Proposed Natural Treatments for Bipolar Disorder

Note: There are no natural treatments that can substitute for medications in the treatment of bipolar disorder. However, some might help enhance the effectiveness of standard treatment.

In a double-blind study, 30 people with bipolar disorder took either fish oil capsules or placebo for 4 months, in addition to their regular medications.¹ Those taking fish oil had longer symptom-free periods than those taking placebo. The researchers used five different standardized tests to measure symptoms, examining levels of depression, mania, and overall progress. The people taking fish oil proved emotionally healthier than those taking placebo on all but one of these tests. Another study found that ethyl-EPA (a modified form of a constituent of fish oil) was helpful along with standard treatment for the depressed phase of bipolar disorder.¹⁹ However, ethyl-EPA does not appear to offer benefits for rapid cycling bipolar disorder.²⁴

Researchers pooling the results of 10 randomized trials involving 329 patients found that omega-3 fatty acids (found in fish oil) improved depressive symptoms in patient with either bipolar disorder or major depression compared to placebo.²³ In a subsequent systematic review, researchers pooled the results of 5 trials involving 291 patients with bipolar disorder only and found that those in the omega-3 group experienced a modest improvement in their symptoms of depression (but not of mania) compared to placebo.²⁵

The same researchers who conducted the fish oil study have also experimented with flaxseed oil for bipolar disorder.⁵ Flaxseed oil contains alpha-linoleic acid (ALA), an omega-3 fatty acid related to the fatty acids in fish oil. In the researchers' informal observations of 22 people with bipolar disorder, all but four appeared to benefit from flaxseed oil. However, lacking a double-blind study, these results can't be taken as meaningful. When a double-blind study is finally performed, flaxseed oil may turn out not to be helpful at all.

One somewhat questionable study reported that an herbal combination utilized in traditional Chinese medicine ("Free and Easy Wanderer") may augment the effectiveness of carbamazepine treatment for bipolar disorder.²⁰

Very weak evidence suggests possible benefits with choline,⁶lecithin,⁷vitamin C,^8-10 and inositol.¹⁴ Inositol may also reduce psoriasis symptoms caused by lithium.²¹ (However, caution is advised with inositol. See Herbs and Supplements to Use Only With Caution.)

A special form of magnet therapy, called rTMS, has shown some promise for bipolar disorder.⁹

Interestingly, use of an anion generator (an air ionizer that produces negative ions) has shown promise for mitigating the symptoms of acute mania.²²

Various supplements may help reduce side-effects of antiseizure drugs. For more information, see the articles on Valproate, Carbamazepine, and Phenytoin in the Drug Interactions database .

Despite promising preliminary indications,¹¹ a double-blind study failed to find that folate enhances the effect of the drug lithium.¹³

Note: Lithium is sometimes sold as a mineral supplement for treating bipolar disorder. However, this proposed use is based on a misunderstanding. When lithium is used medically as treatment for bipolar disorder, it is taken at doses far above any possible nutritional need. No researcher has seriously suggested that lithium deficiency causes bipolar symptoms, and low doses of lithium are unlikely to have any effect at all.

Herbs and Supplements to Use Only With Caution

Antidepressant drugs may cause manic episodes in people with bipolar disorder. For this reason, herbs and supplements with antidepressant properties might also be risky. Case reports suggest that SAMe,^16,17,18St. John's Wort,^7,8 and inositol¹⁵ can indeed trigger manic episodes.

The supplement L-glutamine, while not normally considered to have antidepressant properties, has reportedly triggered episodes of mania in two people not previously known to have bipolar disorder.⁴ A ginseng product has also been associated with an episode of mania.⁶

The supplement chromium is often sold in the form of chromium picolinate. Picolinate can alter levels of neurotransmitters.⁵ This has led to concern among some experts that chromium picolinate might be harmful to people with bipolar disorder.²

It has been suggested that the drug lithium works, in part, by reducing the body's level of vanadium.¹ For this reason, it might be advisable for people with bipolar disorder to avoid using supplements that contain vanadium.

Finally, numerous herbs and supplements may interact adversely with drugs used to prevent or treat bipolar disorder. For example, people who use lithium should avoid herbal diuretics. For more information on this potential risk, see the appropriate individual drug articles in the Drug Interactions database.