Unpredictable mood episodes can be challenging to manage for someone with bipolar disorder — a mental health condition that causes emotional highs (mania) and lows (depression). And while medication and psychotherapy are the gold standard for alleviating symptoms, many people like to explore complementary and integrative therapies, too.
But before you try a complementary or integrative therapy, there are some things to keep in mind. First, products such as dietary supplements that you can buy over the counter aren’t regulated by the U.S. Food and Drug Administration (FDA). This means that any claims about the supplement on its label haven’t been vetted by the FDA, and that you can’t be entirely sure of about the product's quality.
What’s more, many supplements can cause dangerous interactions when mixed with other medicines you take. And while many complementary and integrative therapies for bipolar disorder may help depressive symptoms, some of them can actually worsen manic symptoms, says Blake Gibson, MD, a psychiatrist at the University of Pittsburgh Medical Center (UPMC) Western Psychiatric Hospital.
“It’s absolutely essential that you talk to your doctor to make sure there are no drug interactions [or other potential risks],” says Dr. Gibson.
Finally, the quality of the evidence supporting a lot of these therapies varies, and some that have been touted on the internet or elsewhere as helpful should actually be avoided. Here’s what you should know about 10 popular complementary and integrative strategies — and whether they’re worth trying for bipolar disorder.
Complementary and Integrative Therapies That Might Help Bipolar Disorder
Exercise can do wonders for anyone’s mood, and people with bipolar disorder are no exception.
The rationale One reason exercise is key for people with bipolar disorder is that it causes feel-good chemicals to be released in the body that help stabilize mood, according to the Anxiety and Depression Association of America (ADAA).
What’s more, exercise helps people manage their weight, according to the Centers for Disease Control and Prevention (CDC). That’s important for people with bipolar disorder; a review published in the July 2020 Cochrane Database of Systematic Reviews found that about 68 percent of people with bipolar disorder who’ve sought treatment are overweight or obese. This is partly because weight gain is a common side effect of bipolar medications, the researchers noted.
ADAA experts recommend that people with bipolar disorder exercise for 30 minutes a day, three to five days a week. You can reach your daily exercise goals by walking, jogging, biking, and dancing, among other activities.
The bottom line Regular exercise can benefit both your mood and your physical health. If you’re not sure how to start an exercise routine, reach out to your doctor. They can help you develop a plan that works for you.
Yoga is a practice that can help you relax. Generally, yoga — which has roots in Indian philosophy — involves performing breathing techniques, physical poses or stretches, and meditation, according to the National Institutes of Health (NIH).
The rationale In a review published in August 2022 in the journal Cureus, researchers found that yoga may help relieve symptoms of bipolar depression. But more research is needed to confirm these findings and determine yoga's potential long-term benefits for bipolar depression.
Yoga may also have benefits for preventing manic symptoms, too, says Gibson. “Yoga and similar modalities, like meditation, are wonderful ways to manage stress and promote sleep hygiene. These things are extremely important in bipolar disorder, because we know that stress is the biggest precipitant of a manic episode for patients with bipolar I,” he explains.
The bottom line Yoga can be a helpful way for people with bipolar disorder to manage stress, improve their sleep, and alleviate depressive symptoms.
3. Omega-3 Fatty Acids
Omega-3 fatty acids — essential nutrients that benefit brain and heart health — are found in foods like fish and flaxseeds. They can also be consumed in dietary supplements, such as fish oil, say NIH experts.
The rationale Many studies suggest that foods rich in omega-3s or omega-3 supplements improve bipolar symptoms, according to a systematic review published in the May 2022 Nutritional Neuroscience.
“There’s pretty good evidence that omega-3s can be helpful [for bipolar disorder],” Gibson says. “The challenge is that when patients see the effects, they are typically modest and over time. So it’s something that you have to take daily and continue throughout your life.”
EPA and DHA may be the best types of omega-3s for people with bipolar disorder to take, according to Harvard Medical School, but some research suggests omega-3s may be helpful for symptoms of bipolar depression but not manic symptoms.
The bottom line Omega-3 fatty acids may improve symptoms of bipolar depression. If you’re interested in trying an omega-3 supplement, check with your doctor first to make sure it’s safe to take alongside your medications. They can also give you recommendations if you’re not sure which one to try.
Probiotics are “good” bacteria that naturally live in your body and keep your body working well, according to the Cleveland Clinic. Probiotics are found naturally in fermented foods such as yogurt. They can also be taken as dietary supplements.
The rationale Some research suggests probiotics could be a helpful addition to a bipolar disorder treatment plan. “There is some exciting stuff coming out about probiotics and bipolar disorder specifically,” says Gibson.
A small study published in the November 2018 Bipolar Disorders found that people with bipolar disorder who took probiotic supplements had a much lower rate of rehospitalization than those who didn’t take probiotics. The authors say more research is needed to confirm these findings.
“It was a small study, so we need more robust, randomized clinical trials,” notes Gibson. “But I think probiotics are something that have very little downside and are an exciting option.”
The bottom line Probiotics may have a positive effect on people with bipolar disorder, but more studies are needed to determine their role in a bipolar disorder treatment plan.
Meditation is a popular ancient practice that incorporates mental and physical relaxation techniques to help focus or clear the mind, according to the Cleveland Clinic.
The rationale Some research suggests that meditation can help people with bipolar disorder.
A specific practice called mindfulness-based cognitive therapy (MBCT) — which combines mindfulness meditation techniques with a kind of psychotherapy called cognitive behavioral therapy (CBT) — may help prevent symptoms of depression in people with bipolar disorder, according to a study published in July 2017 in the Journal of Alternative and Complementary Medicine. Plus, the potential benefits appeared to be long-lasting, the researchers wrote.
Some experts have concerns that meditation could worsen psychosis — a potential symptom of bipolar disorder in which a person becomes detached from reality, says Lila Massoumi, MD, an integrative psychiatrist with Michigan Integrative Holistic Psychiatry and a clinical associate professor of psychiatry at Michigan State University in East Lansing, Michigan. That's because there are some individual case reports of psychosis being triggered by meditation in some people.
However, in most of these case reports, the psychosis is described as transient (meaning short-lived), and there are no large-scale studies confirming a relationship between meditation and psychosis, according to a review published in October 2020 in the British Journal of Psychiatry.
The bottom line Meditation may help people with bipolar disorder lessen their depressive symptoms and feel better. It’s generally safe, but it's probably a good idea to talk to your doctor before trying it to make sure it’s right for you. Some popular apps, such as Headspace, Calm, and Insight Timer, offer guided meditation sessions you could try.
Complementary and Integrative Therapies to Approach With Caution if You Have Bipolar Disorder
1. Bright Light Therapy
Bright light therapy — a type of therapy involving exposure to artificial light for a certain amount of time each day — may help alleviate bipolar depression, according to Gibson. It’s commonly used to treat symptoms of seasonal affective disorder (SAD), which is a subtype of both major depressive disorder and bipolar disorder.
The claim Bright light therapy is thought to help regulate the body’s circadian rhythm, or internal clock, according to experts at Harvard Medical School. The circadian rhythm, Harvard experts say, is often disrupted among people with bipolar disorder, and this contributes to mood instability.
In a small study published in the February 2018 American Journal of Psychiatry, 68 percent of bipolar patients who underwent four to six weeks of bright light therapy alongside antimanic medication experienced remission of their depression symptoms, compared with 22 percent of patients exposed to a dim red placebo light.
The caveat Be sure to check with your doctor before starting bright light therapy to make sure it’s safe for you; it may induce an episode of mania in some people with bipolar disorder, Gibson warns. If your doctor gives you the okay to try light therapy, they can help you find the safest way to do so.
The bottom line Bright light therapy could help people with bipolar disorder manage symptoms of depression. But talk to your doctor before trying it, as the therapy may worsen manic symptoms in some people if it’s not used safely.
2. Rhodiola Rosea
Rhodiola rosea, or simply rhodiola, is an herb that grows in cold areas and high altitudes in Asia and Europe, according to the NIH.
The claim Rhodiola supplements are sometimes touted as a remedy for stress, depression, anxiety, and other mental health issues, NIH experts add.
The caveat Rhodiola is not safe for everyone with bipolar disorder because it can precipitate a manic episode in some people, Dr. Massoumi and Gibson warn.
The bottom line Rhodiola should be avoided by people with bipolar depression. Although it has shown promise for unipolar depression, it’s not safe to take for bipolar depression because it could trigger mania.
S-adenosyl-L-methionine (SAMe) is a chemical in the body that helps create and regulate hormones and maintain healthy cells, according to the Mayo Clinic. People can take a synthetic form of SAMe as a dietary supplement, Mayo Clinic experts add.
The claim SAMe has been studied extensively for unipolar depression. Studies have shown that it could have potential benefits for depression, but more research is needed to confirm those findings, according to the NIH.
The caveat Although SAMe may be helpful for unipolar depression, it’s not always safe for bipolar depression. SAMe may worsen symptoms of mania and shouldn’t be taken for depressive symptoms without the guidance of your doctor, NIH experts warn.
“In most of my patients [with bipolar disorder], it causes mania or mood cycling, such as increased suicidal ideation or worsening mood,” warns Massoumi.
SAMe may also interact with antidepressants, antipsychotics, and other medicines that increase levels of the brain chemical serotonin, per the Mayo Clinic.
“The price is another downside. SAMe is pretty expensive,” Gibson adds.
The bottom line Doctors generally don’t recommend SAMe for bipolar disorder because it can induce mania.
4. St. John’s Wort
St. John’s wort is a plant with yellow flowers that’s native to Europe, according to the Mayo Clinic. It’s often sold as a supplement in the form of tablets, liquids, teas, and topical products.
The claim Many people turn to St. John’s wort to manage mild to moderate depression, Mayo Clinic experts say.
The caveat Although many people use it for unipolar depression, most doctors don’t advise using St. John’s wort for bipolar disorder. The reason: St. John’s wort may worsen psychotic symptoms among people with bipolar disorder or schizophrenia, NIH experts warn. Massoumi adds that the supplement can cause unwanted side effects, such as a rash when exposed to sunlight.
What’s more, it can lessen the effectiveness of many common drugs, including antidepressants and birth control pills, according to the NIH. “St. John’s wort interacts with too many drugs by the way it’s metabolized in the liver, so we typically stay away from it,” says Gibson.
The bottom line Most doctors don’t recommend St. John’s wort for bipolar disorder because of potential drug interactions, side effects, and worsened symptoms. If you have bipolar disorder, it’s best to avoid St. John’s wort.