Integrative Management of Bipolar Disorder: Amino Acids and Omega-3s
This is the second post in a series on integrative management of bipolar disorder. Previous post reviewed conventional psychiatric management of bipolar disorder. The focus of this post is on amino acids and omega-3 essential fatty acids. Future posts will provide concise reviews of evidence for a range of non-pharmacologic treatments of this disorder.
Amino acids have beneficial effects on depressed mood, anxiety and insomnia in bipolar patients.
Taking the amino acid L-tryptophan 2–3 gm/day or 5-hydroxytryptophan (5-HTP) 25 to 100 mg up to three times a day may have beneficial effects on anxiety associated with mania. L-tryptophan 2 gm can be safely added to mood stabilizers such as lithium and valproic acid at bedtime improving sleep quality in agitated manic patients. Doses of L-tryptophan as high as 15 gm may be required when insomnia is severe (although individuals who take doses this high should be closely monitored by a psychiatrist, and this dosage may be restricted in some countries). Research findings suggest that when added to sedating antidepressants (such as trazodone) taken at bedtime L-tryptophan 2 gm may accelerate antidepressant response and improve sleep quality. Serious adverse effects have not been reported using this protocol. The amino acid L-theanine, a natural constituent of green tea, reduces anxiety by increasing alpha activity and increasing synthesis of the inhibitory neurotransmitter GABA. Noticeable anxiety reduction is generally achieved within 30 to 40 minutes and effective doses range between 200 mg and 800 mg/day. There are no contraindications to taking L-theanine in combination with mood stabilizers.
Omega-3 fatty acids are beneficial in the depressive phase but do not lessen symptoms of mania.
Countries where there is high fish consumption have relatively lower prevalence rates of bipolar disorder. In a systematic review of controlled trials on omega-3 fatty acids in bipolar disorder only one study was identified in which omega-3s were used adjunctively with a mood stabilizer. The combined treatment protocol resulted in a differential beneficial effect on depressive but not manic symptoms. The reviewers cautioned that any conclusions about the efficacy of omega-3 fatty acids in bipolar disorder must await larger controlled studies of improved methodological quality. Large doses of omega-3 fatty acids may be more effective in the depressive phase of the illness.
Some studies suggest that the omega-3 essential fatty acid ecosapentanoic acid (EPA) at doses between 1 and 4 gm/day may have enhance the effectiveness of atypical antipsychotics used to treat acute mania, however, one placebo-controlled trial failed to confirm an adjuvant effect. The appropriate management of a severely depressed bipolar patient might include a mood stabilizer, an antidepressant and omega-3 fatty acids.
There are few safety issues.
Rare cases of increased bleeding times, but not increased risk of bleeding, have been reported in patients taking aspirin or anti-coagulants together with omega-3s.
To learn more about non-pharmacologic treatments of bipolar disorder read “Bipolar Disorder: The Integrative Mental Health Solution,” by James Lake MD.