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First, before treatment actually starts, you and your doctor must be sure that you don’t have thyroid changes causing your mood problem.
For many people, a very important part of bipolar disorder treatment is getting help coming to terms with having the illness at all.
In fact, multiple research studies have shown that using a therapist to help you with this acceptance stage, and then with making some of the necessary changes in your routines, leads to much better long-term outcomes. Unfortunately, most psychotherapists (as of 2008) are not specifically trained in the bipolar-specific versions of these therapies.
The research behind these approaches has been summarized on a separate page on this website, Psychotherapies for Bipolar Disorder.
Because antidepressants are so widely used, I will take this opportunity here to make sure that you are familiar with the concerns about antidepressants. Antidepressants can cause hypomanic or manic symptoms (sometimes called switching”, meaning from depressed to manic). Finally, could antidepressants cause kindling”, in which the illness worsens more quickly with time than it might have if antidepressants weren’t there? Whatever you do with antidepressants, you really need to work closely with your doctor on this. Meanwhile, however, the good news is that we have at least ten different ways of treating depression in bipolar disorder, without using antidepressants. However, some of these medications have been around longer, so we know much more about their benefits and risks (those whose role is in some doubt have a question mark in the figure above).
Secondly, all of these medications sometimes cause weight gain and can raise the risk of diabetes. If you’ve just been diagnosed as bipolar, most doctors will add a mood stabilizer to your antidepressant.
If you’re currently on a mood stabilizer and not doing well, then in my view you need to ask your doctor what risks she sees in tapering off the antidepressant.
I advise patients that they have not had an adequate trial of mood stabilizers if they were simultaneously on an antidepressant at the time. Bipolar I is a long-term illness that usually requires lifelong preventive strategies, at least after several manic or depressed phases have occurred. However, you obviously have ultimate control over how your medication is managed — you’re the one that has to put the pills in your mouth every day. I have seen mood stabilizers seem to make people more depressed than they were before they started, so that is worth watching for (we stopped the medication and things got better; then tried other approaches). Then hand her a Dear Doctor letter — or use any approach you think might work to get her here! Several medical conditions like Jock itch, Athlete’s foot and ringworm infection may give rise to growth of fungi into the nails. There is chance for you to get these infectious fungi when you visit contaminated swimming pool and share public bathrooms where molds have grown. It is observed that fungi belonging to the group called dermatophytes cause this infection on nails.
Another reason for toenails getting more infected than your fingers is it is under the protection of shoes for most of the time giving no room for breathing. You also have chance to get this infection if you do pedicure or manicure in the utensils that is not properly washed. Aged people and individuals who continuously keep their toes in closed shoes are prone to get fungal infection on nails. In case of severe infection with pain, your doctor may remove the nail by surgery for facilitating new nail to grow in. According to scientific studies, some of the common causes of this disease results from damage to the adrenal cortex.
Damage to the adrenal cortex could be caused by an autoimmune disease, infections such as HIV, tuberculosis, and fungal infections, tumors, blood loss or haemorrhaging, and the use of anticoagulants or blood-thinning drugs.
Those who are at risk of this disease are those who have chronic thyroiditis, Graves’ disease, hypopituitarism, type I diabetes, and vertigo in their medical histories. Some symptoms related to this medical condition include chronic diarrhea, patchy skin colors, changes in blood pressure or heart rate, loss of appetite, fatigue, and lesions in the inside of the cheeks. Since levels of cortisol produced by the body are significantly lower due to Addison’s disease, patients are recommended to take corticosteroids for boosting the amounts of hormones that adrenal glands produce.
A correct dosage of adrenal hormone supplements is important in order to prevent further medical complications.
It is important to contact a healthcare provider when infections and injuries are present during occasions of treatment.
It is also helpful to learn how to inject hydrocortisone during stressful situations in order to prevent the risks caused by delayed dosages of this pharmaceutical product. Severe sunburns typically occur in individuals who remain under the hot sun for long durations without using proper sun protection. Avoid venturing out into the sun between 10 AM and 2 PM, when the sun rays are at their most intense. Intake of some medicines like certain antibiotics, birth control pills, antidepressants, heart medicines, acne drugs, etc., can elevate the skin’s sensitivity to sunlight.
Then skim through again and take some of the links in each section for more details on concepts of particular interest to you. One approach that is crucial for most patients with bipolar disorder is to maintain a regular daily schedule, especially regular patterns of sleep.
Accepting the illness, and accepting some limitations in order to deal with it — sometimes getting some help with this makes a huge difference. Three major forms of bipolar-specific psychotherapy emphasize this process of acceptance and change. Unless you live near one of the training centers for these methods, you may not be able to find a therapist who who has had specific training on using such an approach.


But that’s really tough, especially since motivation goes missing during bipolar depression, and most of those approaches require either motivation or a really good system of habits. Many doctors shy away from talking about bipolar disorder as a possible diagnosis because the think the risks of the treatments are much greater than the risks of antidepressants, for example.
While your mind may leap to considering the risks, you should step back first and consider the evidence for effectiveness, of any treatment you’re considering. Some experts think that antidepressants do not have a role at all in treating bipolar depression, except perhaps as a maneuver of last resort.
Overall, this is thought to occur between 20 and 40% of the time when a depressed patient with bipolar disorder is given an antidepressant.
This means that mood experts agree these are the best choices as a place to start if you’ve never taken a mood stabilizer before.
Olanzapine is worst in this respectLeslie and risperidone and quetiapine are thought to be intermediate. The reason for looking closely at fish oil is not the great results in research trials, although there are some; but rather the complete lack of any risk known at this point. Recent research suggests that thyroid hormone, which is very inexpensive, may be both an antidepressant and a mood stabilizer, at least in women (2010); this has been under study for years, but with recent emerging evidence has climbed much higher on my list of options.
Some of my colleagues have expressed their concern to me that their patients will read this website and stop their antidepressants.
I have seen this happen many, many times: so many, in fact, that I routinely rely on the mood stabilizers to help depressed people, and taper off their antidepressants, even while they are depressed.
Bipolar II is less well defined but intuition is generally correct: the longer people have had symptoms, the longer it makes sense to continue the medication before a trial of tapering it off.
Bipolar disorder in many cases seems to progress, as though each cycle was increasing the likelihood and the severity of yet more cycles. From here you can go back to the Table of Contents (always up there, top right) , or I’d particularly recommend more treatment details. It is caused by fungi by name Tinea unguium and it starts as small whitish or yellow spot on the toenail or fingernail. Fungus lives on warm and moist areas and easily spread infection when it gets into your nails through cuts or wounds and even on small gap between the nail bed and nail. There is more chance for you to get infected when your toenails are exposed to continuous moisture.
People who have nail deformity or poor blood circulation on the toes may also get fungal nail infection.
It becomes slightly yellowish or white and you can find the edges of the nail getting crumbled. For some people, your doctor may also prescribe antifungal nail lacquer like Penlac for painting on the infected nails. If you want to know more about Addison’s disease, it is important to understand its different symptoms as well as some of its common causes. People who have developed this disease also exhibit other symptoms such as nausea and vomiting, continuous weight loss, paleness, and beyond normal craving for salt and salty food. In addition, patients undergoing this kind of treatment are required to take these maintenance medicines for the rest of their lives. Those who are unable to keep their medication due to vomiting and patients who start developing new symptoms are also advised to contact healthcare providers as soon as possible.
Whether you want to avoid developing this medical condition or you want to treat it with the use of hormone replacement therapies, it is always important to seek guidance from skilled doctors and medical physicians. Additionally, Caucasians as well as others with light hair and fair skin are at increased risk to developing intense sunburns. If it becomes a necessity, then make sure to fully cover all parts affected by sun poisoning. It may be noted that the intensity and damaging effect of the sun’s rays tend to amplifyfurther after contact with snow, sand, and water. People who are taking such medications should talk to their health care provider about its effects. Solar urticaria: People affected by solar urticaria may experience the symptoms after spending just a few minutes under the sun. Usually your doctor will also order other tests at this time, if you have not had a recent check of cell counts and blood chemicals, to make sure you don’t have other potential medical causes for your mood problems. Unfortunately, the most important steps you can take, without medications, can seem quite restrictive. All of them are variations on techniques which have been around for a long time: cognitive behavioral therapy, interpersonal therapy, and family therapy.
Worse yet, the training manuals for these therapies, which are easily obtained, tend to focus on Bipolar I.
But if you read Prozac Backlash, which offers an extreme view of the possible risks of antidepressants, you’d probably think at least some of the mood stabilizers look better, by comparison. You won’t see them all but this website now has about 300 pages, many on very specific topics with only a single path that will take you there.
The more you learn the more you’ll be in a position to help determine your own treatment. Such experts point either to the lack of evidence for sustained benefit, or the several lines of evidence that they can do harm.
In a way, this is the same problem as #2 above, except that instead of switching from one state to another, you have both at the same time.
Most of these are ingredients in basic treatment, outlined in the next two sections B and C below. For details, first read basics about thyroid and bipolar disorder; then see my page on high-dose thyroid hormone. If that was really happening very often, I’d have to consider shutting down the site.


In many people, eventually a full depression episode occurs again, despite being on an antidepressant, even one that “worked” before!
Yeesh, this Phelps guy really seems to have a thing about antidepressants, doesn’t he?
So you really ought to know about any risks that might come with doing that, and there are some. Left uncontrolled for a period of time, it can worsen so that previously effective treatments are no longer adequate.
I have seen about three patients where it looked to me as though this might have occurred (out of more than two thousand), but there are so many variables involved it is impossible to be at all certain. If you think your doctor needs to know some of the kinds of things you are learning here, you can gently suggest she read this page you’re on now. Once the infection starts spreading, the entire nail may change into yellow making the infection in-depth. Fungus feed on the dead tissues of the nails and hair follicles and even on the epidermal layer of the skin.
Again many people who get fungal infection would great their toenails affected when compared with fingernails. Further there will be collection of debris under the nails and gradually the nails become thicker than other healthy nails. People who have athlete’s foot and other type of skin infection would also get fungal nail infection.
The production of cortisol is responsible for regulating brood pressure, maintaining healthy sugar levels, and preserving your immune system.
They are also advised to never skip doses of their medication since it could cause life-threatening reactions. Sun poisoning is used to describe cases of burns and skin inflammation that are caused by the sun’s UV rays. The redness and distress that accompany a sunburn may only appear on the affected skin after some hours have passed. Use the sunscreen on all parts of the body, especially on the exposed skin areas, 15 to 30 minutes before going out. For instance, residents of regions in the northern latitudes are more likely to develop PMLE when holidaying in sun-drenched regions.
Because it is not very common to find a problem using these tests, treatment can start even before the results are back. If you include the risk of antidepressants making bipolar disorder worse, then the risks of the mood stabilizers could be regarded as roughly in the same realm as the risks of antidepressants.
More details about the role of antidepressants in bipolar disorder treatment, including links to relevant articles that form the basis of my view, and a summary of an alternative point of view, can be found on the Antidepressant Controversies page. But since those consensus guidelines were written up, most of the new recommendations focus on the non-medication options above. If that worries you, see my little essay about the term antipsychotic; it might reassure you a little bit.
The intent here is not to undermine other doctors, just to educate those who wish to learn more than their doctors have time to teach. For some people, you can even say that the antidepressant is causing depression, by making the cycling continue, including cycling into depression. There are several studies in Bipolar I which seem to indicate that rapidly discontinuing lithium leads to rapid relapse, where tapering off does not present that risk.
The fact that I have yet to encounter other experts writing about this possibility is somewhat reassuring.
If they are frustrated at not being able to help you, which is probably true, their frustration can sometimes seem like it’s aimed at you.
Meanwhile, aldosterone regulates the electrolytes in your body, assists in the excretion of potassium and re-absorption of sodium into the body. Apply the sunscreen after every two hours, or after a swimming session or excessive sweating. Also, PMLE has no known connection to any particular disease or use of any specific medicine. But that often means they will have to rely more heavily on medications, which can mean having to deal with more side effects or risks. The bipolar-specific versions simply incorporate some special features pertinent to people with bipolar disorder. If you have trouble getting your concerns or ideas heard, here are some ideas on talking with doctors.
There is little new, in terms of medications; except a lot more controversy about the role of antidepressants. Sometimes that’s a very good thing, and when that effect is necessary, these are great options. For lithium at least, stopping should take months, decreasing by 150mg increments all the way to zero; and this probably applies, by extension (for the moment, at least, until we have some data to go on), to other mood stabilizers. There will not be any luster or shining of the nail anymore once the infection gets deeper. But listen to this statement from one of the most widely respected bipolar experts in the world, Dr. In other words, there is general agreement that antidepressants are not the first thing to turn to in the treatment of bipolar depression. The process of the separation of the nails from the nail-bed is called onycholysis and this may cause moderate pain on the toes or fingers.



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