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Bipolar Disorder Treatments (That can be taken in addition to Medications)



Important Warning: The following web page is provided for information purposes only. It covers possible complementary treatment approaches that can be used with bipolar disorder medications. The adoption of any of these complementary treatments should be done with a psychiatrist's knowledge and approval as part of a person's complete treatment plan. In fact since many psychiatrists may not be familiar with these complimentary treatments we recommend you print out this information and give it to your psychiatrist or physician when you meet with them so that they understand the research behind the therapies.

Complimentary Bipolar Disorder Treatments - Table of Contents


  • EPA Omega-3 Fish Oils - Research suggests that people that have Bipolar Disorder may benefit by up to a 25% reduction in symptoms when they take fish oil capsules that are high in the EPA (a type of Omega-3 fatty acid) form of oil. It is important to be careful about the type of fish oil you are using - because not all fish oils are effective. The researchers at the University of Scheffield tell us that "What people really need to be looking at is the amount of EPA in the fish oil they are buying. Our data from previous studies suggests that DHA is of little use in the treatment of bipolar disorder but EPA is the substance that yield the best results. Dosage wise it is suggested that about 2,000 mg/day to 4,000 mg/day ( 2 to 4 grams/day) should help."

    Some of our community members have have had good luck with the Now Foods "Super EPA" and "MaxEPA" vitamins purchased from iherb.com - but we encourage you to shop around for the best deal for you. We must be particularly careful in purchasing vitamin supplements because it is an entirely unregulated industry and many less than reputable organizations sell products that do not actually contain the specified doses or have other ingredients - this seems like a particular problem with vitamins coming from Canada. We recommend that any source you choose have a certified "GMP" (Good Manufacturing Practices) certification and approval. (Look for the GMP stamp on the label). Also, Look for products that have a 'UPS' (United States Pharmacopeia) stamp on the label

    (Please note that there are no studies that the bipolar disorder researchers we are in contact with are aware of that support the idea that any type of vitamin or fatty acid (EFA) will cure bipolar disorder. There are currently no cures for bipolar disorder.)

  • Other Vitamins and Nutrients

    There is a wealth of anecdotal information out there from people suffering from a multitude of depressive disorders, who claim that various nutritional supplements help them to manage their disorder. The effect of adequate (or supplementary) vitamin and mineral intake seems to be a fairly individualized matter; as such, any nutritional adjustments should be checked with your treating psychiatrist, and self-monitoring of symptoms will probably tell you the most about what does and does not work for you. Keep track of your own nutritional profile by getting a lab analysis of essential vitamin and mineral levels in your blood - this should identify any major deficiencies.

    However, there has been some research (in addition to case studies and anecdotal evidence) that indicate specific nutrient deficiencies can excaserbate depressive symptoms, anxiety, insomnia, or other symptoms that commonly trouble people with bipolar disorder. The following is a partial list, compiled from numerous scientific and personal patient sources, of nutritional supplements that have shown some benefit:

  • ECT (Electro-Convulsive Therapy)
    Research suggests that Electroconvulsive therapy (ECT) has a modest but definite role to play in the treatment of depression despite the adverse publicity it has received.
  • Various Psychotherapies - CBT, Family, Interpersonal, etc.

    Medication is an essential component to controlling bipolar symptoms; however, for many people, it is not the only component of treatment. Patients in research studies who receive a combination of psychotherapy and medication treatment often have better outcomes than simply medication or therapy alone. Effective psychotherapy programs can equip you with solutions to various life challenges (stress, family relationships, work, school, social gatherings, etc) that can make your illness worse. Many kinds of therapy programs exist - the ones most frequently cited in literature are Cognitive Behavioral Therapy, Family Focused Therapy, and Interpersonal Therapy. Sometimes the therapist can make all the difference, and not all psychiatrists or therapists are equal. Check with a local support group or friends/family for recommendations about good therapists and programs that they have tried. Don't be afraid to move on if, after a reasonable amount of time, you are not seeing positive results.

  • Maintaining Balance and Predictability In Your Life:

This is actually a very important part of managing bipolar disorder over the long-term. Helping to control your stress levels and general health through predictable routines, exercise, good diet, adequate sleep, and other strategies is essential for helping your medication do its job. According to studies presented at the International Conference on Bipolar Disorder in 1997, patients who experienced disruptions in normal daily activities, including sleeping and eating meals, were more susceptible to new episodes of mania, depression, and relapse. Patients who maintained a more predictable routine fared much better.

The following information about the role of stress in exacerbating bipolar symptoms is from Rev. Dr. James T. Stout, diagnosed with manic-depression and author of "Rebuilding Your LIfe: Bipolar Disorder" (2004). It is drawn both from his own experience and from scientific research:

    • Stress, both good (for example, meetings, parties, social outings, movies, working, phone calls, etc) and bad, can worsen symptoms of mania or depression
    • In 60% of cases, the first occurence of major depression or mania is immediately preceded by a significant stressor
    • The more mood swings one experiences, the more one is vulnerable to future relapses. Moreover, the effectiveness of medication may be decreased.
    • Irregularity in a person's routine can incite mania.

Each person can identify things in their lives that are chronic stressors for them; they will not necessarily be the same as the ones cited above. Pay attention to your own life rhythms, and try to list for yourself what things or events tend to increase y our stress levels and/or trigger a manic episode. It's a great idea to share such a list with family and close friends as well, so they can help you maintain a low-stress environment.

  • Suggestions from the Depression and Bipolar Support Alliance for reducing stress and otherwise managing a mood disorder with a healthy lifestyle.

    Many components can contribute to maintaining overall health and balance in your own life. Below are some of the researched techniques that have proven helpful for managing life with bipolar disorder.
  • Getting Adequate and Predictable Sleep. Loss of sleep is stressful for anyone, but studies have shown that sleep loss can be a specific trigger of manic episodes. In one study from the Western Psychiatric Institute and Clinic, researchers identified sleep loss as the strongest common difference between subjects who experienced manic episodes and subjects who did not (the study had 39 total subjects, and lasted 8 weeks). Another study in the Journal of Clinical Psychiatry (Keck 2004) states:
    "sleep patterns are reliable indicators of whether a patient with bipolar disorder is likely to relapse or sustain remission in the near term. Regularly scheduled nightly sleep periods may help prevent rapid cycling in patients with mania, while perturbations in circadian rhythms may be early markers of impending relapse." Because manic episodes often involve insomnia, mania triggered by a loss of sleep can become a self-reinforcing cycle.

    Getting too much sleep may also trigger depression, so it's important to establish how much sleep you need to function at your best. Most people need between 6-8 hours. It is best to establish a routine time for going to bed and waking up each day, and limit caffeine and/or nicotine starting in mid-afternoon.

    Some medications (most notably, SSRI antidepressants) can cause insomnia or sleep difficulties. Check with your doctor about the side effects of the medications (both prescription and over-the-counter) that you regularly take.

  • Getting Adequate Daily Exercise. The mood-lifting effects of exercise are now well-documented by research. Exercise can be a vital alternative for managing bipolar depression, given the various problems that antidepressants can cause for this condition. A study from Duke University noted that over a 16-week period, majorly depressed subjects who walked or jogged for 30min 3 times a week enjoyed the same mood benefits as subjects who recieved medication, or subjects who had a combination of exercise and medication therapy. Lead researcher James Blumenthal concludes that: " exercise may be just as effective as medication and may be a better alternative for certain patients."

    Both aerobic and non-aerobic (i.e. strength-training) exercise can provide benefits; the key seems to be a regular, scheduled routine. Most studies noting the positive benefits of exercise on mood have subjects exercising at least 3 times a week. It may take a few weeks or a month of regular exercise before you notice significant results. If you have not exercised regularly in the past, it is perfectly fine to start small and slowly work your way up. A few minutes of walking (a trip or two around the block) on most days is a great starting point, and as you feel stronger you can work your way up. Concentrate on what makes you feel good, and try to choose an activity that you already enjoy.

  • Interpersonal and Social Rhythm Therapy (IPSRT) has gotten a lot of attention as a promising adjunct to medication treatment. It is a focused psychotherapy program meant to identify the most chaotic or unstable elements in an individual's life, and then work to establish more routine and predictable patterns.
Discredited or Disproved or over-marketed "treatments" for bipolar disorder
  • EM power+ (Empowerplus) by Synergy, or Truehope Nutritional Support
  • EM power+ (also referred to as Empowerplus) is a vitamin and mineral product that was formulated by two lay people (i.e. non-scientists) in Alberta, Canada as a supposed cure for various psychiatric conditions like bipolar disorder and bipolar disorder. The product contains 36 different ingredients and was originally made by a lab in Utah but is now made by another lab in California and has a different formula than the original product but has the same name.

    The company, called Synergy or Truehope Nutritional Support, claims that there is considerable research to back up their claims but the early research at the University of Calgary was very preliminary (see information below) and the clinical trial that was begun at Calgary was halted by Canadian government officials as the product was not approved. In fact, the Canadian government has issued a health hazard warning informing people not to use the product because it has not been proven safe and because the company is encouraging people to go off prescribed medications.

    The Office for Human Research Protection (OHRP) in the US felt that the research into this product that was also being done at the University of Utah did not have sufficient benefit to outweigh the risks. The OHRP also found that no research was being conducted on this product at Harvard. There is at least one lawsuit that we are aware of by a family of a man that states their son went off his medications, began taking the Empowerplus product, and quickly got worse and now they can't get him back on his medication because he is psychotic. Another group is working on a class action lawsuit against Truehope and the company is now facing six additional charges by the Canadian government related to unproven claims that the company has made. We believe that these products are still freely sold in the USA because there are few laws regulating sale of "supplements" in the USA.

    A recent (July, 2004) news article from Canada suggested that:

    "An Alberta health food company (Truehope) that claims to have a cure for mental illnessesis facing six charges under the Food and Drugs Act for allegedly importing and selling its product without government approval.

    The charges come nearly a year after RCMP and Health Canada raided the Raymond main office of Truehope Nutritional Support Ltd.

    Truehope, along with its related company Synergy Group of Canada Inc., markets a nutritional supplement called Empowerplus that it believes can cure a variety of mental illnesses such as bipolar disorder.

    But Canadian law forbids companies from making health claims about its products without first compiling a certain amount of scientific proof to back them up, and Health Canada says Synergy has not yet met those standards.

    Empowerplus is an amalgam of about 36 vitamins, minerals and anti-oxidants, many of which are commonly sold over the counter. (Note: the product sells for up to $700 per month making it one of the world's most expensive mix of common vitamins.)

    Health Canada issued an advisory June 6, 2003, warning people not to take Empowerplus because it could put their health at risk."

    If you've been tempted to consider this product we encourage you to read up on the history of the product and company, compare prices for other vitamin pills (see information above), talk with your psychiatrist and make your own fully-informed decision.

    bipolar disorder.com considers this product to be unproven, with risks and costs that currently outweigh possible benefits. In fact we agree with Dr. Philip Long's assesment of the product:

    "This commercial group (TrueHope/Synergy) has claimed to have discovered a vitamin mixture that has "totally resolved Bipolar Disorder, bipolar disorder, Depression, Autism, Chronic Fatigue Syndrome, and Fibromyalgia" (quoting from a brochure I received in Vancouver advertising their lecture at Douglas College). These false claims of miraculous cures are a medical fraud - period."

    "Think about it - if there was a vitamin mixture that cured Bipolar Disorder, bipolar disorder, Autism etc. - why wouldn't the recipe for this major discovery just be posted on the Internet so all could benefit. EM Power is just a mixture of commonly used vitamins and minerals that anyone can buy at a local health foods store. Why the big secret? Why won't EM Power publish what is in their vitamin mixture? You know the answer - money. EM Power is a typical medical scam promising miracle cures. This isn't the first, and it won't be the last, of medical frauds that use naive individuals, like Dr. Kaplan, to promote a totally bogus miracle cure for mental illness."

    Quote from (Dr. Philip Long), the psychiatrist founder of Internet Mental Health.

    The product is, in our opinion, burdened by excessively positive marketing claims (it is our belief that any claims that a product is a "cure for bipolar disorder" need large, duplicated research studies done by indeptendent organizations otherwise they are just marketing hype and something to be avoided.) Given the minimal testing the Empowerplus product has received, as well as by lack of information (the company won't reveal what is in the product) and very high costs - we've seen estimates that monthly costs can range from $60 to $700 Canadian $ for a vitamin mix that would likely cost only a couple of dollars if purchased independently) - suggesting gross profit margins for the TrueHope "Nonprofit" in the 95% or higher range - which, if not illegal, certainly is (in our view) of questionable ethics for a company/nonprofit (they seem to have a bit of both) that claims to be focused on helping mentally ill people. We recommend you avoid "TrueHope" - but read up on the benefits of other vitamins that have much more research behind them and are available for a fraction of the cost of the "empowerplus" products. For more information and research on Empowerplus, as well as expert opinions, see:

  • A book on the company and products is available at http://www.pigpills.com


  • Here is the Dr. Phil Long's analysis and opinion on Empowerplus (Note: Dr. Long is a well known Canadian psychiatrist who founded the non-profit web site Mentalhealth.com - one of the world's leading mental health web sites)


  • Information on the company and its product history is available at: Canadian Quackery Watch - Scroll Down Page to get to the Empowerplus information.

  • The Medical Post article on the company: "Vitamin Company Tells Psych Patients to Stop Meds"

  • Another Story: Pigs Will Fly - Medical Post, January/February 2004

  • Even Dr. Hoffer - a strong supporter of vitamins use in the treatment of bipolar disorder, states that any advice that a psych patient should go off his meds "should be condemned".

    Hoffer Commentary: http://www.medicalpost.com/mpcontent/article.jsp?content=/content/EXTRACT/RAWART/3721/14A.html

  • Health Canada Warning on Empowerplus:

  • Health Canada executes search warrant related to EM Power plus

  • OHRP Condemnation of research:

    http://ohrp.osophs.dhhs.gov/detrm_letrs/YR02/aug02e.pdf

  • Here is the formal complaint against the University of Calgary by health Canada. To go to subsequent pages, click on the links on the bottom:

    http://www.friendsoffreedom.org/images/Research%20Articles/True-Hope-vs-Health-Canada/bonnie.html

  • Raid! - First by halting a Calgary trial and then by seizing product shipments, Health Canada has pulled the plug on a controversial neutraceutical being sold as a treatment for mental health disorders.

  • Citizens For Responsible Care and Research - on Empowerplus research


  • Dr. Jim Phelps analysis of the True hope product


 

Mega-Vitamin Therapies - Mega-dose Vitamins (very large - i.e. 200%+ of RDAs (Recommended Daily Allowances) of vitamins have also been marketed as a "cure" for bipolar disorder. Again - research has proved this claim innacurate many years ago. As you should expect by now - if anyone makes any claims about a cure for bipolar disorder - ask for some 3rd party validation studies from the major bipolar disorder research centers around the world.

Relevant Research: Music Therapy - Music therapy is one of those things that sounds great, if you'll pardon the pun, but doesn't seem to deliver much. Perhaps it is dependent upon the type of music - since if you listen to low-key, relaxing music it would seem to be likely that it would lower your stress levels and therefore be beneficial. If however, you're listening to acid rock/heavy metal with loud electric guitar solos - you're probably not doing anyone a favor, including yourself. Right now the prognosis for music therapy for bipolar disorder unfortunately doesn't look good - though we certainly wish that it did. Music may, however, be useful as a means of relaxation or group discussion stimulus. Future research may reveal more positive results.

Relevant Research:

Questionable Therapies - to be used with extreme caution, and always under medical guidance

  • St John's Wort, or hypericum, is a popular herbal remedy for mild to moderate depression. However, just because something is "natural" does not mean it is totally safe to use. In the case of bipolar patients, St. John's Wort can induce mania just like prescription antidepressant medications. Moreover, it can interact with some other common drugs, rendering them significantly less effective or inducing other dangerous side effects. ALWAYS check with your doctor before taking any herbal or nutritional remedy on a regular basis, particularly if you are on other prescription medications.

 

 

 


 

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