Bipolar Disorder

Q: Are omega-3s helpful for patients with manic-depression or bipolar disorder?

A: The most exciting and best clinical data from double-blind, placebo- controlled treatment trials is in schizophrenia and manic depression.

In manic depression, the treatments of choice with the best record of efficacy are lithium, valproic acid, and carbamazapine. The action of these drugs in these conditions is well known, and they are still the treatments of choice.

Q: But do higher serum levels of omega-3 play a role in efficacy of these treatments for bipolar disorder?

A: Andrew Stoll, M.D., at Harvard did a double-blind, placebo-controlled trial in bipolar disease. In the study, patients had recently been hospitalized and had either a severe mania or severe depression. All the patients were on medications-lithium and valproic acid. One half of the patients were assigned to take six grams of omega-3 fatty acids a day; the other half were assigned to placebos. After four months, researchers did a preliminary review of the data, and the ethics committee made them stop the trial and put everybody on the active agent, because only one out of 16 of the people taking the omega-3s relapsed into a mania or depression, whereas 8 or 9 out of 15 relapsed on the placebo.

Q: Is six grams a very large dose?

A: Yes, but Eskimos ate diets that were almost completely omega-3 fatty acids, and they had low rates of heart diseases and arthritis.

Q: Is depression common among Eskimos?

A: We don't know. I have looked for that data. But by the time people were doing epidemiological studies of Eskimos, they were eating Western diets.

Q: Is there a toxic level of omega-3?

A: The FDA recognizes up to 3 grams per day of omega-3s as GRAS, or Generally Recognized As Safe.

Q: What are the side effects if you consume more than three grams?

A: It will definitely have a greater effect in thinning your blood and making your platelets not coagulate.

Q: If you had a hemorrhagic stroke, you would be in trouble.

A: Right. That's why Japanese people die more frequently of hemorrhagic stroke, but have lower death rates overall.

Q: And lower rates of depression?

A: Right. And apparently also lower hostility and violence.

Q: That finding is very interesting, especially for countries where there is more hostility and violence.

A: One very reasonable question people ask me is, "Isn't it possible that it's just the Japanese culture that is different and less hostile?" I say, "Well, Japan has approximately onehalf the population of the United States living on an arable land mass the size of Connecticut. And it's a stressful society. Just on the basis of crowding, you would expect higher rates of depression and hostility."

One thing also to consider about the culture is what would happen to a culture, or group of people, if you gave them a psychotropic drug that made them calmer for a couple hundred years. It's quite possible that these brain-specific nutrients have had an effect on culture over a long period of time.

Q: We have interviewed researcher and author Kay Redfield Jamison, M.D., who is manic-depressive. She is at Johns Hopkins and would probably be very interested in your work.

A: Some of my data were recently presented to a National Institutes of Mental Health group. Apparently, Kay was there, or heard about it. I have data of EPA levels in suicide attempters. It looks very much like the curve with depression, in that high plasma levels of EPA predict much lower psychological risk factors toward suicide. Dr. Jamison is doing work on suicide right now, so she called me up and we had a long talk. I sent her information. She actually just sent me a copy of her book, so I have had contact with her.

Q: What is rapid-cycling bipolar disease, and is it common?

A: Rapid cycling is anything more frequent than four times per year, but it can be as frequent as every other day or minute-to-minute in some cases. It is not common and very difficult to treat, often treatment-resistant.

Q: In rapid cycling every other day, for example, it is hard to understand how omega-3s could be a factor. If the tissues are deficient in omega- 3s, how would that trigger the depression, then euphoria, every other day?

A: The brain works in a series of interlinked neural networks, trained to cycles of biological rhythms. What occurs in patients with rapid- cycling bipolar disease is that the brake-the modulator of cycles-is gone. Although not well-defined biochemically, the theory is that omega-3s help put back a brake on that cycling or disrupted, endogenous biological rhythm. In no way are omega-3s proven to be effective in rapid-cycling bipolar disorder. All we have are anecdotal reports in rapid-cycling disorder at this point.

Q: What about the influence of omega-3s in schizophrenia?

A: Malcolm Peet, M.D., in England has given omega-3 fatty acids to patients suffering from schizophrenia. He found a good effect in reducing psychosis and negative symptoms, such as diminished social function. Omega-3s improved their social functioning. It has shown very good effect in this regard.

Q: Can it help people with attention deficit hyperactivity disorder (ADHD)?

A: There has been a lot of discussion about using omega-3 fatty acids in attention deficit hyperactivity disorder. At the NIH conference, everybody who has done a clinical study was present. Two of the three studies discussed showed no effect. The third study showed a good effect, using a combination of omega-3s and omega-6s. What was troubling about this study was that they also sell the product that they investigated.

At this point, there is no strong, compelling double-blind data that shows omega-3s are effective for people with ADHD. Scientific data aside, however, I have heard some impressive stories of efficacy from parents in anecdotal reports. The jury is still out on ADHD.

Q: It would seem that if a parent had a schizophrenic child or a child with ADHD, it wouldn't hurt to give omega-3s.

A: Right, it won't hurt and it might help.