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If you or a loved one suffers from bipolar disorder, you know how difficult it can be to manage the ups and downs that come with this disorder.

The emotional rollercoaster takes its toll, and traditional treatments like therapy and medication often come with undesirable side effects. 

As a result, many patients find themselves looking into natural supplements or alternative therapies as an adjunct to their medical care.

But which supplements work, and which are just hype? 

With everything from fish oil to probiotics being marketed for mood disorders, it can be hard to separate fact from fiction. 

In this article, we’ll cut through the noise and explore the evidence on supplements that may provide real benefits for bipolar. 

But first, let’s understand what bipolar disorder is. 

Understanding Bipolar Disorder

Bipolar disorder, also known as manic-depressive illness, is a mental health condition that causes extreme shifts in mood, energy, and functioning. 

Individuals experience periods of elevated or irritable moods called mania or hypomania that alternate with episodes of low moods called depression.

Between mood episodes, known as the euthymic phase, individuals may experience a normal mood. However, in some cases, residual symptoms can remain.

Symptoms of the three main types of mood episodes in bipolar disorder include:

1. Depressive Episode

  • Persistent feelings of sadness, hopelessness, and helplessness
  • Loss of interest in activities that were once enjoyed
  • Changes in appetite and sleep patterns
  • Fatigue or loss of energy
  • Difficulty concentrating or making decisions
  • Thoughts of death or suicide

2. Manic Episode

  • Inflated self-esteem or grandiosity
  • Decreased need for sleep
  • Racing thoughts or flight of ideas
  • Distractibility or difficulty concentrating
  • Increase in goal-directed activity or psychomotor agitation
  • Excessive involvement in pleasurable activities without consideration for consequences
  • Impaired judgment or impulsiveness

3. Hypomanic Episode

  • Same mood changes and symptoms as mania but not as severe. 
  • The abnormally elevated, expansive, or irritable mood lasts a minimum of four days.
  • Impairment is present, but not to the extent of a full manic episode. 

Bipolar disorder encompasses various types, each characterized by distinct patterns of mood episodes. 

Bipolar I disorder involves at least one full-blown manic episode, whereas bipolar II disorder involves depressive and hypomanic episodes, with the latter being less severe than full mania. 

Cyclothymic disorder, or cyclothymia, is marked by numerous periods of hypomanic and depressive symptoms lasting for extended periods but not meeting the criteria for full episodes.

Bipolar is a lifelong condition with no cure. However, treatments such as mood stabilizing medications, psychotherapy, supplements, and lifestyle changes help manage symptoms and allow individuals to lead productive lives. 

Left untreated, bipolar disorder can be severely disabling due to unpredictable mood shifts and increased risk for substance abuse or suicide. 

What Are Dietary Supplements?

Dietary supplements encompass a broad category of products designed to complement the nutritional intake derived from food. 

These supplements come in various forms, including vitamins, minerals, herbs, amino acids, enzymes, and other substances. 

The primary purpose of supplements is to provide additional nutrients that may be lacking in an individual’s regular diet. 

While they are not intended to replace wholesome foods, supplements can serve as a convenient way to address specific nutritional deficiencies or support overall health and well-being. 

Common examples include multivitamins, omega-3 fatty acids, probiotics, and herbal extracts. 

It’s important to note that dietary supplements are not medications, and their efficacy can vary based on individual health needs and lifestyle factors. 

Are Supplements Effective for Bipolar Disorder?

Disorder
Image Credit: helpguide.org

While supplements are generally not considered a substitute for prescribed medications in the treatment of bipolar disorder, they may help in addition to prescription treatment under a doctor’s guidance.

Many people worldwide turn to supplements as part of their health and wellness routine. 

A study involving 348 patients in the US revealed that 29% reported short-term supplement use, while 20% reported long-term use for managing bipolar disorder. 

Although research on the effectiveness of nutritional supplements yields mixed results, a systematic review published in the journal Psychotherapy & Psychosomatics suggested promising outcomes for nutritional treatments in bipolar disorder management. 

Another review published in 2021 proposed that certain nutrient supplements could target disrupted neurobiological pathways in bipolar disorder, such as inflammation and oxidative stress, potentially serving as adjunctive treatments. 

However, despite being natural, supplements can still interact with medications prescribed for bipolar disorder. 

Therefore, it’s important to discuss any supplements with your prescribing doctor to ensure safe use as part of a comprehensive treatment plan.

Best Supplements for Bipolar Disorder

Here are some of the best supplements that have shown promise for bipolar disorder:

1. Omega-3 Fatty Acids

Omega-3 fatty acids, comprising eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), are essential nutrients found naturally in various foods such as salmon, tuna, sardines, free-range chicken, and omega-3 fortified eggs.

Another form, alpha-linolenic acid (ALA), is present in dark green leafy vegetables like spinach, walnuts, flaxseeds, and soybeans. 

These fatty acids play a crucial role in maintaining overall health, particularly in supporting heart and brain function.

Omega-3 fatty acids are believed to exert their potential positive effects on mood and mental health by influencing various biological processes, including inflammation and neurotransmitter function. 

Specifically in the context of bipolar disorder, research has explored the potential benefits of omega-3 fatty acids, with a focus on bipolar depression. 

In a comprehensive research review by Dr. Jeffrey Rakofsky and Dr. Boadie Dunlop, reasonably strong evidence was found for the use of omega-3 fatty acids as a supplement for managing bipolar depression.

While more research is needed, incorporating omega-3-rich foods or supplements into the diet may be considered as part of a holistic approach to supporting individuals with bipolar disorder.

2. N-Acetyl Cysteine (NAC)

N-acetyl cysteine (NAC) is an antioxidant known for its potential preventive effects against cancer and its application in treating acetaminophen poisoning. 

While some studies have not demonstrated significant benefits of NAC supplements for bipolar disorder, a recent review of six clinical trials suggested that NAC supplementation alongside standard treatments for bipolar depression may be more effective than a placebo. 

However, the researchers highlighted the need for larger studies to confirm and validate these findings.

As with any supplement, individuals considering NAC for bipolar disorder should consult with healthcare professionals to discuss its appropriateness for their specific circumstances

3. Folate

Folate is a water-soluble B vitamin, which is involved in DNA synthesis and regulation of gene expression. 

It also plays a crucial role in the biosynthesis of monoamine neurotransmitters like dopamine, epinephrine, and serotonin. These neurotransmitters are vital for regulating mood and emotional well-being. 

In the context of mental health, folate has garnered attention for its potential role as an adjunctive treatment in mood disorders. 

Several studies have found that individuals with bipolar disorder tend to have lower-than-normal blood folate concentrations

While more research is still needed, there is some evidence that bipolar patients with lower folate levels experience more frequent mood episodes and an earlier age of bipolar onset. 

Supplementing with folate may help address this imbalance and improve symptoms.

A systematic review conducted in 2020 explored the efficacy and safety of adjunctive folate in the treatment of MDD and bipolar manic episodes

The findings from the review suggested that supplementing with folate appeared to be effective and safe in these conditions.

This implies that folate supplementation may contribute positively to the management of mood disorders, potentially offering a complementary approach to conventional treatments.

4. Vitamin B6

Vitamin B6, with its various roles such as anti-inflammatory, serotonin-regulating, and dopamine-lowering, has drawn attention for its possible impact on mental health. 

Found in food sources like poultry, fish, potatoes, chickpeas, bananas, and fortified cereals, vitamin B6 has been studied for its potential benefits in the treatment of bipolar disorder.

In a clinical trial focusing on hospitalized patients experiencing manic episodes, researchers explored the effects of vitamin B6 on mood symptoms, cognitive status, and sleep quality. 

The study suggested that the use of vitamin B6 as an adjunctive therapy to lithium might be associated with improvements in mood symptoms for patients with bipolar disorder during manic episodes. 

This indicates a potential role for vitamin B6 supplementation in enhancing the overall management of bipolar disorder, but further research is needed to confirm and expand upon these findings.

5. Chromium

Chromium is an essential trace element that enhances insulin’s effects and contributes to lowering glucose levels in our body. 

While a well-balanced diet generally provides sufficient chromium, it is naturally present in most vegetables, fruits, whole grains, as well as grain- or grass-fed meats. 

Preliminary data on the use of chromium in the treatment of bipolar depression has generated conflicting but generally positive evidence. 

Small trials have reported slight improvements in depressive symptoms when chromium was added to treatment regimens.

Beyond its potential role in bipolar disorder, chromium supplements have also been subjects of study for their impact on cholesterol levels, heart disease risk, psychological disorders, Parkinson’s disease, and various other conditions. 

6. Magnesium

Magnesium is a vital mineral that plays a role in numerous bodily functions, including muscle and nerve function, blood sugar regulation, and bone health. 

It is commonly found in various foods, such as nuts, seeds, leafy green vegetables, and whole grains. 

While magnesium is readily available through a balanced diet, some individuals opt for supplements to ensure adequate intake.

Preliminary randomized, controlled trials have explored the potential benefits of magnesium supplementation in the context of bipolar disorder. 

The findings support the notion that magnesium may have a positive impact on reducing symptoms of mania. 

However, research in this area is ongoing, and more comprehensive studies are needed to establish a clearer understanding of its effectiveness in managing bipolar disorder.

7. Choline

Choline, a vital nutrient found in various foods, plays a crucial role in regulating memory, mood, muscle control, and cell membrane formation in the brain and nervous system. 

Being a water-soluble vitamin, choline is essential for maintaining overall health, contributing to the structural integrity of cells and supporting various physiological functions.

In the context of bipolar disorder, research suggests that choline supplements may offer potential benefits. 

A comprehensive review of older studies indicated that choline supplementation when added to other treatments, might contribute to improvements in symptoms of mania.

While this shows promise, individuals considering supplementation should engage in open discussions with their doctor, ensuring a well-informed approach that aligns with their needs.

Medications for Bipolar Disorder

When lifestyle and supplement interventions alone don’t provide adequate control of bipolar disorder symptoms, prescription medications become essential for management. 

The FDA has approved various drug classes and agents designed to address the complexities of bipolar disorder.

To manage both manic and depressive phases, mood-stabilizing drugs like lamotrigine are commonly used. 

However, doctors commonly prescribe different classes of medications for the treatment of mania and depression.

Atypical antipsychotics, including aripiprazole, asenapine, cariprazine, olanzapine, quetiapine, risperidone, and ziprasidone, are frequently prescribed to quell manic episodes.

For bipolar depression, FDA-approved choices are quetiapine, olanzapine paired with fluoxetine in the drug Symbyax, lurasidone, lamotrigine, and cariprazine. 

By working closely with prescribers, individuals can gain stabilization through strategically combining pharmaceuticals, supplements, and wellness strategies suited to their unique situation and course of illness.

Combination Therapy for Bipolar Disorder

therapy
Image Credit: bphope.com

Bipolar depression often requires a multifaceted treatment approach known as combination therapy. 

Since bipolar disorder involves distinct manic and depressive phases, a single medication or supplement may not effectively regulate the ups and downs.

Combination therapy pairs medications or supplements that target depression symptoms with those that prevent mania relapse. 

When used together under medical guidance, certain combinations can provide more comprehensive stabilization than any one drug alone.

A common and effective pharmacological combination is a mood stabilizer plus adjunct medication. 

Popular options include a mood stabilizer like lamotrigine paired with an atypical antipsychotic drug such as quetiapine. 

Combining antidepressants with natural supplements may also aid some patients by augmenting effects. 

For example, SAMe or fish oil supplements may be added to an antidepressant prescription to boost antidepressant functioning and cover multiple neurotransmitter systems.

Regular monitoring by a psychiatric provider is essential when utilizing combination therapy. 

Frequent check-ins allow for dose adjustments, evaluation of side effects, and optimization of treatment over time based on individual responses and needs. 

Other Treatment Approaches for Bipolar Disorder

In addition to medications and supplements, other therapies can also provide valuable support when managing bipolar disorder long-term. 

These approaches aim to enhance overall well-being, develop coping skills, and provide additional tools to manage depressive and manic symptoms effectively.

1. Psychotherapy: 

Psychotherapy, also known as talk therapy, is a fundamental component of non-medication treatment for bipolar disorder. 

Cognitive behavioral therapy (CBT) and dialectical behavior therapy (DBT) are often recommended for this disorder.

Through regular sessions with a qualified therapist, individuals can gain insight into their condition, learn effective strategies for managing mood swings, and improve their emotional regulation skills.

2. Lifestyle Changes: 

Adopting a healthy lifestyle is essential for managing bipolar disorder. 

Regular exercise, sufficient sleep, and a balanced diet can positively influence mood and overall well-being. 

Mind-body practices like yoga and meditation can also mitigate stress levels and promote emotional resilience when bipolar is stable.

Additionally, practicing good sleep hygiene and maintaining a consistent sleep schedule can help regulate mood and reduce the risk of manic episodes.

3. Deep Brain Stimulation: 

For treatment-resistant cases, deep brain stimulation has shown promise for delivering controlled electric pulses to brain regions involved in emotion regulation.

4. Ketamine Infusions: 

Off-label use of ketamine, an anesthetic, involves supervised low-dose infusions that may rapidly reduce depression symptoms, although the effects are temporary.

5. Support Groups: 

Connecting with others facing similar challenges through group therapy or online communities can provide empowering perspectives and coping strategies.

Conclusion

In conclusion, many studies have shed light on the potential effectiveness of various supplements in managing symptoms associated with bipolar disorder. 

Omega-3 fatty acids, folate, magnesium, vitamin B6, N-acetyl Cysteine (NAC), choline, and chromium have all demonstrated promise in alleviating bipolar symptoms.

However, while incorporating certain supplements may complement a comprehensive treatment plan, they should be seen as supportive measures rather than primary interventions. 

Medications prescribed by healthcare professionals play a central role in managing bipolar disorder, providing targeted and evidence-based solutions to address the complexities of the condition.

FAQ’s:

1. Can supplements completely replace medications for bipolar disorder?

No, supplements are not intended to replace prescribed medications.
They may offer complementary support but should be used in conjunction with, not as a substitute for, medical treatments.

2. Are these supplements universally effective for everyone with bipolar disorder?

Responses to supplements can vary among individuals.
Factors such as overall health, medication interactions, and personal biochemistry can influence the effectiveness of supplements.

3. Can I start taking these supplements without consulting my healthcare provider?

It is important to consult with a healthcare professional before introducing any supplements, as they can interact with medications and may not be suitable for everyone.

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