• Manic-Depression; Manic-Depressive Disease
Principal Proposed Natural Treatments
Other Proposed Natural Treatments
• Choline; Fish Oil; Flaxseed Oil; Folate; Inositol; Lecithin; Vitamin B 12; Vitamin C
Herbs and Supplements to Use Only With Caution for Bipolar Disorder
• Chromium Picolinate; Ginseng; Glutamine; Inositol; S-adenosylmethionine (SAMe); St. John's Wort; Vanadium
Previously known as manic-depressive disease, bipolar disorder is a relatively common mental health condition manifested in its classic form by alternating periods of mania—extreme high energy—and deep depression. In the "up" or manic phase, people may sleep little, talk fast, develop grand and unworkable plans, and sometimes behave bizarrely—for example, giving away all their money overnight. In the "down" phase, they may contemplate suicide. In many people with this disorder, the "down" phase predominates, and for that reason, the diagnosis may be missed. Other, more subtle versions of the condition also exist.
Bipolar disorder is dangerous unless treated, leading to a high rate of suicide and injury. The mineral lithium has been shown to dramatically improve symptoms of mania and reduce the rate of suicide. Various antiseizure medications also appear to help against mania.
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 .)
Interestingly, use of an anion generator (an air ionizer that produces negative ions) has shown promise for mitigating the symptoms of acute mania. 22
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.
1. Naylor GJ. Vanadium and manic depressive psychosis. Nutr Health. 1984;3:79-85.
2. Reading SA. Chromium picolinate. J Fla Med Assoc. 1996;83:29-31.
3. Stoll AL, Locke CA, Marangell LB, et al. Omega-3 fatty acids and bipolar disorder: a review. Prostaglandins Leukot Essent Fatty Acids. 1999;60:329-337.
4. Mebane AH. L-Glutamine and mania [letter]. Am J Psychiatry. 1984;141:1302-1303.
5. Attenburrow MJ, Odontiadis J, Murray BJ, et al. Chromium treatment decreases the sensitivity of 5-HT(2A) receptors. Psychopharmacology. 2002;159:432-436.
6. Vazquez I, Aguera-Ortiz LF. Herbal products and serious side effects: a case of ginseng-induced manic episode. Acta Psychiatr Scand. 2002;105:76-77.
7. Barbenel DM, Yusufi B, O'Shea D, et al. Mania in a patient receiving testosterone replacement postorchidectomy taking St John's Wort and sertraline. J Pscyhopharmacol. 2000;14:84-86.
8. Nierenberg AA, Burt T, Matthews J, et al. Mania associated with St John's Wort. Biol Psychiatry. 1999;45:1707-1708.
9. Dolberg OT, Dannon PN, Schreiber S, et al. Transcranial magnetic stimulation in patients with bipolar depression: a double-blind, controlled study. Bipolar Disord. 2002;4:94-95.
10. Naylor GJ, Smith AH. Vanadium: a possible aetiological factor in manic depressive illness. Psychol Med. 1981;11:249-256.
11. Coppen A, Abou-Saleh MT. Plasma folate and affective morbidity during long term lithium therapy. Br J Psychiatry. 1982;141:87-89.
12. Coppen A, Abou-Saleh MT. Plasma folate and affective morbidity during long term lithium therapy. Br J Psychiatry. 1982;141:87-89.
13. Coppen A, Chaudhry S, Swade C. Folic acid enhances lithium prophylaxis. J Affect Disord. 1986;10:9-13.
14. Chengappa KN, Levine J, Gershon S, et al. Inositol as an add-on treatment for bipolar depression. Bipolar Disord. 2000;2:47-55.
15. Levine J, Witztum E, Greenberg BD, et al. Inositol induced mania? [letter]. Am J Psychiatry. 1996;153:839.
16. Carney MW, Chary TK, Bottiglieri T, et al. The switch mechanism and the bipolar/unipolar dichotomy. Br J Psychiatry. 1989;154:48-51.
17. Carney MW, Chary TK, Bottiglieri T, et al. Switch and S-adenosylmethionine. Ala J Med Sci. 1988;25:316-319.
18. Kagan BL, Sultzer DL, Rosenlicht N, et al. Oral S-adenosylmethionine in depression: a randomized, double-blind placebo-controlled trial. Am J Psychiatry. 1990;147:591-595.
19. Frangou S, Lewis M, McCrone P, et al. Efficacy of ethyl-eicosapentaenoic acid in bipolar depression: randomised double-blind placebo-controlled study. Br J Psychiatry. 2006;188:46-50.
20. Zhang ZJ, Kang WH, Tan QR, et al. Adjunctive herbal medicine with carbamazepine for bipolar disorders: A double-blind, randomized, placebo-controlled study. J Psychiatr Res. 2005 Aug 1. [Epub ahead of print].
21. Allan SJ, Kavanagh GM, Herd RM, et al. The effect of inositol supplements on the psoriasis of patients taking lithium: a randomized, placebo-controlled trial. Br J Dermatol. 2004;150:966-969.
22. Giannini AJ, Giannini JD, Melemis S, et al. Treatment of acute mania with ambient air anionization: variants of climactic heat stress and serotonin syndrome. Psychol Rep. 2007;100:157-163.
23. Lin PY, Su KP. A meta-analytic review of double-blind, placebo-controlled trials of antidepressant efficacy of omega-3 fatty acids. J Clin Psychiatry. 2007;68:1056-1061.
24. Keck PE Jr, Mintz J, McElroy SL, et al. Double-blind, randomized, placebo-controlled trials of ethyl-eicosapentanoate in the treatment of bipolar depression and rapid cycling bipolar disorder. Biol Psychiatry. 2006;60:1020-102. Epub 2006 Jun 30.
25. Sarris J, Mischoulon D, Schweitzer I. Omega-3 for bipolar disorder: meta-analyses of use in mania and bipolar depression. J Clin Psychiatry. 2011 Aug 9.
Last reviewed August 2013 by EBSCO CAM Review Board
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