Conditions:
Bipolar Disorder
Related Terms
•
Manic-Depression, Manic-Depressive Disease
Principal Proposed Treatments
•
Fish Oil
Other Proposed Treatments
•
Flaxseed Oil, Lecithin, Choline, Vitamin C, Folate, Inositol, Vitamin B12
Previously known as manic-depressive disease, bipolar disorder is a common mental health condition manifested by alternating periods of mania—extreme high energy—and deep depression. In the "up" or manic phase, people may sleep little, talk fast, develop grand and unworkable plans, and sometimes behave bizarrely—for example, giving away all their money overnight. In the "down" phase, they may contemplate suicide.
Bipolar disorder was thought to be untreatable, until the accidental discovery that the mineral lithium can dramatically improve symptoms of mania. Later, various antiseizure medications were also found to help for reasons that are not clear. However, all of these treatments can cause significant side effects, and none is completely effective for everyone.
People with this condition generally require life-long treatment with lithium or other drugs to control manic episodes, and sometimes antidepressants to control depression.
Principal Proposed Treatments for Bipolar Disorder
Fish Oil
Fish oil, a substance best known for its possible benefits in preventing heart disease, has shown promise for the treatment of bipolar disorder. The results of a small double-blind study were met with considerable scientific interest, and fish oil is currently the subject of ongoing research.
What Is the Scientific Evidence for Fish Oil?
In a double-blind study reported in 1999, 30 people with bipolar disorder took either fish oil capsules containing omega-3 fatty acids or placebo for 4 months, in addition to their regular medications.1 The study authors found that those taking the fish oil had longer symptom-free periods than those taking placebo. The researchers used 5 different standardized tests to measure symptoms, examining levels of depression, mania, and overall progress. The people taking fish oil proved emotionally healthier than those taking placebo on all but one of these tests.
The idea of using fish oil came from test tube studies suggesting that omega-3 fatty acids might dampen overactive nerve signals, thereby stabilizing mood swings.2 This is similar to one possible explanation of how lithium and antiseizure medications work.3
Remember that fish oil is intended to supplement, not replace, other medications for bipolar disorder.
For more information, including dosage and safety issues, see the full fish oil article.
Other Proposed Treatments for Bipolar Disorder
A variety of other supplements have been proposed for bipolar disorder. However, the evidence that they work is weak at best.
Flaxseed Oil
The same researchers who conducted the fish oil study have also experimented with flaxseed oil for bipolar disorder.5 Flaxseed oil contains alpha-linolenic acid (ALA), an omega-3 fatty acid related to the fatty acids in fish oil. In the researchers' informal observations of 22 people with bipolar disorder, all but 4 appeared to benefit from flaxseed oil. However, lacking a double-blind study, these results can't be taken as reliable. When a double-blind study is finally performed, flaxseed oil may turn out not to be helpful at all.
Flax oil is not meant as a substitute for standard medications. For more information, including dosage and safety issues, see the full flaxseed oil article.
Lecithin and Choline
Two related substances, lecithin and choline, have been proposed as remedies for various psychological and neurological diseases, including bipolar disorder. Lecithin contains a substance called phosphatidylcholine (PC) which breaks down into the nutrient choline. Tiny studies of 6 individuals apiece have found that both lecithin and choline may be helpful in treating symptoms of bipolar disorder, particularly mania.6,7 While promising, these treatments need to be studied in much larger groups before any real conclusions can be drawn.
Vitamin C
Two rather flawed double-blind studies found that vitamin C might help bipolar disorder, 8,9 but it is hard to draw conclusions because of the ways in which the studies were designed: One study used only a single dose of vitamin C.10
Folate
According to one study, deficiencies in folate may be linked to greater levels of emotional symptoms in people taking lithium long-term.11 In this study, those who were found to have the highest levels of folate in their blood also did the best on standardized tests of depression and emotional well-being.12 However, this does not prove that takingextra folate will help.
A double-blind study attempted to answer this question. In it, 75 people on lithium for a variety of disorders were given either folate or placebo for a year.13 Individuals with bipolar disorder who took folate did no better, on average, than those taking placebo.
Other Possible Treatments
A small preliminary trial found suggestive evidence that inositol might be helpful for the depressed phase of bipolar disorder.14 However, caution is advised (see below).
Vitamin B12 has also been suggested.
Risky Combinations
A number of supplements may be risky for those with bipolar disorder. For example, one case report suggests that inositol (mentioned above as a possible treatment in bipolar disorder) may have been responsible for precipitating manic episodes in three people.15
Several reports have raised the concern that SAMe can trigger manic episodes as well.16,17,18 This would not be surprising if true, as SAMe appears to possess antidepressant properties, and antidepressants are well known to trigger manic episodes. This suggests that other natural antidepressant treatments could also cause problems, most notably the herb St. John's wort, but also 5-HTP and phenylalanine. However, there are, as yet, no actual reports of problems.
Finally, there was a case report that high doses of the supplement L-glutamine (more than 2 g per day) may also have triggered episodes of mania in two people without bipolar disorder.
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Last reviewed March 2002 by Medical Review Board
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