Nutritional Supplements for Bipolar Disorder - EMPower for Aggression

Speaking of fantastic claims:

In 2000, this writer happened to come across an item in a Canadian newspaper about an Alberta Company, Synergy of Canada Ltd, that was test marketing a mix of 36 supplements, called EMPower, based on a formula to calm aggressive hogs. I ran a short item in my newsletter, McMan's Depression and Bipolar Weekly, and next thing the company was bombarded with enquiries about its product.

Founder Anthony Stephan's story is compelling, how after his bipolar wife Deborah committed suicide in 1994, and how after exhausting all medical routes, he turned to friend David Hardy for help for two of his bipolar children. David came up with a variation on his formula he used for calming down hogs, and Anthony administered the supplement to his kids. As he describes it:

"Joseph was treated with lithium. When he would take the lithium he complained of severe side effects ... when he refused it, he would lapse into severe mania and panic within a couple of days.

"On January 20, 1996, Joseph started using the nutritional supplementation program. He weaned off the lithium within four days. Within two weeks, his mood and emotional control improved drastically. He has maintained total wellness, and essentially no symptoms of bipolar since that time."

As for daughter Autumn, who first exhibited symptoms when she was 20 and became increasingly difficult to control with her rapid-cycling moods and suicidal states:

"On February 18, 1996, Autumn started the supplement program. Within four days she was forced to eliminate Haldol and Rivotril [Klonopin] because of the drastically increasing side effects. Ativan was no longer required as the mania became more manageable in the absence of hallucinations. After one week on the program, she returned home to her husband. After one month, she began the reduction and elimination of the Epival [Depakote] (used as a mood stabilizer). March 28, 1996 marks the last day that Autumn took medication for bipolar affective disorder.

"Autumn has remained stable and healthy beyond her wildest dreams and the expectations of her psychiatrist, doctor and family for over four years now. In her final visit with her psychiatrist, he indicated that there was never an expectation for remission, given her diagnosis and severe and unrelenting cycles."

The downside of the Synergy program is it initially costs in the neighborhood of $130 a month to go on the eight capsules four times a day regimen. This eventually comes down to about 16 capsules a day, but the expense is likely to come out of your pocket rather than your health plan's.

EMPower has not suffered from lack of controversy. Health Canada has attempted to shut down its operations, its nonprofit arm, Truehope, Synergy's nonprofit arm which works with patients, has been accused of being hostile to psychiatrists and medications, a number of patients have complained of getting worse rather than better, a quack watch group has made Synergy its great white whale, and its founders have been taken to task for making allegedly exaggerated claims.

In December 2001, however, Synergy received a significant boost to its credibility with a pilot study and accompanying commentary published in the Journal of Clinical Psychiatry. In a University of Calgary open trial, 14 bipolar patients were placed on EMPower, concurrent with their meds. Thirty-three of the 36 ingredients in the supplement are vitamins and minerals, most about 10 times the RDA. After 44 weeks, depression scores dropped by 55 percent and mania scores by 66 percent. Most patients were able to lower their meds doses by 50 percent. Two were able to replace their meds with the supplement. Three dropped out after three weeks. The only side effect was nausea, which went away at a lower dose.

In her article, the study's author, Dr Kaplan, noted that deficient levels of some nutrients (eg B vitamins) are related to brain and behavior disorders as well as poor response to antidepressant medication. Less is known about trace elements, but zinc, magnesium, and copper all appear to play important roles in modulating the brain's NMDA receptor (which is being targeted by at least 20 medications presently in the development pipeline). Bipolar disorder, she speculates, may be an error of metabolism, or those with bipolar may be vulnerable to nutrient deficiencies in the food supply. "There is very good work," she said in an interview, "going back to the 1950s on something called biochemical individuality. For example, your requirements for zinc or B12 may be different from another person's. We're not clones. We're really very different biochemically."

In the November 2002 Journal of Child and Adolescent Psychopharmacology, Dr Kaplan reviewed earlier findings into minerals and vitamins and mood, including:

• Low intracellular calcium levels in bipolar patients.
• Serum zinc levels significantly lower in depressed patients, with the severity of the deficiency corresponding with the severity of the illness.
• A double-blind trail finding resulted in improved cognition.
• Dr Benton's study linking thiamin at a high dose to improved cognition and selenium to improved mood.
• A year-long double-blind trial finding high-dose multivitamins improved mood.

In an accompanying commentary to Dr Kaplan's EMPower study, Charles Popper MD of Harvard observed: "In view of the 50 years of experience with lithium, the notion that minerals can treat bipolar disorder is unsurprising ... Depending on how this line of research develops, [we] may need to rethink the traditional bias against nutritional supplementation as a potential treatment for major psychiatric disorders."

Dr Popper notes other promising developments, including omega-3, calcium, chromium, inositol, amino acids, and high-dose multi-vitamins.

Dr Popper in his commentary mentioned using the supplement to treat 22 bipolar patients, 19 who showed a positive response, 11 who have been stable for nine months without drugs.

Dr Popper, who co-chaired the APA symposium mentioned at the beginning of this article, observed that while nutrient supplements are probably safer than psychiatric drugs, one should be mindful of toxic levels and special circumstances. For example, high doses of vitamin A need to be avoided in pregnant women owing to risk of fetal harm.