, later every three to six months.
Three, four hours are enough — and one feels rested. This reduced need for sleep without tiredness is one of the most reliable signs of an elevated phase.
A fast flow of speech that is hard to interrupt, thoughts that jump, many projects started at once — and an unaccustomed confidence that everything will work out.
Large spending, risky deals, sudden resignations, unaccustomed sexual contacts, alcohol or fast driving. These consequences are often noticed by the people around before by the person themselves.
The low phases usually last considerably longer than the high ones and lead to the consulting room far more often. That is why the picture is treated as plain depression for years.
Was there ever a time of several days when you needed clearly less sleep, did much more, and others were worried or noticed it? That one question leads further than any description of the sadness.
Important twice over: a thyroid disorder can imitate mood swings, and treatment with lithium changes the thyroid — so it is checked regularly.
Under lithium, kidney function belongs checked at fixed intervals. How much one drinks and water tablets also play a part.
Lithium can raise the calcium via the parathyroid gland. A raised value explains tiredness and constipation otherwise put down to the illness.
Some mood-stabilising drugs affect blood formation. The value belongs to the follow-up, not to the diagnosis.
A lack causes exhaustion, problems concentrating, low mood and forgetfulness — and it is one of the few causes that can be found and put right with a single blood draw.
Low values are common with low mood. Whether correcting it lifts the mood is not settled; that it makes sense in winter at our latitudes is.
An empty store causes tiredness, lack of drive and problems concentrating long before any anaemia becomes visible. In women of childbearing age the most common single reason.
A building block of the cell coverings in the brain. The studies on mood are inconsistent; as part of a good diet it belongs there anyway.
Needed for making the messengers in the brain. It runs short with alcohol and under certain medicines — and it is always judged together with B12.
The most important pointer on this page and one that is often missing: like every mood-lifting agent St John’s wort can tip into a manic phase in someone predisposed — and at the same time it speeds the liver breakdown of many medicines, which unnoticed weakens an established protection. The two together make it here the least favourable plant remedy.
Best studied is the effect on the low side, where EPA-weighted preparations at around 1–2 g daily show a small advantage in pooled analyses. On the manic side no effect has been found. It is an addition alongside the treatment, not instead of it.
If lithium is taken, the salt and water balance is the decisive point: drinking little, sweating a lot, diarrhoea or a suddenly low-salt diet raise the lithium level — into the toxic range. Water tablets and some painkillers do the same. This is the interaction most often overlooked.
Clearly worthwhile and well supported when deficient — vegan, older adults, certain drugs. No energy boost without a deficiency.
Clearly worthwhile and well studied when deficient; fewer data for the wider uses. Fat-soluble — check blood levels at high doses.
Clearly effective with proven deficiency, useless without. Take only with a documented deficiency — excess is harmful.
In pregnancy clearly established against neural-tube defects, otherwise mainly with deficiency. Can mask a B12 deficiency — watch both.
Lithium influences the thyroid and the kidney. On this treatment TSH and the kidney values belong measured regularly — that is not caution but part of the treatment.
Sleep here is more than a symptom: less sleep can trigger a manic phase, and a beginning mania first costs sleep. This is why the sleep rhythm is one of the most important points in everyday life.
Cortisone at higher doses can trigger mania — within days in some of those treated. Anyone with bipolar disorder belongs told about that before a cortisone burst begins.
The kidney treats lithium like sodium. Less salt, heavy sweating or diarrhoea raise the lithium level — so salt intake is kept steady and more is drunk in heat.
Studies show a small effect on depressive phases, not manic ones. 1–2 g EPA a day is the studied range; it comes in addition to treatment, not instead of it.
Sleep is more than rest in bipolar courses: lack of sleep can trigger a manic phase. Fixed times are therefore part of the treatment, not a side remark.
Acts in studies on depressive phases, not manic ones. 1–2 g EPA a day is the studied range — as an addition to treatment.