What natural remedies can be used to manage bipolar disorder?

Management of Bipolar Disorder with Natural Remedies

Natural remedies should not be used as primary treatment for bipolar disorder, as pharmacotherapy with mood stabilizers remains the first-line treatment for managing bipolar disorder symptoms and preventing relapse. 1, 2

Evidence-Based Treatment Approach

Primary Pharmacological Treatment

• Lithium, valproate, and atypical antipsychotics are the cornerstone treatments for bipolar disorder, particularly for acute mania and maintenance therapy 1
• Lithium is approved for use in patients as young as 12 years for acute mania and maintenance therapy 1
• For bipolar depression, mood stabilizers in combination with appropriate antipsychotics are recommended, with SSRIs preferred over tricyclic antidepressants when antidepressants are needed 1
• Monotherapy with antidepressants is contraindicated in bipolar I disorder and during mixed or manic episodes 3

Adjunctive Non-Pharmacological Approaches

While natural remedies cannot replace conventional treatment, certain evidence-based non-pharmacological interventions may be considered as adjuncts:

Psychoeducation and Psychotherapy

• Psychoeducation should be routinely offered to individuals with bipolar disorder and their families 1
• Cognitive-behavioral therapy and family interventions can be beneficial when provided by trained professionals 1
• Individual psychotherapy supports psychological development, skill building, and symptom monitoring 1

Omega-3 Fatty Acids

• Omega-3 fatty acids have shown some benefit as an adjunctive treatment, particularly in patients with depression and inflammatory markers 1
• The International Society for Nutritional Psychiatry Research recognizes omega-3 fatty acids as a potential adjunctive treatment, though effects are modest 1

Exercise and Lifestyle Modifications

• Active lifestyle approaches including good nutrition, exercise, and sleep hygiene are important adjuncts to pharmacotherapy 3
• Stable social and sleep habits may be particularly helpful in preventing relapse 1

Important Considerations and Cautions

Risks of Relying on Natural Remedies Alone

• Untreated bipolar disorder carries significant risks of suicide (annual rate approximately 0.9% compared to 0.014% in general population) 2
• Life expectancy is reduced by approximately 12-14 years in people with bipolar disorder 2
• Relapse rates are high when conventional treatment is discontinued 1

Monitoring and Follow-up

• Continuous monitoring for suicidal ideation, substance use disorders, and treatment adherence is essential 3
• More than 50% of patients with bipolar disorder are not adherent to treatment, highlighting the need for close follow-up 2
• Regular assessment of mood symptoms, psychosocial functioning, and suicide risk is necessary throughout treatment 4

Special Populations

Children and Adolescents

• Diagnosis of bipolar disorder in very young children should be approached with caution 1
• For adolescents with confirmed bipolar disorder, lithium is FDA-approved for those 12 years and older 1
• Psychosocial interventions addressing environmental, developmental, and social factors are particularly important for younger patients 1

Conclusion on Natural Remedies

While some patients may be interested in natural approaches, the evidence strongly supports conventional pharmacotherapy as the foundation of bipolar disorder treatment. Natural remedies and lifestyle modifications should be viewed as complementary to, not replacements for, evidence-based pharmacological treatments. The risks of untreated or inadequately treated bipolar disorder—including suicide, functional impairment, and reduced life expectancy—are too significant to rely solely on natural remedies.