Bipolar disorder involves extreme shifts in mood, energy, and levels of activity. Medications can help people manage symptoms, but these can have adverse effects. A number of natural remedies may also help.

The National Alliance on Mental Illness (NAMI) estimate that around 2.6 percent of people in the United States have bipolar disorder, and nearly 83 percent of cases are severe. On average, it starts when a person is 25 years old.

A person with bipolar disorder experiences times of severe depression and times of mania, or "high" mood. The risks during a low mood include an inability to function at work and in other areas of life.

During mania, the person may be at risk of making reckless decisions. If the mood becomes too high or low, psychosis can develop.

There is no cure for bipolar disorder, but treatment enables people to manage it. Some lifestyle adaptations can also help, alongside the medication.

Counseling, cognitive behavioral therapy (CBT), and a range of lifestyle changes can help people with bipolar disorder to manage their symptoms and improve their overall quality of life.

Sleep

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Regular sleep is important for people with bipolar disorder.

Bipolar disorder can disrupt a person's sleep. During a manic phase, an individual may sleep very little, but during a low phase, they may sleep for a long time.

Missing sleep can trigger a mood change, and getting enough sleep is essential to managing mood.

Good sleep hygiene can encourage people with the condition to have regular sleep.

Tips include:

  • going to bed and getting up at regular hours
  • making sure the room is comfortable
  • avoiding screen time and potentially stressful situations before bed
  • not eating a large meal too soon to sleeping
  • avoiding or limiting alcohol intake

People with bipolar disorder who have difficulty sleeping should speak to their physician.

Diet

A healthful diet is an important lifestyle habit for a person with bipolar disorder.

A 2011 study found that up to 68 percent of people seeking treatment for bipolar disorder have excess weight or obesity. People with bipolar disorder also had a higher risk of various other conditions, including diabetes, low bone density, and cardiovascular disease.

A healthful diet can help to reduce the risk of these conditions.

In 2013, another study found that people with bipolar disorder are more likely to engage in binge eating than the general population.

This may be a side effect of medication or due to overeating during episodes of depression.

Being overweight can complicate recovery and increase the risk of diabetes, high blood pressure, and anxiety.

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Regular eating habits can help people with bipolar disorder to stay healthy and avoid gaining excess weight.

Doctors do not know what causes bipolar disorder, but it may be due to an imbalance of chemicals in the brain. These chemicals, also called neurotransmitters, are noradrenaline, dopamine, and serotonin.

Serotonin can also affect appetite. It may be that when serotonin levels are low, people experience cravings for carbohydrates and sweet foods.

Tips for maintaining a healthful diet include:

  • keeping to regular eating times
  • ensuring that the diet is varied, well-balanced, and has plenty of fresh fruits and vegetables
  • making a meal plan for the week, preparing a list before going to the grocery store, and sticking to it

Learning and practicing new recipes during times of positive mood may help a person to establish these habits.

Exercise

Moderate and regular exercise can help to balance mood and prevent a number of health problems, such as obesity and cardiovascular disease.

There is a lack of evidence to show that physical activity can specifically help people with bipolar disorder, but some research suggests it may help to improve mood during a low phase.

A 2015 review of studies suggested that exercise "may be a viable and effective strategy to deal with the depressive phase of bipolar disorder."

Another review, published in 2016, concluded that "generally, exercise was associated with improved health measures, including depressive symptoms, functioning, and quality of life."

More studies are needed to find out how much exercise an individual should have, how often, and how intense the activity should be, especially as bipolar disorder involves a number of physical and psychological factors.

Practicing moderation

People with bipolar disorder have a higher risk of engaging in addictive behaviors.

One study found that 56 percent of people with the condition had at some time experienced addiction involving either alcohol or drugs.

Certain circuits in the brain play a role in pursuing rewarding experiences. One study has suggested that people with bipolar disorder have stronger activation in these circuits.

This may be what drives the person towards risky behavior.

The positive side of this, say the authors of the study, is that it encourages people to work with energy toward their goals and ambitions.

On the other hand, it may mean that an individual focuses fully on the short-term rewards of a decision while disregarding the possible long-term risks.

Tips for avoiding these problems include:

  • becoming more aware of any tendency to engage in risky — for example, addictive — behaviors
  • seeking help if there is already a problem
  • asking friends and loved ones to support any decisions to avoid destructive or addictive behaviors

Friends who are aware of the risks might, for example, suggest going to see a movie instead of a bar on a night out.

Managing a manic episode

It is not always possible to prevent a manic episode, but as the condition progresses, the individual and their friends and family may start to notice the signs of a mood change.

Here are some tips when this happens:

  • See a doctor, if it is the first time, if you have discontinued treatment, or if treatment is not working.
  • Follow the treatment plan and keep all medical appointments, as medications may need adjusting.
  • Try to keep to a regular sleeping pattern and avoid unnecessary stress when possible.
  • Eat a healthful diet and get enough exercise.
  • Avoid alcohol and other substances.
  • Keep track of your moods and feelings.

If you have people around you, try to share with them what is happening so that they can support you.

Other remedies that do not involve the use of traditional drugs include supplements and counseling.

Herbs and supplements

Some people with bipolar disorder use herbs or supplements in an attempt to relieve their symptoms.

Omega-3

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Salmon contains omega-3 oil.

The fish oil extract omega-3 may help, according to some studies. Scientists have found that bipolar disorder is less common in countries where people consume a lot of fish. People with depression may also have lower levels of omega-3 in their blood.

Omega-3 fatty acids may have numerous health benefits, but it is best to eat them in their natural form. Cold-water fish, nuts, and plant oils are good sources.

Magnesium

Some scientists think magnesium has a role regulating mood and both manic and depressive episodes and work with the medications to make them work effectively.

As a result, some doctors may recommend magnesium supplements. Discuss magnesium supplements with your doctor. Taking a multivitamin will include the daily recommended dosage of magnesium.

Vitamins

Some people suggest that vitamins may help, specifically vitamin C and folic acid.

Researchers have found weak evidence that vitamin C may help, but none to support the use of folic acid specifically for bipolar disorder.

There is evidence that folic acid supports cognitive health, but it is not clear whether this or other vitamins can help with bipolar disorder.

Overall, it is not clear that dietary supplements can help people with bipolar disorder. More studies are needed to confirm the benefits of any supplement.

Nutrients in the diet

However, a diet that provides a variety of nutrients through fresh foods can help protect a person from a range of health problems. Green leafy vegetables are high in folic acid, and citrus fruits are a great source of vitamin C.

Anyone with bipolar disorder who decides to use complementary medicine should continue with their prescribed medication therapy sessions, and they should consult their physician before using supplements or an alternative therapy.

Choose "natural" products with care

People sometimes use St. John's wort to treat depressive symptoms, but they may increase the risk of mania and interfere with antidepressants.

People with bipolar disorder should not use St. John's wort.

Always speak to a doctor before trying any natural or alternative therapy. Some can interact with other drugs, and they may have adverse effects.

The FDA does not officially regulate supplements and herbal products, so people may not know exactly what they are buying.

Counseling and CBT

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Research shows that CBT can help people to manage the challenges of bipolar disorder.

Counseling, for example, cognitive behavioral therapy (CBT) appears to be helpful in managing the symptoms of bipolar disorder.

A meta-analysis published in 2017 concluded that "CBT is effective in decreasing the relapse rate and improving depressive symptoms, mania severity, and psychosocial functioning."

The studies reviewed showed that the effects of CBT were "mild to moderate," and the improvements were most significant if a person attended sessions of 90 minutes or longer.

CBT can help people to identify negative and destructive habits and behaviors, and to change them to more positive ones.

A psychiatrist who specializes in bipolar disorder will normally guide a person's treatment.

Sometimes there may be a wider team of professionals, including a social worker and a counselor.

Medications

A doctor may prescribe mood-stabilizing medications during a manic episode.

These include:

  • lithium
  • valproic acid
  • carbamazepine
  • lamotrigine

Regular monitoring may be necessary, as the dose sometimes needs adjusting.

If a person experiences psychosis, they may also need an antipsychotic drug, such as:

  • olanzapine
  • risperidone
  • quetiapine
  • aripiprazole
  • ziprasidone
  • lurasidone
  • asenapine

Doctors do not usually prescribe antidepressants alone for a person with bipolar disorder, even during a low mood, because they can trigger a manic episode.

For this reason, the person will normally use an antidepressant with a mood stabilizer or antipsychotic.

A doctor may recommend hospitalization if a patient is experiencing psychosis or if their symptoms may pose a danger to themselves or other people.

Bipolar disorder requires lifelong treatment, even when patients with the disorder are feeling better.

However, some lifestyle considerations can help to make the condition more manageable.