Vitamins that may be helpful
People diagnosed with depression may have
lower blood levels of omega-3 fatty acids.4 5 A double-blind trial found
that bipolar patients taking 9.6 grams of omega-3 fatty acids from fish oil per day in addition to their conventional
medications had significant improvements compared with those taking placebo.6
Similar benefits were reported in a preliminary trial that used 1.5 to 2 grams per day of pure
eicosapentaenoic acid, a component of fish oil.7
L-tryptophan is the amino acid used by the
body to produce serotonin, a chemical messenger important for proper brain function.
Supplementation with L-tryptophan has led to improvement in depression in many
studies,8 9 but information is limited about its effect on bipolar
disorder. Case reports on two bipolar patients treated with lithium or an antidepressant drug described marked improvements when
they were given 12 grams daily of L-tryptophan.10 11 Two trials using 6
grams of L-tryptophan daily for acute mania in patients with bipolar disorder found little or
no improvement,12 13 but another double-blind, controlled study using
9.6 grams daily reported better results.14
L-tryptophan is converted to
5-hydroxytryptophan (5-HTP) before it becomes serotonin in the body. In a controlled
trial, 200 mg daily of supplemental 5-HTP had antidepressant effects in bipolar patients,
though it was not as effective as lithium.15 In a double-blind trial, patients with
bipolar disorder had greater improvement with a combination of 5-HTP at 300 mg daily plus an
antidepressant drug than with 5-HTP alone.16
S-adenosylmethionine (SAMe) is another
amino acid that has an impact on serotonin levels, and it has demonstrated significant
antidepressant effects in clinical trials.17 18 19 In both
controlled and preliminary studies, SAMe has been shown to be helpful for the depressive
symptoms of bipolar disorder. However, some patients have switched from depression to mania
while using SAMe at 500 to 1,600 mg daily.20 21 This is a known side
effect of other antidepressant medications.22 The mania induced by SAMe resolved
when the supplement was discontinued, and in one case resolved spontaneously while the patient
continued taking SAMe.23 Therefore, people with bipolar disorder should supplement
with SAMe only under the supervision of a qualified healthcare practitioner.
Both folic acid and vitamin B12 are used in the body to manufacture
serotonin and other neurotransmitters. It is well known that deficiency of either nutrient is
associated with depression.24 25 There is some evidence that patients
diagnosed with mania are also more likely to have folate deficiencies than healthy
controls.26 Other studies, however, have found that folic acid deficiency was not
more common in bipolar patients taking lithium than in healthy people.27
28 29 Some studies have found that people who take lithium long term, and who
also have high blood levels of folic acid, respond better to lithium.30
31 Not all studies have confirmed these findings, however.32 A double-blind
study of patients receiving lithium therapy showed that the addition of 200 mcg of folic acid
per day resulted in clinical improvement, whereas placebo did not.33
There have been case reports of both mania and depression associated with vitamin B12
deficiency, and these symptoms cleared after treatment with injections of B12.34
35 However, B12 deficiency has not been reported in bipolar disorder patients, and
no studies have been published investigating the effects of vitamin B12 supplementation in
people with bipolar disorder.
Vitamin C helps the body to reduce its load
of vanadium and this has been studied for its possible role in treatment of bipolar
disorder.36 A double-blind trial found that both manic and depressed bipolar
patients were significantly improved after one-time administration of 3 grams of vitamin C,
compared with a placebo.37 The same study found that both manic and depressed
patients did better on a reduced-vanadium diet compared to a normal diet. Another double-blind
study reported that 4 grams per day of vitamin C in combination with a drug known as EDTA
(which also helps remove elements such as vanadium from the body) was helpful to depressed
bipolar patients but not to those experiencing mania.38 Until more is known, people
with bipolar illness should avoid supplements containing vanadium and consider supplementing
with vitamin C.
Inositol is a nutrient found in large
amounts in the brain, but its possible role in mood disorders is unclear. Inositol levels may
be reduced in certain parts of the brains of depressed and bipolar patients.39
However, lithium reduces normal brain levels of inositol, and this may be one of the ways
lithium helps people with bipolar disorder.40 41 42 Although
inositol is known to have significant antidepressant properties when administered in large
amounts of 12 grams per day,43 44 case reports involving bipolar
patients have reported either no benefit,45 some benefit,46 or worsening
of symptoms from inositol supplementation.47 Until controlled research clarifies
the effects of inositol in people with bipolar illness, it should only be used under the
supervision of a qualified healthcare practitioner.
Acetylcholine levels in the brain may affect mood disorders, and supplemental choline can increase acetylcholine levels. In a
preliminary trial, six people with bipolar disorder were given 1 to 2 grams of choline twice
per day (2 to 4 grams per day). Five of the six had a significant reduction in manic symptoms,
and four of the six had a reduction in all mood symptoms.48 No properly controlled
trials have yet investigated the effects of choline in treating people with bipolar
disorder.
Restriction of dietary calcium was reported
to alleviate manic episodes in one bipolar patient, and calcium supplementation (approximately
800 mg per day) increased mania symptoms slightly in six manic-depressive patients, according
to another uncontrolled report.49 Therefore, if calcium supplementation is desired
by people with bipolar disorder, it should be taken with caution.
Lithium is a mineral contained in certain
drugs used in the medical treatment of bipolar disorder. Lithium may be present in some trace
mineral supplements, but amounts are too small to have any effect on bipolar disorder.
Vanadium is a trace mineral nutrient that
may adversely influence bipolar disorder. Elevated blood and hair levels of vanadium have been
reported in people with mania and depression, and one effect of the bipolar medication lithium
is to interrupt a biochemical action of vanadium in the body.50 Vanadium is
therefore one suspect in the search for a cause of bipolar disorder. People with bipolar
disorder should avoid supplements containing vanadium until more is known.
In a preliminary trial, 11 patients with bipolar disorder were treated for six months with
a moderate-potency vitamin-mineral formula (E.M. Power+ manufactured by Evince International,
of Farmington, Utah) that also contained a proprietary blend of amino acids and other
nutrients. The severity of depression decreased on average by 71% and the severity of mania
decreased by 60% during the study.51 A double-blind study is needed to confirm
these promising results.
Are there any side effects or interactions?
Refer to the individual herb for information about any side effects or interactions.
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