11 - The role of fish oil in managing Bipolar II Disorder  pp. 141-150

The role of fish oil in managing Bipolar II Disorder

By Anne-Marie Rees and Gordon Parker

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Introduction

As noted earlier (Chapter 5), an increase in Bipolar II Disorder (BP II) is suggested. Any prevalence increase could be artefactual, reflecting changes in attribution, definition, destigmatisation, help-seeking or other factors. Alternately, there may have been a real increase and numerous determinants have been proposed, including genetic factors, greater use of illicit drugs and many social and environmental factors. In relation to the last, there has been considerable interest in a dietary contribution, particularly involving omega-3 fatty acids.

What are omega-3 fatty acids?

Omega-3 (n-3) fatty acids are long-chain polyunsaturated fatty acids (PUFAs) found in various plant and marine life. The marine-based n-3 PUFAs primarily consist of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), and appear to be highly biologically active. In contrast, plant-based n-3 PUFAs, from flaxseed, walnuts and canola oil, are usually in the form of the parent n-3 PUFA, alpha-linolenic acid (ALA). Although dietary ALA can be endogenously converted to EPA and DHA (see the metabolic pathways in Figure 11.1), this process occurs inefficiently, with only 10–15% of ALA being metabolised in this way.

The history of n-3 PUFAs

In the last 150 years, rapid expansion in western populations has been associated with a change in diet, with n-3 PUFAs from fish, wild game and plants being replaced by saturated fats from domestic animals and omega-6 (n-6) PUFAs from common vegetable oils (corn, safflower and soybean) and other sources such as wheat germ.

Chiu, C. C., Huang, S. Y., Chen, C. C. and Su, K. P. (2005). Omega-3 fatty acids are more beneficial in the depressive phase than in the manic phase in patients with Bipolar I Disorder. (Letter to the Editor.) Journal of Clinical Psychiatry, 66, 1613–14.
Chiu, C. C., Huang, S. Y., Su, K. P. et al. (2003). Polyunsaturated fatty acid deficit in patients with bipolar mania. European Neuropsychopharmacology, 13, 99–103.
Edwards, R., Peet, M., Shay, J. and Horrobin, D. (1998). Omega-3 polyunsaturated fatty acid levels in the diet and in red blood cell membranes of depressed patients. Journal of Affective Disorders, 48, 149–55.
Frangou, S., Lewis, M. and McCrone, P. (2006). Efficacy of ethyl-eicosapentaenoic acid in bipolar depression: randomised double-blind placebo-controlled study. British Journal of Psychiatry, 188, 46–50.
Hibbeln, J. R. (1998). Fish consumption and major depression. Lancet, 351, 1213.
Hirashima, F., Parow, A., Stoll, A. et al. (2004). Omega-3 fatty acid treatment and T2 whole brain relaxation times in bipolar disorder. American Journal of Psychiatry, 161, 1922–4.
Keck, P. E. Jr, Freeman, M. P., McElroy, S. L. et al. (2002). A double-blind, placebo-controlled trial of eicosapentaenoic acid in rapid-cycling bipolar disorder. Bipolar Disorders, 4, 26–7.
Keck, P. E. Jr, McElroy, S. L., Mintz, J. et al. (2006). Double-blind, placebo-controlled trials of ethyl-eicosapentaenoate in the treatment of bipolar depression and rapid-cycling bipolar disorder. Biological Psychiatry, 60, 1020–2.
Kinrys, G. (2000). Are omega-3 fatty acids beneficial in depression but not mania? In reply. Archives of General Psychiatry, 57, 716–17.
Logan, A. C. (2003). Neurobehavioural aspects of omega-3 fatty acids: possible mechanisms and therapeutic value in major depression. Alternative Medicine Review, 8, 410–25.
Maes, M., Christophe, A., Delanghe, J. et al. (1999). Lowered omega-3 polyunsaturated fatty acids in serum phospholipids and cholesteryl esters of depressed patients. Psychiatry Research, 85, 275–91.
Marangell, L. B., Suppes, T., Ketter, T. A. et al. (2006). Omega-3 fatty acids in bipolar disorder: clinical and research considerations. Prostaglandins, Leukotrienes and Essential Fatty Acids, 75, 315–21.
Noaghuil, S. and Hibbeln, J. R. (2003). Cross-national comparisons of seafood consumption and rates of bipolar disorders. American Journal of Psychiatry, 160, 2222–7.
Osher, Y., Bersudsky, Y. and Belmaker, R. H. (2005). Omega-3 eicosapentaenoic acid in bipolar depression: report of a small open-label study. Journal of Clinical Psychiatry, 66, 726–9.
Parker, G., Gibson, N., Brotchie, H., Heruc, G., Rees A-M. and Hadzi-Pavlovic, D. (2006). Omega-3 fatty acids and mood disorders. American Journal of Psychiatry, 163, 969–78.
Peet, M., Murphy, B., Shay, J. and Horrobin, D. (1998). Depletion of omega-3 fatty acid levels in red blood cell membranes of depressive patients. Biological Psychiatry, 43, 315–19.
Rapoport, S. I. and Bosetti, F. (2002). Do lithium and the anticonvulsants target the brain arachidonic acid cascade in bipolar disorder? Archives of General Psychiatry, 59, 592–6.
Sampath, H. and Ntambi, J. M. (2004). Polyunsaturated fatty acid regulation of gene expression. Nutrition Review, 62, 333–9.
Stoll, A. L., Damico, K. E., Marangell, L. B. and Severus, W. E. (2000). Reply to Su, K-P., Shen W. W., Huang S-Y.: Are omega-3 fatty acids beneficial in depression but not mania? (letter). Archives of General Psychiatry, 57, 716–17.
Stoll, A. L., Locke, L. B., Marangell, L. B. and Severus, W. E. (1999a). Omega-3 fatty acids and bipolar disorder: a review. Prostaglandins, Leukotrienes and Essential Fatty Acids, 60, 329–37.
Stoll, A. L., Severus, W. E., Freeman, M. P. et al. (1999b). Omega-3 fatty acids in bipolar disorder: a preliminary double-blind, placebo-controlled trial. Archives of General Psychiatry, 56, 407–12.