Supplements and Natural Treatments for Bipolar Disorder

People search for natural treatment for bipolar disorder for good reasons: side effects, a wish for more control, or a sense that medication alone is not the whole answer. The honest summary is that no supplement has been shown to stabilize mood or prevent episodes, a couple have modest add-on evidence for bipolar depression, and a few can push a person toward mania. This page grades the evidence supplement by supplement, explains which ones to avoid, and shows how to bring a supplement question to your prescriber safely.

The bottom line first

NIMH states that the FDA has not approved any complementary health approach for treating bipolar disorder. The 2023 VA/DoD guideline reviewed nutraceuticals, probiotics and vitamins and found the evidence insufficient to recommend for or against them. Medication remains the foundation, and our bipolar disorder guide explains the treatment options that do have strong evidence.

That framing matters because supplements are often marketed as an alternative. The risk is not only that a supplement fails to work. It is that someone stops lithium, lamotrigine or another mood stabilizer to try it, and stopping suddenly is one of the clearest relapse risks in bipolar disorder. Our page on stopping psychiatric medication explains why changes need a plan.

How to read supplement evidence

Three questions sort most claims quickly:

1. What kind of study? Randomized, placebo-controlled trials count most. Open studies, animal work and case reports are a starting point, not proof.
2. Which phase of bipolar disorder? Bipolar depression, mania and long-term relapse prevention are separate questions. Helping one does not mean helping the others.
3. Added to what? Nearly every positive bipolar supplement trial tested the product as an add-on to medication. None shows it works instead of medication.

Omega-3: modest at best, and only for depression

Omega-3 fatty acids are the most studied supplement in bipolar disorder. A 2012 meta-analysis in the Journal of Clinical Psychiatry found a small-to-moderate effect on bipolar depression (Hedges g 0.34) across five datasets and 291 people, and no significant effect on mania. The authors also found that smaller studies reported larger effects, a pattern that often shrinks as better trials arrive.

Put plainly, omega-3 is not a mood stabilizer. It may be a reasonable add-on to discuss for someone with persistent depressive symptoms, and eating fish regularly fits the heart-healthy pattern described in our page on nutrition and bipolar disorder. List it like any prescription; our interactions guide explains when fish oil matters for bleeding risk.

NAC: interesting, but it did not prevent episodes

N-acetylcysteine (NAC) is an antioxidant precursor that has been studied across several psychiatric conditions. In a 24-week randomized trial of 75 people with bipolar disorder, adding NAC to usual treatment improved depressive symptoms. It did not lengthen the time until the next mood episode, and the benefit disappeared after it was stopped.

So NAC sits in the “mixed” column. It is not dangerous for most people, but it is not a substitute for maintenance treatment, and the VA/DoD guideline still rates the evidence as insufficient.

Supplements that can push toward mania or psychosis

Some products marketed for low mood or energy act on the same systems antidepressants do, and in bipolar disorder that can tip the balance.

• SAMe. The National Center for Complementary and Integrative Health (NCCIH) says people with bipolar disorder should not take SAMe for depression except under a provider’s supervision, “because SAMe may worsen symptoms of mania.”
• St. John’s wort. NCCIH describes case reports of dangerous effects, including worsening psychotic symptoms in people with bipolar disorder. It also speeds the breakdown of many medicines: the lurasidone (Latuda) label lists it among strong inducers that should not be combined with lurasidone.
• DHEA. Published case reports describe mania beginning after people started DHEA, a hormone precursor sold over the counter. Case reports cannot show how often this happens, but they are reason enough to avoid it without supervision.

Our page on mania symptoms describes the early signs in more detail.

Lithium orotate, vitamin D and other popular searches

Lithium orotate is sold as a supplement. It is not FDA-approved for bipolar disorder and is not interchangeable with prescription lithium, which is dosed and checked with blood levels because the gap between helpful and toxic levels is narrow. Taking it alongside prescription lithium adds lithium your prescriber cannot account for.

Vitamin D, B12 and other vitamins. Correcting a measured deficiency is ordinary good medical care and can help energy and wellbeing. It is not a bipolar treatment, and the VA/DoD guideline found no good evidence for vitamins in bipolar disorder.

Probiotics and “gut” blends. Promising early research, insufficient clinical evidence. Our broader evidence review of supplements in psychiatry covers how these products perform across other conditions.

Interactions with bipolar medications

Beyond St. John’s wort, the interactions most worth checking involve sedation (calming herbs added to quetiapine or other sedating medications), bleeding (high-dose fish oil with blood thinners or regular anti-inflammatory painkillers) and products that change how the liver clears drugs. Our guide to supplement and medication interactions walks through each category and the warning signs that need same-day attention.

• Photograph every label, including blends, gummies and teas. Blends often hide St. John’s wort or other active herbs.
• Add one product at a time, so a change in mood or side effects can be traced.
• Use one pharmacy where possible so interaction checks see everything.
• Mention supplements again whenever a medication changes.

At Willow & Stone

Dr. Stacey Forbes, DNP, APRN, PMHNP-BC, reviews every supplement alongside prescriptions during the 90-minute integrative evaluation, and advanced lab testing is ordered as needed when a result would change a decision. The aim is usually fewer products, chosen for a reason. Learn more about bipolar disorder treatment at Willow & Stone.

Common Questions

Sources & Further Reading

• NIMH: Bipolar Disorder (NIH Pub. 25-MH-8088, revised 2025)
• VA/DoD Clinical Practice Guideline: Management of Bipolar Disorder (Version 2.0, 2023)
• Sarris et al. Omega-3 for bipolar depression and mania: meta-analysis. J Clin Psychiatry 2012
• Berk et al. N-acetylcysteine as add-on in bipolar disorder: randomized trial. Biol Psychiatry 2008
• NCCIH: S-Adenosyl-L-Methionine (SAMe): In Depth
• NCCIH: St. John’s Wort and Depression: In Depth
• Markowitz et al. Mania onset while using dehydroepiandrosterone. Am J Psychiatry 1999
• DailyMed: Latuda (lurasidone) prescribing information

This article is general education, not a diagnosis or advice for your situation. Do not start, stop, or change a medication without talking to the clinician who prescribes it; stopping a mood stabilizer suddenly can trigger relapse.