Ayurvedic Management of Bipolar Disorder

By: Josh Greene

Introduction
    Bipolar disorder is a Western psychological diagnosis, characterized by mood swings between elation or mania and depression. It has an extensive amount of symptoms and manifestations that can vary greatly depending on the constitution, environment and imbalances of the individual. In susceptible individuals, bipolar disorder is primarily amplified by low ojas (immunity, strength, contentment, ability to cope) and high vata (biological principle of movement and dryness) in the mind and nervous system. As we shall discover, Ayurveda offers a multitude of holistic tools and ways of approaching this disease that can restore health so as to not rely as heavily on conventional treatments.

Western Definition
    “Bipolar disorder, also known as manic-depressive illness, is a brain disorder that causes unusual shifts in mood, energy, activity levels, and the ability to carry out day-to-day tasks. Symptoms of bipolar disorder are severe. They are different from the normal ups and downs that everyone goes through from time to time.”   Modern psychology defines several subcategories of bipolar disorder that make up a spectrum of possible manifestations. All of these types are characterized by extreme mood swings that alternate between mania, hypomania (elevated, euphoric, hyperactive or irritable mood) and depression or can exist in a variety of combinations simultaneously. Bipolar I disorder involves episodes of the most severe high and low mood swings and is your classic manic to depressed presentation.  It is defined as: “One or more manic episodes.”   Bipolar II disorder is a milder form, involving episodes of hypomania that alternate with depression. It is defined as: “No manic episodes, but one or more hypomanic episodes and one or more major depressive episode.”   Cyclothymic disorder describes even milder mood changes. It is defined as: “A history of hypomanic episodes with periods of depression that do not meet criteria for major depressive episodes.”   When the episodes do not fall into the previous three subcategories, the term Bipolar Disorder NOS (Not Otherwise Specified) is used and defined as: “A catchall category, diagnosed when the disorder does not fall within a specific subtype.”   Another subcategory is “rapid cycling,” which can pertain to any of the aforementioned subtypes. It is characterized by frequency and is defined as: “A patient who presents with more than four or five episodes in 1 year.”    This disease is quite different from normal mood states of happiness and sadness that everyone experiences, symptoms of bipolar disorder can be quite severe and potentially life threatening.

Ayurvedic Definition
    Traditional Ayurveda has no specific equivalent disease for the diagnosis of bipolar disorder written in the classical Ayurvedic texts. One of the main ancient treatises on Ayurveda is the Charaka Samhita. It uses the term “Unmada” as a very general term for insanity. Insanity according to the author Charak is “wandering about of mind, intellect, consciousness, knowledge, memory, inclination, manners, activities and conduct.”   Charak goes on to describe five different types of insanity. While none of these perfectly correlate to the western description of bipolar disorder, some of the descriptions and symptoms are similar and some parallels can be drawn. Fitting a set of symptoms into the diagnosis of a particular disease is not a prerequisite to treating it using Ayurvedic methods.  Bipolar disorder manifests due to imbalances in the three fundamental biological qualities that govern the body and mind; vata, pitta and kapha; and the mental principles of sattva, rajas and tamas, which are the “qualities of consciousness.”  
    Some modern Ayurvedic practitioners liken bipolar disorder to being a lack of stability or ojas, which leads to difficulty sustaining emotional responses.   Ojas is defined to “maintain immunity, strength, integrity, and vitality.”   It acts as the container that holds the other two energies in the body: tejas, the energy of intelligence and discrimination; and prana, the body’s life energy. These three subtle energies are the forces that govern the functioning of the mind.  During the elated or manic phase, prana and tejas are high and during the depressive state, prana will be low and tejas can be either high or low.

Signs and Symptoms (Rupa and Laksana)
    Bipolar disorder is a disease in which individuals experience periods of elation, either manic or hypomanic and periods of abnormal depression that interfere with functioning in daily life.  In general, men tend to have more frequent elated or manic episodes, while women more often depressive episodes. The peak age of onset is in the early thirties. 
The elated and vata symptoms of bipolar disorder include talkativeness, excessiveness, racing thoughts, hyper-sexuality, euphoria and impulsive over-spending (of money, time, energy). Some other manic and more pitta type symptoms include over-confidence, irritability, aggression or anger directed outwardly against other people, under-sleeping and hyperactivity. On the other side of the coin are the depressive (more kaphic) symptoms of bipolar disorder, including feelings of sadness, lethargy, lack of enthusiasm, apathy, lack of appetite, lack of sexual interest, over-sleeping and hypoactivity. It should be noted that while there are typical vata, pitta and kapha symptoms, you could have for example a depression that is primarily governed by vata, pitta or kapha. “There are many people who say, "well if anxiety is due to vata then depression must be due to kapha, because it is heavy." Well, that’s sometimes true, but not always true in fact severe depression tends to be more of a vata condition.”   Emptiness, hopelessness, difficulty concentrating or making decisions, insomnia, restlessness, memory problems, uncontrollable crying, weight loss, despair and even suicidal thoughts are also all symptoms of depression that are chiefly vata symptoms.  All of these listed symptoms can manifest in the short term as well as the long term and can appear in countless combinations, making each patient a unique case.

Etiology and Pathology (Nidana and Samprapati)
    In western medicine the exact cause of bipolar disorder is unknown. Genetics are a substantial factor in the disease manifestation, but it rarely appears without environmental circumstances such as traumatic life events or extreme social stressors. It is found to be more common among individuals who are affluent, extroverted, achievement-oriented and use activity to combat depression.  Outwardly, bipolar disorder is seemingly two opposing high and low conditions that have a pendulum type correlation to each other. However there can be aspects of anxiety, elation or mania even during depressive states and vise versa.  While multiple doshas will likely be involved in the oscillations of bipolar disorder, the very changeability of this disease points to an underlying variable vata imbalance as the principal doshic disturbance. “High Vata in the mind manifests as fear, alienation, anxiety and possible nervous breakdown. There is insomnia, tremors, palpitations, unrest and rapid shifts in mood. Insanity, of the manic depressive type or schizophrenia, is an extreme Vata imbalance.”   More specifically, the cause is primarily samana vayu (vayu is another word for vata).   Dr David Frawley refers to samana vayu as “the equalizing life energy.”   Samana vayu literally means, “balancing air.” “In the mind, the role of samana vayu is to balance and stabilize the other vayus. When it is healthy, the other vayus find greater stability. When it is disrupted, a person loses control of his thoughts and feelings. Samana vayu is also responsible for absorbing sensory impressions into the workings of the brain and mind.”   The other two vayus that play an essential role in this disorder are prana and vyana. When prana vayu is disturbed it affects our thoughts and emotions. Prana is also responsible for the intake of impressions into the brain and mind as well as movement of neurotransmitters through the nervous system. Vyana is also responsible for movement in the nervous system and circulation of thoughts and emotions.  Aggravated pitta pushed by vata leads to the mental principle of rajas, which may result in mania. Rajas is defined as “quality of consciousness; the principle of kinetic energy; active, mobile.”   It is responsible for all movements, changes and excitability. Aggravated kapha pushed by vata leads to the mental principle of tamas, which may result in depression. Tamas is defined as “quality of consciousness; inertia.” and is responsible for sleep, heaviness, dullness and depression.   These two principles of the three basic mental states are destructive. The third being sattva which brings balance, light and purpose. The higher the air element in the vata, the faster the individual moves through the different cycles.
    Regardless of the doshic imbalance, all patients suffering from bipolar disorder are likely to have low ojas (contentment, ability to cope, vitality and immunity). This low ojas is the instability that is allowing the vata movement from one mood state to another. The patient will also be more susceptible to vata changes in mood when they are under stress. It is this stress that wears down the “container of ojas.”    As was mentioned previously, bipolar disorder usually doesn’t manifest until one’s twenties or thirties.  It is possible that as the patient moves out of the kapha phase of life into the busier more stressful pitta time of life, they lose the grounding of the water and earth elements and become more susceptible to the heat of pitta, which in turn contributes to the drying of vata. Changes in the underlying emotions are brought on by vata-provoking qualities in the individual’s lifestyle, habits, foods and activities. These qualities are dry, rough, light, cold, subtle and mobile.  Some specific etiologies include: Eating while anxious or depressed, eating on the run, taking in stimulants such as coffee or cigarettes, using intoxicants such as alcohol or recreational drugs, following irregular routines, traveling frequently, going to bed late, loud music or noise, engaging in excessive physical or sexual activity, failing to change with the seasons (especially autumn), overloading on stimulation such as TV, mass media, suppressing inner creativity and emotional sensitivity.  Bipolar disorder affects as many as 5.7 million American adults, which is about 2.6 percent of the population over the age of eighteen.  The disease is also quickly on the rise especially in children; one study showed as high as a 40-fold increase between 1995 and 2002.  One of the reasons for this could be the increasingly vatagenic environment to which today’s children are exposed.  “The fact that we have more of these problems is because our culture is over stimulating people.” “Wherever there is excess stimulation, the natural consequence is long term depression once the stimuli gets removed.”  
    The pathology path of vata’s movement through the body begins when vata accumulates and becomes aggravated in the purishavaha srota (colon). From there it overflows into the rasa dhatu (plasma tissue), and rakta dhatu (blood tissue). If the bodies’ tissues and pathways have preexisting weaknesses due to genetics or in the case of the brain and mind, emotional trauma, then under the right conditions repeated doshic disturbances will relocate to those sites. In the case of bipolar disorder, vata moves from the plasma and blood and relocates to the mano vaha srota (pathway of the mind) resulting in loss of awareness of one’s situation and fluctuations in emotional states. It also secondarily relocates into the majja dhatu (nervous tissue) and majja vaha srota (pathway of the nervous system), resulting in biochemical changes to the neurotransmitters being released effecting our thoughts.  Once vata has taken root in these tissues and pathways, it starts to manifest the myriad of signs and symptoms of bipolar disorder.

Diagnosis (Nidanam)
    The Western diagnosis of bipolar disorder is based on symptoms and how they change and progress, as well as life and family history. There is no definitive biological test and diagnosis can be difficult even for an experienced psychologist or psychiatrist. The diagnosis is primarily based on the self history as well as what is reported by friends, family and co-workers “using the criteria for both manic and major depressive episodes.”   Both of these must have been present, and the subtype of bipolar disorder will depend on the frequency, severity and duration of the episodes.
    In Ayurvedic medicine the label of bipolar is not really relevant to treatment. Diagnosis is based on the patient’s prakruti (underlying constitution) and the past and present history of vikruti (short-term symptoms and doshic imbalances).  The practitioner must consider the long- and short-term state of doshas and subdoshas; the patient’s levels of ojas, tejas and prana; as well as the state of mental principles, sattva, rajas and tamas.  Ayurvedic practitioners must also identify the major stressors that are pushing the patient’s mental states to opposite poles. 

Western Medical Treatment
    There is no known cure for bipolar disorder. The two main Western methods for treatment are medications and psychotherapy. When used in conjunction, they have shown to be effective at preventing relapses and reducing the severity of the patient’s symptoms.  As Dr David Frawley states: “Modern Medicine attempts to change the consciousness through altering the chemistry of the brain.” 
    The main medications used are mood stabilizers such as lithium, valproic acid (Depakote) and lamotrigine (Lamictal); antipsychotics such as olanzapine (Zyprexa), quetiapine (Seroquel) and aripiprazole (Abilify); and lastly, antidepressants such as fluoxetine (Prozac), paroxetine (Paxil) and bupropion (Wellbutrin).  These medications are an amazing product of modern science. They have a strong effect on brain chemistry and are often very useful for managing this disease and improving the lives of individuals. Any medical doctor can prescribe these medications, but typically a psychiatrist, rather than a family practice or other specialty physician, would manage bipolar disorder. The downsides to these medications include countless known side effects and imperfect research as to how they affect the body and mind in other ways especially long term. From an Ayurvedic perspective, these medications do not treat the deep doshic root causes of the disease, but rather they balance and suppress the manifesting symptoms. “One of the main problems with modern medicine is that acute care has become the primary care both for the physical and the psychological medicine, which often causes more trouble with the chronic diseases.”   It is also very possible that these medicines simply move the doshas into other parts of the body, only to negatively affect the health of the individual in other ways. For example, vata being pushed into the medas or asthi dhatu could cause wasting, osteoporosis, or arthritis; vata staying in the majja dhatu could lead to other types of brain problems, such as Parkinson’s or Alzheimer’s; vata entering the shukra dhatu could cause sterility or low libido. 
    The other main Western treatment is psychotherapy or “talk” therapy.  Some common psychotherapy treatments that have been used to treat bipolar disorder are:
    “Cognitive behavioral therapy, helps people with bipolar disorder learn to change harmful or negative thought patterns and behaviors.  Family-focused therapy includes family members. It helps enhance family coping strategies, such as recognizing new episodes early and helping their loved one. Interpersonal and social rhythm therapy helps people with bipolar disorder improve their relationships with others and manage their daily routines. Regular daily routines and sleep schedules may help protect against manic episodes. Psychoeducation teaches people with bipolar disorder about the illness and its treatment. This treatment helps people recognize signs of relapse so they can seek treatment early, before a full-blown episode occurs.”  
    Usually a licensed psychologist, social worker, or counselor provides these therapies. The efficacy of therapy and medications was highlighted in the largest treatment study ever conducted for bipolar disorder. Researchers compared people in two treatment groups: the first was treated with three psychoeducation sessions over six weeks, while the second was treated with medication and thirty of the above mentioned types of intensive psychotherapy sessions over nine months. The results showed that group two individuals were more likely to get well faster and stay well longer with fewer relapses, lower hospitalization rates, and greater adherence to their treatment plans.   Some other Western treatment methods include electroconvulsive therapy (ECT), sleeping medications, increased omega 3 fatty acid intake, ketogenic diets and canabanoids. All of these have mixed results or insufficient data to show significant usefulness.

Ayurvedic Treatment (Chikitsa)
    In management of any psychological disease, Ayurveda works to change the energetics of the mind.  The two main Ayurvedic treatments for managing bipolar disorder center on increasing our ojas and reducing our stressors. The stronger our ability to cope and withstand the stressors of the world, the less likely our moods will fluctuate between highs and lows. When ojas is strong  we are less likely to be buffeted by the doshas.  The more we identify our stressors and reduce them, the less ojas will be worn down.  The patient’s therapist and family are good allies in helping the patient identify these stressors. The main tools used in managing the mind are “diet and herbs on a physical level, prana and the senses working at a more subtle level, and mantra and meditation working more at the level of the mind itself.” 
    In dealing with the doshas, vata must be balanced first even if there are other current imbalances. The practitioner does not want simply to treat the current vikruti, only to drive the movement from one mood to another. It is no coincidence that many of the treatments for vata will also build ojas.  The main thing that helps both is to develop regular solid routines and stability. This includes: waking and sleeping times, eating times and food choices, work schedules and one’s general activities throughout the day.  Irregular patterns place stress on our body’s ability to function at its best. Some examples of this are regular mealtimes and bedtimes. When our body’s biological clock can anticipate meal or sleep times, it will release chemicals such as amylase, pepsin and acid needed to digest food in the former and chemicals such as melatonin needed to sleep in the latter. When the body is subject to irregularity, we will be prone to problems like indigestion and insomnia that put great stress on our bodies and reduce ojas. This is especially true of digestion, since we identified samana vayu as being the main causative factor in changes from one mood to another and the digestive tract as being the primary site of all doshic disturbances in the body.  Sleeping times are also important. Going to bed around 10:00pm and awakening near sunrise will help the body change mental states in the kapha times of day when it is more stable. The morning should be devoted to steady and healthy morning routines, including meditation and exercise.   Since vata has the qualities of: “cold, light, mobile, dry and piercing, and follows a transverse course,”  it is necessary to implement the opposite qualities in any treatment. Regardless of the type of treatment, an emphasis on warm, heavy, stable, moist, oily and dull qualities should be made.
    The best place to start in dealing with bipolar disorder is to identify and minimize stressors that trigger changes in the mood states. Family and friends may be useful in helping to identify what these are as patients may have some denial about this. Our society is largely work driven and it may be necessary for patients to reduce their workload in order to reduce stress and focus on their health. Prioritization of all the things one wants to do in order to create a more laid back and relaxed schedule can often be difficult. The patient’s surroundings at home can also be a major source of stress. Keeping the home tidy, free of clutter and clean helps to cultivate a more sattvic and stress free environment. Time in nature is also an excellent method for reducing stress, building ojas and pacifying vata.
    The most important factor concerning meals is eating at regular times each day and also making sure not to go without eating. Food pacifies vata and diet should emphasize whole grains, cooked vegetables, mung beans, meats, fresh dairy, nuts and oils in order to ground the patient and build up ojas. Generally, sweet, sour and salty tastes should be emphasized, as well as the qualities of warm, moist and heavy foods. When one is having a pitta manic phase, then cooler and blander foods may be useful, and during depressive states, spicier foods can be used. Canned, frozen, old, processed, microwaved and rancid foods should be avoided.   It is also important to stabilize blood sugar.  Increasing the ratio of fats and proteins in relation to carbohydrates and keeping simple carbohydrates to a minimum will help with this.  Coffee and other stimulants should be avoided since they will only serve to keep someone going artificially without getting true rest and will lead to more vata imbalance. Lunchtime should be the main meal of the day. It should last at least one hour and be taken at the same time, everyday while seated in a peaceful, distraction free environment in order to let food settle and digest before moving on to other activities. Some form of grace and blessing should be given before eating in order to help center ones mind. 
    When treating bipolar disorder with herbal therapies, nervine tonics become the most important for building stability and mental ojas. Nervine sedatives may be useful for elated or manic episodes and nervine stimulants may be useful for depressive states; however, the intent is not to force the brain out of a particular episode by providing herbal uppers or downers. While having sedatives and stimulants on hand is okay, the goal should be to balance the doshas and normalize the production of neurotransmitters using tonics.  A specific formula should depend on the particular constitution and state of the patient. Some generally good herb choices for tonics are ashwagandha, brahmi, shatavari, ginseng, shanka pushpi, nutmeg, skull cap, kappikacchu, haritaki and bhringaraj.  Also, jyotishmati, ginkgo, jatamamsi, oat straw, valerian root, St. John’s wort and Gotu Kola may be useful in some patients.   Brahmi is a great choice for any mood state since it can both act as a mild stimulant and sedative depending on what mood state needs to be balanced. Ashwagandha is very useful for building ojas and pacifying vata in the nervous system and mind. All of these herbs should be taken with herbs that aid in their digestion and absorption.  Triphala is a useful combination of three fruits that not only strongly reduces vata in the intestines, but also helps with the absorption of the other herbs and foods that are being taken and will exponentially multiply their effects. Since bipolar disorder is partially rooted in the nervous system, medicated ghees are an ideal medium for enabling these herbs to penetrate deeply into these tissues.
    The five sense therapies (vision, sound, taste, touch and smell) can be used to place the patient in balancing and restorative surroundings. Color therapy may be useful for the visual sense. Yellow, green, gold, blue, white, violet, and pastels in general are considered sattvic colors; gold and brown are considered to raise ojas; and yellow, green, gold, brown and purple are considered to decrease vata.   Colors can be applied to clothing, home décor, meditation and flowers. Music that the patient finds enjoyable or mantra therapy may be beneficial sound therapy. Since vata is rough, dry cold and sharp, touch therapy should have the opposite qualities. Clothing worn and bedding should be soft and warm. Regular, gentle and steady massage with lots of oil is also an excellent therapy for the touch sense. While professional massage is also excellent, daily self-massage with sesame oil is more affordable, easier to implement and offers the added benefit of self-love needed for more insecure vata type individuals. Aromas that may be useful to calm the mind during elation include sandalwood, chamomile, clary sage and jatamamsi.  For depression, rosemary, cinnamon, thyme, mint and eucalyptus may be useful to help get moving. Rose, basil and lavender may add balance to bipolar disorder.   They can be taken in the form of essential oils with an infuser, or by adding a few drops to a warm bath.
    Exercise can also be an important factor in managing the doshas, as well as helping one relax and sleep well. It is; however, important not to over exert oneself since that can deplete ojas. Generally, working out to half of one’s capacity is advised. Calming exercises like Yoga, Qi Gong, Pilates and Tai Chi are generally wise choices for all three doshas. Aikido, gardening, walking and gentle hiking are also good activities. When the patient is experiencing more pitta manic symptoms, then slow and cooling exercises are best like a cool walk in nature or slow swimming.  When the patient is in a more depressive state, mild running, team sports or Bikram Yoga may be of use.
    Panchakarma (“the five actions”) is the main Ayurvedic method for purification. “Owing to the subtle nature of its processes, it penetrates deep into the nervous system. It is useful for psychological problems caused by excess of the three doshas. Yet it can also be helpful for psychological problems caused by internal factors, emotions and karma.”     The practitioner must of course evaluate the state of the patient’s ama (toxins) and strength of ojas, before deciding on a plan for how aggressively to pursue panchakarma. Since the patient is likely to be low ojas, a slower palliative plan that focuses on strengthening the patient during purification is more likely to be useful. Since the primary problem is vata imbalance, a program with an emphasis on bastis (therapeutic enemas) should be adopted. If the patient is in a manic phase, virechana (therapeutic purgation) may be used and if the patient is in a depressed state, vamana (therapeutic emesis) may be an option. Oleation with medicated oils through abhyanga (Ayurvedic massage) is also a key therapy in palliation, as well as for managing vata whether or not it is a part of panchakarma. Shirodhara (flowing oil on the forehead) and shirobasti (oil in a crown on the head) are also highly recommended for their direct action on the brain, mind and subtle energy fields.
    In Ayurveda sleep is considered one of the great pillars of health. Sleep builds ojas and pacifies vata. Its importance for treatment of bipolar disorder cannot be understated. “There is also a connection between mental health and deep sleep.” “It is the state of deep sleep that allows the mind to renew itself.”   Sleep allows the body and mind to naturally rest and heal. Many of the other therapies, foods and herbs listed here help to regulate the body so that it can get enough quality sleep. Most sleeping pills are a class of drugs called “hypnotics” that put the body into trance-like states that do not go through the normal sleep stages. They do not provide the same quality of sleep as a natural, healthy sleep cycle.
    Meditation, breath, pranayama, as well as other yogic practices, are also of great importance in managing bipolar disorder. They have the ability to cultivate a sattvic mind, as well as to teach the patient how to manage the internal channels and energy moving through their body and mind. Meditation brings us back to a state of awareness that allows us to see the transient nature of things including our own moods and emotional states. Repetition of these practices actually has the ability to change our internal biochemistry, lessening the large fluctuations in our minds. While diet, herbs and lifestyle practices can do much on an outer level to pacify doshas and prevent disease, practices like meditation work on a much deeper and more fundamental level to change the subtle energies in our consciousness.
    Since Ayurveda is not a quick process and relies on the development of healthy routines and habits over a lifetime, it is important for a patient already diagnosed as bipolar to continue with the treatments laid out by his or her physician. If the patient has not received a formal diagnosis and the Ayurvedic practitioner, patient, or a patient’s family has concerns about a severe mood disorder, the patient should be referred to a primary care physician for evaluation.  Even if a patient currently seems stable, if there is a history of severe mood states and he or she falls back into them, then the patient will likely be unable to follow an Ayurvedic lifestyle. Western pharmacology can often provide the acute stability needed for the individual to work on developing long-term habits and routines.  A year on an Ayurvedic treatment plan would be a reasonable minimal timeframe for a patient to follow before talking with his or her physician about coming off medications. 

Conclusion
    Bipolar disorder is a multi-faceted disease consisting of periods of elation and depression. It is a condition of low ojas and high vata in the mind and nervous system. A regimen of Ayurvedic treatments to tonify, develop regularity and reduce stressors can help to build ojas and pacify the vayus. Ayurveda is useful for managing bipolar disorder because it is a holistic approach that looks at the constitution, the state of current imbalances, and the whole environment of an individual before deciding what is the best regimen to bring him or her into a balanced state.  It provides a complete package of useful everyday tools such as lifestyle, diet, herbs, purification and meditation that best suits the specific individual. This is contrasted with Western medicine, which has the tendency to put everyone with similar symptoms into the same box and provide them with pharmacological solutions that suppress symptoms but don’t solve the underlying problem. Ayurveda not only has the ability to treat symptoms of a psychological disease like bipolar disorder, but it can also move past the disease to identify its root causes and the underlying patterns affecting the individual. Combined with meditation and other yogic practices, Ayurveda works on the subtle aspects of mind to heal consciousness and release individuals from disease.

References

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  American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th, text revision (DSM-IV-TR) ed. 2000. ISBN 0-89042-025-4. Bipolar Disorder.  DSM-IV-TR. Bipolar I Disorder.

  ^ DSM-IV-TR. Diagnostic criteria for 296.89 Bipolar II Disorder.

  ^ DSM-IV-TR. Diagnostic criteria for 301.13 Cyclothymic Disorder.

  ^ DSM-IV-TR. Not Otherwise Specified (NOS)

  Judd, Lewis L., and Leighton Y. Huey. "Part Thirteen Psychiatry." Harrison's Principles of Internal Medicine. By Eugene Braunwald. 11th ed. New York [etc.: McGraw-Hill, 1987. 2085-087. Print.

  Charaka. Charaka Samhita Handbook on Ayurveda. Ed. Gabriel Van Loon. Vol. 2. Chaukhambha Orientalia, 2002.  1100. Print.

  Lad, Vasant. Textbook of Ayurveda: Fundamental Principles of Ayurveda. Albuquerque, NM: Ayurvedic, 2002. 308. Print. 

  Thompson, Mary. "The Nervous System." AHP Level 2 Class. California College of Ayurveda, Grass Valley. 16 Sept. 2010. Lecture.

  Ibid Textbook of Ayurveda: Fundamental Principles of Ayurveda. 306.

  Halpern, Marc. Principles of Ayurvedic Medicine. 9th ed. Vol. 2. Grass Valley: California College of Ayurveda, 2007. Print. Textbook.

  Frawley, David, and Marc Halpern. Ayurvedic Psychology: Anxiety and Depression. Rec. 18 Nov. 2006. California College of Ayurveda, 2006. CD.

   Ibid Harrison's Principles of Internal Medicine. 2086.

  Ibid Ayurvedic Psychology: Anxiety and Depression. Disc 4 “Anxiety and Depression”

  ^Ayurvedic Psychology: Anxiety and Depression. Disc 4 “Anxiety and Depression”

  ^Ayurvedic Psychology: Anxiety and Depression. Disc 4 “Anxiety and Depression”

  Frawley, David. Ayurveda and the Mind: the Healing of Consciousness. Twin Lakes, WI: Lotus, 1997. 155. Print.

  Ibid "The Nervous System."

  Ibid Ayurveda and the Mind. 316.

  Halpern, Marc. Principles of Ayurvedic Medicine. 9th ed. Vol. 1. Grass Valley: California College of Ayurveda, 2007. Print. 81. Textbook.

  Ibid Principles of Ayurvedic Medicine. 9th ed. Vol. 1. 78-83.

  Ibid Textbook of Ayurveda: Fundamental Principles of Ayurveda. 308.

  Ibid Textbook of Ayurveda: Fundamental Principles of Ayurveda. 8.

  Ibid "The Nervous System."

  Yarema, Thomas, Daniel Rhoda, and Johnny Branningan. Eat-taste-heal: an Ayurvedic Cookbook of Modern Living. Kapaa, HI: Five Elements, 2006. 28-31 Print.

  ^ Eat-taste-heal: an Ayurvedic Cookbook of Modern Living. 31.

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  ^ “National Trends in the Outpatient Diagnosis and Treatment of Bipolar Disorder in Youth.”

  Ibid Ayurvedic Psychology: Anxiety and Depression

  Ibid Ayurvedic Psychology: Anxiety and Depression.

  Ibid Harrison's Principles of Internal Medicine. 11th ed. 2086.

  Ibid "NIMH • Bipolar Disorder." How is bipolar disorder treated?

  Ibid Ayurvedic Psychology: Anxiety and Depression.

  Ibid "NIMH • Bipolar Disorder." Medications.

  Ibid Ayurvedic Psychology: Anxiety and Depression.

  Ibid Textbook of Ayurveda: Fundamental Principles of Ayurveda. Chapter 6.

  Ibid "NIMH • Bipolar Disorder." Psychotherapy.

  Miklowitz DJ, Otto MW, Frank E, Reilly-Harrington NA, Wisniewski SR, Kogan JN, Nierenberg AA, Calabrese JR, Marangell LB, Gyulai L, Araga M, Gonzalez JM, Shirley ER, Thase ME, Sachs GS. Psychosocial treatments for bipolar depression: a 1-year randomized trial from the Systematic Treatment Enhancement Program (STEP). Arch Gen Psychiatry. 2007 Apr;64(4):419-426.

  Ibid "NIMH • Bipolar Disorder." Other treatments.

  Ibid Ayurvedic Psychology: Anxiety and Depression.

  Ibid "The Nervous System."

  Ibid Ayurvedic Psychology: Anxiety and Depression.

  Ibid "The Nervous System."

  Ibid Ayurvedic Psychology: Anxiety and Depression.

  Bhishagratna, Kaviraj Kunjalal. An English Translation of Sushruta Samhitá: Based on Original Sanskrit Text with a Full Comprehensive Introduction, Additional Texts, Different Readings, Notes, Comparative Views, Index, Glossary and Plates. Varansi: Chowkhamba Sanskrit Series Office, 1981. Chapter 1. Print.

  Ibid Ayurvedic Psychology: Anxiety and Depression.

  Ibid Psychology of Ayurveda: Treatment of Psychological Conditions.

  Ibid "The Nervous System."

  Ibid Ayurvedic Psychology: Anxiety and Depression.

  Ibid "The Nervous System."

  Frawley, David, and Vasant Lad. The Yoga of Herbs: an Ayurvedic Guide to Herbal Medicine. Twin Lakes, WI: Lotus, 2001. Print.

  Halpern, Marc. Psychology of Ayurveda: Treatment of Psychological Conditions. Grass Valley: California College of Ayurveda, 2006. Print.

  Ibid Principles of Ayurvedic Medicine. 9th ed. Vol. 2. 442.

  Ibid Psychology of Ayurveda: Treatment of Psychological Conditions.

  Ibid Ayurveda and the Mind. 203.

  Ibid Ayurvedic Psychology: Anxiety and Depression. Disc 3. “Prana, Tejas and Ojas”. Track 4.