Previously known as manic-depressive disease, bipolar disorder is a relatively common mental health condition manifested in its classic form 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. In many people with this disorder, the "down" phase predominates, and for that reason, the diagnosis may be missed. Other, more subtle versions of the condition also exist.

Bipolar disorder is dangerous unless treated, leading to a high rate of suicide and injury. The mineral lithium has been shown to dramatically improve symptoms of mania and reduce the rate of suicide. Various antiseizure medications also appear to help against mania.

Note: There are no natural treatments that can substitute for medications in the treatment of bipolar disorder. However, some might help enhance the effectiveness of standard treatment.

In a double-blind study, 30 people with bipolar disorder took either fish oilcapsules or placebo for 4 months, in addition to their regular medications.1Those taking fish oil had longer symptom-free periods than those taking placebo. The researchers used five 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. Another study found that ethyl-EPA (a modified form of a constituent of fish oil) was helpful along with standard treatment for the depressed phase of bipolar disorder.19However, ethyl-EPA does not appear to offer benefits for rapid cycling bipolar disorder.24

Researchers pooling the results of 10 randomized trials involving 329 patients found that omega-3 fatty acids (found in fish oil) improved depressive symptoms in patient with either bipolar disorder or major depression compared to placebo.23In a subsequent systematic review, researchers pooled the results of 5 trials involving 291 patients with bipolar disorder only and found that those in the omega-3 group experienced a modest improvement in their symptoms of depression (but not of mania) compared to placebo.25

The same researchers who conducted the fish oil study have also experimented with flaxseed oilfor bipolar disorder.5 Flaxseed oil contains alpha-linoleic 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 four appeared to benefit from flaxseed oil. However, lacking a double-blind study, these results can't be taken as meaningful. When a double-blind study is finally performed, flaxseed oil may turn out not to be helpful at all.

A review of 6 small trials found conflicting but generally beneficial effects of omega-3 fatty acids on depressive symptoms in adults with bipolar disorder. The review was based on mostly small trials.26

One somewhat questionable study reported that an herbal combination utilized in traditional Chinese medicine("Free and Easy Wanderer") may augment the effectiveness of carbamazepine treatment for bipolar disorder.20

Very weak evidence suggests possible benefits with choline,6lecithin,7vitamin C,8-10 and inositol.14Inositol may also reduce psoriasis symptoms caused by lithium.21 (However, caution is advised with inositol. See Herbs and Supplements to Use Only With Caution.)

A special form of magnet therapy, called rTMS, has shown some promise for bipolar disorder.9

Interestingly, use of an anion generator (an air ionizer that produces negative ions) has shown promise for mitigating the symptoms of acute mania.22

Various supplements may help reduce side-effects of antiseizure drugs. For more information, see the articles on Valproate, Carbamazepine, and Phenytoin in the Drug Interactions database .

Despite promising preliminary indications,11 a double-blind study failed to find that folate enhances the effect of the drug lithium.13

Note: Lithium is sometimes sold as a mineral supplement for treating bipolar disorder. However, this proposed use is based on a misunderstanding. When lithium is used medically as treatment for bipolar disorder, it is taken at doses far above any possible nutritional need. No researcher has seriously suggested that lithiumdeficiency causes bipolar symptoms, and low doses of lithium are unlikely to have any effect at all.