Nutrient-Based Therapies for Bipolar Disorder: A Systematic Review

Abstract

Background: Pharmacotherapy is the first line of treatment for bipolar disorder, but many patients continue to experience persistent subthreshold symptoms. Alternative adjunct treatments, including nutritional therapies, may have the potential to alleviate residual symptoms and improve the outcomes of standard pharmacotherapy. The aim of this paper is to critically review the current clinical evidence and mechanisms of action of nutrient-based therapies alone or in combination with commonly used pharmacotherapies for mania and bipolar depression. Methods: We conducted a Medline search for clinical trials conducted with humans, published in English from 1960 to 2012 using nutritional supplements such as n–3, chromium, inositol, choline, magnesium, folate and tryptophan alone or in combination with pharmacotherapies for the treatment of bipolar disorder. Results: Preliminary data yields conflicting but mainly positive evidence for the use of n–3 fatty acids and chromium in the treatment of bipolar depression. Limited evidence found that inositol may be helpful for bipolar depression, but larger sample sizes are needed. Preliminary randomized, controlled trials suggest that choline, magnesium, folate and tryptophan may be beneficial for reducing symptoms of mania. Conclusions: Given the potential public health impact of identifying adjunct treatments that improve psychiatric as well as physical health outcomes, nutritional treatments appear promising for the management of bipolar disorder but require further study.

The International College of Neuro-Psychopharmacology (CINP) Treatment Guidelines for Bipolar Disorder in Adults (CINP-BD-2017), Part 2: Review, Grading of the Evidence, and a Precise Algorithm

“…Some data support the usefulness of omega-3 fatty acids as adjunctive therapy in bipolar depression but not mania, but the data are conflicting and inconclusive (Stoll et al, 1999; Chiu et al, 2005; Frangou et al, 2006; Keck et al, 2006b; Frangou et al, 2007; Murphy et al, 2012; Sarris et al, 2012; Sylvia et al, 2013)…”

“…There are some studies suggesting that there is a role for various nutritional supplements such as n-3 fatty acids, chromium, choline, magnesium, and tryptophan alone or in combination with pharmacotherapies for the treatment of BD, but the data are of low quality (Sylvia et al, 2013). …”

Lifestyle interventions targeting dietary habits and exercise in bipolar disorder: A systematic review

“…Unhealthy lifestyle habits such as smoking, substance/alcohol misuse, poor dietary choices, and sedentary life (Kemp et al, 2010, Sylvia, Nierenberg, 2011) contribute to the development and severity of the physical ailments and clinical symptoms in BD (Sylvia et al, 2013a). It becomes apparent that these maladaptive behaviors contribute to poor health outcomes and reduce cost-effectiveness of therapeutic interventions in BD (Elmslie et al, 2001, Fagiolini et al, 2008, Hong et al, 2011, Sylvia et al, 2013b).…”

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

“…Few studies using supplementation and nutrition in addition to existing medications have been conducted in BD patients. [27][28][29][30][31][32][33][34][35] Here we describe a series of 7 patients diagnosed with bipolar disorder, type 1 (BD-1), implementing a holistic treatment approach without the use of pharmaceuticals. The treatment consisted of a combination of healing modalities selected based on patients' distinct individual features.…”