With the rise in health care costs, you may wonder about using alternative medicine and dietary supplements for the treatment of bipolar disorder and other mood disorders. Alternative medicine views the body and mind as an integrated system, which means they influence each other. With alternative medicine, your commitment to living a balanced life plays a key role in your health and healing. However, it is important to recognize that dietary or health supplement and "nutraceuticals" are not recognized by the medical community as comparably effective substitutes for traditional medications used to treat bipolar disorder.
Many alternative remedies and natural dietary supplements are easy to access, whether on the Internet or at your local pharmacy. Yet before you begin taking natural dietary supplements or an alternative remedy, it’s important to do your homework and know what you’re putting into your body. In addition, always discuss any alternative remedy or dietary supplement with your doctor to avoid an herb/drug interaction, which could be medically dangerous. It is important to recognize that the efficacy of dietary supplements is not overseen by the Food and Drug Administration [FDA] in the same way that the FDA regulates conventional medicines and food products, and they may not be recognized by the medical community as relevant or scientifically valid methods for treating bipolar disorder.
What is a dietary supplement?
According to the FDA, in order for an ingredient of a dietary supplement to be a "dietary ingredient," it must be one or any combination of the following substances:
- Herb or other botanical
- Amino acid
- Dietary substance to supplement the diet by increasing the total dietary intake (e.g., enzymes or tissues from organs or glands), or
- Concentrate, metabolite, constituent, or extract
Can supplementing with 5-HTP help bipolar depression and/or mania?
5-hydroxytryptophan (5-HTP) may be used to treat mild depression based on the theory that as a precursor to serotonin, the brain chemical (neurotransmitter) that has a calming effect, 5-HTP can increase serotonin levels and influence mood, sleep patterns, and pain control. When serotonin levels are low, the result can be high anxiety, irritability, insomnia, impatience, and depression.
Although the studies are few, some findings show that 5-HTP supplements may help regulate mood and emotions, even comparable to some antidepressants. For instance, a small study of volunteers with anxiety disorders reported that taking supplements of 5-HTP greatly reduced levels of anxiety.
What is DHEA and can it help bipolar disorder?
The body naturally produces the hormone dehydroepiandosterone (DHEA) until the mid-20s, at which point the production of DHEA declines. Advertisers claim that supplementing with DHEA may have antiaging benefits, boost mood, and improve symptoms of depression.
In one study of patients with HIV/AIDS, DHEA supplementation was found to be better than placebo in reducing depression symptoms. In another study of patients with Addison’s disease, researchers reported improvements in both mood and fatigue after supplementation with DHEA. But, because DHEA affects hormone levels in the body, experts say more studies are necessary before recommending DHEA for use by the public.
Most studies on DHEA supplementation in healthy individuals show few side effects if the supplements are taken orally in recommended doses. DHEA is not recommended for people with abnormal heart rhythms, blood clots, or a history of liver disease. Also, do not take DHEA if you are pregnant or breastfeeding. The long-term effects of regular DHEA use are not known.
DHEA alone is not an acceptable alternative to your bipolar medications. It has been shown to cause mania, irritability or impulsive behaviors, and may have other adverse psychiatric effects.
Can fish oil supplements boost mood with bipolar disorder?
Fish oil contains the omega-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), which are crucial for the production of hormones and nerve tissue. Results from one study showed positive effects of omega-3 fatty acids in treating depression but not for mania. Supplementing the diet with fish oil is less understood with bipolar disorder, because conflicting study results exist on whether or not it has value for treating or preventing episodes of mania or depression. If you are using fish oils, you must use a product that contains both EPA and DHA for this to be an effective addition to your medications.
Because there is evidence that omega-3 fatty acids can benefit cardiovascular health, some experts believe taking 1 gram per day of omega-3 fatty acid supplements may be beneficial.
Omega-3 Fatty acids may help, when used with your other medications, in treating your bipolar disorder.
What about St. John’s wort and bipolar disorder?
St. John's wort (Hypericum perforatum), an herbal therapy that’s been shown in studies to lift symptoms of minor to moderate depression, has been used in Europe for centuries. Minor to moderate depression is a common disorder that's under diagnosed and under treated. Not only can minor to moderate depression affect your daily functioning and quality of life, it’s also a serious risk factor for major depression.
Studies show that St. John’s wort may affect various brain chemicals (neurotransmitters), including serotonin, epinephrine, and dopamine. One of these neurotransmitters (serotonin) is the same chemical affected by the prescription drug Prozac, a selective serotonin reuptake inhibitor (SSRI). St. John’s wort may also improve sleep because hypericum extract increases the brain's output of melatonin at night. Melatonin is a hormone produced in the brain (that is itself controlled by a master clock in the brain) that regulates circadian rhythms, including the sleep-wake cycle.
But St. John’s wort is not recommended for the treatment of bipolar disorder. Drugs such as quetiapine, olanzapine-fluoxetine and lurasidone are the only FDA-approved treatments for bipolar depression, while mood stabilizers such as lithium, divalproex, or lamotrigine may also have value. Antidepressants have not been proven to help bipolar depression, and may also sometimes carry a risk of causing or worsening manic symptoms. Doctors advise caution and monitoring when using any antidepressant, including St. John’s wort, for treatment of bipolar depression. In addition, St. John’s wort may cause serious herb-drug reactions if taken with other SSRI medications such as Prozac.
Are natural therapies safe and effective?
No matter what the advertising flyer claims at the natural food store, even the most popular medicinal herbs with pharmaceutical compounds have ingredients that have not been tested and are not scrutinized by FDA. Unlike products that have FDA approval, many herbal products have not gone through clinical trials to show that they are safe and effective before going onto the market.
As we learn more about natural remedies, some alternative treatments may emerge as the best strategies for treating health conditions, while others may lead to severe side effects. That said, this does not mean that natural supplements do not work -- and there are many natural supplements that are safe and effective. Supplements may work differently for some people than for others. You need to pay attention to what works for you and obtain the professional guidance of your doctor.
One of the most common mistakes people make when using alternative treatments is to stop the conventional medical treatment altogether. In most cases, supplements are not a proven alternative to medication for treating bipolar disorder, but sometimes may help in addition to your medicine.
Also, keep in mind that supplements -- as natural as they may be -- can still interact with your medication. That’s why it’s important to discuss all medications and supplements with your doctor. If your doctor isn’t familiar with any potential interactions, your pharmacist is another good source of information.
And as a rule of thumb, just because something is natural doesn't mean that it is always safe (remember, plants like hemlock and nightshade are also natural, but poisonous!). Even supplements have side effects.
Herbal treatments are not recommended without medical supervision for pregnant women, children, the elderly, people with ongoing disease processes (basically anyone taking a prescribed medicine regularly) or those with compromised immune systems. In addition, some herbs have sedative or blood-thinning qualities, which may dangerously interact with NSAIDs or other pain medications. Others may cause gastrointestinal upset if taken in large doses.