Bipolar Disorder and Essential Fatty Acids

Omega 3 oil(s) can be helpful in treating a variety of conditions.

Though the exact mechanism is unknown, it is thought that supplementing omega 3s through fish and/or flaxseed oil may help in the treatment of depression - a symptom of bipolar disorder.

Read more details about Essential Fatty Acids.

In a double-blind study reported in 1999, 30 people with bipolar disorder took either fish oil capsules or placebo for 4 months, in addition to their regular medications.¹ Those taking the fish oil had longer symptom-free periods than those taking placebo. The researchers used five different standardized tests to measure symptoms, examining levels of depression, mania, and overall progress. The people taking fish oil proved emotionally healthier than those taking placebo on all but one of these tests. Another study found that ethyl-EPA (a modified form of a constituent of fish oil) was helpful along with standard treatment for the depressed phase of bipolar disorder.¹⁹ A third study failed to find ethyl-EPA helpful for rapid cycling bipolar disorder.²⁴

The same researchers who conducted the fish oil study have also experimented with flaxseed oil for bipolar disorder.⁵ Flaxseed oil contains alpha-linoleic acid (ALA), an omega-3 fatty acid related to the fatty acids in fish oil. In the researchers' informal observations of 22 people with bipolar disorder, all but four appeared to benefit from flaxseed oil.

Safety Issues

Fish oil appears to be generally safe. The most common problem is fishy burps. However, there are some safety concerns to consider.

For example, it has been suggested that some fish oil products contain excessive levels of toxic substances such as organochlorines and PCBs. ¹ If possible, try to purchase fish oil products certified not to contain significant levels of these contaminants. Note:Various types of fish contain mercury, but this has not been a problem with fish oil supplements, according to reports on Consumerlab.com.

Fish oil has a mild blood-thinning effect; ² in one case report, it increased the effect of the blood-thinning medication warfarin (Coumadin). ³ Fish oil does not seem to cause bleeding problems when it is taken by itself ⁴ or with aspirin. ⁵ Nonetheless, people who are at risk of bleeding complications for any reason should consult a physician before taking fish oil.

Fish oil does not appear to raise blood sugar levels in people with diabetes. ⁶ Nonetheless, if you have diabetes, you should not take any supplement except on the advice of a physician.

Fish oil may modestly increase weight and lower total cholesterol and HDL (“good”) cholesterol levels. ⁷ It may also raise the level of LDL ("bad") cholesterol; however, this effect may be short-lived. ⁸ If you decide to use cod liver oil as your fish oil supplement, make sure you do not exceed the safe maximum intake of vitamin A and vitamin D . These vitamins are fat soluble, which means that excess amounts tend to build up in your body, possibly reaching toxic levels. The official maximum daily intake of vitamin A is 3,000 mcg for pregnant women as well as other adults. Look at the bottle label to determine how much vitamin A you are receiving. (It is less likely that you will get enough vitamin D to produce toxic effects.)

Interactions You Should Know About

If you are taking warfarin (Coumadin) or heparin , do not take fish oil except on the advice of a physician.

1. Jacobs MN, Santillo D, Johnston PA, Wyatt CL, French MC. Organochlorine residues in fish oil dietary supplements: comparison with industrial grade oils. Chemosphere. 37(9-12):1709-21.
2. Emsley R, Niehaus DJ, Oosthuizen PP, Koen L, Ascott-Evans B, Chiliza B, van Rensburg SJ, Smit RM. Safety of the omega-3 fatty acid, eicosapentaenoic acid (EPA) in psychiatric patients: results from a randomized, placebo-controlled trial. Psychiatry Res. 161(3):284-91.
3. Buckley MS, Goff AD, Knapp WE. Fish oil interaction with warfarin. Ann Pharmacother. 38(1):50-2.
4. Harris WS. Dietary fish oil and blood lipids. Curr Opin Lipidol. 7(1):3-7.
5. Leaf A, Jorgensen MB, Jacobs AK, Cote G, Schoenfeld DA, Scheer J, Weiner BH, Slack JD, Kellett MA, Raizner AE. Do fish oils prevent restenosis after coronary angioplasty? Circulation. 90(5):2248-57.
6. Harris WS. Dietary fish oil and blood lipids. Curr Opin Lipidol. 7(1):3-7.
7. Emsley R, Niehaus DJ, Oosthuizen PP, Koen L, Ascott-Evans B, Chiliza B, van Rensburg SJ, Smit RM. Safety of the omega-3 fatty acid, eicosapentaenoic acid (EPA) in psychiatric patients: results from a randomized, placebo-controlled trial. Psychiatry Res. 161(3):284-91.
8. Cobiac L, Clifton PM, Abbey M, Belling GB, Nestel PJ. Lipid, lipoprotein, and hemostatic effects of fish vs fish-oil n-3 fatty acids in mildly hyperlipidemic males. Am J Clin Nutr. 53(5):1210-6.

1. Naylor GJ. Vanadium and manic depressive psychosis. Nutr Health. 1984;3:79-85.

2. Reading SA. Chromium picolinate. J Fla Med Assoc. 1996;83:29-31.

3. Stoll AL, Locke CA, Marangell LB, et al. Omega-3 fatty acids and bipolar disorder: a review. Prostaglandins Leukot Essent Fatty Acids. 1999;60:329-337.

4. Mebane AH. L-Glutamine and mania [letter]. Am J Psychiatry. 1984;141:1302-1303.

5. Attenburrow MJ, Odontiadis J, Murray BJ, et al. Chromium treatment decreases the sensitivity of 5-HT(2A) receptors. Psychopharmacology. 2002;159:432-436.

6. Vazquez I, Aguera-Ortiz LF. Herbal products and serious side effects: a case of ginseng-induced manic episode. Acta Psychiatr Scand. 2002;105:76-77.

7. Barbenel DM, Yusufi B, O'Shea D, et al. Mania in a patient receiving testosterone replacement postorchidectomy taking St John's Wort and sertraline. J Pscyhopharmacol. 2000;14:84-86.

8. Nierenberg AA, Burt T, Matthews J, et al. Mania associated with St John's Wort. Biol Psychiatry. 1999;45:1707-1708.

9. Dolberg OT, Dannon PN, Schreiber S, et al. Transcranial magnetic stimulation in patients with bipolar depression: a double-blind, controlled study. Bipolar Disord. 2002;4:94-95.

10. Naylor GJ, Smith AH. Vanadium: a possible aetiological factor in manic depressive illness. Psychol Med. 1981;11:249-256.

11. Coppen A, Abou-Saleh MT. Plasma folate and affective morbidity during long term lithium therapy. Br J Psychiatry. 1982;141:87-89.

12. Coppen A, Abou-Saleh MT. Plasma folate and affective morbidity during long term lithium therapy. Br J Psychiatry. 1982;141:87-89.

13. Coppen A, Chaudhry S, Swade C. Folic acid enhances lithium prophylaxis. J Affect Disord. 1986;10:9-13.

14. Chengappa KN, Levine J, Gershon S, et al. Inositol as an add-on treatment for bipolar depression. Bipolar Disord. 2000;2:47-55.

15. Levine J, Witztum E, Greenberg BD, et al. Inositol induced mania? [letter]. Am J Psychiatry. 1996;153:839.

16. Carney MW, Chary TK, Bottiglieri T, et al. The switch mechanism and the bipolar/unipolar dichotomy. Br J Psychiatry. 1989;154:48-51.

17. Carney MW, Chary TK, Bottiglieri T, et al. Switch and S-adenosylmethionine. Ala J Med Sci. 1988;25:316-319.

18. Kagan BL, Sultzer DL, Rosenlicht N, et al. Oral S-adenosylmethionine in depression: a randomized, double-blind placebo-controlled trial. Am J Psychiatry. 1990;147:591-595.

19. Frangou S, Lewis M, McCrone P, et al. Efficacy of ethyl-eicosapentaenoic acid in bipolar depression: randomised double-blind placebo-controlled study. Br J Psychiatry. 2006;188:46-50.

20. Zhang ZJ, Kang WH, Tan QR, et al. Adjunctive herbal medicine with carbamazepine for bipolar disorders: A double-blind, randomized, placebo-controlled study. J Psychiatr Res. 2005 Aug 1. [Epub ahead of print].

21. Allan SJ, Kavanagh GM, Herd RM, et al. The effect of inositol supplements on the psoriasis of patients taking lithium: a randomized, placebo-controlled trial. Br J Dermatol. 2004;150:966-969.

22. Giannini AJ, Giannini JD, Melemis S, et al. Treatment of acute mania with ambient air anionization: variants of climactic heat stress and serotonin syndrome. Psychol Rep. 2007;100:157-163.

23. Lin PY, Su KP. A meta-analytic review of double-blind, placebo-controlled trials of antidepressant efficacy of omega-3 fatty acids. J Clin Psychiatry. 2007;68:1056-1061.

24. Keck PE Jr, Mintz J, McElroy SL, et al. Double-blind, randomized, placebo-controlled trials of ethyl-eicosapentanoate in the treatment of bipolar depression and rapid cycling bipolar disorder. Biol Psychiatry. 2006;60:1020-102. Epub 2006 Jun 30.