Do your patients with bipolar disorder use dietary supplements?

It is increasingly evident that physicians should routinely ask patients with bipolar disorder about the use of dietary supplements. In our recent study of 348 patients with bipolar disorder, about 3 out of 10 patients used dietary supplements in addition to prescribed drugs, with 2 in 10 of these taking supplements for the long term (Bauer et al. 2015). The patients tried about 40 different supplements, with fish oil, vitamin B preparations, multivitamins, and melatonin taken most frequently. Dietary supplements have the potential to interfere with the treatment of bipolar disorder due to patient misconceptions, and the safety and quality of some products. Patients may turn to dietary supplements to counteract side effects of prescribed drugs or because of a poor outcome. The majority of dietary supplements are selfselected, rather than recommended by a physician, and product choice is primarily influenced by friends, testimonials, aggressive marketing claims, price, and traditions (OIG 2012; New York State 2005). Many patients have misconceptions about dietary supplements, such as that “natural” is synonymous for safe, that supplements are safer than prescribed drugs, that megadoses are safe, and that the products and advertisements are preapproved by the FDA. Dietary supplements may interact with prescription drugs or with other dietary supplements (Izzo and Ernst 2009). Most interactions with dietary supplements reported in the literature involve prescription drugs that affect the central nervous system or cardiovascular system (Tsai et al. 2012). Patients with bipolar disorder may also be at increased risk of interactions because they often take multiple prescription drugs. Another concern is that some dietary supplements may potentially cause psychiatric adverse reactions such as anxiety, panic attack, confusion, hallucinations, or mania (Ernst 2003). The FDA estimates