Bipolar requires managing two distinct categories of symptoms: manic symptoms, such as impulsive behavior, excessive irritability, and anxiety, and depressive symptoms, like a low mood, poor appetite, and emotional indifference. While there aren't many complementary or alternative medicine remedies for manic behavior, there are a few non-prescription therapies that help alleviate depression. Most people suffering from bipolar disorder actually spend the majority of their time depressed rather than manic.
Keep in mind, though, that just because these therapies exist, people with bipolar disorder can't simply throw away their antidepressants. "Bipolar is a very serious, lifelong disorder," says Philip Muskin, MD, professor of clinical psychiatry at Columbia University Medical Center in New York. "If you need an antidepressant, you should take it. These types of therapies are additional or complementary, rather than alternative."
Complementary Treatments for Depression in Bipolar Disorder
The complementary treatments  that have shown some benefit for the depressive side of bipolar disorder are rhodiola rosea, S-adenosylmethionine (SAMe), and St. John's wort.
- Rhodiola. Officially known as rhodiola rosea, this herb has been used for years to help manage stress. Now, new evidence has demonstrated rhodiola's positive effect on people suffering from depression. A recent clinical trial showed significant improvements in depressed mood among participants who were given rhodiola extract compared with those who were given a placebo. "Rhodiola is mildly stimulating," notes Dr. Muskin. "I wouldn't use it as a solo therapy, but it is a good adjunct for someone who is on antidepressants and feels like they [still] don't have a lot of energy."
- SAMe. SAMe, or S-adenosylmethionine, is a co-enzyme that has been researched extensively and has been shown to reduce symptoms of depression. However, this nutritional supplement treatments  should be used with caution, as it can actually provoke mania in people with bipolar disorder. "Anything that is a real antidepressant can cause mania in bipolar people," says Muskin, "so there is some risk that a patient taking SAMe might become manic." Several clinical trials are now ongoing to determine the best way to use SAMe in people with depression-related disorders.
- St. John's wort. This plant, whose therapeutic use dates back to ancient Greece, is one of the better-known natural mood enhancers. Even so, evidence is mixed on whether St. John's wort actually has a positive effect on major depression or bipolar disorder. A recent review of published scientific evidence on the use of complementary therapies for patients with bipolar disorder found that there is evidence to support the use of St. John's wort for mild to moderate depression. The review also found, however, that like other antidepressants, St. John's wort has the potential to cause mania. Additionally, St. John's wort interacts with many other medications people with bipolar disorder may be taking.
Complementary Therapy for Manic Symptoms in Bipolar Disorder
One therapy that has demonstrated promise to help curb manic symptoms in bipolar disorder is the use of omega-3 fatty acids . Omega-3 fatty acids are recommended for many people, as they have been shown to lower triglycerides and help maintain heart health. But people suffering from bipolar disorder may have extra motivation to start eating more fish that are heavy in omega-3s, such as salmon, mackerel, and sardines; they may also want to consider taking omega-3 supplements. One small study at Massachusetts General Hospital found that manic symptoms were reduced among children given omega-3 supplements over a two-month period.
"If you look at countries where they eat a lot of fish, they have relatively low incidence of bipolar disorder," says Muskin. "In the brain, we think omega-3s might help with moving neurotransmitters in and out, which may help stabilize moods."
Complementary Bipolar Treatments: A Few Words of Caution
"The reality is that there are not a lot of data on complementary therapies for bipolar disorder," says Muskin. "That doesn't mean these products shouldn't be used, but when patients try to find out about them, they shouldn't expect to be able to go to [Web sites] like The New England Journal of Medicine and download a lot of articles."
Muskin recommends ConsumerLab.com as a reputable site where people can go to research complementary therapies. He says, "You can find out whether or not the product you're buying really contains the product you think it does, as well as what it's indicated for and whether it has contaminants." The National Institutes of Health  also provides an extensive online database of dietary supplements that includes detailed product and manufacturer.
Most of these therapies are safe, and with the exception of St. John's wort, there is limited evidence of negative interactions with prescription medications. Regardless, patients and their family members should actively research these products before taking them, especially since complementary therapies do not undergo the same strict review process as pharmaceutical medications.