Omega-3 fatty acids for bipolar disorder

  • Review
  • Intervention

Authors


Abstract

Background

Bipolar disorder is a complex psychiatric disorder and is amongst the top thirty causes of worldwide disability. Mood stabilisers are the primary pharmacological intervention, both in the treatment of acute episodes and in prophylaxis. There is, however, mounting evidence that dietary supplementation with omega-3 fatty acids may be beneficial in psychiatric conditions, particularly those involving disturbances of mood.

Objectives

To review the efficacy of omega-3 fatty acids as either a monotherapy or an adjunctive treatment for bipolar disorder.

Search methods

Electronic searches of the following databases were performed: CCDANCTR-Studies and CCDANCTR-References were searched on 12/2/2008, Supplementary searches were carried out on Biological Abstracts, CINAHL, The Cochrane Library, CCDAN Register, EMBASE, MEDLINE, and PsycINFO. The search strategy also included cited reference searching, personal contact with all authors of studies initially included and contact with the omega-3 producing pharmaceutical companies.

Selection criteria

All relevant randomised controlled trials were included in the review. Studies involving males and females of all ages with a diagnosis of bipolar disorder qualified for inclusion. Studies using any type or dose of omega-3 fatty acid treatment as monotherapy or in addition to standard pharmacotherapy were eligible. The primary outcome was symptom severity; and secondary outcomes were adverse effects, dropout and satisfaction with treatment.

Data collection and analysis

Two review authors independently inspected the citations identified from the search. Potentially relevant abstracts were identified and full papers ordered and reassessed for inclusion and methodological quality. All relevant data were extracted. The weighted mean difference (WMD) was used for continuous outcome data, with 95% confidence intervals (CI).

Main results

Five studies met inclusion criteria for the review, however, methodological quality was highly variable. Only one study, involving 75 participants, provided data for analysis, and showed a benefit of active treatment over control for depression symptom levels (WMD -3.93, 95% CI -7.00 to -0.86)and Clinical Global Impression scores (WMD -0.75, 95% CI -1.33 to -0.17) but not for mania (WMD -2.81, 95% CI -7.68 to 1.90). No serious adverse effects were reported in the five studies. The pattern of dropout was highly variable between studies.

Authors' conclusions

Results from one study showed positive effects of omega-3 as an adjunctive treatment for depressive but not manic symptoms in bipolar disorder. These findings must be regarded with caution owing to the limited data available. There is an acute need for well-designed and executed randomised controlled trials in this field.

摘要

背景

Omega3脂肪酸在雙相情感疾患的使用

雙相情感疾患是一種複雜的精神疾病,也被列為前三十大全世紀引起失能的疾病。情緒穩定劑是藥物治療中最基本被用來處理急性治療跟預防性治療。然而越來越多的證據顯示含有Omega3脂肪酸的飲食可能對精神狀況是有益處的,特別是那些有情緒混亂的狀況。

目標

回顧Omega3脂肪酸單獨治療及加成治療在治療雙相情感疾患的療效。

搜尋策略

2008年12月2日電子搜尋CCDANCTRStudies及CCDANCTRReferences的資料庫,並輔以Biological Abstracts、CINAHL、The Cochrane Library、CCDAN Register、EMBASE、MEDLINE、 PsycINFO資料庫的搜尋。搜尋策略也包括了發表文獻摘要搜尋,個別接洽試驗作者,也包括和生產Omega3脂肪酸藥商公司接洽。

選擇標準

在回顧中,所有相關的隨機對照試驗被納入,研究試驗對象包括男女及任何年紀有雙相情感疾患診斷就符合被納入的條件,試驗使用是Omega3脂肪酸以任何形式或劑量當作單獨治療或加成到一般標準藥物治療都可以納入,主要結果是看症狀嚴重度,其他要看的是副作用、退出率及對治療滿意度。

資料收集與分析

兩位回顧作者獨立審視從搜尋找到的文獻,可能相關的摘要會被辨識出來,全文會被訂閱且重新評估納入條件及試驗方法學品質,所有相關資料會被提取,加權平均差異(WMD)是以95%信賴區間(CI),被用來看連續性資料。

主要結論

在回顧內有5個研究符合納入條件,然而方法學品質的差異性很大,只有一個試驗,共有75位試驗個案,有提供資料來分析,顯示Omega3脂肪酸治療在憂鬱症狀改善(WMD −3.93, 95% CI −7.00 to −0.86)及臨床整體改善(WMD −0.75, 95% CI −1.33 to −0.17)優於控制組,但在躁症部份沒有差異(WMD −2.81, 95% CI −7.68 to 1.90)。在這5個試驗中,沒有嚴重副作用事件被報導,退出試驗的方式在這些試驗間差異也很大。

作者結論

從一個試驗的結果顯示Omega3脂肪酸在雙相情感疾患的治療,針對憂鬱症狀加成治療時,有其效果,但針對躁症症狀時則無。這樣的發現必須注意到有限的資料可以被取得,在這個領域中,設計良善且是隨機對照的試驗有其迫切需求。

翻譯人

本摘要由彰化基督教醫院許文郁翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

Omega3脂肪酸在雙相情感疾患的使用這個系統性的回顧中,研究Omega3脂肪酸在治療雙相情感疾患的療效。在回顧內有5個研究符合納入條件,只有一個試驗,可提供資料來分析,這個研究針對混合門診病人族群,把ethylEPA當成加成治療,治療憂鬱症狀有益處,但在躁症部份則沒有,沒有嚴重副作用事件被報導。現有的證據不足以建議使用Omega3脂肪酸在雙相情感疾患。然而由於Omega3脂肪酸一般的健康益處及安全性,從這篇回顧初步的證據提供一個強烈的事實,以在這特殊比率的族群中施行高動力高品質的試驗。

Plain language summary

Omega-3 fatty acids for bipolar disorder

This systematic review investigated the efficacy of omega-3 fatty acids for bipolar disorder. Five randomised controlled trials met inclusion criteria for the review. Only one trial provided data that could be analysed, investigating ethyl-EPA as an adjunctive treatment in a mixed outpatient population. Some positive benefits were found for depressive symptoms but not for mania, and no adverse events were reported. There is currently insufficient evidence on which to base any clear recommendations concerning omega-3 fatty acids for bipolar disorder. However, given the general health benefits and safety of omega-3, the preliminary evidence from this review provides a strong case for well-powered, high-quality trials in specific index populations.

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