Bipolar Disorder and Complementary Medicine: Current Evidence, Safety Issues, and Clinical Considerations

Sarris, Jerome; Lake, James; Hoenders, Rogier

doi:10.1089/acm.2010.0481

Cited by 24 publications

(17 citation statements)

References 79 publications

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“…On the other hand, a metaanalysis of five placebo‐controlled O3FA trials revealed a significant effect favoring O3FAs, though the effect size was only moderate (0.34) and the metaanalysis may have combined a heterogeneous population of BD patients. Two qualitative reviews both concluded that current evidence only weakly supports use of O3FAs and an effect size analysis of studies adding O3FAs to standard BD phamacotherapies concluded that there were mixed results for O3FA. Other analyses in that same review revealed large effect sizes for NAC and a chelated mineral and vitamin formula in the treatment of BD depression, though, again, design limitations limit the confidence in the reported effect sizes.…”

Section: Discussionmentioning

confidence: 99%

“…[15,16] Given the need for better treatments of BD depression, we aimed to examine the evidence base for nutritional supplements through a systematic literature review. Although three qualitative reviews, [17][18][19] a Cochrane Database review [20] and a meta-analysis [21] have previously explored the use of nutritional supplements for bipolar disorder, they differ from this review in their scope or in the standards of evidence used for inclusion. The current review aims to provide an up-todate, comprehensive perspective on all nutritional supplements evaluated in randomized controlled trials for efficacy in BD depression.…”

Section: Introductionmentioning

confidence: 99%

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Review of Nutritional Supplements for the Treatment of Bipolar Depression

Rakofsky

Dunlop

2013

Depress Anxiety

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Many patients view psychotropics with skepticism and fear and view nutritional supplements as more consistent with their values and beliefs. The purpose of this review was to critically evaluate the evidence base for nutritional supplements in the treatment of bipolar depression (BD). A literature search for all randomized, controlled clinical trials using nutritional supplements in the treatment of BD was conducted via PubMed and Ovid MEDLINE computerized database. The studies were organized into essential nutrients/minerals, nonessential nutrients, and combinations of nutritional products. Among essential nutrients/minerals, omega-3-fatty acids (O3FAs) have the strongest evidence of efficacy for bipolar depression, although some studies failed to find positive effects from O3FAs. Weak evidence supports efficacy of vitamin C whereas no data support the usefulness of folic acid and choline. Among nonessential nutrients, cytidine is the least supported treatment. Studies of N-acetylcysteine have not resolved its efficacy in treating acute depressive episodes relative to placebo. However, one study demonstrates its potential to improve depressive symptoms over time and the other, though nonsignificant, suggests it has a prophylactic effect. Studies of inositol have been mostly negative, except for 1 study. Those that were negative were underpowered but demonstrated numerically positive effects for inositol. There is no evidence that citicholine is efficacious for uncomplicated BD depression, though it may have value for comorbid substance abuse among BD patients. Finally, combination O3FA-cytidine lacks evidence of efficacy. The findings of this review do not support the routine use of nutritional supplements in the treatment or prophylaxis of BD depression. Studies with more rigorous designs are required before definitive conclusions can be made. Despite the inadequacy of the existing data, clinicians should remain open to the value of nutritional supplements: after all, lithium is a mineral too.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Review of Nutritional Supplements for the Treatment of Bipolar Depression

Rakofsky

Dunlop

2013

Depress Anxiety

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“…In recent literature, most reports concerned the effectiveness of a multivitamin and herbal supplement blend (EMPowerplus) 54 and were funded by the manufacturer. This supple- 58 We did not find studies utilizing an amalgam of treatment strategies in a synergistic manner that were specific to individual patients' conditions at particular stages of their treatment. In our experience, applying treatment strategies drawn from diverse fields of healing are more conducive to returning patients to health.…”

Section: Global Advances In Health and Medicinementioning

confidence: 93%

Medication-free Alternatives for Long-term Maintenance of Bipolar Disorder: A Case Series

Gurevich¹,

Robinson

2015

Glob Adv Health Med

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Psychopharmacological treatment has been the mainstay in long-term maintenance of bipolar disorder (BD) patients for the last 60 years. Conventionally accepted treatment options are primarily based on expert opinion rather than on well-executed, independently funded research. Investigation of maintaining patients without medications using treatment alternatives has been neglected. This clinical case series examines the outcomes of 7 BD patients who experienced a poor response or significant side effects with conventional treatment modalities. Patients were gradually and safely withdrawn from all medications. Treatment strategies were based on an individualized holistic approach using herbs, nutritional supplements, vitamins, amino acids, acupuncture, dietary recommendations, and behavioral modifications. Multiple treatment modalities were combined addressing the etiological causes for BD symptoms. Upon withdrawal from psychotropic medications, patients were free of medication-induced side effects and obtained psychiatric stability for at least 10 months. Further research is needed to investigate the long-term outcomes of BD treatment modalities based on well-defined successful outcome criteria, such as reduction in symptoms, improvement in quality of life, overall health outcomes, and cost effectiveness.

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“…In its mixture of papers, this issue differs from earlier publications on CAM in psychiatry, like reviews on herbal medicine [18–20] or CAM [21], guidelines incorporating, for example, St. Johns' Worth for the treatment of mild to moderate single depressive episodes based on meta-analytic evidence [22–24], or the work of the International Network of Integrative Mental Health (INIMH), founded in 2010 and reviews of its protagonists on bipolar disorders or ADHS [25, 26]. So, we hope this special issue can contribute to further discussion on CAM in psychiatry—the subject may be named integrative mental health [27], mind-body medicine [28], or integrative psychiatry [29].…”

Section: Cam In Psychiatrymentioning

confidence: 95%