Interest in complementary and alternative medicine (CAM) for bipolar disorder—acupuncture, omega-3 fatty acids, N-acetylcysteine (NAC), massage, homeopathy, naturopathy, hypnosis, etc.—has exploded on social media. But does any of it actually work? If you know me, you know that I look for medical evidence. Someone once attempted to insult me by saying that I would try heroin if it had clinical evidence. Um, yeah. Clinical evidence is what says something is safe and effective, so, yes, I would try it. (Of course, I don’t think heroin is going to pass that bar any time soon.) Here’s what the evidence says about CAM for bipolar disorder (spoiler: some adjuncts help depressive symptoms; others are all hype).
(Jump to evidence at-a-glance.)
Acupuncture for Bipolar Disorder: RCT Evidence
When evaluating alternative treatments for bipolar disorder, acupuncture shows the following:
- A pooled analysis of two randomized controlled trials (RCT; 20–26 patients) examined acupuncture as an adjunct to standard medication for bipolar depression and hypomania. Both real and sham acupuncture produced improvement—but no significant difference between them. This suggests benefits likely stem from non-specific effects like attention and ritual.
- A case series of acupuncture for bipolar disorder showed various results from useful to no effect at all—but lacked a control group, limiting conclusions.
Bottom line: Acupuncture seems generally safe, but evidence does not support specific benefits over placebo (a placebo is a substance that does nothing).
Omega-3 Fatty Acids (Fish-Oil) and Bipolar Depression
Omega-3 has almost moved out of the alternative treatment for bipolar disorder category, but not quite.
- A 2012 meta-analysis of bipolar trials (double-blind, placebo-controlled) found that omega‑3 supplements improved depressive symptoms but not mania.
- A 2021 systematic review (five trials) confirmed effectiveness for residual depressive symptoms.
- A 2023 randomized trial with 31 patients showed lower relapse rates over six months and reduced depressive severity.
- Despite promising signals, a 2018 American Psychiatric Association (APA) review emphasized strong publication bias and trial heterogeneity, urging caution.
Bottom line: Omega‑3s may help with bipolar depressive symptoms and relapse prevention, but findings are modest and inconsistent. (More on diet in bipolar disorder, here.)
N-Acetylcysteine (NAC): Antioxidant Adjunct
This alternative treatment for bipolar disorder has some evidence behind it.
- A 2008 double-blind RCT (n = 75, 24 weeks) reported significant improvement in depressive symptoms for those taking NAC (1 g twice daily) adjunctively; benefits were lost after washout.
- A 2020 meta-analysis of six double-blind RCTs (248 patients) found a moderate effect favoring NAC vs. placebo, but noted high heterogeneity.
- However, a 2021 meta-analysis failed to show a statistically significant benefit for NAC add‑on therapy.
Bottom line: NAC shows mixed evidence—some trials are promising, but recent reviews are inconclusive. More large, high-quality studies are needed. (More on N-acetylcysteine in bipolar disorder can be found here.)
Massage and Hypnosis: Stress Relief, Not Symptom Control
These alternative treatments for bipolar disorder are not supported.
- There are no direct RCTs of massage or hypnosis in bipolar disorder.
- However, these methods have documented benefits for stress and anxiety relief in other psychiatric conditions (here and here).
Bottom line: While probably safe, their role is supportive—not therapeutic—for anxiety in bipolar disorder.
Homeopathy and Naturopathy: No Benefit, Real Risks
I do not like these alternative treatments for bipolar disorder at all.
- No rigorous trials (RCTs or meta-analyses) support homeopathy or naturopathy for bipolar disorder.
- Naturopathy often includes unsubstantiated herbal mixes, and many use them to replace evidence-based treatment—posing a real risk of treatment delay, side effects, or drug interactions.
- The overall medical consensus is that homeopathy does not work, ever. It is no better than a placebo in all conditions studied.
Bottom line: Strongly not recommended as a primary or adjunct treatment for bipolar disorder.
Bipolar Alternative Medicine Evidence at a Glance
| Treatment | Evidence Summary |
|---|---|
| Acupuncture | RCTs show improvement in symptoms but no specific benefit over placebo |
| Omega‑3 fatty acids | Meta-analyses suggest benefit for bipolar depressive symptoms and relapse prevention, but not mania |
| N‑Acetylcysteine (NAC) | The evidence is mixed: early RCTs positive, later meta-analyses inconclusive |
| Massage / Hypnosis | No bipolar-specific RCTs; may help stress/anxiety |
| Homeopathy / Naturopathy | No evidence; potential harm |
Risks, Interactions, and Money Pits
Here are some of the risks alternative medicine offers to those using it for bipolar disorder treatment.
- Delay to effective care: Using unproven alternatives may lead to poorer outcomes if medications are postponed.
- Interactions and safety: Even natural supplements can affect drug metabolism and have side effects.
- Waste of resources: Time and money spent on ineffective methods could be better spent on evidence-based treatments..
- False reassurance: Feeling better due to placebo effects, not actual symptom remission, can be dangerous.
Bottom Line: What to Try—What to Skip
I understand why people want to try alternative treatments for bipolar disorder. They can seem seductive. They promise improvements without side effects. They’re outside the medical system, which is often a selling feature for those who have had previous bad experiences with the system. Some people offering these alternatives are very convincing salespeople. All of this can make putting your money and time into them seem to make sense.
But please believe me when I tell you that by and large, these alternatives do not work. They will not help you, no matter what a salesperson says.
Remember this:
What do you call alternative medicine that works? Medicine.
In other words, if it worked, it would be part of the medical system.
In short:
- Core treatments remain medications (e.g., mood stabilizers, atypical antipsychotics, etc.) as prescribed by psychiatrists.
- If you’d like to try alternative therapies, consider:
- Omega‑3 supplements (EPA-rich) or NAC—only as adjuncts, not replacements
- Acupuncture, massage, hypnosis—for stress relief, not symptom control
- Avoid homeopathy and naturopathy unless integrated with medical care.
- Always consult your prescriber before starting supplements or any alternative treatment to monitor for interactions and ensure continuity of evidence-based care.
Have you tried any alternative treatments for bipolar disorder? Share your experience below—evidence counts, but anecdotes help others feel less alone.
IMNSHO, the value of evidence in mental health is far trickier to interpret than in other areas of medicine. Not to say it isn’t relevant, but that the existence of evidence (for) is less a predictor of sucess. The lack of evidence (for, against) is (slightly) less a predictor of failure, depending on the type of product. Lack of evidence for a medication (backed by a company that can afford to run real studies) is more significant (in the real-world sense) than lack of evidence for something that you can grow in your backyard. The combinatorial explosion that is any mental health diagnosis makes the relevance of a treatment in any individual circumstance much harder to predict, evidence or no. People get victimized on both sides—clinicians who blame the patient when an “evidence-based” treatment fails and predatory companies who can make outrageous claims on the most questionable basis. Thanks so much for cautioning about CAM side effects and interactions.