Bipolar disorder and complementary medicine: current evidence, safety issues, and clinical considerations.
BACKGROUND
Bipolar disorder (BD) is a debilitating syndrome that is often undiagnosed and undertreated. Population surveys show that persons with BD often self-medicate with complementary and alternative medicine (CAM) or integrative therapies in spite of limited research evidence supporting their use. To date, no review has focused specifically on nonconventional treatments of BD.


OBJECTIVE
The study objectives were to present a review of nonconventional (complementary and integrative) interventions examined in clinical trials on BD, and to offer provisional guidelines for the judicious integrative use of CAM in the management of BD.


METHODS
PubMed, CINAHL,(®) Web of Science, and Cochrane Library databases were searched for human clinical trials in English during mid-2010 using Bipolar Disorder and CAM therapy and CAM medicine search terms. Effect sizes (Cohen's d) were also calculated where data were available.


RESULTS
Several positive high-quality studies on nutrients in combination with conventional mood stabilizers and antipsychotic medications in BD depression were identified, while branched-chain amino acids and magnesium were effective (small studies) in attenuating mania in BD. In the treatment of bipolar depression, evidence was mixed regarding omega-3, while isolated studies provide provisional support for a multinutrient formula, n-acetylcysteine, and l-tryptophan. In one study, acupuncture was found to have favorable but nonsignificant effects on mania and depression outcomes.


CONCLUSIONS
Current evidence supports the integrative treatment of BD using combinations of mood stabilizers and select nutrients. Other CAM or integrative modalities used to treat BD have not been adequately explored to date; however, some early findings are promising. Select CAM and integrative interventions add to established conventional treatment of BD and may be considered when formulating a treatment plan. It is hoped that the safety issues and clinical considerations addressed in this article may encourage the practice of safety-conscious and evidence-based integrative management of BD.
Department of Psychiatry, Faculty of Medicine, The University of Melbourne, The Melbourne Clinic, Melbourne, Victoria, Australia. jsarris@unimelb.edu.au
Jerome
J
Sarris
James
J
Lake
Rogier
R
Hoenders
D000111:Acetylcysteine / Q000627:therapeutic use; D015670:Acupuncture Therapy; D000597:Amino Acids, Branched-Chain / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000188:drug therapy* / Q000628:therapy; D000529:Complementary Therapies / Q000009:adverse effects; D019587:Dietary Supplements / Q000009:adverse effects; D004359:Drug Therapy, Combination; D015525:Fatty Acids, Omega-3 / Q000627:therapeutic use; D006801:Humans; D055048:Integrative Medicine; D008274:Magnesium / Q000627:therapeutic use; D018977:Micronutrients / Q000627:therapeutic use; D011619:Psychotropic Drugs / Q000627:therapeutic use; D014364:Tryptophan / Q000627:therapeutic use
D000597:Amino Acids, Branched-Chain; D015525:Fatty Acids, Omega-3; D018977:Micronutrients; D011619:Psychotropic Drugs; D014364:Tryptophan; D008274:Magnesium; D000111:Acetylcysteine