Nutraceuticals and phytoceuticals in the treatment of bipolar disorder: A systematic review and network meta-analysis.

What was studied

This network meta-analysis looked at nutraceuticals and plant-based products in bipolar disorder. It pooled randomized trials with 2,222 people in all. The trials tested 22 treatments. The key outcomes were shifts in depressive or manic symptoms. Others were response and acceptability. The authors searched databases from the start to July 1, 2025.

What they found

No treatment beat placebo for depressive symptoms. Placebo did better than palmitoylethanolamide (PEA) in one trial. For manic symptoms, PEA and folic acid did better than placebo. The difference was -4.58 for PEA and -2.42 for folic acid. Results varied a lot between trials. The PEA finding relied on one trial from a region with larger effects. Free-and-easy-wanderer-plus combined with carbamazepine did better than placebo for response and acceptability.

What it means for patients

The authors say current evidence does not support firm advice for any of these products. This applies to acute bipolar depression or mania. They say more high-quality research is needed.

Why it is not certain yet

Confidence in the evidence was mostly low or very low. This was most true for manic symptoms. The PEA result came from one trial. Larger effects went with lower study quality scores.

Source

Nutraceuticals and phytoceuticals in the treatment of bipolar disorder: A systematic review and network meta-analysis.

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