Mitrochondrial dysunction plays a role in recurring mood  disorders and might explain why most treated patients have relapses according to leading investigator in psychiatry and psychopharmacology. This is a top story in the Clinical Psychiatry News, a psychiatry research journal, the October 2009 edition. Patients with mitochondrial disease such as certain forms of Parkinson's might be at increased risk for depressive disorders. Richard Shelton MD noted Lithium and valproate interact with mitochondria. Some mitochondria targeted anti-oxidants in drug development may be useful for bipolar disorder. "We can say with reasonable confidence that bipolar disorder is condition of mitochondrial dysfunction".
Two common nutritional supplements sold on Internet and in health food stores are mitochondrial modulators that might help patients with depressive disorders. Dr. Shelton recommends are N-acetly cysteine (NAC) at a dose of 2g per day and acetyl-l-carnitinne (AL-CAR) at a dose of 500mg twice a day. His patients have benefited but this evidence is anecdotal. He considered CoQ10 at 300 mg per day, alpha lipoic acid (ALA) at 600 mg twice a day, and creatine monohydrate at 3-5 g per day. ALA has been studied with clinical trials, none with unipolar or bipolar disorders.
Many people use SAMe or S-aenoslymethionine, in major depressive disorder, but Dr. Shelton discouraged its use. SAMe helps form glutathione, and homocysteine. Research shows a relationship between an accumulation of homocysteine and increased cardiovascular disease.