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Omega-3 and Omega-6 Polyunsaturated Fatty Acids in Bipolar Disorder: A Review of Biomarker and Treatment Studies.

Abstract

OBJECTIVE

There is growing evidence that inflammation is an important mediator of pathophysiology in bipolar disorder. The omega-3 (n-3) and omega-6 (n-6) polyunsaturated fatty acid (PUFA) metabolic pathways participate in several inflammatory processes and have been linked through epidemiologic and clinical studies to bipolar disorder and its response to treatment. We review the data on PUFAs as biomarkers in bipolar disorder and n-3 PUFA used as treatment for bipolar disorder.

DATA SOURCES

PubMed and CINAHL were searched for articles on PUFA and bipolar disorder published in the English language through November 6, 2013, with an updated search conducted on August 20, 2015. Keywords searched included omega 3 fatty acids and bipolar disorder, omega 3 fatty acids and bipolar mania, omega 3 fatty acids and bipolar depression, omega 3 fatty acids and mania, omega 3 fatty acids and cyclothymia, omega 3 fatty acids and hypomania, fatty acids and bipolar disorder, essential fatty acids and bipolar disorder, polyunsaturated fatty acids and bipolar disorder, DHA and bipolar disorder, and EPA and bipolar disorder.

STUDY SELECTION

Studies selected measured PUFAs as biomarkers or introduced n-3 PUFA as treatment.

RESULTS

We identified 17 relevant human clinical articles that either compared PUFA levels between a bipolar disorder group and a control group or used a PUFA intervention to treat depression or mania in bipolar disorder. Human studies suggest low n-3 red blood cell PUFA concentrations and correlations with clinical severity in studies of plasma concentrations in symptomatic bipolar disorder. Results of published n-3 PUFA dietary supplementation trials for bipolar disorder indicate efficacy in treatment for mania or depression in 5 of 5 open-label trials, efficacy in treatment of depression in 1 of 7 randomized controlled trials, and a signal for treatment of depression in 1 meta-analysis.

CONCLUSIONS

Biomarker studies of PUFA and treatment studies of n-3 PUFA in bipolar disorder show promise for indicating a way forward in the study of PUFA in bipolar disorder. Investigation of the intake and metabolism of the n-3 and n-6 PUFA when supplementation is provided in treatment trials might offer clues for identification of when and how PUFA may be important for treatment in bipolar disorder.

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  • Publisher Full Text
  • Authors+Show Affiliations

    ,

    Department of Psychiatry, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, 500 University Dr, PO Box 850, Mail Code: HO73, Hershey, PA 17033-0850. esaunders@hmc.psu.edu. Department of Psychiatry, Penn State College of Medicine and Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA. Department of Psychiatry and Depression Center, University of Michigan, Ann Arbor, Michigan, USA.

    ,

    Section on Nutritional Neurosciences, Laboratory of Membrane Biochemistry and Biophysics, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland, USA.

    ,

    Department of Psychiatry, Penn State College of Medicine and Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA.

    ,

    Department of Psychiatry, Penn State College of Medicine and Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA.

    ,

    Department of Psychiatry, University of Illinois, Chicago, Illinois, USA.

    Office of Scientific Director, National Institute on Aging, National Institutes of Health, Bethesda, Maryland, USA.

    Source

    The Journal of clinical psychiatry 77:10 2016 Oct pg e1301-e1308

    MeSH

    Biomarkers
    Bipolar Disorder
    Fatty Acids, Omega-3
    Fatty Acids, Omega-6
    Humans
    Randomized Controlled Trials as Topic
    Reference Values

    Pub Type(s)

    Journal Article
    Review

    Language

    eng

    PubMed ID

    27631140

    Citation

    Saunders, Erika F H., et al. "Omega-3 and Omega-6 Polyunsaturated Fatty Acids in Bipolar Disorder: a Review of Biomarker and Treatment Studies." The Journal of Clinical Psychiatry, vol. 77, no. 10, 2016, pp. e1301-e1308.
    Saunders EF, Ramsden CE, Sherazy MS, et al. Omega-3 and Omega-6 Polyunsaturated Fatty Acids in Bipolar Disorder: A Review of Biomarker and Treatment Studies. J Clin Psychiatry. 2016;77(10):e1301-e1308.
    Saunders, E. F., Ramsden, C. E., Sherazy, M. S., Gelenberg, A. J., Davis, J. M., & Rapoport, S. I. (2016). Omega-3 and Omega-6 Polyunsaturated Fatty Acids in Bipolar Disorder: A Review of Biomarker and Treatment Studies. The Journal of Clinical Psychiatry, 77(10), pp. e1301-e1308. doi:10.4088/JCP.15r09925.
    Saunders EF, et al. Omega-3 and Omega-6 Polyunsaturated Fatty Acids in Bipolar Disorder: a Review of Biomarker and Treatment Studies. J Clin Psychiatry. 2016;77(10):e1301-e1308. PubMed PMID: 27631140.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Omega-3 and Omega-6 Polyunsaturated Fatty Acids in Bipolar Disorder: A Review of Biomarker and Treatment Studies. AU - Saunders,Erika F H, AU - Ramsden,Christopher E, AU - Sherazy,Mostafa S, AU - Gelenberg,Alan J, AU - Davis,John M, AU - Rapoport,Stanley I, PY - 2015/02/26/received PY - 2015/11/05/accepted PY - 2016/10/28/pubmed PY - 2017/5/26/medline PY - 2016/9/16/entrez SP - e1301 EP - e1308 JF - The Journal of clinical psychiatry JO - J Clin Psychiatry VL - 77 IS - 10 N2 - OBJECTIVE: There is growing evidence that inflammation is an important mediator of pathophysiology in bipolar disorder. The omega-3 (n-3) and omega-6 (n-6) polyunsaturated fatty acid (PUFA) metabolic pathways participate in several inflammatory processes and have been linked through epidemiologic and clinical studies to bipolar disorder and its response to treatment. We review the data on PUFAs as biomarkers in bipolar disorder and n-3 PUFA used as treatment for bipolar disorder. DATA SOURCES: PubMed and CINAHL were searched for articles on PUFA and bipolar disorder published in the English language through November 6, 2013, with an updated search conducted on August 20, 2015. Keywords searched included omega 3 fatty acids and bipolar disorder, omega 3 fatty acids and bipolar mania, omega 3 fatty acids and bipolar depression, omega 3 fatty acids and mania, omega 3 fatty acids and cyclothymia, omega 3 fatty acids and hypomania, fatty acids and bipolar disorder, essential fatty acids and bipolar disorder, polyunsaturated fatty acids and bipolar disorder, DHA and bipolar disorder, and EPA and bipolar disorder. STUDY SELECTION: Studies selected measured PUFAs as biomarkers or introduced n-3 PUFA as treatment. RESULTS: We identified 17 relevant human clinical articles that either compared PUFA levels between a bipolar disorder group and a control group or used a PUFA intervention to treat depression or mania in bipolar disorder. Human studies suggest low n-3 red blood cell PUFA concentrations and correlations with clinical severity in studies of plasma concentrations in symptomatic bipolar disorder. Results of published n-3 PUFA dietary supplementation trials for bipolar disorder indicate efficacy in treatment for mania or depression in 5 of 5 open-label trials, efficacy in treatment of depression in 1 of 7 randomized controlled trials, and a signal for treatment of depression in 1 meta-analysis. CONCLUSIONS: Biomarker studies of PUFA and treatment studies of n-3 PUFA in bipolar disorder show promise for indicating a way forward in the study of PUFA in bipolar disorder. Investigation of the intake and metabolism of the n-3 and n-6 PUFA when supplementation is provided in treatment trials might offer clues for identification of when and how PUFA may be important for treatment in bipolar disorder. SN - 1555-2101 UR - https://www.unboundmedicine.com/medline/citation/27631140/Omega_3_and_Omega_6_Polyunsaturated_Fatty_Acids_in_Bipolar_Disorder:_A_Review_of_Biomarker_and_Treatment_Studies_ L2 - http://www.psychiatrist.com/JCP/article/Pages/2016/v77n10/v77n1014.aspx DB - PRIME DP - Unbound Medicine ER -