(05-04-06) EPA Improves Clinical Symptoms in Bipolar Patients

Striking cross-country observations that the prevalence of various mental disorders rises sharply as seafood intake drops have drawn attention to the possible involvement of long-chain omega-3 polyunsaturated fatty acids (n-3 LC-PUFAs) in mental health. For example, bipolar disorder, a condition characterized by disabling mood swings from depression to mania, is more common in populations with low fish consumption. Small studies in patients with the condition, particularly the form where depression predominates, have reported significant clinical benefits when eicosapentaenoic acid (EPA) supplementation is added to regular medical treatment. No randomized controlled studies have been reported until now.

Frangou and colleagues at the Institute of Psychiatry in London evaluated the supplementation of 1 or 2 gm EPA/day for 12 weeks in 75 patients diagnosed primarily with Bipolar I disorder (65 of 75 patients), the depressive form of the condition. Participants were randomized to consume either dose of EPA or placebo in addition to their current medication and were clinically assessed at baseline and 12 weeks using the Hamilton Depressive, Young Mania, and Clinical Global Impression rating scales. The primary outcome measure was change in Hamilton rating score, with secondary evaluation the need to adjust or increase existing medication.

Patients consuming EPA achieved significantly lower Hamilton rating scales and clinical global impression scores (data not shown) at the end of 12 weeks of treatment compared to the baseline and with those on placebo (Figure 1). There were no significant differences in the Young Mania ratings or between the two doses.

These findings confirm the positive results from previous small trials with EPA or EPA and DHA in patients with bipolar disorder and suggest that EPA is an effective adjunct to current medical therapy in bipolar disorder. For example, in an uncontrolled study, Osher and colleagues recently observed that 7 of 10 bipolar patients consuming 2 gm EPA/day had 50% reductions in their Hamilton depression rating scores within a month of adding EPA to their treatment. EPA was well tolerated and did not induce mania in these patients. Both the Frangou and Osher studies reported improvements at low EPA doses without serious side effects, qualities that are appealing in view of the undesirable side effects associated with current drug therapies. Whether they would have positive effects in patients not on drug therapy remains unknown.
Source: Frangou S, Lewis M, McCrone P. Efficacy of ethyl-eicosapentaenoic acid in bipolar depression: randomized double-blind placebo-controlled study. Br J Psychiatry 2005;60:1-6.

Osher Y, Bersudsky Y, Belmaker RH. Omega-3 eicosapentaenoic acid in bipolar depression: report of a small open-label study. J Clin Psychiatry 2006;83:187-188.

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