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
- Bipolar Disorder Treatments that Have Shown Some Benefit in Extensive Scientific Testing
- Biplar Disorder Treatments Being Researched that are Showing some Early Positive Results
- Disproven (or Unproven) & Overmarketed “Bipolar Disorder Treatments”
- Questionable Therapies (ASK YOUR DOCTOR AND USE WITH CAUTION)
- 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.)
- Low cost and Wide availability of EPA fish oil capsules in North America, Europe and Asia.
- Low Risk – EPA fish oil has been consumed by people for thousands of years and appear to have little or no side effect or negative impact on the body (We recommend only “GMP” (Good Manufacturing Practices) certified EPA fish oils from leading vitamin companies (such as Now Foods, and Twinlabs – to name two).
- Some research has suggested that fish oils may be “pro-oxidative” and therefore it may be advisable to take some antioxidant vitamins (vitamin E, vitamin C, Alpha Lipoic Acid, etc.) at the same time as the fish oil).
- Details and Research:
- Omega-3 fatty acids: Do ‘fish oils’ have a therapeutic role in psychiatry?
- University of Scheffield on Diet and bipolar disorder (News)
- Decreased antioxidant enzymes and membrane essential polyunsaturated fatty acids in schizophrenic and bipolar mood disorder patients. (Research)
- 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:
- Vitamin B Complex – some studies have indicated that deficiencies in Vitamins B1 (thiamin), B2, B6, and B12 can contribute to depression. There has also been preliminary evidence to show that supplements of B-vitamin complexes (in general, these B vitamins are taken together) improves symptoms in depressed subjects.
- Folate/Folic Acid – found in leafy green vegetables, oranges, and other fruits (as well as over-the-counter supplements), folate may improve the functioning of some antidepressants, helping to reduce depression symptoms. However, another source (Pendulum Resources – independent info site) warned manic-depressive patients to use folic acid with caution, as too much may induce mania. This is probably a good one to ask your doctor or psychiatrist about, if you have particular problems controlling depressions.
- Folate for Depressive Disorders (2003 research study)
- Folic Acid and Psychopathology (Research review article, 1989)
- Pseudodementia in a twenty-one-year-old with bipolar disorder and vitamin B12 and folate deficiency (2000 case study – this young woman’s symptoms were actually reversed after the deficiencies were corrected. Although this is a rare dramatic response, it might be beneficial to get a full analysis of essential vitamin and mineral levels in your blood, to determine if there are any major deficiencies)
- L-Tryptophan – an amino acid that the body uses to make the neurotransmitter serotonin. L-tryptophan might possibly help relieve depression; however, its role in improving the specific symptoms of bipolar disorder is unclear and unproven. Supplements are usually only available by prescription. 5-hydroxy-tryptophan (or 5HT) is a related compound that is sold over- the-counter, and has shown more positive results in alleviating depression for patients with bipolar disorder.
- A Controlled Trial of L-Tryptophan in Mania (1985)
- Antidepressant potentiation of 5-hydroxytryptophan by L-deprenil in affective illness (1980)
- L-tryptophan in affective disorders: indoleamine changes and differential clinical effects (1974)
- A Single Case-Study Report of One Subject’s Improvement with L-Tryptophan Supplements (1984)
- Vitamin C (ascorbic acid) – this vitamin is being preliminarily examined for beneficial effects in manic-depressive patients. Vitamin C helps to clear Vanadium from the body, a trace mineral that is sometimes abnormally high in bipolar patients. The research studies on this topic (see below) also showed that patient symptoms improved with a reduced-Vanadium diet. The Yale-New Haven Health Complementary Medicine website recommends that: “until more is known, people with bipolar illness should avoid supplements containing vanadium and consider supplementing with vitamin C.”
- Lecithin (Phosphatidyl Choline) – available in health food stores, this compound is an acetylcholine (brain neurotransmitter) precursor). Anecdotal evidence (and to some extent, older research) report it to have mood stabilizing effects. Most writers recommend starting with a low dose (about 2 capsules) and gradually increasing if necessary, splitting up the doses over the course of the day.
- 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.
- Articles and Research
- 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.
- Psychotherapy: How it works and how it can help (from the Depression and Bipolar Support Alliance)
- Colorado University Researchers Show Family Helpful in Treatment of Bipolar Disorder (family-focused therapy reduces relapses over treatment with medication alone).
- Cognitive Behavioral Therapy for Bipolar Disorder (powerpoint slides presented at the 2nd Int. Conference on Bipolar Disorder, 1997)
- Group Psychoeducation Helpful in Bipolar Disorder (study showing reduced relapses/hospitalizations over a two-year follow-up period. Medscape article – requires free registration for viewing).
- 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.
- Disruptions in Sleep Routines May Lead to Mania in Manic Depressives
- Treating Bipolar Illness: Focus on Treatment Algorithms and Management of the Sleep-Wake Cycle (Am J Psychiatry, 1999)
- Lifestyle Considerations for People with Bipolar – 10 Tips for Getting Better Sleep. You have to scroll down a bit to get to the sleep section, but there is lots of other good info in this article as well.
- 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.
- Exercise Helps Keep Your Psyche Fit (American Psychological Association, 1999)
- Exercise Against Depression (from the Physician in Sports Medicine. Includes recommendations for how to formulate a realistic exercise routine that will still get results).
- Testimonials from People with Bipolar Disorder about how exercise has helped them manage their moods.
- The Influence of Physical Activity on Mental Well-Being (a meta-review of research, concluding that the evidence supports exercise as a viable intervention for treating depression)
- 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.
- Steady Circadian Rhythms are Music to Bipolar Patients’ Ears (Clinical Psychiatry, 1999)
- Researchers Find New Approach to Treating Bipolar Disorder (includes preliminary data from a study of IPSRT effects).
- Short explanation of how IPSRT can specifically fit the needs of bipolar patients (provided by The International Society for Interpersonal Psychotherapy)
- Articles and Research:
- Stem Cell-Based Therapies – In 2003, researchers from the University of Illinois Department of Psychiatry stated that “The use of stem cells for neuroreplacement therapy is no longer science fiction–it is science fact. We have succeeded in the development of neural and mesenchymal stem cell transplantation to produce neural cells in the brain. We have seen the improvement of cognitive function in a memory-impaired aged animal model following stem cell transplantation. These results may promise a bright future for stem cell strategies. “
- Articles and Research:
- Errant Stem Cell Activity Implicated in bipolar disorder (News)
- Stem Cell Source Found in Human Brain (News)
- The latest research on stem cells and Parkinson’s disease
- U.S. Losing Edge in Stem Cell Research (News)
- Why Cloning Didn’t Happen in U.S. (News)
- Bioethics Shuffle Ignites Outcry (News)
- Stem cell strategies, future and beyond (Research)
- Neuroreplacement therapy and stem cell biology under disease conditions (Research)
- Aberrant tyrosine transport across the cell membrane in patients with bipolar disorder (Research)
Discredited or Disproved or over-marketed “treatments” for bipolar disorder
- EM power+ (Empowerplus) by Synergy, or Truehope Nutritional Support
- 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:
- 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:
- 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.
- Vitamins in psychiatry. Do they have a role?
- Vitamin therapy in the absence of obvious deficiency. What is the evidence?
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.
- Effects of group musical therapy on inpatients with chronic psychoses: a controlled study
- Music improvisation with schizophrenic patients–a controlled study in the assessment of therapeutic effects
- Possibilities for inclusion of group music therapeutic methods in the treatment of psychotic patients
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.
- Mania associated with St. John’s Wort (Biol. Psychiatry, 1999)
- A Case of Mania Induced by Hypericum (World J Biol Psychiatry, 2002)
- St John’s Wort: Herb May Cause Problems for Bipolar (mentions some specific medications by name that may interact negatively with the herb)
- Government-Issued Warnings on the Use of St. John’s Wort (BBC News, 2000)