Joe Kraynak

Article / Updated 10-04-2023

As you're setting up your cannabis grow room, with the right humidity, ventilation, and other necessary climate conditions, you'll also need to consider lighting, watering, and fertilizing. Lighting is a key factor in growing healthy cannabis indoors. The types of lights, the way you set them up, and other pieces that control and direct them are the keys to your yield and the flavor of your end product. Here, we guide you through the process of choosing and installing your grow lights. Before you head out to your local nursery or hardware store to shop for grow lights figure out how much light you need. In general, a standard 1,000 watt grow light will cover four plants that have a fully grown diameter of about 3 feet, depending on strain. If you set up your grow lights and plants and notice that some parts of one or more plants aren’t receiving light, you’ll need to add one or more lights. Choose light fixtures and bulbs Most standard household light fixtures and bulbs are insufficient for growing cannabis. They don’t provide the intensity and quality of light the plants need for optimal growth. The exception is fluorescent lights (typically T5s) or compact fluorescent lights (CFLs), which are okay, but result in smaller, lower-quality buds. We don’t recommend fluorescent lighting. After ruling out fluorescent lighting, your choice of grow lights depends on your goal and the stage of growth: If your goal is high yields, choose a high intensity discharge (HID) bulb — metal-halide (MH) for the vegetative stage and high-pressure sodium (HPS) during the flower stage. These bulbs emit a lot of light and a lot of heat, so you need to position them at a greater distance from the plants. If you’re looking for better terpene yields for extraction, use light-emitting diode (LED) or ceramic metal halide (CMH) bulbs, because these preserve the terpenes without bulking up the flower weight and density the way high-intensity discharge (HID) lighting does. Your choice of light fixture depends on the bulbs you want to use. After choosing a bulb type, shop for grow light system that includes all the lighting components you need, including the bulbs. Components/features of a grow room lighting system include the following: Fixture with reflector hood: The fixture holds the bulbs, and the reflector hood directs the light down to the plants. Reflector hoods come in different types: Closed hood: Shaped like a box, a closed hood reflector creates a more focused beam of light (and heat). Vented hood: Similar to a closed hood reflector but with openings on the ends for connecting the hood to in-line duct fans for cooling. Wing: Typically a curved and textured aluminum sheet that provides a less focused beam of light than a closed hood reflector. The light covers a greater area but is less intense (so is the heat). Parabolic: Shaped like an umbrella, a parabolic hood distributes light like a wing but in a more circular pattern. Your choice of hoods is a personal preference. Go with a closed hood if you’re concerned about heat or with an wing or parabolic if you’re not. Ballast: The ballast provides control over the current that the lightbulb draws from the power source. The following two types of ballasts are most common: Magnetic: Less expensive, heavy, hot, potentially noisy, susceptible to flicker, and supports only bulbs of a certain wattage. If you want to change from a 400W bulb to a 600W bulb, for example, you need to replace the ballast. Digital: More expensive, smaller, lighter, cooler, quieter, less susceptible to flicker, more efficient, may be equipped with a dimmable option, may cause radio frequency interference. Hooks and pulleys: Grow light systems often include hooks and pulleys for hanging the light fixtures in your grow room. Pulleys enable you to more easily raise and lower the light fixtures to place them at the right distance from the tops of the plants. Timer: Grow light systems typically come with a timer, or you can purchase a timer separately, which automates the process of cycling the lights on and off on schedule. Mount your light fixtures Mount the light fixtures to the ceiling of the grow room above the plants, positioning the fixtures to ensure equal distribution of light over the entire canopy. How you mount the light fixtures depends on the fixture and how your grow room ceiling is configured. Using hooks, ropes, or chains and possibly pulleys, you can hang your fixtures in a way that you can easily raise and lower them to the proper distance from the tops of your plants. Position the lights above the plants, so all parts of all plants are receiving light. The light should be as close to the top of the tallest plant as possible without burning it. Keep a close eye on the plants whenever adjusting the lights, and if the top of any plant is getting burned, raise the light. Don’t place anything flammable close enough to the light that there’s any possibility the light will ignite it. Set and reset timers During the vegetative stage, plants require 18 to 24 hours of light. During the bloom/flower stage, they need 10 to 12 hours of light and at least 12 hours of total darkness (for photoperiod strains); auto-flowering strains will flower without 12 hours of darkness. Putting your grow lights on timers greatly simplifies the process of managing the required light/dark cycles, but you still need to manage the changes in lighting over the growth cycle. If you plan to have a continuous garden with some plants in veg and some in bloom, set up your lighting differently in those two areas. For photoperiod strains, use a separate grow tent or grow room for plants that are in the vegetative stage and those that are in the flower stage. To monitor your plants through the growth cycle and adjust the lighting, take the following steps: Position the lights at the proper distance above the canopy for the vegetative stage. Adjust your light timer(s) to provide 18 to 24 hours of light. Experiment with different settings in that range over several grows to find the optimum amount of light for each strain you grow. Keep an eye on your plants, adjusting the lighting as necessary to keep the lights the proper distance from the tops of the plants as they grow taller.When your plants are about half the size of full-grown plants, they’re ready to switch from the vegetative to the flower stage. (At this point, you either adjust the lighting, as explained in the remaining steps or move the plants to the flower tent or room.) The size of a full-grown plant is strain dependent and impacted by light, container size, and other environmental influencers such as CO2. You may have to go through several rounds of growing a particular strain to develop a clear idea what the size of a full-grown plant is and when the plant is ready to switch from the vegetative to the flower stage. If you were using MH bulbs during the vegetative stage, change to HPS bulbs for the flower stage. You don’t need to change out fluorescent, CFL, or LED bulbs. When changing to the brighter HPS bulbs, shade the plants for a couple days to prevent them from getting blasted by the more intense light. You can place a piece of cardboard between the light and the plants to serve this purpose, but make sure it’s as far as possible from the light to prevent a fire. Adjust the height of your lights to position them the proper distance from the tops of the plants for the flower stage. Adjust the timers, so that the plants receive at least 12 hours of total darkness and 10–12 hours of light. Auto-flowering strains don’t need 12 hours of darkness; experiment with the lighting between grows to determine what’s best. Continue to monitor your plants during the flower stage, adjusting the height of the lights as needed to keep them the proper distance from the tops of the plants as the plants grow taller. When the stigma (the hair-like strands that cover the bud) on half the buds turn orange and red, your plant is ready for harvest. Measure the light Light intensity has a big impact on yield. All parts of all plants should have exposure to the light, and the lights should be as close to the plants as possible without burning them. If the top of any plants are wilting or burnt from the light, raise the lights. For more sophisticated grows, obtain a photosynthetic active radiation (PAR) meter and take measurements at several different locations above the canopy to measure the PAR output of the lights. The PAR measure should never rise above 1,200 PAR. Watering and fertilizing Whether you’re growing indoors or outdoors, you need to decide on a system for watering and fertilizing your plants. You basically have two options: manual and automatic. During your first grows, we recommend the manual method as you develop a sense of how much water and fertilizer your plants generally need. After developing an understanding of your plants’ water and nutrient needs (which may vary depending on the strain), consider installing an automated irrigation system. These systems are equipped with timers that water and feed plants automatically on a pre-set schedule. Automated irrigation provides the same benefits of lighting systems — the convenience and reliability of automation. However, you still need to monitor your plants to be sure they’re getting enough and not too much water and nutrients. Using a hydroponics system In all hydroponics systems, plants are placed in trays or containers that contain a grow medium other than soil, such as pea gravel, expanded clay aggregate, coco coir, or vermiculite. These various systems are then used to deliver water and nutrients to the roots: Aeroponic: Plants sit in a tray above a water/nutrient reservoir with their roots dangling down. Solution from the reservoir is sprayed up onto the roots at regular intervals, and excess solution drips down into the reservoir. Drip: Nutrient-rich water is dripped slowly at regular intervals into the grow medium where the roots can absorb it. Unused water drains back to the reservoir to be reused or to a waste reservoir and then discarded. Deep water culture (DWC): Plants sit in baskets above an aerated (and typically chilled) water/nutrient reservoir with their roots submerged in the solution, which allows for continuous feeding. Ebb and flow: Plants sit in pots in a grow tray. Nutrient-rich water is pumped into the grow tray at regular intervals and flows into holes at the bottom and sides of the pots. The pumping stops and water is allowed to drain back into the reservoir from which it was pumped. Nutrient film technique (NFT): NFT is like a cross between DWC and ebb and flow. Plants sit in baskets above a grow tray. Nutrient-rich water is continuously pumped from a reservoir into the grow tray and then drains from the opposite end of the grow tray back into the reservoir. This arrangement delivers a continuous flow of nutrient-rich water to the roots. Wick: A plant sits in a container above an aerated, nutrient-rich water reservoir, and a rope or other absorbent material (such as felt) is placed through the middle of the growth medium and into the reservoir. Through capillary action, the solution from the reservoir “climbs” the rope, providing the plant with as much or as little water and nutrients as it demands. Tips for hydroponics systems Here are a few suggestions for increasing your odds of a successful hydroponics grow: Disinfect all your hydroponics equipment with isopropyl alcohol or bleach between grows to kill off any bacteria or other infectious agents. Anaerobic bacteria can build up in dirty systems and kill your plants from the roots up. Use clean, pH neutral water. Water from a reverse osmosis (RO) system or distilled water is suitable. Aerate the nutrient-rich water solution. You can place an aeration stone in the bottom of the reservoir attached to a small air pump like those carried by local pet stores. Without aeration, your plants may not receive the oxygen they need. Replace the water/nutrient solution every couple weeks. Don’t merely add nutrients, because nutrient concentrations may become too high as a result. (Remember to use a fertilizer with a higher nitrogen concentration during the vegetative stage and higher potassium and phosphorous during the flower stage.) After dumping the old nutrient solution, run a dilute water and hydrogen peroxide solution through the system to clear out any infectious agents and then rinse with plain water. Consider flushing the grow medium with plain water whenever you change the nutrient solution. When choosing and setting up a hydroponics system, research to find out the type of system that’s best for your grow space and skill level. Simpler is usually better. Use high quality food grade plastics in your system and make sure it’s leak free before starting your grow. Keep your grow room impeccably clean At the risk of sounding like your mother, we encourage you to keep your grow room clean. A dirty grow room provides the ideal environment for bacteria, fungi, and pests. Here are a few guidelines for keeping your grow room clean: After each use, wash and disinfect plant containers, grow trays, irrigation hoses, and pumps. Use soap and water followed by isopropyl alcohol or a bleach solution (one part bleach to three parts water). Then, carefully rinse everything with plain water. Keep your grow room free of any dead plant mater and debris. This is where many pests and pathogens can get a foothold in a garden of healthy plants. Watch for common pests such as aphids, fungus gnats, spider mites, and thrips. If you see even one of these nasty critters, identify it and find an effective pesticide. This is where your friendly garden store or grow store staff comes in handy.

Article / Updated 07-10-2023

Bipolar disorder and borderline personality disorder often share many of the same symptoms — mood shifts, emotion dysregulation, impulsivity. Prior to settling on a diagnosis of bipolar disorder, your doctor should consider borderline personality disorder, among other conditions with symptoms that overlap with those of bipolar disorder. Treatment for bipolar disorder and borderline personality disorder differ significantly, so determining which condition a person has plays a major role in selecting the most effective treatments. The following sections present guidelines for distinguishing between bipolar disorder and borderline personality disorder. Considering whether symptoms represent a deviation from a person's baseline A core diagnostic feature that's helpful in distinguishing between bipolar disorder and borderline personality disorder is whether the symptoms represent a deviation from a person's usual moods and behavior: Borderline personality disorder describes patterns of ineffective interpersonal skills and poorly modulated emotional and behavioral responses to the ups and downs of day-to-day life. These patterns have developed since adolescence or even earlier, and the symptoms have always been present — they are part of the person's typical or baseline self. Bipolar disorder is a condition in which emotional and behavioral patterns emerge that differ from the person's typical or baseline self. For example, the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) requires that a hypomanic (elevated mood and energy) episode be an "unequivocal change in functioning that is uncharacteristic of the individual when not symptomatic." Distinguishing between situational and episodic symptoms Mood dysregulation in borderline personal disorder and bipolar disorder also differs according to whether the moods changes are situational and short-lived or episodic (lasting for an extended period of time): Borderline personality disorder is characterized by affective dysregulation — big, painful, emotional reactions to stimuli that wouldn't typically cause so much internal and external upheaval. People living with borderline personality disorder struggle chronically with feelings of anger, sadness, and anxiety that often trigger painful and damaging behaviors, such as explosive rages, impulsive actions, or self-harm. These frequent mood changes and behavioral responses are the baseline for a person with this disorder — they occur often and may occur minute-to-minute or hour-to-hour. Something, often frustration, perceived frustration, or fear of abandonment typically triggers the mood disruption in borderline personality disorder. Bipolar disorder is characterized by episodes of mania, hypomania, or depression that last for longer periods of time (days or weeks), are a change from a person's baseline, may occur without any clear trigger, and typically diminish significantly when the mood episode ends. Comparing the types of mood symptoms Although borderline personality disorder and bipolar disorder share some symptoms (for example, irritability that may result from and lead to interpersonal conflict), their symptoms differ: Borderline personality disorder mood symptoms tend toward chronic feelings of irritability/anger, sadness/emptiness, and anxiety. Euphoric feelings aren't part of the diagnostic criteria for borderline personality disorder. Bipolar disorder requires at least one episode of mania or hypomania (elevated mood or euphoria). Mood symptoms in bipolar disorder — specifically mania or hypomania — almost always include some periods of euphoria and grandiose thinking — not just anger. (It can be just irritability/anger, but this isn't typical.) Comparing the nature of the impulsivity Borderline personality disorder and bipolar disorder share the symptom of impulsivity, but the nature of the impulsivity differs: In borderline personality disorder, the impulsivity is a chronic symptom; difficulty controlling or regulating behavior is a challenge that is part of everyday life. In bipolar disorder, impulsivity and disinhibited behaviors occur in the context of a manic or hypomanic period; they aren't chronic or baseline. And if someone is impulsive at baseline, the impulsivity must look significantly worse during a sustained period of time to qualify as a symptom of mania or hypomania. Differentiating bipolar depression from borderline personality disorder The depressive phase of bipolar disorder is also often confused with borderline personality disorder, because both conditions are characterized by periods of sadness that may be accompanied by irritability or anger. However, the two differ in the following ways: Borderline personality disorder is characterized by chronic sadness and anger, which again are part of the person's baseline self. Bipolar depression is episodic, not momentary, and is not limited to mood symptoms such as sadness, anger, or irritability. Bipolar depression is characterized by broader changes in function, which can include low energy and fatigue, diminished interest in activities normally considered pleasurable, changes in appetite or weight, sleeping too much or too little, moving slowly or having physical agitation, feelings of worthlessness or excessive guilt, diminished ability to think clearly or concentrate on a given task or make decisions, and recurrent thoughts of death or suicide. Determining whether they can occur together People with borderline personality disorder are at high risk of developing major depressive episodes and anxiety disorders. They can also develop bipolar disorder, but for both diagnoses to be present the bipolar symptoms have to be different from the person's typical way of behaving (the baseline self). The sadness or impulsivity or anger must differ significantly from the person's usual patterns and must be sustained for longer than just a few moments. Also, sustained euphoric/grandiose periods are almost always going to be present in bipolar disorder, and these must differ from the person's baseline thoughts, feelings, and behaviors. The differentiation between borderline personality disorder and bipolar disorder is often challenging, but important. If you're getting different diagnoses from different doctors, try to have a conversation with your doctor about why the doctor has made a particular diagnosis. Expressing your confusion and asking about your doctor's thought process is okay. If your current doctor is unwilling to have this conversation, consider exploring it with another doctor or therapist. You have a right to understand your diagnosis and have your questions answered.

Article / Updated 07-05-2023

To be a savvy consumer in the world of doctors and therapists, you have to assess your caregiver's credentials and qualifications, make informed treatment choices for your bipolar disorder, determine how you can tell if treatment is working, and know what to do if you begin feeling worse. This article provides a list of questions to ask a psychiatrist or therapist to obtain the information you need. (If you have other questions, write them down so you remember to ask them.) Research shows that medical outcomes improve dramatically when patients are empowered to ask questions and actively participate in their care. Don't assume that the doctor has all the answers and will tell you everything you need to know. Be proactive! You have the right to ask for clarification, simplification, or more information at any point in your care. How much experience do you have in treating bipolar disorder? Some psychiatrists and therapists are like general practitioners, whereas others specialize in particular areas, such as bipolar disorder, depression, anxiety disorders, or schizophrenia. Still others specialize in treating children and adolescents. Professionals who have more experience in treating bipolar disorder may be more attuned to the many ways people experience bipolar disorder and better equipped to sort through your history and ask pertinent questions to effectively identify patterns of your condition. They may also have a deeper range of experiences with different treatments and know how to apply their understanding of how people have responded to them over the years. Is it tough to get an appointment? If you can't get in to see your doctor or therapist when your moods begin to cycle, they can't help you much. So before you choose a psychiatrist or therapist, make sure that you won't have to wait three months before your next appointment. (Getting in for an initial appointment with the doctor may take more time because those appointments are longer.) Ask the office how far in advance you usually need to call to make a follow-up appointment so you can get an idea of how hard it is to get in to see this particular doctor or therapist. Can I contact you during a crisis? Nights, weekends, and holidays — the three times you most need your doctor or therapist, they're at home, spending time with their friends and family. The nerve of these medical people! Everybody, even doctors and therapists, needs some time off, but as a person with bipolar disorder, you need some numbers to call in a crisis. Doctors and therapists have a variety of systems for after-hours emergencies. Ask for your doctor's policy and procedures, which should include the following information: Office number: When you call the office after hours, a recorded message should provide instructions for emergency calls. After-hours number: Does the doctor use an answering service that can reach them? Do you call their cellphone or home phone for emergencies? Make sure you're clear about this. Name and number of the person who covers for the doctor or therapist when they're out: Doctors often take turns being on call. Emergency number of the hospital or mental health center where you should go in a crisis: If you're in the middle of a mental health crisis and you can't get in touch with your doctor, where should you go? Ask how long it typically takes your doctor or therapist to return calls if you need to leave a message. What's the diagnosis and how did you arrive at it? Sometimes a doctor prescribes medication without providing a final diagnosis, especially when some uncertainty exists. For example, if a patient is experiencing mania, the doctor may prescribe an antimanic medication without diagnosing bipolar disorder until they have the opportunity to rule out other possibilities. However, your doctor will have some ideas (working diagnoses, as they're often called) that drive their treatment choices. If your doctor doesn't mention a diagnosis, ask them to explain their thinking and the possible diagnoses they're considering. You have a right to understand what they think may be going on and why they're choosing particular treatment plans. How your doctor arrived at your diagnosis may be just as important as the diagnosis itself. Make sure your doctor has considered your family history, any prior mood episodes, the possibility of medication- or substance-induced symptoms, other medical conditions that may be causing symptoms, and aspects of your life that may be causing stress or sleeplessness or is otherwise contributing to symptoms. What's the treatment plan? Your doctor may hand you one or more prescriptions for antidepressants, antimanics, antipsychotics, or sedatives, but your medication doesn't make up your complete treatment plan. In most cases, you should have a doctor and a therapist; ideally, they work together to develop a treatment plan specifically for you. The doctor typically handles the medications, and the therapist deals with everything else, although some doctors are more actively involved in the bigger treatment picture. Your treatment plan should include the following: Medications Individual therapy, self-help, and lifestyle changes Family education and, possibly, family therapy Instructions on what to do if your moods begin to cycle Whenever your doctor recommends a change in medication, be sure to ask what the goal of the change is and how you and your doctor will evaluate whether the change met its objective. In the real world, having ready access to a psychiatrist and therapist isn't always possible. In such cases, you may find yourself relying on your primary-care physician, self-help, lifestyle changes, family and friends, and community resources. When can I expect to feel better? Your doctor and therapist are likely to tell you to remain patient, but you should know upfront what patient means. A week? A month? Two months? In most cases, you can expect to see some improvement in one to two weeks, but some medications may take four to six weeks or even longer to become fully effective. Ask your doctor and therapist to be sure. Typically, your doctor will follow up with you two to four weeks after your initial appointment or after you start a new medication to assess the effectiveness of the treatment and monitor for side effects. If you're feeling very unstable, they may want to see you even sooner. If the doctor tells you to come back in more than one month after you start a new medicine, find out why they don't want to follow your situation more closely. How will I know I'm getting better? With bipolar disorder, feeling better may convince you that you are better even when you're not, particularly if you're cycling into mania. Ask your doctor for more objective signs that your mental health is improving. When an episode of depression is lifting, you may experience these signs: Sleeping more regularly and getting better-quality sleep Doing more with less effort — in other words, better energy Socializing more Crying less Diminished thoughts of death or suicide When recovering from an episode of mania, these signs may appear: More sleep in general and less restless sleep overall Sustained stability in thought patterns — not racing or flying from topic to topic Reduction in pressured speech (rapid, nonstop talking) More typical energy and activity levels Fewer and less intense confrontations with others Improved ability to control impulses Less irritability What should I do if I feel worse? Getting just the right combination of medications requires communication between you and your doctor. Being able to get in touch with your doctor between visits is especially important when you're first starting medicine. Some medications may not work for you or may have an adverse effect on you. If your condition fails to improve or worsens or if you have a bad reaction to the medication (such as a rash or shortness of breath), contact your doctor, who may suggest one or more of the following steps: Stop taking the medication. Keep taking the medication to see whether the side effect settles down or the desired effects kick in and then call or come in to the office in a few days. Take a lower dose of the medication. Take a higher dose of the medication. Add something else to the medication. Be sure to follow up all these actions with additional phone calls or office visits to further optimize your treatment plan. How did you pick this medicine and what can happen when I take it? Most doctors hand you a prescription for the medications they think are going to be most effective and have the least chance of causing serious side effects. The doctor should always review with you how they chose this medicine over other ones (alternatives) and carefully review the potential effects and side effects of the medicine they have chosen to prescribe. Make sure that your doctor has answered the following questions for you before they reach for the prescription pad: How effective is the medication at treating the symptoms I have? Are there more effective medications? What are the potential risks and side effects of this medication, and what are the chances that I'll experience them? Are there any medications that may have fewer, less serious side effects? How will this medicine interact with other prescribed medications and over-the-counter products and with other substances including alcohol and caffeine? Make sure you always know the possible side effects and interactions of a medication before you begin taking it so you know what to watch for. Armed with a list of the most common and most serious potential side effects, ask what you should do if you notice any signs that you may be experiencing one of them. Will you work with my other providers? Coordinated treatment, especially between your doctor and therapist, is an essential component of success. Ask your doctor and therapist if they're willing to exchange notes. Make sure they have each other's contact information and signed consent forms that enable them to share information. If you want family members, friends, and other nonprofessionals to enter the treatment discussion, ask the doctors if they're willing to talk with the people in your support network. Your doctor and therapist can't legally discuss your condition or treatment with anyone unless you've signed consent forms for them.

Article / Updated 06-05-2023

A natural cures approach to life doesn’t mean you should never take treatment for ailments. Antibiotics are necessary for treating severe bacterial infections, but they’re often overused and frequently cause more harm than good: Antibiotics don’t just target the bad bacteria. They also wipe out many of the beneficial bacteria that improve digestion and produce nutrients, such as B vitamins, that your body needs to survive. Killing off beneficial bacteria upsets the delicate balance of intestinal microflora, leading to yeast overgrowth and infection. Alterations of the gut flora can have devastating effects on your overall health. The bacteria in your gut shapes your metabolism and can affect your behavior and your ability to fight pathogens. Overuse of antibiotics over time results in bacteria that are resistant to the antibiotic, making the medication less effective or completely ineffective in treating the infections they were developed to cure. Even if you don’t take prescription antibiotics, many of the foods you eat probably contain antibiotics. Seventy percent of all antibiotics are sold to commercial livestock suppliers, so if you consume meat or dairy products from these suppliers, you’re probably getting a daily dose of antibiotics. To reduce your exposure to antibiotics from these sources, purchase free-range, grass-fed, pastured animal products. Take antibiotics only for bacterial infections that threaten life or limb, never for viral infections, such as the common cold, the flu, most coughs and sore throats, some ear and sinus infections, or bronchitis. Antibiotics do not cure viral infections. Using antibiotics to treat viral infections only kills the good bacteria in your system and contributes to making bacteria more resistant to antibiotic treatment. If you must take an antibiotic to treat a bacterial infection, then follow this protocol to help preserve the good bacteria and restore a healthy balance of microflora in your gut during and after antibiotic treatment: During the time you’re taking the antibiotic, maintain a healthy gut by taking the following supplements: Colostrum: 10,000 mg daily L-glutamine: 3 grams twice daily For 30 days, including the time you’re taking the antibiotic, take the following probiotics: Saccharomyces boulardii: 250 mg twice daily Multistrain containing Lactobacillus acidophilus, Bifidobacterium longum, and Lactobacillus plantarum: 15 billion CFUs After the 30 days, switch to lower maintenance doses of broad-spectrum probiotics: Multistrain probiotic: 5 billion CFUs daily, containing 3 billion Lactobacillus helveticus, 1 billion Lactobacillus rhamnosus, and 1 billion Bifidobacterium longum HOWARU bifido (Bifidobacterium lactis): 15 billion CFUs daily Follow these dietary suggestions: Consume whole foods with plenty of vegetables, oily fish, and quality proteins. Consume fermented foods, including sauerkraut, kvass, kombucha, kimchi, pickles, and fermented vegetables. These are a great source of probiotics. Avoid foods that feed yeast and pathogenic bacteria, including sugar, juice, wheat, and potatoes.

Article / Updated 05-03-2023

When you have bipolar disorder, you're encouraged to chart your moods, sleep, and energy levels daily to record patterns that may help you spot the early warning signs of a developing mood episode (mania or depression). In addition, this log provides valuable information to guide your doctor and therapist in their treatment decisions. Print this version of the mood chart and make as many copies as you need — or feel free to make your own, if you're spreadsheet-savvy. In the column for each day, record the following: Mood level: Place a check mark in the box that represents your overall mood for that day, which ranges from –5 (Depressed) to +5 (Manic). Hours sleep: Record the total number of hours you slept. Assigning sleep hours for a day can get tricky, because you're likely to fall asleep late one day and wake up early the next day. Consider assigning sleep hours to the night before. For example, if you slept from 10 p.m. Sunday to 6 a.m. Monday, assign those hours to Sunday (add in any nap time from during the day on Sunday). Energy level: Write a number from 0 (no energy) to 5 (supercharged) in the Energy level box. Notes: Jot down notes, such as a change in medication, exercise routine, or diet. Bring your mood charts to your doctor and therapy visits. Having this type of document to point back to and reflect on can be a powerful tool.

Article / Updated 05-03-2023

When choosing whether to take the name-brand or generic version of a medication for bipolar disorder, you and your doctor may want to consider the possible differences. Many people wonder whether name-brand medications are any better or even any different from their generic equivalents. Although the Food and Drug Administration (FDA) regulates both name-brand and generic medications, how those regulations apply to generic medications can lead to differences in how effective the medication is and in the side effects it causes, even when the generic has the same amount of the same active ingredient(s) as the name-brand version. The following sections provide the guidance you need to make well-informed choices between generics and name-brand medications. Consider the cost Most of the time for most people and with most medicines, generics are equivalent products and work just fine. The choice is usually straightforward: With the generic costing less, working just as well, and having the same or similar side effect profile, the more affordable generic is the better choice. However, in a minority of situations, the name-brand product is the better choice. In some cases, cost can be the determining factor in whether the person is able to obtain and take the medication. Being able to afford medications is critical for people to take the right amount of medication and to keep taking it. If the medicine is too expensive, people sometimes try to ration their medicines by lowering or skipping doses or even stopping a medicine entirely. Oddly, in certain situations, insurers cover the cost of a certain name-brand medication but not its generic. This is usually related to a financial arrangement between the insurance company and the pharmaceutical company that makes the name-brand product. Similarities between name-brand and generic medications According to the FDA, generic medications contain the same active ingredients as their name-brand counterparts, so theoretically, they should be equally effective, and in most cases they are. Here's how the two are similar: Same active ingredient(s): The vast majority of generic medications contain the same active chemical as in the name-brand version. Very similar bioequivalence: The generic version of the medication must be bioequivalent to the name brand. To be bioequivalent, the bioavailability of the generic must be very similar to that of the original medication. Bioavailability represents the amount of active chemical that gets into the system and the rate at which it does so. The bioavailability of the generic doesn't have to be identical to that of the original medication; it can be between 80 and 125 percent of the name brand. This may sound like a wide variation, but for most medications, in most people's bodies, the difference doesn't seriously affect how the generic works or the side effects it causes when compared to the name brand. Differences between name-brand and generic medications Although the generic is required by the FDA to deliver nearly the same amount of the same active ingredient(s) at about the same rate as the name-brand version, response to differences in the two can become more pronounced in the following areas: Individual response: How a person's body absorbs and then breaks down the medication can affect their response to a medication that's more or less bioavailable. If you change from a name brand to a generic, or vice versa, and you feel differently on it, let your doctor know. Medication class: Certain classes of medications have had some difficulties with these differences in bioavailability. For example, anticonvulsants (medicines for seizures, that are also often used to treat bipolar disorder) have a narrow therapeutic window, which means that getting control of seizures can require extremely tight management of doses and blood levels (within very narrow ranges). Studies have suggested that although patients who are started on a generic brand of an anticonvulsant may do well, changing from a previously well-managed dose of name brand to a similar dose of generic may cause reduced control of seizures. No specific studies show the same challenges with preventing mood cycles, but you and your doctor should consider and discuss the possibility. Extended-release versions: Long-acting versions of medications can be more difficult for generic companies to duplicate. In 2012, the FDA withdrew approval for a particular type and dose of a generic form of the long-acting antidepressant Wellbutrin XL. After patient and doctor complaints, the FDA tested and found that the generic version was only about 40 percent as bioavailable as the name brand. Other generic versions (by other manufacturers) were bioequivalent, but this one was withdrawn from the market. A similar incident happened recently with a generic version of the long-acting ADHD medication Concerta. Fillers: Medications include a variety of fillers and dyes that create the actual pill. Individuals may have more or less tolerance for these inactive ingredients (whether they're in the generic or name-brand version); they may even experience allergic reactions to them. Dealing with differences between generics of the same medication One downside to using a generic product is that a number of different manufacturers typically make the same product, and pharmacies may change suppliers to manage cost or supply levels. So, even though you may be stable on a generic version of your medicine, when you switch to a different generic, your response could change. With anti-seizure medications, this can be especially risky, but it could affect benefits or side effects in less dangerous but very important ways with other kinds of medicine, as well. Another concern is that the generic may look different depending on the manufacturer, which isn't usually a big problem, but it can cause challenges for certain populations, such as the elderly, who may experience confusion with that kind of change, or children, who may have difficulty swallowing a pill if it is much larger, for example.

Article / Updated 05-03-2023

Oppositional defiant disorder (ODD) is not just typical childhood rebellion. All children are oppositional at times; it's part of growing up and developing independence and personality. For most kids, rebellious behaviors respond fairly well to the usual carrot-and-stick parenting techniques, but oppositional kids exhibit a much more tenacious defiance. Parents describe the child as being stubborn, strong-willed, or simply a pain in the neck. When this pattern creates significant problems in function — at school, at home, with friends, or during activities — a doctor or therapist may suggest a diagnosis of ODD, which is described in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, as: "A pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least 6 months . . . and is not exclusively directed at siblings." ODD's irritable mood and behavioral difficulties — not doing as one's told — can overlap with mania. Although this is often a confusing area, the child with ODD demonstrates these symptoms chronically and not episodically. Furthermore, ODD doesn't include other manic symptoms such as energy changes and grandiosity. ODD is a problematic diagnosis in many regards, because its core symptoms are nonspecific. Irritable mood and defiant behavior can be associated with a wide range of developmental and psychiatric conditions. Your child needs a careful medical and psychiatric evaluation to help understand the mechanisms underlying these difficult symptoms. Bipolar disorder/mania is one possible explanation, but others can include unipolar depression, attention deficit hyperactivity disorder, language disorders, autism spectrum disorder, and trauma, among others.

Article / Updated 04-27-2023

Pinpointing the location of bipolar disorder in your brain is almost as difficult as finding affordable health insurance. Brain imaging studies have found few consistent changes when looking at large brain structures. They've had much more success looking at changes at the cellular level and, in particular, at functional changes in cells and groups of cells in different brain areas. Here is some basic brain anatomy and physiology that helps explain the research. Dissecting the brain Looking at a whole human brain from the outside, as shown, you see the cerebral hemispheres (the large sections, not labeled in the figure, that comprise most of the brain), the cerebellum (the small ball toward the back of the hemispheres), and the brain stem (a long, thin structure leaving the brain and connecting it to the spinal cord). The cerebral hemispheres are divided into four sections that serve broadly different functions — the frontal lobe, the parietal lobe, the temporal lobe, and the occipital lobe. When you open the brain up, pulling the two hemispheres apart into two equal parts, and look inside, you see a number of brain structures within the hemispheres. Within the outer layer, researchers have identified a number of cell areas related to different functions. Several of these areas appear frequently in studies of bipolar, including the prefrontal cortex and the anterior cingulate cortex. Below the large outer layer are a number of structures, some of which are quite important in bipolar disorder research, including the thalamus, hypothalamus, hippocampus, and amygdala. Exploring the functions of different areas of the brain Now that you have a bird's-eye view of the brain, consider the functions of some of these areas: Cerebral hemispheres: The cerebral hemispheres include most of the thinking and planning parts of the brain as well as areas important to sensory input and learning and memory. The areas are as follows: The frontal lobe is the executive of the brain, serving to coordinate and manage the many functions within the body and brain. The parietal lobe is involved in managing sensory experiences, in addition to playing a role in many other functions. The temporal lobe is involved in smell and auditory sensory input, speech and language, and memory and learning. The occipital lobe is the center for processing visual stimuli. All of these areas perform many other functions, as well, and functions may overlap between areas. Cerebellum: The cerebellum appears to manage the fine-tuning of complex movements and also seems to be involved in regulating thought, language, and mood responses. Brain stem: The brain stem manages basic survival mechanisms, such as breathing and the heartbeat, and is involved in the management of consciousness, alertness, and sleep/wake cycles. Cerebral cortex: The cerebral cortex is the outer layer of brain cells in the hemispheres. It's considered to be the site of higher level thinking, coordinating incoming information and generating movement, actions, and thoughts. It's broken down into a number of smaller areas associated with specific types of function. Prefrontal cortex: The prefrontal cortex is a section of the cerebral cortex that is highly developed and is involved in regulating complex thinking and behavior; it's considered a center of judgment and planning. Hippocampus: The hippocampus is located in the cortex (subcortical) and is especially important in learning and memory. Thalamus: The thalamus is a structure that sits below the cortex (subcortical) that serves as a relay station for sensorimotor input, conveying it to areas of the cortex. It also regulates sleep, consciousness, and levels of alertness. Hypothalamus: The hypothalamus is also subcortical and regulates many survival mechanisms such as hunger/thirst and sleep/wake and energy cycles, all components of circadian rhythms — physical, mental, and behavioral patterns that occur in approximately 24-hour cycles. Amygdala: The amygdala, another subcortical area, is a major player in the brain's reaction to emotions. Limbic system: The term limbic system is used to describe a number of brain areas important to emotional function. The list of areas can be different in different textbooks but the hippocampus, thalamus, hypothalamus, and amygdala are considered main components of this system. Anterior cingulate cortex: The anterior cingulate cortex is a part of the cortex that has strong associations between the prefrontal cortex and the limbic system and is thought to play an important role in regulation of strong emotions. Viewing the brain under a microscope The brain has several layers. The outer layer of the brain is called the cortex, often referred to as the gray matter. The layer beneath the cortex is a network of fibers that connect different areas of the brain, often referred to as the white matter. The fibers are protected and insulated by a layer called the myelin sheath. Within the brain is a system of cavities, including spaces called the ventricles, that make, circulate, and then reabsorb cerebrospinal fluid. This fluid serves as a mechanical shock absorber to the brain but also brings nutrients from and filters waste back into the blood stream. Another important component of brain anatomy is comprised of cells that make up all of these structures. Brain cells include neurons and glia. Neurons form the telecommunications system in the brain and body, dictating body functions by generating, sending, and reacting to electrochemical signals. Glial cells, once thought to be just a support network for neurons, play a major role in brain function and in the brain's communications and reaction systems. The gray matter of the cortex includes the cell bodies (central section) and dendrites (one of the connecting ends) of neurons, as well as glial cells. The white matter is made up of the axons (another type of connecting end) of neurons. Understanding how brain cells communicate Neurons communicate with one another in many different ways, but communication occurs primarily across the synapse — the space between neurons or between neurons and other cells, such as a gland or muscle cell. The most common type of communication occurs when one end of the neuron (often the axon, but not always) releases a chemical messenger into the synapse (as shown in the figure below). The next cell (often the dendrite of another neuron) receives the chemical messenger. Receptors on the outside of the second cell latch onto the chemical messenger. Cells have many different types of receptors for all of the chemical messengers; the type of receptor influences how the message is received and processed and how the instructions are transmitted to the second cell. After a chemical messenger occupies the receptor, it can generate many different responses in the receiving cell, depending on the chemical messenger and the receptor type. After the messenger has done its job, it's released from the receptor and then taken back into the first cell, a process called reuptake. In the brain, the chemical messengers are often referred to as neurotransmitters. Nervous system cells communicate in ways beyond the synapse. For example, chemicals called neuropeptides communicate between cells but not across synapses. Of great importance in the current research on bipolar disorder is the communication between glial cells and neurons. Disruptions in these communication systems may be at least as important as problems in neuron-to-neuron transmissions. Intracellular (within-cell) communication may also play a role.

Article / Updated 04-27-2023

When you love a person with bipolar disorder and want to support him or her, you will get a lot of suggestions from a lot of sources, some of which are more reliable than others. This article presents advice you can count on: seven ways to help a loved one with bipolar while retaining your own composure. These ideas have evolved from medical research and practice, along with personal stories and experience, and they can be powerful tools. Many of the suggestions are based on the few common principles covered here. With these in mind, you can begin to develop your own personal toolkit tailor-made for you and your loved one's needs. Don't take it personally. This principle is one of the hardest to put into action. Bipolar disorder symptoms include many behaviors that hurt your loved one and the people around him or her. It can seem clear to you that your loved one isn't trying hard enough or is just trying make things difficult. Don't give in to those thoughts. Blame the illness, not the person. What gets said or done to you isn't about you; it's about your loved one's distress and disrupted nervous system. Accept that you can't control your loved one or the illness. Your support is most effective when you let go of any ideas that you can force your loved one to do the things you think he or she needs to do. Empathizing rather than shaming, observing rather than criticizing, expressing feelings rather than demands, and trying to collaborate instead of control are some of the strategies that grow out of this principle. Keep cool. Bipolar disorder generates a lot of heat and high emotions. Responding with your own high emotions feeds the fire. Following this principle means figuring out how to refrain from yelling and screaming and how to walk away (disengage) from an interaction when necessary. You may want to explore ways to help you do this, such as mindfulness practices or regular exercise. Your lower tone can make a big difference for your loved one. Engage in discussion to create solutions. Effective communication is at the heart of helping your loved one. Listening attentively more than talking is one of your best tools in following this principle. Asking questions and really focusing on the answers opens up dialogue. Thoughts and feelings expressed clearly and compassionately are much more likely to yield positive outcomes than are blanket pronouncements and rambling lectures. Avoid the four big communication no-nos. Criticism, blame, judgment, and demand are likely to drive a wedge between you and your loved one. Work as a team to solve problems and address issues in ways that serve everyone's interests. Put safety first. Bipolar disorder can cause symptoms that are dangerous or even deadly. Being ready and able to call for help for your loved one is critical for everyone's safety and wellbeing. Your loved one may be unhappy, even angry, when you take action, but you can sort that out when they're feeling better. Planning ahead for crises — anticipating them, understanding that the risks are real, and being prepared to take action when needed — are strategies born out of this principle. Take care of yourself. You're in a better position to help others when you're physically and emotionally well. Discover how to leave a situation if you anticipate or observe danger. Care for your own health by paying attention to sleep, nutrition, and exercise, for example. This principle can feel hard to practice when you're exhausted by managing day-to-day crises, but caring for yourself alleviates the exhaustion and helps you maintain your role as a patient and effective caregiver.

Cheat Sheet / Updated 04-12-2023

To manage bipolar disorder effectively, you first need to know what it is. Then you can develop and follow a treatment plan, which usually includes a combination of medication, therapy, self-help, and support from a network of understanding and committed friends and family members. This Cheat Sheet can help you get up to speed on the basics of bipolar disorder in a hurry.