• Herbal remedies
  
• Vitamins
  
• Minerals
  
• Nutritional supplements
  

Once upon a time, only the health nuts crowed about the virtues of herbs from the Peruvian rain forest or multivitamin bars. Now soft drinks are spiked with St. John's wort and gingko biloba, and One-a-Day vitamins share a shelf with a One-a-Day herbal mood supporter.

My mom is always sending me articles she clips out of magazines about herbal remedies and how vitamins can cure everything. I'm curious, but nervous. I actually bought some grapeseed oil, but I still haven't opened it. I make sure [my daughter] takes her vitamins and that's about it. Maybe someday I'll try the grapeseed oil and see if it helps. At least it should be safer than some of the things she has been given by her doctor! --Estella, mother of 8-year-old Selena (diagnosed bipolar II disorder)

Although the glossy, new veneer of today's supplements may make them look attractive, it's just as important to be a smart consumer in this area as it is with traditional medicine. Being well-informed can be more difficult, however. Medications with approval from the FDA or similar government bodies undergo rigorous testing. Study results and detailed information about these compounds are available in numerous books, online, or directly from the manufacturers.

With supplements, that's not always the case. It seems like every week another paperback book appears making wild claims for a new antioxidant compound or herbal medication. These books--not to mention magazine articles, web sites, and semi-informed friends--sometimes wrap conjecture up in a thin veneer of science. They may reference studies that are misinterpreted, that appeared in disreputable journals, or that were so poorly designed or biased that no journal would publish them.

Supplement salespeople, and particularly those who take part in multilevel marketing schemes, seem to have taken lessons from their predecessors in the days of the traveling medicine show. They have little to lose by making outrageous claims for their products, and much to gain financially. Here are just a few of the unsupported claims found in a single five-minute sweep of supplement-sales sites on the Internet:

• "Glutathione slows the aging clock, prevents disease and increases life."
• "Pycogenol...dramatically relieves ADD/ADHD, improves skin smoothness and elasticity, reduces prostate inflammation and other inflammatory conditions, reduces diabetic retinopathy and neuropathy, improves circulation and enhances cell vitality..." [and, according to this site, cures almost anything else that might ail you!]
• "Sage and bee pollen nourish the brain."
• "Soybean lecithin has been found to clean out veins and arteries--dissolve the gooey sludge cholesterol--and thus increase circulation, relieve heart, vein and artery problems. It has cured many diabetics--cured brain clots, strokes, paralyzed legs, hands and arms!"

Take the time to browse your local store's shelves, and you'll probably spot a number of dubious products. Some companies try to deceive you with sound-alike names, packaging that mimics other products, or suggestive names that hint at cures. Other colorful bottles of pills contain substances that can't actually be absorbed by the body in oral form--for example, "DNA" (deoxyribonucleic acid, the building block of human genetic material) graces the shelves of some shops. One manufacturer of this useless "supplement" claims that "it is the key element in the reprogramming and stimulation of lazy cells to avoid, improve, or correct problems in the respiratory, digestive, nervous, or glandular systems." This company notes that its "DNA" is extracted from fetal cells; other brands are apparently nothing but capsules of brewer's yeast.

Some other supplements provide end products of internal procedures, such as glutathione, instead of the precursors needed for the body to make a sufficient supply on its own, such as vitamin E. This approach may not work. When in doubt, consult with your doctor or a competent nutritionist.

How can you assess supplement claims? Start by relying primarily on reputable reference books for your basic information, rather than on advertisements or the popular press. Watch out for any product whose salespeople claim it will cure anything. Supplements and vitamins may enhance health and promote wellness, but they rarely effect cures. Be wary of universal usefulness claims. The worst offenders in supplement advertising tout their wares as cure-alls for a multitude of unrelated conditions.

There are a few other sales pitches that should make you wary. If a product's literature references the myth of the long-lived Hunzas, someone's trying to pull the wool over your eyes. This tale of hardy Russian mountain folk who supposedly all live to be well over one hundred years old was refuted long ago by reputable researchers. If it's a natural substance but a particular company claims to be the only one to know the secret of its usefulness, that really doesn't make much sense. Be especially cautious when sales pitches are written in pseudoscientific language that doesn't hold up under close examination with a dictionary. This is a popular ploy. For example, one supplement sold by multilevel marketers claims to "support cellular communication through a dietary supplement of monosaccharides needed for glycoconjugate synthesis." Translated into plain English, this product is a sugar pill.

Even when you have seen the science behind a vitamin or supplement treatment, there's still the problem of quality and purity. It's almost impossible for consumers to know for sure that a tablet or powder contains the substances advertised at the strength and purity promised. Whenever possible, do business with reputable manufacturers that back up their products with potency guarantees or standards. In many European countries, potency is governed by government standards; in the US, it's a matter of corporate choice.

Natural does not mean harmless. Whenever a vitamin or supplement is powerful enough to heal, it also has the power to harm if misused. Be sure to work closely with your physician or a nutritionist if your child will be taking anything more complex than a daily multivitamin.

Herbal remedies

Many herbs have been used to treat neurological disorders through the ages. Herbalists call these substances nervines, and some may prove useful for treating specific symptoms of bipolar disorders.

Of all the herbal remedies, this group of plant extracts are among the strongest, and the most likely to cause serious side effects. Along with the herbal sleep aids mentioned earlier in this chapter, nervines that have been tried by people with bipolar disorders or related conditions include:

• Black cohosh (Cimicifuga racemosa). A nervous system depressant and sedative, sometimes used by people with autoimmune conditions for its anti-inflammatory effects. Its active ingredient appears to bind to estrogen receptor sites, so it may cause hormonal activity.
• Damiana (Turnera aphrodisiaca). A traditional remedy for depression. As its Latin name indicates, it is also believed to have aphrodisiac properties. Whatever the case may be there, it does seem to act on the hormonal system. Its energizing quality might be dangerous for bipolar patients.
• Gingko biloba. An extract of the gingko tree, advertised as an herb that can improve your memory. There is some clinical evidence for this claim. It is an antioxidant, and is prescribed in Germany for treatment of dementia. It is believed to increase blood flow to the brain.
• Ginseng (Panax quinquefolium). Has an energizing effect that may be helpful to people whose depression is accompanied by extreme fatigue and lethargy.
• Grapeseed oil and pycogenol. Both are extra-powerful antioxidants. (Pycogenol is derived from marine pine trees.)
• Gotu kola (Centella asiatica, Hydrocotyl asiatica). An Ayurvedic herbal stimulant sometimes recommended for depression and anxiety.
• Licorice (Glycyrrhiza glabra, Liquiritia officinalis). Boosts hormone production, including hormones active in the digestive tract and brain.
• Sarsaparilla (Hemidesmus indicus). Like licorice, it seems to affect hormone production as well as settling the stomach and calming the nerves.
• St. John's Wort (Hypericum perforatum). Has gained popularity as an herbal antidepressant. It has the backing of a decent amount of research. Those choosing to use this remedy should follow the same precautions as with SSRIs and MAOIs, two families of pharmaceutical antidepressants. It can also cause increased sensitivity to light. It is available by prescription in Germany, where it is the most widely used antidepressant. It is potentially dangerous to use St. John's Wort with prescription antidepressants or any other medication that could affect serotonin.

The only herbal remedy I tried was St. Johns Wort, and I saw no improvement in my mood. --Stephanie, age 32 (diagnosed with bipolar disorder at age 15 and now the mother of a bipolar child)

Vitamins

A varied, healthy diet is your best source of vitamins. Some researchers believe that people with bipolar disorders may metabolize certain vitamins differently, and therefore require either careful intake via food or supplementation.

If you plan to pursue vitamin therapies, purchase a basic guide to vitamins and minerals that includes information about toxicity symptoms. Some people metabolize vitamins and minerals differently, and may be more or less susceptible to potential toxic effects. Along with your doctor's guidance, a good reference book can help you avoid problems.

Also, take vitamin company sales pitches and dosage recommendations with a grain of salt. The testimonials these companies produce are intended to sell their products, not to help you develop a treatment plan. Consult a physician or a professional nutritionist who does not sell supplements for unbiased, individualized advice.

Vitamins often cited as important in mood regulation include the B vitamins. If you are deficient in any of the Bs, depression, anxiety, and fatigue can result. The B vitamins work together, so it's best to take a B-complex supplement that mixes them in proper proportions along with folic acid. The Bs have a generally energizing effect and help build up the immune system. Some alternative practitioners recommend vitamin B-12 shots for depressed patients. They don't always work, but sometimes they can have surprisingly quick mood-elevating effects. Because of that energizing effect, however, they may not be a good idea for those who are hypomanic or manic. B vitamins are used up more quickly when the body or mind is stressed, so supplementing during these times could have a preventive effect. A list of B vitamins follows:

• Vitamin B-1 (Thiamin). Alone, or in addition to a regular B-complex pill, B-1 might be a good idea for bipolar patients who suffer from circulation problems, tingling in the extremities, anxiety, irritability, night terrors, and similar symptoms.
• Vitamin B-6 (Pyridoxine). In addition to a regular B-complex pill, B-6 might be indicated for bipolar patients who present with a great deal of irritability, and for those with marked premenstrual symptoms and/or motion sickness. If you start to experience tingling in your hands or feet, reduce or discontinue the B-6.
• Vitamin B-12. Helps your body turn food into energy, and without enough of it you are likely to feel listless and fatigued. Vegetarians may also be deficient in B-12, as it's found mostly in meat.
• Vitamin E. An antioxidant that also seems to reduce the frequency of seizures in some people who have epilepsy. It's especially important to take vitamin E if you take Depakote, Depakene, or another anticonvulsant, as these drugs deplete vitamin E. If you have high blood pressure, monitor it carefully after starting vitamin E, and reduce the dose if your blood pressure rises.

Vitamins A and D are fat-soluble, so they are stored in the body's fat cells for later use. Having a little socked away for a rainy day is probably okay, but if you take too much, hypervitaminosis may develop.

Symptoms of hypervitaminosis A include orangeish, itchy skin; loss of appetite; increased fatigue; and hard, painful swellings on the arms, legs, or back of the head. Symptoms of hypervitaminosis D include hypercalcemia, osteoporosis, and kidney problems.

Don't overdo it with any fat-soluble vitamin, and also be careful with fish-oil supplements (and cod liver oil), which are high in both vitamins A and D.

Folic acid can counteract the effects of Depakote, Depakene, and some other anticonvulsants if taken in large amounts. It may also cause manic mood swings.

Minerals

Minerals are naturally occurring substances that are basic building blocks for cells and chemical processes in the body. Most of them are needed in relatively small amounts, amounts that are covered through the combination of a reasonably decent diet and a regular multivitamin with minerals.

Supplementing with specific minerals can be helpful for alleviating bipolar symptoms, however. Minerals that are sometimes suggested include:

• Calcium. Important for the regulation of impulses in the nervous system and for neurotransmitter production. If you supplement with magnesium, you should also take twice that amount of calcium--these two minerals need each other to work. However, excessive levels of calcium (hypocalcinuria) can result in stupor.
• Chromium picolinate. May help control the sugar and carbohydrate cravings that many patients experience while taking Depakote or Depakene. Chromium picolinate can act like a stimulant, however, so keep an eye out for this side effect.
• Magnesium. Lowers blood pressure, and is also important for the regulation of impulses in the nervous system and neurotransmitter production. Magnesium deficiency can cause anxiety and insomnia, and it can also lower your seizure threshold. This mineral is rapidly depleted during periods of stress, hard work, hot weather, or fever, and that's probably one of the reasons that these conditions can precipitate a seizure. If you are supplementing with vitamin B-6, you will need to add magnesium as well.
• Manganese. Deficiency is marked by fatigue, irritability, memory problems, and ringing or other noises in the ears. It is needed in trace amounts only, but some people's diets do not include enough.
• Zinc. Another trace mineral that's often absent from the diet. Symptoms of deficiency can include mental disturbance.

Nutritional supplements

If it's not an herb, vitamin, or mineral, you can simply call it a nutritional supplement. That means the manufacturer agrees not to market it as a drug, and the FDA agrees to consider it a food. Meanwhile, consumers are left unsure about whether these supplements provide nutrients (they usually don't), cure disease (rarely, if ever), or simply promote health.

The supplements category includes amino acids. There are 22 of these simple compounds, which combine to create all of the body's proteins. Most amino acids are produced by the body itself, but some people do report benefits from taking amino acid supplements. These may combine several amino acids, or include just one.

Along with the amino acids listed in the section "Other sleep supplements" earlier in this chapter, supplements that may be suggested for symptoms of bipolar disorders include:

• Lecithin (phosphatidyl choline). A phospholipid found mostly in high-fat foods. It is said to have the ability to improve memory and brain processes. Lecithin is necessary for normal brain development; however, double-blind studies of patients with Alzheimer's disease did not substantiate claims that it can help people recover lost brain function. The ketogenic diet increases the amount of lecithin in the body, which may be one of the reasons for its success in some cases of hard-to-treat epilepsy. Some people with epilepsy have also reported reducing their number and severity of seizures from taking lecithin alone.

Some studies of lecithin-use by people with bipolar disorder indicate that it can stabilize mood, while others indicate that it tends to depress mood (and might therefore be more useful to a person who is manic or hypomanic). It does not appear to cause harm, and there are some logical reasons to think it might help--especially for patients who also have seizures. Lecithin capsules are available, but many people prefer the soft lecithin granules. These are a nice addition to fruit juice smoothies, adding a thicker texture. Lecithin is oil-based, and it gets rancid easily. It should be refrigerated.

• Choline. One of the active ingredients in lecithin. It is needed by the brain for processes related to memory, learning, and mental alertness, as well as for the manufacture of cell membranes and the neurotransmitter acetylcholine. Acetylcholine is involved in emotional control and other regulatory functions. Its effectiveness for bipolar symptoms is unknown.
• Inositol. Another active ingredient in lecithin. It is required by the neurotransmitters serotonin and acetylcholine, and may repair some types of nerve damage. Clinical studies indicate that inositol supplements may be helpful for some people with obsessive-compulsive disorder, depression, and panic disorder. Its effectiveness for bipolar symptoms is unknown.
• Taurine. An amino acid that appears to have antiseizure capabilities, and has gotten good reviews from some adults with bipolar disorders. It inhibits abnormal electrical activity in the brain, and is often found to be deficient in brain tissue where seizures have been occurring. Interestingly, rapid cyclers report the best results. Recommendations range from 500 to 1000 mg per day, divided into as many as three doses. Experts recommend buying only pharmaceutical-quality L-taurine from reputable manufacturers. Unusual EEG activity has been reported in patients using doses over 1000 mg per day.
• GABA. (gaba-amino butyric acid) An amino acid-like compound that acts like a neurotransmitter by inhibiting other neurotransmitters. A number of medications are under development that would affect GABA production or usage; some existing drugs that affect GABA, such as Gabapentin and Depakote, are used to treat manic depression. You should not take these medications with GABA supplements unless your physician recommends it and oversees the process. Supplementation with over-the-counter GABA is sometimes recommended for anxiety, nervous tension, and insomnia, especially insomnia associated with racing thoughts. If you experience shortness of breath, or tingling or numbness in your hands or feet when taking GABA, lower or discontinue this supplement.
• Tyrosine. An amino acid that serves as a precursor to the neurotransmitters norepinephrine and dopamine. It may help the body form more of these neurotransmitters, and is also believed to provide support for optimal thyroid gland function. Tyrosine can raise blood pressure, so talk to your child's doctor about using it if your child takes other medications that affect blood pressure.
• Phenylalanine. An essential amino acid, as well as the precursor of tyrosine. It has an indirect effect of boosting production of norepinephrine and dopamine. Like tyrosine, phenylalanine can raise blood pressure.
• Methionine. An antioxidant amino acid that has been shown to be helpful for some individuals suffering from depression. It has an energizing effect--and as with SAME, below, that could precipitate mania in bipolar patients.
• SAME (S-adenosyl-methionine). A metabolite of methionine that is used to treat depression and arthritis in Europe. It became available in the US in early 1999. It is believed to affect dopamine and serotonin, and to have anti-inflammatory effects. However, it is not recommended for people with bipolar disorder, as it may cause mania.