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, according to 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:
1. 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. The anti-inflammatory effects of omega-3 fatty acids could help regulate mood, according to research published in 2015 in the Journal of the American College of Nutrition. Adding 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.”
2. St. John’s Wort
This herb, which is often used in Europe for mood management, is one of the better-known natural mood enhancers. However, evidence is mixed on whether St. John’s wort actually 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 that people with bipolar disorder could 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.
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 active to determine the best way to use SAMe in people with depression-related disorders as well as bipolar disorder.
5. Ubiquinone (COQ10)
Coenzyme Q10, also known as ubiquinone, ubidecarenone, coenzyme Q, and abbreviated at times to CoQ10, CoQ, or Q10 is a coenzyme that is ubiquitous in animals and most bacteria (hence the name ubiquinone).
This fat-soluble substance, which resembles a vitamin, is present in all respiring eukaryotic cells, primarily in the mitochondria. It is a component of the electron transport chain and participates in aerobic cellular respiration, which generates energy in the form of ATP. Ninety-five percent of the human body’s energy is generated this way. Therefore, those organs with the highest energy requirements—such as the heart, liver, and kidney—have the highest CoQ10 concentrations.
Major depression, bipolar disorder, and schizophrenia, long considered separate entities, are now recognized as having common roots in mitochondrial dysfunction and elevated brain oxidative stress levels. People with these conditions have higher markers of oxidant damage and lower cellular antioxidant levels than do healthy controls, and CoQ10 is typically lower than normal. In one study, 51.4% of depressed patients’ CoQ10 levels fell below the lowest values in control subjects.
CoQ10 deficiency is particularly marked in people whose depression responds poorly to medication, a possible indication that the deficiency needs to be corrected in order for prescription meds to work.
A major breakthrough in our understanding of the causes of mental illness came in 2011 and 2012, when researchers discovered that oxidative and other related stresses in the brain were capable of creating new molecular configurations that triggered an autoimmune response in the brains of people with depression and schizophrenia.
Restoring natural levels of antioxidants such as CoQ10 is therefore an attractive approach in these conditions. One study of depression in older adults with bipolar disorder found a significant reduction in symptom severity during treatment with CoQ10 at 1,200 mg/day.
The ubiquinol form of CoQ10 is far better absorbed, so a much lower dose, perhaps around 400 mg/day of ubiquinol should provide benefits seen when much higher doses of the more common ubiquinone form of CoQ10 is used.
Finally, some medications in common use against depression, such as amitryptiline, are capable of lowering CoQ10 levels in the blood, further reducing available energy in the brain. Thus, people taking such drugs are especially likely to benefit from CoQ10 supplementation.