(20-10-09) Long-Chain Omega-3 PUFAs Promising in Adolescents with Bipolar Disorder

One of the most challenging mental health conditions to treat and manage is bipolar disorder, a group of mood disorders characterized by episodes of mania or hypomania and depressive spells. These mood swings are more severe than the ups and downs of daily life. Left untreated, the condition can be disabling. In
America alone, bipolar disorders affect nearly 6 million adults or from 2% to 5% of the adult population. The condition most frequently appears first in adolescence and approximately 1% of adolescents develop it. This prevalence doubles by young adulthood. Individuals who develop bipolar disorder are more likely to have psychosocial problems and borderline personality symptoms. These
observations underscore the urgency of finding safer, effective treatments for the disorder. Although several drugs are used to alleviate symptoms, all have side effects that contribute to low compliance.

Long-chain omega-3 polyunsaturated fatty acids (n-3 LC-PUFAs) have generated research interest as a possible alternative to current drug treatments. Besides being benign, blood levels of these fatty acids are depressed in patients with bipolar disorder. Although the literature on their use in bipolar disorder is small, several small studies have reported promising findings. A recent review
concluded that a combination of the n-3 LC-PUFAs eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) was associated with significant improvements in symptoms. However, there may be considerable differences in their effects on
the manic and depressive phases of the illness. Most studies to date have involved only a small number of patients and differed in their design, fatty acid doses and duration, usually in the context of an adjunct to mood-stabilizing drugs. Thus, larger studies of solid design are much needed.

The study described here was a small open-label (unblinded) experiment of pre-and-post design involving 18 participants diagnosed with bipolar disorder I, II or unspecified. All were taking mood-stabilizing medications and were stabilized on these medications for at least 6 weeks prior to enrolment.
Patients included both sexes averaging 16 years of age for the females and 13 for the males. Participants took n-3 LC-PUFAs as an add-on treatment and continued their other psychotropic medications. All participants consumed tuna oil capsules providing 360 mg EPA and 1560 mg DHA daily for 6 weeks. Three participants withdrew from the study because of gastrointestinal disturbance.

Symptoms of mania were assessed with the Young Mania Rating Scale and for depression with the Hamilton Depression Rating Scale. The investigators used the Global Assessment Scale for Children to assess global functioning, while parents assessed internalizing and externalizing behavior before and after supplementation using the Child Behavior Checklist-Parent Report.

Compared with baseline values, red blood cell EPA and DHA concentrations increased significantly, although docosapentaenoic acid levels fell slightly, but significantly. Both clinician assessments of mania and depression fell significantly with n-3 LC-PUFA supplementation, while scores on global functioning increased significantly (Figure). Parental ratings of internalizing and externalizing behavior were significantly improved after EPA and DHA
supplementation. The age of the participant and the number of years between diagnosis and study enrolment were directly related to improvements in the
parents? ratings of internalizing and externalizing symptoms. Changes in the red blood cell n-3 LC-PUFA concentrations were not associated with the changes in symptoms, probably because of the small number of participants.

A small, open-label study such as this has clear limitations, including
investigator and participant bias because no placebo control group was
included, and the effects of other confounding variables. The fact that the participants were stabilized on their medications suggests that the changes in symptoms were due to the n-3 LC-PUFA intervention, not the drug therapy.
Without a control group, one cannot assess the effect of participation bias and medications alone. Also, the number of participants was small. In spite of these serious limitations, the study suggests that n-3 LC-PUFAs might be of substantial benefit in patients with bipolar disorder, especially in treating the depressive phase. Improvements in mania, while statistically significant, were less than 50%, the criterion often used to gauge clinical effectiveness.

Clayton EH, Hanstock TL, Hirneth SJ, Kable CJ, Garg ML, Hazell PL. Reduced mania and depression in juvenile bipolar disorder associated with long-chain ?-3 polyunsaturated fatty acid supplementation.

Source: Eur J Clin Nutr 2009;63:1037-1040.

News

---

In evidenza

"L'informazione presente nel sito serve a migliorare, e non a sostituire, il rapporto medico-paziente."

Per coloro che hanno problemi di salute si consiglia di consultare sempre il proprio medico curante.