Medication-free Alternatives for Long-term Maintenance of Bipolar Disorder: A Case Series

Michael I. Gurevich, Md and Cassandra L. Robinson, Ms, Lpn

Michael I. Gurevich

Private Psychiatric Practice, Glen Head, New York

Find articles by Michael I. Gurevich

Cassandra L. Robinson

Helfgott Research Institute, National College of Natural Medicine, Portland, Oregon

Find articles by Cassandra L. Robinson
Author information Copyright and License information Disclaimer
Private Psychiatric Practice, Glen Head, New York
Helfgott Research Institute, National College of Natural Medicine, Portland, Oregon


Psychopharmacological treatment has been the mainstay in long-term maintenance of bipolar disorder (BD) patients for the last 60 years. Conventionally accepted treatment options are primarily based on expert opinion rather than on well-executed, independently funded research. Investigation of maintaining patients without medications using treatment alternatives has been neglected. This clinical case series examines the outcomes of 7 BD patients who experienced a poor response or significant side effects with conventional treatment modalities. Patients were gradually and safely withdrawn from all medications. Treatment strategies were based on an individualized holistic approach using herbs, nutritional supplements, vitamins, amino acids, acupuncture, dietary recommendations, and behavioral modifications. Multiple treatment modalities were combined addressing the etiological causes for BD symptoms. Upon withdrawal from psychotropic medications, patients were free of medication-induced side effects and obtained psychiatric stability for at least 10 months. Further research is needed to investigate the long-term outcomes of BD treatment modalities based on well-defined successful outcome criteria, such as reduction in symptoms, improvement in quality of life, overall health outcomes, and cost effectiveness.

Keywords: Bipolar, medication-free maintenance treatment, integrative


El tratamiento psicofarmacológico ha sido el pilar fundamental en el mantenimiento a largo plazo de los pacientes con trastorno bipolar durante los últimos 60 años. Las opciones terapéuticas aceptadas convencionalmente se basan principal-mente en la opinión de los expertos y no en investigaciones bien realizadas y financiadas de forma independiente. La investigación del mantenimiento de pacientes sin medica-mentos usando tratamientos alternativos no ha recibido mucha atención. Esta serie de casos clínicos examina los resultados de 7 pacientes con trastorno bipolar que experimen-taron una respuesta escasa o efectos secundarios significativos con modalidades de tratamiento conven-cionales. A los pacientes se les retiró toda la medicación de forma gradual y segura. Las estrategias terapéuticas se basaron en un enfoque individual holístico, utilizando productos de herboristería, suplementos nutricio-nales, vitaminas, aminoácidos, acupuntura, recomendaciones dieté-ticas y modifcaciones del comportamiento. Se combinaron múltiples modalidades terapéuticas para abordar las causas etiológicas de los sínto-mas de trastorno bipolar. Tras la reti-rada de la medicación psicotrópica, los pacientes no tenían efectos secundarios inducidos por los fárma-cos y habían conseguido estabilidad psiquiátrica durante al menos 10 meses. Es necesaria más investig-ación para averiguar los resultados a largo plazo de las modalidades tera-péuticas del trastorno bipolar basa-dos en criterios de resultados positivos bien definidos, tales como la reducción de los síntomas, la mejora de la calidad de vida, los resultados generales de salud, y la rentabilidad.


1. Hirschfeld RMA, Bowden CL, Gitlin MJ, et al.
Practice guideline for the treatment of patients with bipolar disorder. In: American Psychiatric Association, editor. American Psychiatric Association practice guidelines for the treatment of psychiatric disorders.
Washington, DC: American Psychiatric Association; 2002: 547–634. []
2. Mukherjee S, Sackeim H, Schnur D.
Electroconvulsive therapy of acute manic episodes: a review of 50 years’ experience.
Am J Psychiatry.
1994; 151(2): 169–76. [PubMed] []
3. Sikdar S, Kulhara P, Avasthi A, Singh H.
Combined chlorpromazine and electroconvulsive therapy in mania.
Br J Psychiatry.
1994; 164(6): 806–10. [PubMed] []
4. Small JG, Klapper MH, Kellams JJ, et al.
Electroconvulsive treatment compared with lithium in the management of manic states.
Arch Gen Psychiatry.
1988; 45(8): 727–32. [PubMed] []
5. Baldessarini R, Henk H, Sklar A, Chang J, Leahy L.
Psychotropic medications for patients with bipolar disorder in the United States: polytherapy and adherence.
Psychiatr Serv.
2008; 59(10): 1175–83. [PubMed] []
6. Freeman MP, Stoll AL.
Mood stabilizer combinations: a review of safety and efficacy.
Am J Psychiatry.
1998; 155(1): 12–21. [PubMed] []
7. Verdoux H, Tournier M, Bégaud B.
Antipsychotic prescribing trends: a review of pharmaco-epidemiological studies.
Acta Psychiatr Scand.
2010; 121(1): 4–10. [PubMed] []
8. Gallego JA, Bonetti J, Zhang J, Kane JM, Correll CU.
Prevalence and correlates of antipsychotic polypharmacy: a systematic review and metaregression of global and regional trends from the 1970s to 2009.
Schizophr Res.
2012; 138(1): 18–28. [PMC free article] [PubMed] []
9. Olfson M, Blanco C, Liu SM, Wang S, Correll CU.
National trends in the office-based treatment of children, adolescents, and adults with antipsychotics.
Arch Gen Psychiatry.
2012; 69(12): 1247–56. [PubMed] []
10. Stephenson CP, Karanges E, McGregor IS.
Trends in the utilisation of psychotropic medications in Australia from 2000 to 2011.
Aust N Z J Psychiatry.
2013; 47(1): 74–87. [PubMed] []
11. Buoli M, Marta S, Carlo AA.
Is the combination of a mood stabilizer plus an antipsychotic more effective than mono-therapies in long-term treatment of bipolar disorder? A systematic review.
J Affect Disord.
2013: 1–7. [PubMed] []
12. Bowden CL, Calabrese JR, Sachs G, et al.
A placebo-controlled 18-month trial of lamotrigine and lithium maintenance treatment in recently manic or hypomanic patients with bipolar I disorder.
Arch Gen Psychiatry.
2003; 60(4): 392–400. [PubMed] []
13. Thase ME, Bhargava M, Sachs GS.
Treatment of bipolar depression: current status, continued challenges, and the STEP-BD approach.
Psychiatr Clin North Am.
2003; 26(2): 495–518. [PubMed] []
14. Baldessarini RJ, Tondo L, Viguera A.
Discontinuing lithium maintenance treatment in bipolar disorders: risks and implications.
Bipolar Disord.
1999; 1(1): 17–24. [PubMed] []
15. Suppes T, Baldessarini RJ, Faedda GL, Tondo L, Tohen M.
Discontinuation of maintenance treatment in bipolar disorder: risks and implications.
Harv Rev Psychiatry.
1993; 1(3): 131–44. [PubMed] []
16. Baldessarini RJ, Tondo L.
Recurrence risk in bipolar manic-depressive disorders after discontinuing lithium maintenance treatment: an overview.
Clin Drug Investig.
1998; 15(4): 337–51. [PubMed] []
17. Suppes T, Baldessarini RJ, Faedda GL, Tohen M.
Risk of recurrence following discontinuation of lithium treatment in bipolar disorder.
Arch Gen Psychiatry.
1991; 48(12): 1082–8. [PubMed] []
18. Sachs GS, Thase ME.
Bipolar disorder therapeutics: maintenance treatment.
Biol Psychiatry.
2000; 48(6): 573–81. [PubMed] []
19. Judd LL, Akiskal HS, Schettler PJ, et al.
The long-term natural history of the weekly symptomatic status of bipolar I disorder.
Arch Gen Psychiatry.
2002; 59(6): 530–7. [PubMed] []
20. Judd LL, Akiskal HS, Schettler PJ, et al.
A prospective investigation of the natural history of the long-term weekly symptomatic status of bipolar II disorder.
Arch Gen Psychiatry.
2003; 60(3): 261–9. [PubMed] []
21. Peselow ED, Fieve RR, Difiglia C, Sanfilipo MP.
Lithium prophylaxis of bipolar illness. The value of combination treatment.
Br J Psychiatry.
1994; 164(2): 208–14. [PubMed] []
22. Kahneman D, editor. editor. Thinking, fast and slow.
New York, NY: Farrar, Straus and Giroux; 2011. []
23. Tversky A, Kahneman D.
Judgement under uncertainty: heuristics and biases.
1974; 185(4157): 1124–31. [PubMed] []
24. Zandi PP, Judy JT.
The promise and reality of pharmacogenetics in psychiatry.
Psychiatr Clin North Am.
2010; 33(1): 181–224. [PMC free article] [PubMed] []
25. Gianfrancesco FD, Rajagopalan K, Sajatovic M, Wang R.
Treatment adherence among patients with bipolar or manic disorder taking atypical and typical antipsychotics.
J Clin Psychiatry.
2006; 67(2): 222–32. [PubMed] []
26. Zarate CA.
Antipsychotic drug side effect issues in bipolar manic patients.
J Clin Psychiatry.
2000;61(suppl 8):52–61. [PubMed] []
27. Kaplan BJ, Simpson JS, Ferre RC, Gorman CP, McMullen DM, Crawford SG.
Effective mood stabilization with a chelated mineral supplement: an open-label trial in bipolar disorder.
J Clin Psychiatry.
2001; 62(12): 936–44. [PubMed] []
28. Gardner A, Kaplan BJ, Rucklidge JJ, Jonsson BH, Humble MB.
The potential of nutritional therapy.
2010; 327(5963): 268. [PubMed] []
29. Akhondzadeh S, Gerbarg PL, Brown RP.
Nutrients for prevention and treatment of mental health disorders.
Psychiatr Clin North Am.
2013; 36(1): 25–36. [PubMed] []
30. Lakhan SE, Vieira KF.
Nutritional therapies for mental disorders.
Nutr J.
2008; 7: 2. [PMC free article] [PubMed] []
31. Frazier EA, Fristad MA, Arnold LE.
Feasibility of a nutritional supplement as treatment for pediatric bipolar spectrum disorders.
J Altern Complement Med.
2012; 18(7): 678–85. [PubMed] []
32. Gately D, Kaplan B.
Database analysis of adults with bipolar disorder consuming a micronutrient formula.
Clin Med Psychiatry.
2009; 4: 3–16. []
33. Popper C.
Do vitamins or minerals (apart from lithium) have mood-stabilizing effects?
J Clin Psychiatry.
2001;62(12):933–5. [PubMed] []
34. Sylvia LG, Peters AT, Deckersbach T, Nierenberg AA.
Nutrient-based therapies for bipolar disorder: a systematic review.
Psychother Psychosom.
2013; 82(1): 10–9. [PubMed] []
35. Sarris J, Mischoulon D, Schweitzer I.
Adjunctive nutraceuticals with standard pharmacotherapies in bipolar disorder: a systematic review of clinical trials.
Bipolar Disord.
2011;13(5-6):454–65. [PubMed] []
36. Busner J, Targum SD.
The Clinical Global Impressions Scale: applying a research tool in clinical practice.
2007; 4(7): 28–37. [PMC free article] [PubMed] []
37. Gottschall EG, editor. editor. Breaking the vicious cycle: intestinal health through diet.
Baltimore, ON: Kirkton Press; 1994. []
38. Haas SV, Haas MP.
The treatment of celiac disease with the specific carbohydrate diet; report on 191 additional cases.
Am J Gastroenterol.
1955; 23(4): 344–60. [PubMed] []
39. Ulsamer B, editor. editor. The art and practice of family constellations. Leading family constellations as developed by Bert Hellinger.
Heidelberg, Germany: Carl Auer International; 2008. []
40. Waite WL, Holder MD.
Assessment of the emotional freedom technique.
Sci Rev Ment Health Pract.
2003; 2(1): 1–10. []
41. Salas MM, Brooks AJ, Rowe JE.
The immediate effect of a brief energy psychology intervention (Emotional Freedom Techniques) on specific phobias: a pilot study.
2011; 7(3): 155–61. [PubMed] []
42. Davidson PR, Parker KCH.
Eye movement desensitization and reprocessing (EMDR): a meta-analysis.
J Consult Clin Psychol.
2001; 69(2): 305–16. [PubMed] []
43. Shapiro F, Solomon RM.
Eye movement desensitization and reprocessing. In: Weiner IB, editor; , Craighead WE, editor. , editors. Corsini encyclopedia of psychology.
Hoboken, NJ: John Wiley & Sons, Inc.; 2010. []
44. Klinghardt D, editor. editor. Applied psycho-neurobiology seminar and manual.
Redmond, WA: Klinghardt Academy; 2012. []
45. Salzberg S, editor; , Goldstein J, editor. editors. Insight meditation.
Louisville, CO: Sounds True (Audio CD); 2004. []
46. Dosch P, editor; , Dosch MP, editor. editors. Manual of neural therapy according to Huneke.
New York, NY: Thieme; 2007. []
47. Dosch MP, editor. editor. Atlas of neural therapy with local anesthetics.
New York, NY: Thieme; 2012. []
48. Frances A, editor. editor. Saving normal: an insider’s revolt against out-of-control psychiatric diagnosis, DSM-5, Big Pharma, and the medicalization of ordinary life.
New York, NY: William Morrow Paperbacks; 2012. []
49. Frances A.
How many psychiatric diagnoses fit on the head of a pin?
Aust N Z J Psychiatry.
2014;48(11):1067–8. [PubMed] []
50. Frances A.
ICD, DSM and the Tower of Babel.
Aust N Z J Psychiatry.
2014; 48(4): 371–3. [PubMed] []
51. Frances A.
The new crisis of confidence in psychiatric diagnosis.
Ann Intern Med.
2013; 159(10): 720. [PubMed] []
52. Healy D, editor. editor. Pharmageddon.
Oakland, CA: University of California Press; 2013. []
53. Mrazek DA, Hornberger JC, Altar CA, et al.
A review of the clinical, economic and social burden of treatment-resistant depression: 1996-2013.
Psychiatr Serv.
2014; 65(8): 977–87. [PubMed] []
54. Rucklidge JJ, Kaplan BJ.
Broad-spectrum micronutrient formulas for the treatment of psychiatric symptoms: a systematic review.
Expert Rev Neurother.
2013; 13(1): 49–73. [PubMed] []
55. Scarna A, Gijsman HJ, McTavish SF, Harmer CJ, Cowen PJ, Goodwin GM.
Effects of a branched-chain amino acid drink in mania.
Br J Psychiatry.
2003; 182: 210–3. [PubMed] []
56. Stoll AL, Sachs GS, Cohen BM, Lafer B, Christensen JD, Renshaw PF.
Choline in the treatment of rapid-cycling bipolar disorder: clinical and neurochemical findings in lithium-treated patients.
Biol Psychiatry.
1996; 40(5): 382–8. [PubMed] []
57. Sartori HE.
Lithium orotate in the treatment of alcoholism and related conditions.
1986; 3(2): 97–100. [PubMed] []
58. Sarris J, Lake J, Hoenders R.
Bipolar disorder and complementary medicine: current evidence, safety issues, and clinical considerations.
J Altern Comp Med.
2011; 17(10): 881–90. [PubMed] []
Leave a Reply