Bipolar disorder involves episodes of mania and depression, or mixed episodes combining both extremes at the same time. For most individuals, the episodes are separated by periods of normal mood.

Extreme mania can trigger psychotic symptoms such as delusions and hallucinations; extreme depression can bring a risk of suicide. Drug options are fairly limited, carry side effects, and many patients continue to have persistent relapses, impairments and psychosocial problems despite drug treatment. The development of safe, effective treatments which patients will adhere to is critical.

Diet and nutrition is one possible area of treatment. The research suggests that fatty acids, vitamins, minerals, and other nutrients are important for mental health in the general population, and may be useful in treating mood disorders.

One study of bipolar patients in the Veterans Affairs (VA) healthcare system found they were more likely to report “suboptimal eating behaviors, including having fewer than two daily meals, and having difficulty obtaining or cooking food” than non-bipolar patients. Deficiencies are therefore more likely.

Omega-3 fatty acids have been investigated for potential benefit in bipolar disorder, usually alongside medication. They are often deficient among people in the U.S. and other developed countries. Furthermore, altered fatty acid metabolism has been detected in patients with bipolar disorder.

A 1999 study looked at this topic. The researchers explain, “Fatty acids may inhibit neuronal signal transduction pathways in a manner similar to that of lithium carbonate and valproate, effective treatments for bipolar disorder.” They gave 30 patients a supplement of three fatty acids or placebo for four months. The supplement group “had a significantly longer period of remission” than those on placebo.

But further study has not confirmed this benefit. In 2005, a group of experts wrote that fatty acids “may modulate neurotransmitter metabolism and cell signal transduction in humans” and that abnormalities in fatty acid metabolism may play a causal role in depression.

Their trial of the omega-3 fatty acid eicosapentaenoic acid (EPA) for bipolar depression involved 12 patients, who were given 1.5 to 2 grams per day of EPA for up to six months. Depression scores were reduced by 50 percent in eight of the patients, with no side effects or increase in manic symptoms. But the team add that their study was very small. “The ultimate utility of omega-3 fatty acids in bipolar depression is still an open question,” they concluded.

Experts from the Global Neuroscience Initiative Foundation in Los Angeles report that people with bipolar disorder are more likely to have vitamin B deficiencies, anemia, omega-3 fatty acid deficiencies, and vitamin C deficiency. They believe that essential vitamin supplements, taken alongside lithium, “reduce depressive and manic symptoms of patients suffering from bipolar disorder.” However, many of these links, although biologically plausible, are still unconfirmed.

In recent years, several studies have investigated the importance of folic acid in bipolar disorder. Deficiency of folic acid (vitamin B9, known in the body as folate) can increase levels of homocysteine. Raised homocysteine has been strongly linked to depression and less strongly to bipolar disorder.

A team from Israel measured homocysteine levels in 41 bipolar patients and found “patients who show functional deterioration have plasma levels of homocysteine which are significantly elevated as compared with controls.” They add that bipolar patients without deterioration had homocysteine levels which were almost identical to the non-bipolar group.

Homocysteine can be effectively lowered by increasing intake of folic acid. Foods fortified with folic acid are frequently consumed in the U.S., and supplements are widely available.

Individuals with bipolar disorder who do not comply with their medication regimen are at higher risk for committing suicide or being institutionalized. Dr. Shaheen E Lakhan of the Global Neuroscience Initiative Foundation in Los Angeles says, “One way for psychiatrists to overcome this noncompliance is to educate themselves about alternative or complementary nutritional treatments.

“Psychiatrists should be aware of available nutritional therapies, appropriate doses, and possible side effects in order to provide alternative and complementary treatments for their patients.”

Proper medical diagnosis and consideration of all possible treatment options should always be the first plan of action. As with any form of treatment, nutritional therapy should be supervised and doses should be adjusted as necessary to achieve optimal results.