Bipolar-Like Mood Symptoms, How Lupus Can Cause

Systemic lupus erythematosus (also known as lupus or SLE) is an autoimmune disorder which can cause chronic disease in different parts of the body. While the exact mechanisms for lupus are unknown, the condition ultimately represents an immune system gone awry, attacking normal cells it mistakenly sees as dangerous.

The central nervous system is just one of the attacks of this autoimmune response. When it happens, it can manifest with psychiatric symptoms that are extremely similar to bipolar disorder.

While the symptoms of the two disorders overlap (as do the drugs used to treat them), SLE and bipolar are in no way related. Despite popular belief, SLE does not cause bipolar disorder.

On the other hand, SLE is sometimes incorrectly misdiagnosed as bipolar disorder. When this happens, a person may be exposed to not needed and inappropriate treatment.

Neuropsychiatric Symptoms of Lupus

When lupus affects the central nervous system, it can cause a variety of symptoms, both neurological and psychiatric. We refer to this condition as neuropsychiatric systemic lupus erythematosus (NPSLE). Symptoms can range from mild to severe and include:

• Migraines

• Mood disorders, including depression and bipolar-type symptoms

• Memory loss

• Loss of cognitive function

• Tremors, tics, and involuntary movement

• Clumsiness

• Seizures

• Blurry vision

• Hearing difficulties

• Speech issues

• Confusion and delirium (illusions)

• Tingling, numbness, burning, painful nerve sensations

• Stroke

NPSLE affects about 40% of people with lupus, most frequently manifesting as depression, memory deficits, and general cognitive reduction. It’s considered a serious problem that leads to a diminished quality of life and an increased illness. Ongoing research suggests NPSLE is associated with a ten-fold increase in mortalities compared to people in the general population.

What causes these issues?

Rather than having one specific cause, NPLSE is due to a combination of factors including immune dysfunction, hormonal irregularities, vascular inflammation, and direct damage to nervous tissue. Even drug side effects may contribute to the symptoms. Moreover, the protective layer which surrounds the brain, called the blood-brain barrier, can be disturbed by lupus, allowing toxins to infiltrate and harm neural matter.

Some of the symptoms of NPLSE may also be related to a condition called demyelinating syndrome in which the autoimmune response gradually strips away the myelin sheath (think of it as the insulating cover) of a nerve. Depending on where this occurs, it can trigger a variety of sensory, cognitive, and visual problems.

Diagnosing this problem?

Because it is difficult to differentiate between the multiple causes of NPSLE (including independent psychiatric disorders), there is no cookie-cutter standard for diagnosis. As such, diagnosis is typically made by exclusion, probing all other possible causes including infection, coincidental disease, and alternatively drug side effects. This is made on a case-by-case basis under the direction of a specialist experienced in NPSLE.

If demyelination syndrome is sensed, tests may be performed to confirm the existence of autoimmune antibodies (autoantibodies) linked with myelin damage.

How To Treat Depression (Bipolar symptoms) Naturally

1.  Consider why you might feel depressed. Sometimes depression is a symptom of something circumstantial in your life, rather than biochemical imbalances. Does your job require you to sell out your integrity every day? Have you been unable to admit that you need to end your marriage? Are you feeling spiritually disconnected or sexually restless? Are you suffering from creative blocks? Is your body failing you? Are you facing financial ruin?

Be honest with yourself about what might be off-balance in life, and make an effort to get to the root of why you might be feeling depressed.

2.  Move your body. Exercise helps release endorphins and make you happy, which act as natural antidepressants. Runner’s high, is real?

3.  Keep mealtime regular. Keeping your blood sugar stable reduces mood swings and improves your metabolism.

4.  Eat a serotonin-enhancing diet. Many antidepressants like Prozac (depression medication) act by inhibiting the reuptake of serotonin by receptors in the brain, thereby increasing serotonin levels. But you can increase your brain’s serotonin levels by eating foods that boost your serotonin levels naturally.

Serotonin-enhancing foods include:

• Foods high in omega-3 fatty acids (such as wild salmon, sardines, herring, mackerel, and anchovies, which are even higher in omega-3 fatty acids than other fish)

• Healthy fats like coconut oil

• Eat a high protein diet, especially proteins high in tryptophan, like free-range turkey or pulses.

5.  Avoid caffeine, which reduces serotonin levels. If you need an energy boost, supplement with L-Tyrosine (500 – 1000 mg) or tyrosine rich foods like chicken, turkey, fish, milk, yogurt, cottage cheese, cheese, peanuts, almonds, pumpkin seeds, sesame seeds, soy products, lima beans, avocados, and bananas.

6.  Expose yourself to sunlight, which can boost mood and increase Vitamin D levels. If you live somewhere that gets little sun, invest in a therapeutic lightbox. Alternatively, take vitamin D supplements 25ug per day or vitamin D rich foods like Salmon, Herring, Sardine, Herring, Cod Liver Oil, Tuna. Oysters. Shrimp. Egg Yolks, Mushrooms.

7.  Try mood-enhancing supplements: (DISCLAIMER: Although you can get these supplements over the counter, I always recommend doing this under the care of a physician, since supplements can have side effects and risks and can interact with other medications.)

• 5-HTP 50-300 mg up to three times/day — start at 50mg in the morning. Converts directly into serotonin. If you are taking too much, you will feel sleepy or have runny stools. Also usually helps with anxiety, although sometimes it can paradoxically cause anxiety. Must use with great caution if you’re taking an antidepressant.

• St. John’s Wort 300mg three times/day. If you don’t feel better within a week, slowly increase your dose to a max of 600mg three times/day. May decrease the effectiveness of birth control pills.

• SAMe 200mg on an empty stomach twice/day. Increase your dose every two weeks to a maximum dose of 600mg twice daily. This can be a very effective antidepressant, but it can also be expensive. Side effects at higher doses include GI upset, nausea, agitation, and insomnia.

• L-Theanine 100-600mg daily. Reduce if you feel sleepy. Found in green tea.

• Fish oil (DHA/EPA) 1-3 g/day with food.

8.    Meditate or try guided imagery. Meditation’s effects on mood are well documented. Settling your mind can lift your mood, in addition to a whole host of other health benefits.

9.    Get your hormones balanced. If your thyroid, adrenal or sex hormones are out of whack, your mood can get all wonky. See a good integrative medicine doctor and ask them to order and interpret the following tests:

• Thyroid gland tests – TSH, free T4, free T3, total T3, thyroid antibodies

• Adrenal gland tests – cortisol, DHEA-S, pregnenolone

• Sex hormone tests – estradiol, progesterone, free and total testosterone

10.  Make efforts to bolster your mental health by being more authentic in all aspects of your life. Too often, we walk around wearing masks, pretending to be something we’re not. We fake it at the schoolyard, in the boardroom, in the bedroom, at church — and then we wonder why we wind up depressed. Consider signing up for this e-course or live workshop about getting in touch with your authentic self.

11.  Talk it out. See a therapist, psychiatrist, or life coach and express how you feel. Sometimes just finding someone you trust who will help you work through your feelings can make all the difference in the world (talk to someone).

If all else fails and you truly need anti-depressants, don’t struggle and feel shame. Sometimes you can do all the correct things right, and if your imbalance is biochemical, you might need the medication. But don’t forget to nurture the rest of you too. Depression, like most physical and mental illnesses, is multifactorial and requires a global investigation of your whole health, not just your mind and body, but your relationships, your work, your financial picture, how you express yourself creatively, how you satisfy yourself sexually, your environment. Think of it this way, if you had an issue with any other area in the body you would seek medical advice, why is the mind any different?

Medical Treatment (Medication) for depression

Typically speaking, the medications used to treat psychiatric and mood disorders may also be used to treat the psychiatric symptoms of lupus.

In the event of severe NPSLE, treatment will be focused on the use of medications that suppress and moderate the autoimmune response. Options include taking a high-dose of corticosteroids (such as prednisone or dexamethasone with intravenous cyclophosphamide). Other treatments include rituximab, intravenous immunoglobulin (antibody) therapy, or plasmapheresis (plasma dialysis). Medium symptoms may be treated with oral azathioprine or mycophenolate.

It’s important to note, however, that high doses of corticosteroids may exacerbate mood disorders and, in rare cases, lead to psychosis.

Look out for the signs of lupus depression

Life with lupus is hard and our symptoms that come and go, flare-ups and remission periods, and the unpredictability of what each day will produce. It’s usual to experience feelings of sadness, aggravation, irritation, or glumness. It’s also normal to mourn for the loss of the life you had before lupus ravaged it.

As you learn more about lupus and how to adjust and adapt to necessary life changes, feelings of unhappiness, frustration, anger and sadness will lessen.

However, there is a difference between temporary negative feelings and negative feelings that become overwhelming and long-lasting, which may signal a serious but treatable illness called clinical depression.

Symptoms of clinical depression

People are considered clinically depressed when they have a depressed or irritable mood, decreased energy, and other symptoms in the list below that last for more than a few weeks and are severe enough to disrupt daily life. Probably the best single marker for clinical depression is the loss of interest in activities and responsibilities that used to be important; for example, if you find yourself saying, “I used to enjoy gardening, cooking, and going to church. I don’t feel like doing any of those things anymore.” Clinical depression may be brought about by lupus, by the various medications used to treat lupus, and/or by any of the factors and forces in a person’s life that are not related to lupus. For reasons that are not entirely understood, people with chronic disease often experience this type of depression.

If recognized and properly treated, symptoms of clinical depression can improve.

These are among the most common psychological and physical symptoms of clinical depression:

• Feelings of helplessness or hopelessness

• Sadness

• Crying (often without reason)

• Insomnia or restless sleep, or sleeping too much

• Changes in appetite leading to weight loss or weight gain

• Feelings of uneasiness, anxiety, or irritability

• Feelings of guilt or regret

• Lowered self-esteem or feelings of worthlessness

• Inability to concentrate or difficulty thinking

• Diminished memory and recall

• Indecisiveness

• Lack of interest in things formerly enjoyed

• Lack of energy

• General slowing and clouding of mental functions

• Diminished sexual interest and/or performance

• Recurrent thoughts of death or suicide

Clinical depression may not be recognized in people with lupus because its symptoms and the symptoms of active lupus can be so similar. For example, lack of energy, trouble sleeping, and diminished sexual interest can be attributed to lupus itself. However, these are also symptoms of clinical depression.

How dealing with chronic illness can lead to depression

A variety of factors can contribute to clinical depression in people with chronic illnesses. The most common cause is the emotional drain from the stress of coping with the complications of physical illness. Add to that economic, social, and workplace concerns. Moreover, various medications used to treat lupus—especially corticosteroids—may cause clinical depression.

When certain organs or organ systems are affected by lupus (such as the brain, heart, or kidneys), clinical depression may occur. A lupus flare also can trigger clinical depression, both because you feel ill and because it may seem as though you are never going to be free of lupus.

More facts about clinical depression and lupus

• Between 15 and 60 per cent of people with a chronic illness will experience clinical depression.

• Clinical depression may be a result of the ways in which lupus physically affects your body.

• Some of the medicines to treat lupus—especially corticosteroids such as prednisone (and at higher doses of 20 mg or more)—play a role in causing clinical depression.

• Clinical depression may be a result of the continuous series of emotional and psychological stressors associated with living with a chronic illness.

• Clinical depression may be a result of neurologic problems or experiences unrelated to lupus.

• Clinical depression also produces anxiety, which may aggravate physical symptoms (headache, stomach pain, etc.).

• Two common feelings associated with clinical depression are hopelessness and helplessness. People who feel hopeless believe that their distressing symptoms may never improve. People who feel helpless believe they are beyond help—that no one cares enough to help them or could succeed in helping, even if they tried.

What can you do?

Seek psychotherapy. Clinical depression generally improves with a combination of psychotherapy and medication. You should not feel embarrassed or hesitant about asking your doctor for a referral to a psychiatrist, psychologist, or therapist.

Psychotherapy, under the guidance of a trained professional, can help you learn to understand your feelings, your illness, and your relationships, and to cope more effectively with stress. Cognitive-behavioural therapy—a special type of psychotherapy—can be very helpful when you are living with chronic illness. Support groups led by a therapist or trained counsellor, such as those organized by the Foundation’s national network of chapters and affiliates, also can be instrumental in helping you deal with symptoms of clinical depression.

Take antidepressant medications. Several types of prescribed drugs can help ease the effects of clinical depression. Anti-anxiety medicines are also available to reduce worry and fearful feelings. In some people, improvements can occur in a matter of weeks once the medication is started.

Find ways to reduce pain. Chronic pain can be a factor in the development of clinical depression. Besides medication (which can also play a role in clinical depression), experts often recommend non-medication ways to conquer—or at least reduce—chronic pain, such as yoga, Tai Chi, Pilates, acupuncture, biofeedback, meditation, behavioural changes, play therapy, and chiropractic care.

You may consider over-the-counter treatments for your depression and/or pain. It is important to discuss all herbs and supplements with your rheumatologist or primary care provider before trying them as certain ingredients can cause reactions with your prescribed medications.

Get more exercise. If you are physically able, take part in some sort of physical activity every day. This can be as simple as walking the dog, yard work or gardening, or window shopping at the mall.

Improve your sleep habits. Not getting enough restful sleep can cause many health problems, including symptoms of clinical depression. To improve your sleep, and, in turn, your mental well-being, try to:

• Get seven to eight hours of sleep in a 24-hour period.

• Do aerobic exercise every day, such as brisk walking—or whatever you can manage.

• Avoid caffeine, nicotine, and alcohol several hours before bedtime.

• Know which medications keep you from sleeping and take those early in the day.

• Have a good mattress, comfortable bed linens, the right room temperature, and the right amount of darkness.

• Include rest periods throughout your day when needed.

If you still aren’t getting enough sleep, find a reputable sleep centre and talk to your doctor about sleep medications and/or possible physical causes for your sleeplessness.

Build a support system. Stay in touch with family members, former work buddies, or long-time friends. Make phone calls, join Facebook, try video conferencing, or consider adding an animal companion to your family.

Change your self-talk. Feelings of anger and self-pity can bring on unproductive thoughts; for example, “It’s not fair. I haven’t done anything wrong. Why me? Or I’m too weak even to fight off this illness.” Replace negative, self-defeating inner language with truthful, productive thoughts, such as: “I feel lousy, but I have many blessings.”

You can also list the people and things in your life for which you are grateful: A loving spouse or significant other; your children, and the children of your extended family; caring relatives; good friends; a beloved pet; work or hobbies you enjoy and are able to do; a home you love; volunteer activities; fellowship at school, at a place of worship, or at a community center. Try to add to this list every day!

Discover the values of volunteerism. Volunteerism can provide real emotional benefits. Helping with a charitable cause that is meaningful to you can create social, supportive connections. Helping others can have a positive impact on your sense of well-being.

Strive to accept the new “you.” Pace yourself, and don’t feel bad about delegating some of your responsibilities. Ask for help, and accept help graciously. Finally, focus on what you have and what you can do, rather than on what you don’t have and can’t do.

Just as clinical depression develops over time and not overnight, conquering clinical depression is a gradual process. However, most people with lupus find that, in time, their overall attitude and sense of well-being are greatly improved.

Things always seem harder in the moment!