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Probiotics for Bipolar Mania

By: Marcelo Campos, MD

Bipolar disorder can be a debilitating disease. Dealing with this illness is quite difficult for patients, family, and friends. The manic phases can profoundly disrupt people’s quality of life. The cost is another reason for concern, as patients can be hospitalized for days until their symptoms are well controlled. After discharge there is a high risk of relapse, so careful observation is important to prevent rehospitalizations. But what if a simple supplement could help manage these serious flare-ups?

Bipolar disorder and gut health

There is growing evidence that mood disorders may be related to overall inflammation and to changes in the microbiome, the bacteria that live in our digestive tract. We have learned that probiotics may help improve a variety of health conditions, in part due to an anti-inflammatory effect.

Researchers from Johns Hopkins University School of Medicine designed an interesting study to determine if probiotics could help people discharged from the hospital after a manic flare-up avoid rehospitalization. The study randomized 66 patients with bipolar disorder who were hospitalized for mania and divided them into two groups of 33 patients. They gave a probiotic combination of Lactobacillus and Bifidobacterium species to one group and a placebo to the second group. They asked all patients to continue taking their regular medications for bipolar disorder and followed them for a total of 24 weeks. Before the start of the study, the researchers identified which patients had higher markers of inflammation (that is, people with more overall inflammation in the body).

What this study on probiotics and mania showed

The results were striking. The rates of rehospitalization were 51.1% in the placebo group and 24.2% in the group who took probiotics. On average, the reduction in readmission was 74% lower in the probiotic combination compared with the placebo arm of the study. The most significant finding was an almost 90% reduction of hospitalization in the group with the highest inflammation score who took probiotics. Additionally, patients who took probiotics and were rehospitalized stayed in the hospital on average 2.8 days, compared with 8.3 days for those taking placebo.

The microbiome and mood disorders beyond bipolar

This study adds to the data that suggest gut flora has an effect on psychiatric diseases. We still do not know if an intestinal microbiome disarray is the cause of mania and bipolar disorder. However, this research supports an assertion that overall inflammation is associated with gut inflammation, which in turn can modulate mood disorders, or at least severe cases of mania for bipolar patients. The evidence of a “gut-brain axis principle” is more robust, especially after some studies showing that the type of bacteria that live in our bowels could cause brain inflammation. This most recent research indicates that we could potentially manage the symptoms of severe cases of bipolar disorder merely by changing the makeup of our microbiome.

What now?

A few words of caution before you buy probiotics to address mood changes. The study was small, and the selected patient population had a more severe form of bipolar disorder. Similar studies for patients with milder symptoms of depression and schizophrenia found little to no effect when comparing probiotics to standard treatment. We need a lot more data from high-quality research to change what we currently recommend for the treatment of other psychiatric illnesses.

Yet, this research still has the potential to change practice after patients with bipolar disorder get discharged from the hospital for mania. Adding probiotics to the regular medication regimen is simple, cheap, has no side effects, and appears to be highly effective.

Thriving with BPAD

Dr Alice Lam – 22nd January 2020

Dr Alice Lam has worked as a GP both in the UK and Australia and has advocated for countless patients. To access her health writing service, please go to

A hopeful, holistic attitude with the right support means that people who live with bipolar disorder can thrive, not just ‘survive’.

It is so important to remember that you are not defined by your illness. Though bipolar disorder is thought to be biological in origin, with changes in genes accounting for maybe 60-70% of BPAD [1], it is also believed that the other factors are environmental, meaning there is so much that you can do to get better and stay well.

Making use of the medical model

The medical model emphasises regular monitoring, medications and psychotherapy to treat the condition in the acute and maintenance phase. Side effects such as weight gain or tremor from medications may need to be addressed in a collaborative manner with your doctor. Regular testing for medication levels, organ health (like kidney and liver function, cholesterol and sugar may also be necessary, especially as it has been found that there are higher rates of diabetes and cardiovascular disease in people with bipolar disorder [1].

Your team may include a psychiatrist, GP, psychologist, dietician, exercise physiologist and more. It’s important to find the right health care professionals so that you can feel comfortable and confident working with them towards your health goals. This article [2] might help you with some ideas on what to look for in your health care provider.

In addition to talking therapy with your psychiatrist and one-to-one sessions with a psychologist, therapy may be available in the form of inpatient or outpatient group programs. Depending on where you live in relation to public and private psychiatric facilities, available programs might include: Cognitive Behavioural Therapy (CBT), Mindfulness, Schema therapy, Acceptance and Commitment Therapy (ACT), Interpersonal therapy, Art and Music therapy to name a few. Many people have found such courses invaluable, not just because they are taught in a kind, supportive environment but also because the benefits of these tools can last a lifetime. Ask your psychiatrist about these if you are interested.

You can also speak to your GP about the following Care Plans, which can help eligible persons with allied health costs:

  • GP Mental Health Care Plan – you can read more on this here [3].
  • GP Management Plan – you can read more on this here [4].

Bringing in a wellness and recovery focus

A more person-centred, holistic approach complements your other treatments by strongly encouraging appropriate lifestyle modifications and personal strategies.

Some of these personal stories [5] on the Depression and Bipolar Support Alliance (DBSA) website by people with lived experience of bipolar disorder may inspire you further on your own journey. Here are some of their experiences:

  • Enjoying a safe space to share stories and be more open about the condition
  • Feeling it was cathartic to be able to speak about the condition
  • Feeling they were not helpless or worthless
  • Being able to share both the struggles and the journey
  • Being able to celebrate small successes to build strength and hope
  • Finding it helpful to learn about topics such as self-management, new research etc.

Remember you are not alone – a helpful exercise might be to write down the people who are in your support network. This might include a partner, peers from a local group (or online forum), friends, family, doctor or psychologist. These people can offer not only a listening ear but can also help you reach your goals.

Dr.Holly Swartz, Professor of Psychiatry at University of Pittsburgh School of Medicine, U.S.A. highly recommends optimising lifestyle factors given bipolar disorder doubles the rate of cardiovascular disease and medications exacerbate it. Healthy schedules, routine and sleep are all therefore needed to support bipolar disorder recovery and to achieve goals [6].

The Quality of Life Tool (QoL) tool [7] was produced by The Collaborative RESearch Team to study psychosocial issues in Bipolar Disorder. It is a free online resource for a user to intermittently fill in a simple questionnaire where they can rate satisfaction levels for energy, mood, sleep, work, money, relationships and other domains. The tool then displays the data as a graph and table where the user can easily see where they’ve progressed, and where they might want to focus more attention.

You can find some tips in our October [8] newsletter on Routine, Goal Setting and Values and the DBSA has some useful information here too [9].

Check our newsletter for the next monthly support group your area.



  1. Fink, C. and Kraynak, J., 2016. Bipolar Disorder for Dummies. 3rd ed. New Jersey,
    John Wiley & Sons, Inc.
  2. Dr Alice Lam, GP & Health Writer. 2020. How To Get The Best Out Of Your GP. [ONLINE] Available at: [Accessed 17 January 2020].
  3. healthdirect. 2020. Mental health care plan. [ONLINE] Available at: [Accessed 17 January 2020].
  4. The Department of Health. 2020. Chronic Disease Management Patient Information. [ONLINE] Available at: [Accessed 17 January 2020].
  5. Depression and Bipolar Support Alliance. 2020. Videos. [ONLINE] Available at: [Accessed 17 January 2020].
  6. Depression and Bipolar Support Alliance. 2020. Videos: Thriving with Bipolar – Treatment plans and collaborating with your doctor. [ONLINE] Available at: [Accessed 17 January 2020].
  7. CREST.BD. 2020. CREST.BD Quality of Life Tool. [ONLINE] Available at: [Accessed 17 January 2020].
  8. BipolarLife. 2020. Newsletter – October 2019. [ONLINE] Available at: [Accessed 17 January 2020].
  9. Depression and Bipolar Support Alliance. 2020. Setting & Achieving Goals. [ONLINE] Available at: [Accessed 17 January 2020].


Come along to our newly formed Women’s Support Group held on the fourth Tuesday of every month at The Youth House next to the Monash Church of Christ, 44-48 Montclair Ave, Glen Waverley 3150, 7:30pm – 9:30pm.

Gain support, understanding and friendship in a safe and open environment.

You will always be made to feel welcome.

Food and refreshments provided.

Contact : Amanda 0403 535 332 or email [email protected]

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