The standard approach to treating bipolar disorder calls for a combination of medication and psychotherapy—a mood stabilizer for the mania, an anti-depressant to treat the depressive side, and psychotherapy to deal with the stressors and triggers that often push the disorder through the protective barrier of medications.

There are, however, some alternative and complementary treatments available that may help when the standard treatments are ineffective or cause intolerable side effects. When used in place of standard medications and therapies, these are known as “alternative.” When used along with standard medications and therapies, they are called “complementary” or “adjunctive.”

Caution: Consult your doctor before trying any alternative or complementary treatment, even if it is advertised as “natural.” Don’t assume that your doctor is ignorant or unwilling to consider the use of alternative treatments. Many doctors know something about them, are quite willing to discuss them with you, and can help guide you in making informed and safe decisions. As always, never make medication adjustments without your doctor’s approval.

Vitamins, minerals, and oils

Sometimes consuming a little more of what’s already a part of your diet may contribute to calming your mania or reducing your depression:

• Omega-3 fatty acids: One relatively limited study has shown that high levels of Omega-3 (2 to 7 grams daily) can help prevent recurrence of mania and depression. Larger, more recent studies report that Omega-3 doesn’t reduce mania or mood cycling, but that in some cases, high doses of Omega-3 fatty acids can improve the effectiveness of antidepressants. Where do you get Omega-3? Cold water fish (salmon, mackerel, herring, tuna, anchovies, and sardines), wild animals (deer, buffalo, and free-range chickens), Omega-3 enhanced eggs, dark green, leafy vegetables (like purslane), flaxseed oil, walnuts, and Omega-3 supplements.
• Choline and phosphatidyl choline: is an essential nutrient for healthy cell membranes. It is also the precursor to acetylcholine, one of the crucial brain chemicals involved in memory. A small study has shown choline to be effective in treating rapid cycling bipolar disorder when combined with lithium.
• B complex vitamins: B-complex vitamins consist of B1 (thiamine), B2 (riboflavin), B3 (niacin), B5 (pantothenic acid), B6 (pyridoxine), B7 (biotin), B12 (cobalamin), and folic acid (folate or folacin), all of which your body uses to build cells, particularly nerve cells. Taking them together in the appropriate relative concentrations is important, because too much of one can cause a deficiency of another.
• Folic acid: Folic acid is critical in the development of the human nervous system, so pregnant women must take folic acid supplements. People who abuse alcohol and people with certain illnesses who must take particular medications are at risk for folate deficiencies. Some research has connected low folate levels to depression, so checking levels and supplementing with folic acid may be part of treatment for depression, particularly in people in these high-risk categories.
• Vitamin C: People with bipolar mania often have an elevated level of the trace mineral vanadium in their system. Vitamin C may help the body reduce the levels of vanadium. Whether this is effective in stabilizing moods, however, has yet to be determined.
• Vitamin E: Some healers have touted vitamin E as a cure for everything from heart disease and cancer to depression, but large recent studies call these connections into question. True deficiencies are rare, and vitamin E may actually cause medical problems at high doses, so always consult your doctor.
• Magnesium: A magnesium deficiency is rare, but high-risk groups include older adults, people who abuse alcohol, diabetics, and people with a number of other medical conditions that require a variety of medications. Low body stores of magnesium may be related to a number of health problems, including mood regulation.
• Zinc: Some clinical studies suggest that low levels of zinc may contribute to depression, but a well-balanced diet typically provides enough zinc. People who abuse alcohol and patients with chronic stomach problems that include diarrhea are at risk of zinc deficiency.
• EMPowerplus: EMPowerplus is an all-in-one pill or powder designed to treat multiple deficiencies in numerous areas of the body, including the central nervous system. This supposed wonder-brew is charlatanism at its worst. No reliable studies support its effectiveness, and its advocates recommend stopping all other medications before trying it. One of my patients followed their advice, and it was a disaster. The Canadian government shut down this company for awhile because it was so out of control. Consult your doctor before following any advice this company may offer.

Herbs and supplements

Nature provides a host of effective cures and treatments for common ailments, but do herbs and “natural” supplements hold out any promise for people with bipolar disorder? Some people seem to think so. The following list covers many of the herbs and supplements used in an attempt to treat depression and mania:

• St. John’s wort: Limited studies suggest that St. John’s wort (a medicinal herb) is effective in treating mild to moderate unipolar depression. Be careful, though; like most antidepressants, St. John’s wort carries the risk of inducing mania. It can also interact with a number of drugs, so, as always, consult your doctor first.
• Ginkgo biloba: Gingko biloba’s (a medicinal herb) use in treating mood disorders isn’t well established, but its effectiveness is being explored. At high doses, it can thin the blood too much and cause bleeding, so consult your doctor.
• Black cohosh: Marketed primarily to help women with night sweats and hot flashes, black cohosh (a medicinal herb) hasn’t yet proven its effectiveness in formal research studies. Some studies have shown that it can trigger an autoimmune response in the body that attacks the liver, so consult your doctor before trying it.
• SAMe: Short for S-Adenosylmethionine, SAMe (a natural substance found in your body) has been proved to function effectively as an antidepressant in some studies. However, SAMe can induce mania at rates similar to the SSRI antidepressants, making it extremely risky for treating bipolar depression.
• GABA: GABA (gamma-aminobutyric acid, an inhibitory of the nervous system neurotransmitter) taken as an oral supplement doesn’t cross the blood-brain barrier, so any claims that it is a natural cure for bipolar disorder are baseless.
• Taurine: An amino acid, taurine helps regulate the electrical activity in the brain and may counteract the effects of excitatory neurotransmitters, including dopamine and norepinephrine. Some studies show that taurine levels are depleted in the brains of people with bipolar disorder, but no studies currently show that taking supplements will improve depression.
• Melatonin: Melatonin is a hormone that the brain uses in response to light and dark and is part of the body’s sleep/wake machinery. Supplements may reduce insomnia for sufferers of some types of sleep problems. It’s safe for short-term use, even in children. Check with your doctor before you use melatonin, however, because it can interact with some psychiatric medications.
• 5-HTP: This supplement provides your body with the building blocks it needs to assemble serotonin, but no evidence proves that taking supplements of 5-HTP improves mood.
• Valerian: Valerian is an herb commonly marketed for the treatment of insomnia. Although studies are currently deemed inconclusive, some have reported positive results. Valerian appears to be relatively safe, but be cautious, especially if you’re taking other medications or are pregnant or nursing.
• Kava: This plant/herbal product purportedly reduces stress and anxiety, but some reports have linked it to liver damage, so practice extreme caution.

Caution: Before ingesting any substances (natural or otherwise), check with your doctor, and do additional research on your own. A reliable information source is the National Institute of Health’s National Center for Complementary and Alternative Medicine (NCCAM).

Lithium Orotate

If your doctor prescribed lithium as a mood stabilizer, you’re probably taking lithium carbonate (commonly sold as Carbolith, Cibalith-S, Duralith, Eskalith, Lithane, Lithizine, Lithobid, Lithonate, Lithotabs, and Priadel). You can also find a supposedly safer form of lithium at your local health food store—lithium orotate. The theory behind the claim is that lithium orotate delivers lithium to the brain more efficiently than lithium carbonate, so you need to take less of it to get the same effect. However, no studies show that lithium orotate is effective in treating mania or depression.

Because the recommended dosage of lithium orotate delivers less lithium to your system (than a dose of lithium carbonate), lithium orotate is considered “safer,” but if you take any form of lithium, inform your doctor, so he or she can have your blood levels tested. If blood levels are too high, the situation can become dangerous or even deadly. Under no circumstances should you take lithium orotate if you are already taking a prescribed dose of lithium carbonate.

Buyer beware

People often think that vitamins and herbs are “worth a try.” If you can get them at the store without a prescription, they must be safe, right? Well, not exactly. These so-called nutraceuticals carry their own potential risks and drawbacks. Unconventional treatments…

• May cause you to forgo more effective treatments.
• Can be costly.
• May not be covered by your insurance.
• May be very complex.
• Can have negative or even dangerous side effects.
• May cause dangerous interactions with your prescribed medications.
• Are less strictly regulated.

Remember: Always consult your doctor before you try an alternative treatment.

Share your experience

If you have tried any of the treatments discussed in this article or other alternative treatments I haven’t mentioned, I encourage you to share your experience with other visitors to this site. Keep in mind, however, that anecdotal evidence from others is no substitute for data collected from controlled studies. In other words, just because something worked for someone else doesn’t mean it will work for you. Talk to your doctor before trying anything someone else recommends.