Bipolar disorder requires managing two distinct categories of symptoms. Manic symptoms may include impulsive behavior, excessive irritability, and anxiety, while depressive symptoms may include a low mood, poor appetite, and emotional indifference, according to the National Institute of Mental Health. Though there aren’t many complementary or alternative medicine (CAM) remedies for manic behavior, a few non-prescription therapies may help alleviate depression. Most people who have bipolar disorder spend the majority of their time depressed rather than manic, notes the National Institutes of Health.
But just because CAM therapies exist doesn’t mean that people with bipolar disorder should throw away their antidepressants. “Bipolar is a very serious, lifelong disorder,” says Philip Muskin, MD, professor of psychiatry at Columbia University Medical Center in New York City. “If you need an antidepressant, you should take it. These other types of therapies are additional or complementary rather than alternative.”
The complementary and non-pharmacological treatments that have shown some benefit for the depressive side of bipolar disorder are:
Officially known as rhodiola rosea, this herb has been used for years to help manage stress and has also demonstrated positive effects on people struggling with depression. While rhodiola doesn’t ease depression to the extent that an antidepressant will, it has fewer side effects, according to a study published in 2015 in Phytomedicine. “Rhodiola is mildly stimulating,” Dr. Muskin notes. “I wouldn’t use it as a solo therapy, but it is a good adjunct for someone who is on antidepressants and feels like they [still] don’t have a lot of energy.”
SAMe, or S-adenosylmethionine, is a coenzyme found naturally in the body that has been extensively researched and shown to reduce symptoms in people with major depressive disorder, according to a review of research published in 2015 in CNS & Neurological Disorders – Drug Targets. But SAMe should be used with caution in people with bipolar disorder who are suffering from depression because it can actually provoke mania, according to the National Center for Complementary and Integrative Health (NCCIH). It should be used only under the direct supervision of a physician.
“Anything that is a real antidepressant can cause mania in bipolar people,” Muskin says, “so there is some risk that a patient taking SAMe might become manic.” Several clinical trials are now underway to determine the best way to use SAMe in people with depression-related disorders as well as bipolar disorder.
3. St. John’s Wort
This herb, which is often used in Europe for mood management, is one of the better-known natural mood enhancers. Even so, evidence is mixed on whether St. John’s wortactually has a positive effect on major depression or bipolar disorder. The NCCIH states that St. John’s wort may help with depression but can also cause psychosis, and the agency warns that it could interact with many other medications people with bipolar disorder may be taking. St John’s wort has been shown to have similar side effects to some antidepressant medications because it appears to affect the body in a similar way, according to 2015 research published in the journal Clinical and Experimental Pharmacology and Physiology.
People who meditate using a supervised mindfulness-based cognitive therapy approach may see a reduction in depression that directly correlates to how many days they meditate. The more they meditated, the fewer symptoms they had, according to a study published in 2013 in Behaviour Research and Therapy.
5. Omega-3 Fatty Acids
People with bipolar disorder may have extra motivation to start eating more fish that are heavy in omega-3s, such as salmon, mackerel, and sardines, or they may want to consider taking omega-3 supplements. That’s because the anti-inflammatory effects ofomega-3 fatty acids could help regulate mood, according to research published in 2015 in the Journal of the American College of Nutrition. Adding about 300 milligrams of omega-3s each day to a depression treatment plan can enhance results, according to research published in 2012 in the journal Polish Psychiatry. “If you look at countries where they eat a lot of fish, they have a relatively low incidence of bipolar disorder,” Muskin says. “In the brain, we think omega-3s might help with moving neurotransmitters in and out, which may help stabilize moods.”
6. Light Therapy
People with bipolar disorder may have interrupted circadian rhythms, which means their daily biological clock isn’t working well. A number of strategies may help to reset this internal clock and improve bipolar management, according to a 2012 research review published in Dialogues in Clinical Neuroscience. These include timed exposure to periods of light and darkness and a forced change in sleep times. Be sure to discuss these or other similar strategies with your doctor before you try them on your own.
7. Traditional Chinese Medicine
This approach relies on certain herbal combinations and comprehensive changes in diet and daily habits. There is not enough evidence yet to support or rule out Chinese herbal preparations, concludes a review published in 2013 in Evidence-Based Complementary and Alternative Medicine. But some combinations may benefit mood disorders. Work with a practitioner trained in the field in collaboration with your doctors.
8. Interpersonal and Social Rhythm Therapy
This technique teaches people with bipolar disorder to maintain a more regular schedule in all aspects of life, including sleeping, waking, eating, and exercise. It has been shown to improve daily functioning, according to a study published in 2015 in Bipolar Disorders.
9. Eye Movement Desensitization and Reprocessing Therapy
EMDR uses a supervised program of eye movements, combined with actively remembering traumatic experiences, to improve symptoms. This approach can be helpful to people who have bipolar disorder and a history of trauma, according to research published in 2014 in the journal Psychiatry Research.
Complementary Bipolar Treatments: A Few Words of Caution
“The reality is that there is not a lot of data on complementary therapies for bipolar disorder,” Muskin says. “That doesn’t mean these products shouldn’t be used, but when patients try to find out about them, they shouldn’t expect to be able to go to [websites] like The New England Journal of Medicine and download a lot of articles.”
Muskin recommends ConsumerLab as a reputable site where people can go to research complementary therapies. “You can find out whether or not the product you’re buying really contains the product you think it does, as well as what it’s indicated for and whether it has contaminants,” he says. The National Institutes of Health Office of Dietary Supplements also provides an extensive online database of dietary supplements that includes detailed product and manufacturer information.
Most of these therapies are safe, and there is limited evidence of negative interactions with prescription medications. Regardless, patients and their family members should actively research these products and discuss options with a psychiatrist before taking them, especially because complementary therapies do not undergo the same strict review process as pharmaceutical medications.
Additional Reporting by Madeline Vann, MPH.