Bipolar disorder is the 6th leading cause of disability worldwide, according to the World Health Organization, resulting in nine-year reduction in expected lifespan. Sadly, statistics from the National Institute of Mental Health (NIMH) also show that as many as one in five patients with bipolar disorder completes suicide.
Further, while nine out of 10 people are satisfied with their treatment for bipolar disorder, the Depression and Bipolar Support Alliance says side effects remain a problem.
Well, a new study shows that those who have bipolar disorder might benefit from dietary intervention that emphasizes increasing omega-3s EPA and DHA, while reducing omega-6 fatty acids. The study was presented at the American Society of Clinical Psychopharmacology (ASCP) 2020 Virtual Conference in late May.
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The lead study investigator, Dr. Erika Saunders, believes the omega-3s in particular are responsible for mood stability in bipolar disorder, at least according to this latest research. And the suspected mechanisms for how this happens is through omega-3s’ incorporation into the membranes of neurons in the brain as well as their creation of signaling molecules.
Dr. Saunders is Chair for the Department of Psychiatry; Director of the Mood Disorder Program and Associate Professor at Penn State Milton S. Hershey Medical Center. In addition, she is an adjunct research investigator at the University of Michigan Medical School.
Before we dive into the details of Dr. Saunders’s study, let’s discuss some of the specifics about bipolar disorder.
The Highs and Lows of Bipolar Disorder
According to the NIMH, bipolar disorder (formerly called manic-depressive illness or manic depression) is a mental disorder that causes unusual shifts in mood, energy, activity levels, concentration, and the ability to carry out day-to-day tasks.
There are three types of bipolar disorder — Bipolar I, Bipolar II and Cyclothymic disorder. All three types, NIMH says, involve clear changes in mood, energy, and activity levels. These moods range from periods of extremely “up,” elated, irritable, or energized behavior (known as manic episodes) to very “down,” sad, indifferent, or hopeless periods (known as depressive episodes). Less severe manic periods are known as hypomanic episodes.
Bipolar I Disorder is defined by manic episodes that last at least seven days, or by manic symptoms that are so severe that the person needs immediate hospital care. Usually, depressive episodes occur as well, typically lasting at least two weeks. Episodes of depression with mixed features (having depressive symptoms and manic symptoms at the same time) are also possible.
Bipolar II Disorder is defined by a pattern of depressive episodes and hypomanic episodes, but not the full-blown manic episodes that are typical of Bipolar I Disorder.
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Cyclothymic Disorder (also called Cyclothymia) is defined by periods of hypomanic symptoms as well as periods of depressive symptoms lasting for at least two years (1 year in children and adolescents). However, the symptoms do not meet the diagnostic requirements for a hypomanic episode and a depressive episode.
Sometimes a person might experience symptoms of bipolar disorder that do not match the three categories listed above, which is referred to as “other specified and unspecified bipolar and related disorders.”
The Latest Research
The subjects in this study ranged in age from 20 to 75 years old and had similar levels of mood symptoms and pain. In addition to the treatment these study subjects were already receiving, 41 of them also consumed a diet high in omega-3 fatty acids and low in omega-6 fatty acids, while the others (n=41) received a control diet with omega-3 and omega-6 levels typical in the US diet. They did this for a period of 12 weeks.
Neither of the groups knew the omega-3 or omega-6 content of their food, and all received an abundance of guidance from a dietitian, along with recipes and advice on how to eat out at restaurants.
According to one of the researchers, the group receiving the high omega-3/low omega-6 diet, for example, would eat more salmon and tuna, while the other ate more white fish and seafood with low omega-3 content. Alongside these dietary changes, the intervention group also used a different type of cooking oil, which contained a blend of macadamia and olive oil.
At the conclusion of the study, researchers noted significant reductions in subjects’ mood swings, energy, irritability and pain.
Dr. Saunders explained to Medscape that studies like this are necessary since many bipolar patients do not achieve complete mood stability with medication, making the need for additional treatments imperative.
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Other Recent Studies on Omega-3s and Mental Health
Some consistent features in those who have been diagnosed with bipolar disorder include anxiety and depression. The research on omega-3s in these areas is a bit more advanced than bipolar disorder, and the studies have been largely positive, as long as subjects were given appropriate doses.
Like the recent bipolar/omega-3 study discussed earlier in this blog, a study published in World Psychiatry last September focused specifically on strong the connection is between diet and mental health. Researchers who conducted this study believe we all have the ability to control the foods that impact our mood. And if we can focus on the ones that deliver nutrients shown in research to benefit our mental health most, then we could be well on our way to preventing and even treating some of these disorders down the road.
In this vein, a team led by Sydney’s NICM Health Research Institute conducted the world’s largest review (a meta-synthesis) of top-tier evidence, examining 33 meta-analyses of randomized control trials (RCTs) and data from nearly 11,000 people with mental health disorders, including depression, stress and anxiety disorders, bipolar disorder, personality disorders, schizophrenia and attention-deficit/hyperactivity disorder (ADHD).
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Although the majority of nutritional supplements assessed did not significantly improve mental health, the researchers found strong evidence that certain supplements are an effective additional treatment for some mental disorders, supportive of conventional treatment.
All nutrient supplements were found to be safe when recommended dosages and prescriptive instructions were adhered to and there was no evidence of serious adverse effects or contraindications with psychiatric medications.
The strongest evidence was found for omega-3 supplements as an add-on treatment for major depression — reducing symptoms of depression beyond the effects of antidepressants alone.
Further, there was some evidence to suggest that omega-3 supplements may also have small benefits for ADHD.
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Another study, published in Psychotherapy and Psychosomatics, evaluated the potential of omega-3s as adjunctive treatment for depression. In this case, a subcommittee of the International Society of Nutritional Psychiatry Research (ISNPR) organized an expert panel to develop a consensus-based practice guideline for the clinical use omega-3s in major depressive disorder (MDD).
The panel focused their efforts on five important areas, including general concepts, acute treatment strategy, depression recurrence monitoring and prevention, use in special populations, and potential safety issues. From there, they devised several strategies to assist doctors in administering omega-3s to their patients.
- Clinicians and other practitioners are advised to conduct a clinical interview to validate clinical diagnoses, physical conditions, and measurement-based psychopathological assessments in the therapeutic settings when recommending omega-3s in depression treatment.
- With respect to formulation and dosage, both pure eicosapentaenoic acid (EPA) or an EPA/docosahexaenoic acid (DHA) combination of a ratio higher than 2 (EPA/DHA >2) are considered effective, and the recommended dosages should be 1–2 grams of net EPA daily, from either pure EPA or an EPA/DHA (>2:1) formula. Doctors should keep in mind that quality might affect the therapeutic value of the omega-3 product.
- Potential adverse effects, such as gastrointestinal and dermatological conditions, should be monitored, as well as obtaining comprehensive metabolic panels. The expert consensus panel has agreed on using omega-3s EPA and DHA in MDD treatment for pregnant women, children, and the elderly, and prevention in high-risk populations.
The ISNPR subcommittee also suggested future research in this area focus on personalizing the clinical application of omega-3s in subgroups of MDD who have a low Omega-3 Index or high levels of inflammatory markers.
The Omega-3 Index has deep roots in the heart health arena. But its role in brain health is at the forefront of current research. As there is an established Omega-3 level for heart health and pregnancy, there might one day be a specific cut point for mental health and cognitive function. There is definitely more to this story, so stay tuned.