What Supplements Not to Take with Bipolar: A Critical Guide

October 5, 2025 •

4 min read

According to a 2015 study, up to 30% of patients with bipolar disorder used dietary supplements in addition to their prescribed medications, often without medical supervision. For individuals managing this condition, understanding what supplements not to take with bipolar is essential to prevent severe mood destabilization, dangerous drug interactions, and other serious health problems.

Quick Summary

This resource provides crucial information about specific supplements that can cause adverse effects, including triggering manic episodes, worsening depression, or interacting dangerously with prescribed medications for bipolar disorder. It highlights the importance of professional consultation before incorporating any supplement into a treatment plan.

Key Points

Danger of "Natural": Many herbal and natural supplements are not regulated by the FDA and can be very potent, leading to unpredictable and dangerous side effects for those with bipolar disorder.
High-Risk Supplements: Supplements like St. John's Wort, SAM-e, 5-HTP, Ginseng, Creatine, DHEA, and Rhodiola rosea are known to potentially trigger manic episodes and should be avoided.
Dangerous Drug Interactions: Certain supplements can interfere with the effectiveness of prescribed bipolar medications, such as Gingko biloba with Depakote or St. John's Wort with many psychiatric drugs.
Mania Risks: Even supplements sometimes seen as helpful, like high-dose omega-3s, have a risk of triggering mania in susceptible individuals with bipolar disorder.
Crucial Consultation: Before starting any new supplement, always consult with your healthcare provider or pharmacist to ensure it won't interfere with your treatment plan or cause harm.
Prioritize Lifestyle: A nutritious whole-foods diet, good sleep hygiene, regular exercise, and stress management are key, safe components of bipolar management, reducing reliance on potentially risky supplements.

The Risks of Self-Prescribing "Natural" Remedies

For many, the word "natural" implies safety. However, when it comes to managing a complex medical condition like bipolar disorder, this assumption is dangerous. Supplements, including herbs and amino acids, contain powerful compounds that can significantly affect brain chemistry. For someone whose mood is already being regulated by prescription medication, adding a supplement can lead to unpredictable and harmful consequences, including a full-blown manic episode or a severe depressive state.

Supplements that Can Trigger Mania and Mood Instability

Many supplements touted for their mood-enhancing effects can destabilize the delicate chemical balance required for managing bipolar disorder. This is particularly true for supplements with stimulating or antidepressant properties.

St. John's Wort

This herbal remedy is widely used to treat mild to moderate depression but is highly contraindicated for individuals with bipolar disorder. It can trigger mania, hypomania, or rapid cycling, and it interacts with numerous prescription drugs, including antidepressants and mood stabilizers. The risk of serotonin syndrome, a potentially life-threatening condition caused by excessive serotonin levels, is a major concern when St. John's Wort is combined with medications.

S-Adenosyl-L-Methionine (SAM-e)

While some studies have explored SAM-e for its antidepressant potential, it is strongly cautioned against for people with bipolar disorder. It has been shown to worsen manic symptoms and can interfere with the effectiveness of mood-stabilizing medications.

5-HTP (5-Hydroxytryptophan)

5-HTP is a precursor to serotonin and is often marketed for mood and sleep support. However, increasing serotonin levels without proper medical supervision can be highly dangerous for bipolar individuals. Case studies suggest 5-HTP can trigger mania and significantly raise the risk of serotonin syndrome when combined with other mood-regulating drugs.

Ginseng (Panax ginseng)

Often used to boost energy and mental well-being, certain forms of ginseng can be a powerful stimulant. In people with bipolar disorder, this can lead to an increase in manic symptoms. It may also alter the levels of some antipsychotic medications in the bloodstream, which is extremely dangerous.

Rhodiola rosea

This adaptogenic herb is used for fatigue and stress but can dangerously influence neurotransmitters like serotonin and dopamine. For those with bipolar, it may trigger manic episodes, and it can interact negatively with antidepressants and monoamine oxidase inhibitors (MAOIs).

Creatine

This amino acid, popular with athletes, has been shown to have antidepressant-like effects in some studies. However, the same mechanism that can help with depression could also increase the risk of mania or hypomania in people with bipolar disorder. It is crucial to have medical supervision if considering this supplement.

DHEA (Dehydroepiandrosterone)

DHEA is a hormone precursor that some believe can improve mood and energy. However, it can significantly affect hormone levels in the body, which has been linked to triggering mania, irritability, and impulsivity in people with and without a prior history of bipolar disorder.

Ephedra (Ma Huang)

This stimulant, once used in weight-loss supplements, is known to cause symptoms consistent with mania, including extreme elation and reduced need for sleep. It should be strictly avoided.

Critical Drug-Supplement Interactions

Some supplements don't necessarily trigger mood swings but can critically interfere with the effectiveness of prescribed bipolar medications.

Ginkgo Biloba: This herb is sometimes used for memory but can reduce the effectiveness of mood stabilizers like Depakote.
Kava and Valerian: These herbs, used for anxiety and sleep, can increase the depressive effects on the central nervous system when combined with mood stabilizers or anti-anxiety medications.
Folic Acid (Synthetic B9): While folate is important, supplemental folic acid can interfere with anticonvulsant medications. It's often safer to get this nutrient through a balanced diet rich in leafy greens.
Lithium supplements: The mineral lithium used in supplements for general health is not the same as the carefully regulated, higher-dose prescription lithium used as a mood stabilizer. Self-medicating with over-the-counter lithium is ineffective and can be dangerous.

A Balanced Nutrition Diet and Professional Guidance

Beyond avoiding specific high-risk supplements, adopting a healthy lifestyle is crucial for managing bipolar disorder. This includes a balanced diet rich in whole foods, managing sleep patterns, and consistent exercise. Consult a healthcare provider before making any changes to your supplement regimen. An experienced physician or dietitian can help determine which, if any, supplements might be safe and beneficial for you. For more resources on nutrition and diet for mental health, consider consulting the Food for the Brain Foundation.

Comparison Table: Risky Supplements and Their Effects


Supplement	Primary Risk	Specific Interaction	Bipolar Specific Effect
St. John's Wort	Mania induction	SSRIs, mood stabilizers	Triggers mania, rapid cycling
S-Adenosyl-L-Methionine (SAM-e)	Mania worsening	Antidepressants, antipsychotics	Worsens manic symptoms
5-HTP	Serotonin Syndrome	SSRIs, mood stabilizers	Triggers mania, risk of SS
Ginseng	Mania induction	Antipsychotics	Increases mania, alters med levels
Creatine	Mania induction	None noted	Increases risk of mania
DHEA	Mania induction	Hormonal medications	Triggers mania, irritability
Rhodiola rosea	Mania induction	Antidepressants	May trigger manic episodes
Ephedra (Ma huang)	Mania induction	N/A	Causes stimulant-induced mania
High-dose Omega-3s	Mania triggering	Blood thinners	Can trigger mania at high doses

Conclusion

While a balanced diet and healthy lifestyle are vital for managing bipolar disorder, the use of over-the-counter supplements carries significant risks. Many herbal and amino acid supplements can interfere with prescribed mood stabilizers, trigger manic or depressive episodes, and lead to other dangerous side effects. Always prioritize professional medical advice and never self-prescribe supplements, no matter how natural or benign they may seem. Your mental health team is best equipped to guide you on safe and effective complementary treatments.

Frequently Asked Questions

No, St. John's Wort should be avoided by people with bipolar disorder. It can trigger manic episodes and interact dangerously with mood-stabilizing medications and other antidepressants.

SAM-e can increase the risk of mania in individuals with bipolar disorder. Though it is sometimes used for depression, it can worsen manic symptoms and interfere with prescribed bipolar medications.

5-HTP is not recommended for people with bipolar disorder. As a precursor to serotonin, it can trigger mania and poses a risk of serotonin syndrome, especially when combined with other medications affecting serotonin levels.

Ginseng may induce mania and alter the effectiveness of certain antipsychotic medications. Due to its stimulating effects, it is not recommended for individuals with bipolar disorder.

While Creatine has shown antidepressant effects, it can also increase the risk of mania or hypomania in people with bipolar disorder. It should only be used under strict medical supervision.

No, but high doses of omega-3s can potentially trigger mania in some individuals. It is best to discuss appropriate dosages and sources, such as through diet, with a healthcare provider.

It is crucial to consult a doctor because many supplements can interact negatively with prescribed bipolar medications, trigger mood episodes, or cause other serious health problems. A doctor can ensure any added supplement is safe for your specific treatment plan.

No, the term "natural" does not mean safe, especially with a sensitive condition like bipolar disorder. Many natural compounds can be potent and affect brain chemistry, leading to adverse effects and dangerous interactions with medications.