Omega-3s and Mental Health: Part II. Omega-3s and Bipolar Disorder

Omega 3’s and Mental Health

Part II:

Omega-3’s and Bipolar Disorder

M. Russell Thomas, PhD

BIPOLAR DISORDER

Defining Bipolar Disorder.  Bipolar disorders are mental disorders characterized by intense mood swings ranging from depression to mania, racing and/or fleeting thoughts, and sleep disturbances.  Individuals with Bipolar disorder are particularly challenged to regulate impulsive behavior, are easily irritated, distracted and often talk as if they are in a contest to see how many words they can say in 60 seconds!  It is as if their “life throttle” is stuck wide open when in the manic phase, while just getting out of bed and functioning can be the biggest challenge of the day while in the depressed phase.  It is a challenging life and the intensity of symptoms can vary.   According to the Diagnostic and Statistical Manual (DSM-IV) published by the American Psychiatric Association, Bipolar disorder affects roughly 1-2% of the population.  In America alone, that translates to about 3 to 6 million people who are battling this mood disorder.  I, personally, think this is an underestimation of the real numbers, as many suffering from Bipolar disorder mask their illness with alcohol and/or drugs and are never diagnosed.  Unlike Major Depression that is more prevalent among females, bipolar disorders are equally distributed among gender.  Bipolar disorder also has a well-established, 1^st generation genetic relationship. 

Common Treatment.  Throughout the past few decades, I have often heard of Bipolar disorders referred to a disorder of “chemical imbalance”.  People who are using the term chemical imbalance are referring to a disturbance of neurotransmitters in the brains of those battling the disorder.  While exact brain mechanisms are unknown and remain the focus of research, it is fairly well established that Bipolar disorders are best treated with medication.  I have seen 100s of people battling Bipolar disorders in my career and it is rare, indeed, for the disorder to stabilize without medication.  Often this regimen of medications involves complex combinations of mood stabilizers, antidepressants, antipsychotics (for thought disturbance) and even occasionally psychostimulant (think Attention Deficit Disorder) medications.  In more intense Bipolar illnesses, the process of finding the right combination of medications can be frustrating and time consuming, often involving costly hospitalizations, strained marriages, time off from jobs and in some cases, incarceration.

In spite of the myriad of medication combinations often used to treat Bipolar disorder, the cornerstone of medication treated remains a class of medications referred to as mood stabilizers.  These include old line medications such as Lithium, Depakote, and Tegretol, as well as some newer medications such as Lamictal, Topamax and Seroquel.  Usually these medications are effective controlling the symptoms of a bipolar illness; however, like most medications there is a downside with troubling side effects ranging from dry mouth, weight gain, tremors, restlessness, vertigo and diarrhea (I’m starting to sound like those commercials on TV!). 

In addition to medication, usually psychotherapy is effective to develop coping skills, learn effective skills to manage the illness, and deal with ambiguous feelings about taking the medication itself.  One problem that I have observed throughout my 30 year psychology career is people treating their Bipolar illness like a cold.  That is to say, that once they stabilize and feel better, like cold medicine, they quit taking the medication.  In such cases, the probabilities are good that sooner or later there will be a relapse of some sort.

The Dilemma: To medicate or not medicate, this is the question!  Honestly, I understand why those battling Bipolar disorders don’t want to take the medication.  I mean really, would I want to gain 10-20% body weight or more, shuffle nervously from foot to foot, drink water all the time and have to run to the bathroom every 20 minutes?  Sadly, in many cases this is what taking the medication means in order to stabilize or eliminate bipolar symptoms.  I had a patient that joked often about the “Lithium shuffle”, referring to the shifting of weight constantly back and forth from one leg to another.  Sure enough, I was often able to identify individuals who were taking the medication just by observing their “Lithium shuffle”.  While he was using humor to cope, many in this situation can’t get in touch with this humor and suffer tremendously with the side effects of mood stabilizer medications.

So Is there any Hope?  I have looked my entire career for anything besides medications to help those suffering from bipolar illnesses.  One of the areas that I think holds some of the highest promise is the area of nutrition, specifically Omega-3 fatty acids.  I will summarize the information that is currently available.  As always, I want to emphasize that this information is intended to be information and not intended to be medical advice.  If you or a family member are struggling with a bipolar illness you should discuss this information with your prescribing physician.

BIPOLAR DISORDER and OMEGA 3’s

The association between Bipolar disorder and Omega 3s is a little more obscure than that between Depression and Omega 3s.  However, numerous studies have established differences in the cell membranes, particularly the fatty acid structures in those battling bipolar illnesses when compared to others not battling bipolar illnesses.  Remember to think of Bipolar as a mood disorder with 2 ends.  Think of it as, Bi- meaning “two”, and pole, meaning “end” and you understand that what we are talking about.  The impact of Omega 3s on Bipolar is like the disorder itself, …it has 2 ends.  On one end are a few studies that have demonstrated some efficacy of Omega-3s to alleviate symptoms[1]^,[2] while other studies have failed to observe any significant improvement in symptoms of Bipolar illness[3].  What does seem to be consistent in the scientific literature is the idea that when Omega 3s are added to standard psychiatric medicines, particularly the mood stabilizers there is positive and exponential effect to lower symptoms of Bipolar illness.  In the study by Stoll, et al (1999), the authors observed a significantly longer period of time between relapses when Omega-3s were added to the mood stabilizer medications.

Dosing.  In my article on Omega-3’s and Depression, I discussed 2 types of fatty acids that are critical in mental health functions:  EPA and DHA.  While EPA levels appear to have a greater impact on depression, both may play a significant role in Bipolar disorders.  Frangou, et al[4] reported that about 1000 to 2000 mg was sufficient to manage bipolar symptoms (added to other psychotropic meds) while earlier reports had suggested 4000 to 6000 mg were needed.  It is noted that effects were not observed until week 4 and persisted to improve throughout any entire year.  Other studies have established a regimen of 1000 to 1500 mg of DHA, in a 2:1 ration (EPA:DHA) to have a positive effect to reduce and/or manage bipolar symptoms[5].

SUMMARY of OMEGA-3s & BIPOLAR ILLNESS

It is clear that there is a relationship between the Omega-3 fatty acids, specifically DHA and EPA; however, that relationship is not currently well understood.  After reviewing the data, it seems safe to say that the following are fairly well established:

• Omega-3’s, particularly with EPA being somewhere between 2000 and 4000 mg and DHA being around 1500 mg, when added to standard psychotropic medications have a positive impact to control and/or alleviate symptoms of bipolar illness.
• Omega-3’s holds promise that under certain conditions may be able to be used as a stand-alone treatment.  Unfortunately those conditions remain a mystery at this time.
• Omega-3’s when used by patients battling bipolar illnesses, probably will not reach maximum benefit inside of a month and may continue to produce additional benefits up to a year or more after instituting a regular regimen.