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Another one of those persistent themes on bipolar forums is: “I don’t wanna take medications, what natural supplements and vitamins can I use to control bipolar disorder?” Well, I hate to break it to you, but herbal supplements can be just as dangerous as prescription drugs. For example, St. John’s Wort in particular, be very, very cautious with that one because it can interact badly with SSRIs and then there’s also the mania risk… Oh, and it did nothing for me when I tried it in the past.

Plus, one of the first-line treatments for bipolar disorder, lithium, is not a pharmaceutical compound. That’s right! What your doctor might prescribe for you is already all natural! Awesome, right? If nothing else, it should drive home the point that side effects are inherent in treatments that are “natural” just like they are for the “unnatural” ones. If you’re prescribed lithium, you should probably stick with lithium carbonate rather than the OTC option of lithium orotate, because (it’s actually a lot cheaper and) the dosing for lithium orotate is not well established and toxicity is still an issue. In fact, when I went looking, there was hardly any information on lithium orotate for bipolar disorder – not a good sign.

Most of us can’t ditch prescription drugs, even with mega doses of vitamins and all the flower power in the world. It just isn’t feasible because these “natural” treatments (by the way, since when is extensive unregulated chemical processing of herbs natural?!?) just aren’t as effective at treating symptoms. You might get away with it if you have a very mild case of bipolar disorder – bordering on cyclothymia, perhaps – but if your symptoms are strong enough to qualify for the bipolar diagnosis, you’re probably out of luck. Count yourself lucky that there are pharmaceutical treatments that can help; lots of people don’t have that option for their health problems!

In any case, nothing is without potential side effects. You are always running a risk when you put anything at all into your body, and that’s something we have to do every day anyway. Many hyper-processed foods are far more unnatural and potentially damaging to your body than any vitamin or supplement. Some people will say that vitamins and supplements are a waste of money and not helpful, but I’m of the mind that anything I can do to help my body out is worth trying. That said, there are some vitamins and supplements that seem to make a beneficial difference with minimal risks. I’m a big fan of melatonin as a sleep aid (it’s your body’s natural hormone for triggering sleep) that has minimal side effects. I only use it as needed and it’s really effective for me.

The jury is still out on most of this in terms of conclusive medical evidence on efficacy for bipolar disorder, because no one is really doing expensive double-blind studies on Vitamin D or B complex for bipolar disorder. In some ways, it’s just common sense that these are going to be helpful based on what we already know about them. So there’s good reason to try some of these options in addition to your existing medications anyway – with your doctor’s permission. If you want to try non-prescription remedies alone, be smart about it – consult your doctor and a naturopath or homeopath with lots of experience who has treated people with bipolar disorder before. This is not something to screw around with, given the potential negative consequences. In general, I’m very wary of herbal and nutritional supplements. The effects are just not as well known as the more common vitamins and minerals. All of them are unregulated by the FDA, meaning you really don’t know what you’re getting in that little pill and how it was prepared.

Extra vitamins are not very likely to be harmful to your health, however, and most people’s diets don’t contain enough of these vitamins anyway. It’s obviously best to try to get them through good eating habits, so gorge yourself on those veggies! The results of my recent blood testing showed that I have normal/acceptable levels of all the vitamins they screened for – basically the B’s and Folic acid – but I’ve been taking those supplements for months, so perhaps it would have been a different story if I hadn’t been intervening. I also eat a particularly healthy diet with lots of green stuff, fatty fishes, and very little poultry or red meat. I avoid anything with artificial hormones or non-vegetarian diets because that is just plain gross and also potentially bad for your health.

Second, some drugs strip your body of particular resources. I looked up Lamictal on Crazy Meds when I was just getting started on it, and found that most anticonvulsant medications deplete Folic acid and Vitamin D, both of which are implicated in depression. Ironically, the drugs that help you beat depression reduce your body’s natural levels of other substances that help you beat depression. This alone should be enough to have you talking to your doc about taking vitamins to offset these effects. Finally, a bunch of these vitamins are well known to have positive benefits with respect to mental health and cognitive functioning. Even “normal” people take them for these reasons.

So clearly Vitamin D and Folic acid are good ones to consider increasing. Vitamin D levels are definitely lower in people with depression, and seasonal depression is thought to be caused in part by lower natural Vitamin D production due to lack of sunlight. A light box can help with that too. I take a 1000 IU D3 supplement, and a Vitamin B Complex tablet with Folic acid. Notably, however, apparently taking too much Folic acid can lower the seizure threshold – probably not a big deal if you’re on anticonvulsants, but anyone with comorbid epilepsy should take note.

The B-complex vitamins are packaged together because they actually need to be taken in certain proportions. Too much of one can deplete others, which is not good! B-complex supports nerve cell development, as does Folic acid – doubtless one of the reasons that Folic acid is also commonly available in the same tablet, which is very convenient. Practically every resource out there on vitamins and supplements for bipolar disorder heavily emphasize the B vitamins. It’s even possible to get a walloping huge dose of the B’s by injection from your doctor, but this is usually only administered if you’re super-deficient. Vitamin C also seems to be a good one*, and most sources suggest Vitamin A, although there seems to be a higher risk of “hypervitaminosis” with A. Your skin turns orangey with too much A! Too much D can also be pretty bad for you, so a normal-to-high dose of 1000 IU seems to be a good rule of thumb.

That brings up another topic of concern: just how much of this stuff do I take? There are really no guidelines that I can find. I’ve been sticking with 1000 IU, though some people take a lot more. There are serious risks to doing that for very long, which vary by vitamin. You should probably do some of your own research or ask your doctor when it comes to figuring out dosages. The one exception is with fish oil – a very reputable site suggests that around 1000 IU is ideal, and going over 2000 IU provides no substantial benefit (and possibly less benefit.)

And this brings me to my final topic for the day – fish oil! One of the most touted supplements, this one is taken for the Omega-3 fatty acids that are well known to support cognitive functioning. As the aforementioned web site explains and documents, the results of scientific research have been contradictory and/or inconclusive, but it’s a very low risk option with high potential benefit. It takes a couple months for the fish oil to do its thing, but it seems to be worthwhile. Dosage on Omega-3s, as mentioned, should be around 1000 IU. Most supplements are a lot less than that; I get the triple-strength pills now so that I can swallow fewer mega-capsules in the morning. Also, the Omega 3-6-9 supplements are apparently no better than the Omega-3 ones in terms of concentrations of the right stuff – potentially more expensive and not as beneficial, actually.

Another note that the PsychEducation site highlights is that you need a particular ratio of the EPA and DHA components in Omega-3 fish oil softgels – approximately 2-to-1 on the EPA, and you should be getting around a gram per day. That’s two triple-strength caps of the Rite-Aid brand softgels that I take. Not all supplements are composed that way, and some don’t tell you what they contain at all, so go with the Omega-3 supplements whose labels show that they contain at least 60% EPA. If you eat a lot of fish – which has a higher mercury risk than most of the supplements – you might be able to get similar volumes of EPA. Most of us don’t eat that much fish on a daily basis, so the softgels are a good option. I’ve never had “fish burps” from taking them; they claim to be lemon flavored but I’ve never noticed any taste at all, and apparently you can stick ’em in the freezer to reduce that effect if you notice it.

One thing I haven’t covered here is whether to take prescription medications and supplements together and/or with food. I don’t really know the answer to that one. I kind of assume that the supplements aren’t much different from food in the way our body consumes them, though I could certainly be wrong on that. It definitely isn’t good for me to take a big ol’ Vitamin C tablet without food because it makes an empty stomach even more acidic and that’s not a good thing, especially if you have acid reflux issues (I don’t.) I also take most of my medications with food because some of them have previously made me hurl if taken alone, and that’s a horrible way to start the day, not to mention you’re then out a dose that didn’t have time to be absorbed. So this issue might vary depending on which medications and which vitamins are being taken – another question for a doctor, but I wouldn’t be surprised if they just shrugged their shoulders.

Does this stuff help me out? Maybe. It’s hard to tell because I started all these therapies at the same time, so sorting out causality on effects is difficult at best. Some of the benefits I’ve seen that are completely unrelated to mental health include much stronger, healthier fingernails. My nails used to split and chip if you looked at them cross-eyed, and now they rarely show any damage at all. Weird, eh? I can’t attribute it to anything other than the fish oil and vitamins, though. So there you go – even if you don’t notice improvements in your mental health, you might get stronger nails and shinier hair. Who doesn’t like that? 🙂

* Update: Vitamin C will cause faster rates of clearance and reduces blood levels and efficacy of amphetamines, e.g., stimulants like Adderall. If you take stimulant ADD meds, be sure to check the interactions carefully to make sure that the meds aren’t affected by Vitamin C, Citric Acid, or Ascorbic Acid (language varies on packaging) — I learned this the hard way. This would also mean you should be very moderate with citrus juices. In general, it’s wise to be extra attentive about grapefruit as well, since there are sometimes issues with properly absorbing the meds due to an interaction with one of the enzymes in grapefruit.