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Omega-3 fatty acids for bipolar disorder

  • Review
  • Intervention




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.


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.








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。






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。





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



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.