Bipolar disorder vitamins, herbs, and supplement that may offer some help and relief, natural therapy and remedy using nutritional supplementation by Ray Sahelian, M.D.
April 12 2014

Bipolar disorder is a long-term illness with a variable course. Some of the symptoms may include mania, an excessively elevated, expansive, and irritable mood; increased libido; decreased need for sleep; rapid speech; racing thoughts; increased activity and agitation; occasional delusions. It may also include periods of depression and other symptoms such as excessive guilt; anhedonia (absence of pleasure); or thoughts of death. This condition has a high relapse rate. A vast majority of the hospitalizations for treatment of bipolar disorder are repeat admissions.

Natural therapies for bipolar disorder, vitamins, herbs, supplements and natural remedy
We are slowly beginning to discover that natural supplements may play a role in the therapy of bipolar disease. Much has yet to be learned, but there are at least three nutrients that offer some hope.
I am not aware of any other natural supplements that have been tested and found consistently effective in the treatment.

Fish oils, omega-3 fatty acids
It's quite possible that one of the biochemical abnormalities in bipolar disorder is a higher amount of omega-6 fatty acids and a shortage of omega-3 fatty acids. If this is the case, fish oil supplements may help. It is difficult to predict in any one person whether fish oils would help and if so how many softgels would be required. Under medical supervision a person can start with 3 softgels a day and gradually increase over time as needed. Other options are krill oil or flax seed oil.

Omega-3 fatty acid treatment and T(2) whole brain relaxation times in bipolar disorder.
Am J Psychiatry. 2004;.
The authors hypothesized that changes in brain membrane composition resulting from omega-3 fatty acid administration in patients with bipolar disorder would result in greater membrane fluidity, as detected by reductions in T(2) values. Women with bipolar disorder (N=12) received omega-3 fatty acids for 4 weeks. A cohort of bipolar subjects (N=9) and a group without bipolar disorder (N=12) did not receive omega-3 fatty acids. T(2) values were acquired at baseline and after 4 weeks. Bipolar subjects who received omega-3 fatty acids had significant decreases in T(2). There was a dose-dependent effect when the bipolar omega-3 fatty acid group was subdivided into high- and low-dose cohorts. Omega-3 fatty acids lowered T(2) values, consistent with the hypothesis that the fluidity of cell membranes was altered. Further studies are needed to clarify the significance of alterations in brain physiology induced by omega-3 fatty acids, as reflected in T(2) values.

Lower high-density lipoprotein cholesterol and increased omega-6 polyunsaturated fatty acids in first-degree relatives of bipolar patients.
Psychol Med. 2004
Lower serum high-density lipoprotein cholesterol and increased ratio of omega-6 / omega-3 fatty acids have been reported in unipolar and bipolar depressed patients. Changes in cholesterol and fatty acids have been suggested to affect membrane viscosity and consequently serotonergic neurotransmitter expression. The goal of this study was to investigate whether lower baseline cholesterol and increased omega-6 and lower omega-3 fatty acids are present in healthy first-degree relatives of bipolar disorder patients compared with controls and whether these changes were associated with neuroendocrine responses to an i.v. tryptophan challenge or mood. Baseline cholesterol, fatty acids and mood were determined in healthy first-degree relatives of patients with bipolar disorders and healthy matched controls. Prolactin and cortisol were measured following tryptophan infusion. First-degree relatives showed significantly lower plasma high-density lipoprotein cholesterol and increased total omega-6 fatty acids in phospholipids. Lower total omega-3 and higher total omega-6 fatty acids in phospholipids were positively correlated with peak prolactin response to tryptophan. Lower total omega-3 fatty acids in phospholipids and cholesteryl esters were associated with lower mood. Abnormalities of lower plasma high-density lipoprotein cholesterol and increased total omega-6 fatty acids in phospholipids in these subjects are in agreement with findings in bipolar disorder and major depressed patients. Changes in fatty acids show an association with central serotonergic parameters. It is suggested that these abnormalities in cholesterol and fatty acids may constitute a trait marker for bipolar disorders.

Testimonial
Last year my psychiatrist suggested fish oil for bipolar disorder and I have been taking twelve fish oil 1200mg softgels a day for almost a year and have felt great!
   Thanks for letting us know. Sometimes it is good to have your doctor re-evaluate to see if fewer softgels would work as well.

I'm sure my son has bipolar disease, he has been diagnosed with depression, but the doctors hesitated giving him anything until he went to a psychiatrist, which he can't afford (no insurance) will taking the supplement fish oil help him?
   It is not possible for us to predict whether fish oils will treat his bipolar disease or depression, but fish oils do have a positive effect on mood for some users.

Choline supplement
Choline, a nutrient that converts into phosphatidylcholine, has shown to be beneficial in bipolar disease, particularly those who are prescribed lithium. More studies are needed to confirm this initial finding.

Oral choline decreases brain purine levels in lithium-treated subjects with rapid-cycling bipolar disorder: a double-blind trial using proton and lithium magnetic resonance spectroscopy.
Brain Imaging Center, McLean Hospital, Belmont, MA, USA. Bipolar Disord. 2003.
Oral choline administration has been reported to increase brain phosphatidylcholine levels. As phospholipid synthesis for maintaining membrane integrity in mammalian brain cells consumes approximately 10-15% of the total adenosine triphosphate (ATP) pool, an increased availability of brain choline may lead to an increase in ATP consumption. Given reports of genetic studies, which suggest mitochondrial dysfunction, and phosphorus (31P) magnetic resonance spectroscopy (MRS) studies, which report dysfunction in high-energy phosphate metabolism in patients with bipolar disorder, the current study is designed to evaluate the role of oral choline supplementation in modifying high-energy phosphate metabolism in subjects with bipolar disorder. Eight lithium-treated patients with DSM-IV bipolar disorder, rapid cycling type were randomly assigned to 50 mg / kg/day of choline bitartrate or placebo for 12 weeks. Brain purine, choline and lithium levels were assessed. Patients received four to six MRS scans, at baseline and throughout treatment. Patients were assessed using the Clinical Global Impression Scale and the Hamilton Depression Rating Scale at each MRS scan. There were no significant differences in change-from-baseline measures of CGIS, YMRS, and HDRS, brain choline / creatine ratios, and brain lithium levels over a 12-week assessment period between the choline and placebo groups or within each group. However, the choline treatment group showed a significant decrease in purine metabolite ratios from baseline (purine / n-acetyl aspartate; purine / choline compared to the placebo group, controlling for brain lithium level changes. Brain lithium level change was not a significant predictor of purine ratios. The current study reports that oral choline supplementation resulted in a significant decrease in brain purine levels over a 12-week treatment period in lithium-treated patients with DSM-IV bipolar disorder, rapid-cycling type, which may be related to the anti-manic effects of adjuvant choline. This result is consistent with mitochondrial dysfunction in bipolar disorder inadequately meeting the demand for increased ATP production as exogenous oral choline administration increases membrane phospholipid synthesis.

5HTP
Is 5HTP helpful for people with bipolar disorder? What about ashwagandha herb or
kava
root extract?
   As of 2014 I have not seen any studies regarding the treatment of bipolar disorder with
5-HTP supplements, kava root, or ashwagandha. However, if your doctor approves, you could try a daily dose of 5HTP 50 mg or 100 mg for a week or two to see if there are any effects. 5HTP is best tried by itself since the combination of this supplement with prescription medications could lead to unexpected side effects.

Lithium orotate
The swings in mood from depression to mania that afflict people with bipolar disorder can be tempered with drugs such as lithium, but adding an antidepressant drug to ease the depression component is not helpful. I have come across lithium orotate and there may be some possibility that this supplement could help but long term benefit and side effects are not yet fully known.

Caution
Some nutrients and herbs have a stimulant effect and (hypothetically) may aggravate bipolar disorder or induce mania. These include SAM-e pills, ginseng, St. John's wort and others of a stimulatory nature.

Bipolar symptom
Symptom of bipolar disorder are characterized by recurrent episodes of depression, mania, and/or mixed symptom states. These episodes cause unusual and extreme shifts in mood, energy, and behavior that interfere significantly with normal, healthy functioning.

Bipolar Disease Manic symptoms include:
* Increased energy
* Severe changes in mood, either extremely irritable or overly silly and elated
* Overly-inflated self-esteem; grandiosity
* Decreased need for sleep, ability to go with very little or no sleep for days without tiring
* Increased talking, talks too much, too fast; changes topics too quickly; cannot be interrupted
* Distractibility, attention moves constantly from one thing to the next
* Increased sexual desire or high libido, increased sexual thoughts, feelings, or behaviors; use of explicit sexual language
* Increased goal-directed activity or physical agitation
* Disregard of risk, excessive involvement in risky behaviors or activities

Bipolar Depression symptoms include:
* Loss of energy
* Persistent sad or irritable mood
* Loss of interest in activities once enjoyed
* Significant change in appetite or body weight
* Difficulty sleeping or oversleeping
* Physical agitation or slowing
* Feelings of worthlessness or inappropriate guilt
* Recurrent thoughts of death or suicide

Bipolar medication treatment
A number of medications are available to treat this condition. The most common are mood stabilizers like lithium and anticonvulsant medications. Many people who have bipolar disorder keep taking these medications for years or decades after their last mood swing to stay healthy. This is called maintenance therapy. During a period of depression or mania, a person may need other medications, like antipsychotic drugs and sometimes antidepressants.

Weight gain side effects
Obesity and weight gain in bipolar disorder patients are partly related to prescribed drugs with a strong effect by clozapine and olanzapine. Lesser but still relevant weight gain is caused by quetiapine, risperidone, lithium, valproate, gabapentin and by some antidepressants. Ziprasidone, aripiprazole, carbamazepine and lamotrigine do not seem to cause significant weight gain.

University attendance and stress
The rituals of college -- making new friends, studying until dawn, excessive partying -- can stress out any young adult. But students with bipolar disorder, or those at risk for the condition, are even more vulnerable in a college environment. Academic pressures, social concerns, and sleep disruptions can lead to bouts of depression as well as mania, the euphoric, revved-up state characteristic of bipolar disorder.

Smoking related to risk for suicide
People with bipolar disorder who smoke appear to have a heightened risk of suicidal behavior -- possibly because they are generally prone to impulsive acts. Bipolar Disorders journal, November 2009.

Having a family member who committed suicide increases the likelihood that patients with bipolar disorder will themselves attempt suicide.

Research
Prescribing anti-depressants alone to bipolar patients can trigger manic behavior and rapid "cycling" between mania and depression that could lead to suicidal thoughts.

Bipolar disorder, a sometimes misdiagnosed mental illness characterized by wide emotional swings, may be identifiable by chemical abnormalities visible in victims' brains. Detailed brain scans performed on 42 adults, half of whom had been previously diagnosed as bipolar, showed consistently different levels of five chemicals in areas of the brain that control behavior, movement, vision, reading and sensory information, they said. The Mayo Clinic study used a high-power magnetic resonance imaging scanner that had twice the magnetic field strength of scanners previously used to examine the brains of bipolar patients. Roughly 2 million Americans suffer from bipolar disorder, according to the National Institute of Mental Health.

Emails
Could you elaborate on the use of SSRI's and bipolar. 2 physicians (one a psychiatrist) told me recently that bi-polar patients should not use SSRIs - nor SAMe. I could not find this in your book. How about St. John's Wort?
   Both SAM-e and St. John's wort are strong antidepressants, and they can shift a bipolar person into a manic state, that is possible.

My wife has no sex drive at all and we are investigating herbal treatments such as Passion Rx. She has been under treatment for bipolar disorder for about 20 years and is very stable in that regard, and under the care of a psychiatrist to monitor her meds, which include Lithobid and Depakote. I suppose she should ask her psychiatrist first, but are you aware of any special issues for such patients with regard to herbal remedies?
   There can be unexpected reactions when herbal aphrodisiacs are mixed with pharmaceutical drugs. It is not possible for us to predict such reactions or possible side effects that could occur. Many herbs have stimulating properties, they can increase body temperature, and can increase heart rate or cause insomnia in high doses.

I suffer from bipolar disorder and take Geodon, Lamictal, Welbutrin and lorazepam to help my condition. I'm pretty sure one of the drugs is causing me to not have a sex drive. The drugs work well for me and I really don't want to change any of them. I was wondering if taking an aphrodisiac herb will help me even though I'm on medication?
   Sexual enhancing herbs are potent and could interact with the medications. With so many medications in the body it is difficult to predict the response to any sexual herb or formula. There are no easy answers when so many prescription drugs are involved.

I have seen a few warnings against using rhodiola rosea herb if you are diagnosed with bipolar disorder. Iíve seen the warning on some labels and online.
   There are many herbs, when used in high concentrations, that can cause overstimulation, restlessness, and perhaps induce mania. Rhodiola rosea herb may theoretically fall in this category, along with ginseng, tongkat ali, horny goat weed, and others, but we have not seen, as of August 2008, any specific human research that has evaluated the role of rhodiola herb in inducing mania. As with many herbs that increase energy levels, it is best to use lower dosages to avoid side effects of restlessness and insomnia.

My wife was diagnosed bipolar disorder about 22 years back. She just got relapse after sever years. She had been on Lithium and Risperdal medications. Her doctor has now put her on Geodon with Lithium, and apparently she is getting side effects like feeling short of breath, loss of energy, etc. I gave her Flax seed oil (with Omega 3,6 & 9) and saw positive outcome. Shall I continue flaxseed oil, or also give her fish oil? Will appreciate your response.
    I can't give specific advice but it is worth trying each separately for 2 or 3 weeks and then a combination, if her doctor approves. It is difficult to predict the interaction between supplements and medications.

My son shows signs of extreme mood swings, mania in the form of extreme irritability, depression, mild learning disabilities, inability to keep job due to irritability. He has improved somewhat on Empower by Truehope but duration is only 3-4 hours and product is outrageously expensive. Not sure it is doing the job.

I take Zoloft and Lamictal but not happy with the results, I am looking for some natural products.