Bipolar Disorder Medication, Herbs, and Supplements

For someone with bipolar disorder, finding the most effective bipolar medications is key for treating and preventing episodes of mania or depression. Of course, it's important to take them as prescribed. And it's also important to be aware of what else you are taking when you do. Taking bipolar medications with over-the-counter herbs and natural supplements may be dangerous. Some herbs and supplements can cause dangerous interactions with medications or make bipolar drugs less effective. In addition, these natural therapies may also sometimes cause more serious health problems.

What Are Some Common Bipolar Drugs

The drug lithium has been used for decades to treat bipolar disorder, also called manic depression. Several anticonvulsants are also prescribed for bipolar disorder. They include

Newer, atypical antipsychotic drugs used to treat bipolar disorder include:

These drugs are generally given during the agitated state of mania or depression, and some are also used specifically to treat bipolar depression (for example, Seroquel, Latuda, Symbyax) or to help prevent relapses during long-term use (e.g.,  Abilify, Geodon, Seroquel and Zyprexa).

In addition, the doctor may prescribe an antidepressant, an anti-anxiety medication, or a sleep medication if mood stabilizers alone are not adequate for managing mood symptoms.

 

Is It Safe to Take Herbs and Supplements With Bipolar Medication?

Even though herbs and natural dietary supplements are sold over the counter, they are not necessarily 100% safe. For instance, some over-the-counter weight loss supplements contain ephedra. They have been known to produce symptoms consistent with mania. Those symptoms include extreme elation with reduced need for sleep. Other supplements that can potentially cause mania include DHEA (dehydroepiandrosterone), SAMe (s-adenosylmethionine), St. John’s Wort, and rhodiola rosea.

Herbs and natural dietary supplements have not been tested or regulated by the FDA. So it's important to use caution when taking them. Most credible manufacturers list contraindications or warnings on the product label. But some manufacturers do not. When the wrong herb or supplement is taken with bipolar medications, there can be dangerous drug-herb interactions. The result of these interactions can include:

 

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Which Herbs Are Unsafe When Taken With Bipolar Drugs?

The herb evening primrose oil may sometimes be unsafe when taken with some anticonvulsants. Lamictal, an anticonvulsant prescribed to treat bipolar disorder, is one. The herb ginkgo biloba -- taken by some to increase memory and attentiveness -- may reduce the effect of Depakote, another bipolar drug.

If you take the anticonvulsant Trileptal (a drug that is sometimes used experimentally in bipolar disorder, but not a proven "mood stabilizer") or the atypical antipsychotic Abilify for bipolar disorder, then avoid taking St. John's wort. St. John's wort is an herb sometimes taken to try to boost mood in cases of mild to moderate depression. There are reports that it may decrease the levels of Trileptal and Abilify in the blood. In addition, taking anticonvulsants with St. John's wort may also increase depression of the central nervous system.

St John's wort can also cause serotonin syndrome when it's taken with an SSRI antidepressant. Symptoms can include hallucinations, fluctuating blood pressure, nausea, and vomiting.

Patients who take anticonvulsants or anxiety medications such as alprazolom (Xanax), busprione (Buspar), clonazepam (Klonopin), diazepam (Valium), or lorazepam (Ativan) should avoid the following herbs:

All three are known to cause sedation or drowsiness. Taking kava -- which is used to cause a relaxed state -- with some anxiety drugs may lead to a marked level of drowsiness.

Do All Herbs and Natural Dietary Supplements Interact With Drugs?

In one study, researchers found 32 drugs that may interact with herbs and natural dietary supplements. Of the drugs that most commonly interact with herbs, the study listed sedatives and antidepressants. These are drugs that people with bipolar disorder frequently take.

How Can I Know if an Herb or Supplement Will Interact With my Bipolar Medication?

Talk to your doctor about your bipolar medications and supplements. Make sure there's no dangerous interaction. It's often helpful to put all of your natural therapies -- herbs, vitamins, and other natural dietary supplements -- in a bag and take it with you to your doctor's visit. Your pharmacist may also be able to answer questions about drug interactions with herbal supplements. Your doctor can see the supplements and determine if they are safe or unsafe to take with your bipolar medication.

Your most important goal is to take your bipolar medications regularly. That way, you can keep your condition managed. Working closely with your doctor, you can find the most effective bipolar treatment that meets your specific needs. The right medication will allow you to live an active and meaningful life.

WebMD Medical Reference Reviewed by Joseph Goldberg, MD on November 7, 2017

Sources

SOURCES:
Office of Dietary Supplements: "Dietary Supplement Fact Sheets."
Office of Dietary Supplements: "Frequently Asked Questions."
National Center for Complementary and Alternative Medicine: "St. John's Wort."
The American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-5.

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