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Omega-3 Supplements Tied to Notable, Sustained Mental Health Improvements

January 12, 2016
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Case study shows reduction in bipolar youth's psychotic mania, depression and anxiety

Medications unchanged, a severely bipolar girl’s depressive, manic and psychotic symptoms improved significantly during the two years her mother added omega-3 supplements to her daily diet.

The case, reported by researchers at Nationwide Children’s Hospital and Ohio State University Wexner Medical Center, is consistent with the small number of published studies on omega-3 treatment of juvenile-onset mood disorders.

These and adult studies suggest that fatty acids in fish oil may improve mental health. But how and which specific conditions they may help are not fully clear.

“There are  a lot of little hints omega 3 is helpful,” says Mary Fristad, PhD, ABPP, professor and vice chair of Research and Academic Affairs, Department of  Psychiatry and Behavioral Health at Wexner Medical Center and  of the study.

The case highlighted in her study shows in one person a breadth of conditions thought to benefit from supplements.

“We had followed ‘Sarah’ for a considerable length of time prior to supplementation,” Dr. Fristad says. “When supplementation began, her symptoms improved considerably and the improvement was sustained for a lengthy period of time.”

The Case

The girl, identified only as Sarah, participated in comprehensive assessments every six months from age 8 to 13, as part of the Longitudinal Assessment of Manic Symptoms research protocol, a federally funded research study led by Dr. Fristad. Sarah was diagnosed with bipolar disorder type 1 with psychotic features.

Sarah had manic episodes at ages 7, 10 and 11, lasting six to 11 months and accompanied by visual and auditory hallucinations and persecutory delusions. She had major depressive episodes at ages 9, 10 and 12, lasting from one to 11 months each. At age 10, she was hospitalized for 15 days suffering from increased homicidal and suicidal ideation, and was also diagnosed with generalized anxiety disorder (GAD).

Due to her symptoms, she had significant difficulties at school, among peers and at home. Sarah received an individualized education plan, weekly psychotherapy and, for a full year before omega-3 supplementation, her medications were limited to three psychotropic drugs.

She continued to take the same dosage of the medications when her mother added omega-3 supplements containing 647 milligrams eicosapentaenoic acid (EPA) and 253 docosahexaenoic acid (DHA), and 1,000 milligrams of vitamin D3 each morning. Sarah, then age 12 and 2 months, also took mixed fish oils containing 540 milligrams of EPA and 360 milligrams of DHA each evening.

After three months, Sarah’s mother reported her emotional reactivity was less severe and she’d begun to complete school assignments independently. At 8 months, her teachers praised her work and behavior and Sarah’s social problem solving improved. Her psychotic symptoms no longer caused impairment, and her anxiety symptoms decreased below the GAD threshold.

After 18 months, her manic symptoms decreased in severity and duration to twice-weekly, one to two hours in length. Academically, she was functioning at a typical seventh grade level. Her scores on the Child and Adolescent Symptom Inventory, 4th edition, showed her ability to focus attention improved nearly 50 percent.

Her mother told researchers that for the first time in her life she understood, “what other parents have described as being normal.”

Moving Forward

“While the growing body of evidence supports the conclusion that omega-3 supplementation dramatically helped this patient, changes seen in Sarah could have been due to maturity, improved abilities to handle tasks, and the added vitamin D,” says Barbara Gracious, MD, a psychiatrist and principal investigator in the Center for Innovation in Pediatric Practice at Nationwide Children’s, and a co-author of the study. “However the improvements in resolution of psychotic symptoms, mood, executive function and anxiety are consistent with literature on omega-3.”

The researchers are interested in omega-3 as an alternative or complimentary approach to children and adolescents with mood disorders for a number of reasons.

“If it is helpful, it doesn’t have the same side effects of mood stabilizers and antipsychotic and antidepressant medications, and it seems to work differently,” Dr. Gracious says. “And, the supplements are readily available, relatively inexpensive and don’t require a prescription.”

Among the ways the supplements may help, include that the omega-3 fatty acids have anti-inflammatory effects. Depression and bipolar illness can be associated with inflammatory processes, including proinflammatory cytokines that can affect the neurons in the brain, Dr. Gracious explains.

Additionally, omega fatty acids make up nerve cell membranes. Higher levels of omega fatty acids likely lead to more flexible membranes,improving cellular receptor function and molecular signaling.

The researchers say more studies are needed to conclusively determine if the fatty acids are beneficial and how.

Dr. Fristad and Dr. Gracious are involved with several such studies, including research with youths whose disorders are on the milder end of the bipolar spectrum, children with depression, and children born extremely premature, who are at risk for cognitive and behavioral problems. And, they’re seeking grants to expand this work.

In the meantime, Dr. Fristad tells parents who want to try omega-3 supplementation for their children that there’s not enough science to tell the optimal dosage or ratio of EPA to DHA. She suggests EPA plus DHA at 1 to 2 grams daily and notes that parents should monitor their children for changes.

Dr. Gracious recommends omega-3 fatty acids for patients not only for potential mental health benefits but also because, for those taking psychotropic medications, they may prevent side effects such as higher triglyceride levels in their blood. It is also helpful for some children who have eczema or asthma, two other disorders associated with inflammation.

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