There is a connection between folic acid and bipolar disorder. The benefits of folic acid supplements include:
1. Relief from depression (bipolar and unipolar).
2. Relief from bipolar mania.3 (folate as an adjunct to lithium in bipolar mania)
3. Prevention of serious birth defects such as spina bifida if you become pregnant and have a baby.
4. Avoiding the unpleasant effects of folic acid deficiency, including grey hair, swollen, inflamed tongue (glossitis), mouth ulcers, peptic ulcer, diarrhea, and anaemia.
Many so-called natural cures are just “old wives tales” or internet snake oil.
However, folic acid supplements have a growing body of medical evidence to prove they nourish the brain and really can help bipolar people. It is easy to benefit from the folic acid and bipolar disorder connection.1
Folic acid information
Folic acid is a B vitamin (B9) that the body needs to make healthy, new cells.
Folic acid is present in foods such as dried beans, peas, lentils, oranges, whole-wheat products, liver, asparagus, beets, broccoli, brussel sprouts, and spinach.
It is also thought that there is an association between folate levels in the blood and mood. Folic acid is regarded as a very safe substance with no specific side-effects.
The folic acid and bipolar connection
Folate has been linked to bipolar disorder in several studies.
There is research establishing the folic acid and bipolar disorder nexus.
Importantly, deficiency in folic acid has been associated with both depression and mania.4 (mood disturbances in folate deficiency)
The majority of folic acid and bipolar disorder research has been into depression.
Folic acid and bipolar disorder evidence
Below are a few of the studies showing the benefits of folic acid. These studies explain important folic acid facts. More studies exist, but these ones have abstracts available online that can give you a good indication of the research without being overwhelmingly technical or detailed.
1. A 1996 paper on Folic acid, vitamin B12, and neuropsychiatric disorders found that both folate and vitamin B12 deficiency may cause similar neurological and psychiatric disturbances including depression.
2. A 1997 study Reduced red-cell folic acid in mania found a relationship between folate deficiency and mania.
3. In 2005 it was suggested by a leading expert in this field of research that there was now enough folic acid facts to justify a recommended treatment of a daily folic acid supplement to improve treatment outcomes in depression. See Treatment of depression: time to consider folic acid and vitamin B12.
This is incredibly important given the lack of FDA approved anti-depressants for bipolar depression. Most bipolar people spend far more time in depression than in mania, yet there are far fewer effective anti-depressant drugs for bipolar people than there are anti-manic agents.
Folic acid supplements have also been shown to be useful as an add-on to other treatments such as lithium.3
It has also been shown that folic acid supplements increased the proportion of severely depressed female patients who responded to fluoxetine (Prozac), as reported by Dr. Alec Coppen and Dr. John Bailey of West Park Hospital in Surrey, England.
4. A 1986 double blind study on the benefits of folic acid involving patients receiving lithium therapy showed that the addition of 200 mcg of folic acid per day resulted in clinical improvement, whereas placebo did not.
This is great because it means we are not being faced with an either/or choice. It seems folic acid supplementation will be helpful if you take no medication, take an SSRI such as Prozac (not advised for bipolar people), or take the conventional mood stabilizer lithium.
You get the folic acid benefit in each scenario – as well as the myriad of other folic acid benefits.
5. The latest study into the benefits of folic acid and bipolar disorder is still on-going. The PRE-EMPT Trial attempted to establish whether folic acid supplementation prevented mood disorders in teenagers whose biological mother or father has experienced depression or mania.
It commenced in December 2005, however, its results were never published.
6. A randomized, double-blind, placebo control trial in 2014 attempted to answer a similar question. It found that there was no significant difference in the incidence of mood disorder development in young people with a family history who supplemented with folic acid.
However, it did find that the onset of mood disorder in this population may have been delayed in patients who were supplementing with folic acid versus those who did not.5
Taking folic acid
The current state of research suggests that for bipolar people to get the full benefits of folic acid, the ideal way is to take 0.8 mg daily. This can be as an oral solution or in pill form. Many people don’t like taking pills so liquid folic acid supplements are a popular way to a folic acid benefit.
The current recommended daily value (DV) of folic acid that everyone should take for optimal nutrition is 0.4 mg. It is possible to get this much folic acid through a normal diet, especially if you eat a breakfast cereal that has folic acid added. Examples are Total, Product 19, Cheerios Plus, Special K Plus, Life, All-Bran and Smart Start. The label on the side of the box should say “100%” next to folic acid.
However, to get the benefits of folic acid for treating bipolar or depression it is likely that a higher amount is needed. The research has been carried out using amounts that vary from 0.8 to 2.5 mg.
Given that folic acid is perfectly safe at much higher levels than the RDA of 0.4 mg, it seems like a good idea to go for the 0.8 mg daily dose for full folic acid benefit.2
PLEASE READ THE SECTION BELOW ON CAUTIONS AND CONSIDER ALSO TAKING A B12 SUPPLEMENT AS THE ONLY RISK OF FOLIC ACID SUPPLEMENTATION IS MASKING B12 DEFICIENCY.
Side effects and cautions
Folic acid is a water soluble vitamin. This means that any excess is simply excreted in urine. Toxic build-up or folic acid overdose are not possible. Even relatively high doses of 10-20mg/day are considered medically safe.
There is just one known health risk associated with taking folic acid. Ironically, this arises from one of the benefits of folic acid – its use in treating anemia. Anemia is a symptom of vitamin B12 deficiency. When people take folic acid the anaemia is relieved.
However, the other symptoms of vitamin B12 deficiency are not relieved by taking folic acid. Therefore taking folic acid can mask vitamin B12 deficiency. This is dangerous as B12 deficiency can cause permanent nerve damage.
The best way to get around this is to either (1) also take the recommended daily amount of B12 (cheap and easy), or (2) have blood levels taken to monitor B12 levels (more expensive and bothersome).
Folic acid and lithium
Another issue around folic acid and bipolar disorder is that folic acid will not interfere with lithium therapy. Instead, the two work together to nourish the brain.3
Two studies have found that people who take lithium long term, and who also have high blood levels of folic acid, respond better to lithium. See also important information on inositol and bipolar.
All people with bipolar disorder should consider whether their diets really do contain a good source of folic acid, or whether they need extra folic acid supplements.