Mental Health Conditions: Bipolar Disorder, Anxiety and Supplements

If you are in a mental health crisis or thinking about hurting yourself, call or text 988 (the U.S. Suicide & Crisis Lifeline). It is free, confidential and open every day at all hours. [1] If someone is in immediate danger, call 911. [2] If someone has swallowed too much of a supplement or medicine, call Poison Help at 1-800-222-1222.

You are not doing anything wrong by looking at supplements. Many people with bipolar disorder, depression or anxiety do. This page explains what the sources we read say, so you can have an open conversation with the person who prescribes your care. Nothing here replaces treatment, and nothing here is a reason to stop a prescribed medicine. Ask the prescriber or pharmacist first.

Treatment first, supplements second

NIMH (part of NIH) says the FDA has not approved any complementary health approach for bipolar disorder, and that these approaches have not been comprehensively studied. [2] It also says bipolar disorder usually requires lifelong treatment and does not go away on its own. [2] NCCIH gives similar advice for depression: do not use a complementary health approach to replace conventional care or to delay seeing a health care provider. [3] Delaying care is the risk NCCIH points to.

Bipolar disorder

Bipolar disorder involves manic episodes, or unusually elevated moods, as well as depressive episodes. [2] That is why mood-active products need extra care.

• Antidepressant effect (documented for medicines). NIMH says antidepressants are not used alone in bipolar disorder because they can trigger a manic episode or rapid cycling. [2] This is about medicines. In the sources we read we did not find a trial testing the same question for herbal products, so we do not claim it applies to them.
• St. John's wort (Hypericum perforatum), reported cases. A systematic review of published case reports found 35 cases of mania linked to 11 herbal medicines, with St. John's wort the most common (14 reports). [4] The authors say causes are hard to prove because the reports are few and seven involved antidepressants taken at the same time. [4] A 2026 case report describes a man in his early twenties with no notable psychiatric history who developed manic and psychotic symptoms while taking standard doses. [5] Its authors call such reactions extremely rare. [5] These are single reports, not proof of how often it happens.
• Proper evidence not found: we searched NCCIH, NIMH and PubMed for controlled trials of St. John's wort in people who have bipolar disorder and found only the case reports above.

Source: the 2018 systematic review. [4] Every report involved use of the product, not stopping it. [4]

Medicine interactions

NCCIH says it has been clearly shown that St. John's wort can interact in dangerous, sometimes life-threatening ways with a variety of medicines. [6] Combining it with certain antidepressants or other drugs that affect serotonin may increase serotonin-related side effects, which can be serious. [6] NCCIH also says it can weaken the effects of many medicines, including some antidepressants such as amitriptyline and bupropion. [6] For depression, NCCIH adds that St. John's wort is not consistently effective. [3] See St. John's wort interactions, supplements and antidepressants and serotonin syndrome warning signs.

If you take lithium or another narrow-range medicine, ask your prescriber or pharmacist before adding anything. See narrow-range medicines.

Anxiety

• Kava. NCCIH says kava supplements have been linked to a risk of severe liver damage, and that more research is needed. [7] See kava and liver injury warning signs.
• Melatonin. NCCIH says people with epilepsy and people taking blood thinners need medical supervision when taking melatonin supplements. [7]
• Ashwagandha. NCCIH says ashwagandha might interact with sedatives and other medicine groups. [8] See ashwagandha interactions.

For care options, see anxiety disorders and when to get help for stress and anxiety.

What you can do

Write down every supplement, tea and extract you take, and bring the labels to your prescriber or pharmacist. Tell them if your mood, sleep or energy changes after starting something new. See talking with a health professional and when 988 comes first.