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By George D Henderson (AHCS)
 Given that the need for help in the management
of unpredictable moods is a common reason for people to become drug
adddicted, we might expect to see an elevated incidence of bipolar
conditions and other mood disorders in people with HCV. These are not
always diagnosed, as the effects are often aggravated by and attributed
to the drugs, and cyclothymic disorder, as well as disthymic and
hypomanic disorder are often ignored by clinicians concerned with the
more serious manic-depressive disorders.
A person with hypomania may just be thought of as "intense", disthymic
disorder often presents as mild depression or pessimism, and a
cyclothymic is often considered a "typical artist", a "drama queen",
"moody" etc.
Because the hypomania has never extended to a delusional, psychotic
mania, and the depression has never turned suicidal, cyclothymia is
easy to believe in as just that individual's character. Most
cyclothymics are normal much of the time. But it does matter when you
are considering Interferon-ribavirin combination therapy, because any
instability is magnified. If these mood disorders are diagnosed, they
will probably be reasons why therapy is contra-indicated; if it is not,
you may well find that symptoms such as "Riba rage" become unbearable;
this could end with you terminating treatment (and complaining about
the effects for some time to come), or perhaps result in you and/or your
provider trying to manage the symptoms with antidepressants, sleeping
pills, and other drugs.
Thus bipolar, icluding hypomanic, manic-depressive and cyclothymic
individuals are some of the most likely to need an alternative to
combination therapy, and are well placed to benefit from it if, as is
often the case, they are sensitive to changes in metabolism that are
often missed by more normal individuals. However, there are some
supplements, including many recommended and useful in HCV, that can
aggravate mood disorders.
It is important to realise that, if you are bipolar, being "up"
doen't always mean being happy, being down "sad" (tho you may be at yr
happiest in a hypomanic state, you can also be very contented in the
"depressed" mood).
So, if you feel you'd like to change out of a depressed mood,
using one of the supplements below may just make you irritable,
agitated, and uncomfortable (or, it may work; but it will be a gamble);
true positive hypomania seems to involve a complex mix of
neurotransmitters (including phenylethamine and endorphins), a
synergistic blend of influences impossible, so far, to copy (if you
could trigger mild hypomania predictably with a drug or supplement you
would be onto a winner) Although SAMe with omega 3, l-tyrosine, and St
John's Wort is marketted as Thomson's Mood Manager, and is definitely
an effective antidepressant, especially used in the AM with 5-HTP
note, it is probably not intended for use by bipolar individuals, may
cause adverse effects in these, and carries a warning to this effect.
SAMe is one of the compounds most useful for preventing cirrhosis,
and it has a track record of successful laboratory and clinial testing http://www.lef.org/magazine/mag97/march97-report.html. This article is highly recommended.
Fortunately SAMe (S-adenolsyl methionine) levels can also be raised
internally by taking the precursor l-methionine (half of the body's
l-methioine is made into SAMe) with methyl donors - 500mg l-methionine,
folic acid 400 mcg and B12 400mcg, while betaine (trimethylglycine)
500mg can also be added, as well as a dose of B6: all to be taken twice
daily.
If SAMe itself is too agitating or too expensive, I recommend this
substitute, which has a more modest uplifting effect. To what extent
this results from improved liver funtion is hard to know; at first,
this improvement may be small; I suspect it was the experience of
hypomania after years of depression that gave me the impression I was
doing the right thing by my liver in taking l-methionine, selenium,
vitamin E, C, etc. It may have taken longer for my liver itself to
change for the better, but I am very grateful that I noticed this
stimulus if this was the case, as it ensured that I would keep on
taking these supplements for long enough to recover my health.
SAMe is also important because it changes homocysteine into methionine;
raised homocysteine levels are found in many degenerative syndromes.
This account below is from http://content.nhiondemand.com/moh/media/monoVMN.asp?ctype=ds&mtyp=4&objID=100032
Normally our bodies produce SAMe from the amino acid methionine.
Since vitamin B12 and folic acid are necessary for the synthesis of
SAMe, a deficiency of these vitamins can lead to a depletion of SAMe.
Clinical Applications:
Alzheimer's Disease, Cardiovascular Disease, Depression,
Fibromyalgia, Inflammatory Bowel, Insomnia, Intrahepatic Cholestasis,
Liver Disease, Osteoarthritis
Functions in the Body:
Antioxidant production
Because SAMe is necessary for the synthesis of glutathione, which
is an antioxidant, it plays a role in protecting the body from free
radical-induced aging damage.
Detoxification
Glutathione is important for detoxification in the liver.
Glutathione depletion is usually found in individuals with liver
malfunction. SAMe supplementation promotes the synthesis of
glutathione, which improves liver function and detoxification.
Healthy Cellular Membranes
The ratio between phosphatidyl choline (PC) and cholesterol in
cellular membranes determines their relative flexibility or stiffness;
PC promotes flexibility whereas cholesterol promotes stiffness. Since
SAMe is an important facilitator of phosphatidyl choline synthesis, it
plays a role in promoting more pliant cellular membranes. Stiffer cell
membranes are not able to transmit cellular signals as effectively and
it is more difficult for neuropeptides and other messenger molecules to
fit into receptor sites when cellular membranes are stiff.
Liver Protection
Protects the liver against alcohol, drugs, and cytokines. It
protects against cholestasis (bile impairment or blockage). It may
protect against chronic active hepatitis. It protects against liver
damage caused by MAO inhibitors and anticonvulsants. It reverses
hyperbilirubinemia. Supplementation of SAMe in cancer patients during
chemotherapy treatment significantly reduced liver toxicity levels.(3)
Methylation Reactions
SAMe functions as a methyl donor for the synthesis of nucleic acids
(DNA and RNA), proteins, phospholipids, catecholamines, and various
other neurotransmitters.
Neuron Protective
Protects against neuronal death caused by lack of oxygen (anoxia).
It regenerates nerves and provokes remyelination of nerve fibers.
Polyamines
SAMe is also necessary for the synthesis of a group of compounds
collectively referred to as polyamines, which are spermidine, puescine,
and spermine. These polyamines are essential for cellular growth and
differentiation, gene expression, protein phosphorylation, neuron
regeneration, and the repair of DNA.
Transsulfuration
SAMe is the precursor in the sulfur metabolic pathways for the synthesis of cysteine, glutathione, and taurine.
General:
SAMe has no reported toxicity.
Health Conditions:
In a placebo controlled trial involving 29 patients, 11 were
bipolar and recieved SAMe. None of the placebo patients were bipolar.
When exposed to SAMe, nine of the 11 bipolar patients were switched
into elevated mood state including hypomania, mania and euphoria. In
patients with bipolar disorder, use SAMe with caution and monitor
closely.(1)
Side Effects
A few minor side effects have been occasionally reported, which include dry mouth, nausea,(2) and restlessness.
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SAMe is needed to form melatonin from serotonin, which helps
explain insomnia in HCV, where SAMe levels are lowered, and also is
used in the synthesis of phosphatidylcholine. Melatonin is also a
useful antioxidant in its own right, as it is soluble in both water and
fats and protects nerves from oxidization; drugs like MMDA (ecstacy)
can damage the parts of the brain affecting mood because of the
accumulation of this damage, a side-effect of their desired action, and
5-HTP or melatonin used after MMDA or other stimulants, especially when
combined with other antioxidants, has been shown to prevent this type
of damage in laboratory animals.
High dose of selenium, over 600 mcg, can cause irritabilty but this
is not the same as hypomania. When I stopped taking selenium
(150-300mcg) after 6 months, I quickly became depressed, that is, I
wanted to sleep and did not fel in the mood for working. When I started
again, after a week, I was right in a day or two.
Another supplement that bears warnings for bipolar individuals is the Arctic Root, Rhodiola.
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