Double-Blind, Randomized, Placebo-Controlled Trials of Ethyl-Eicosapentanoate in the Treatment of Bipolar Depression and Rapid Cycling Bipolar Disorder

Psychopharmacology Research Program, Department of Psychiatry, University of Cincinnati College of Medicine and the Mental Health Care Line, Cincinnati, Ohio 45267-0559, USA.
Biological Psychiatry (Impact Factor: 10.26). 12/2006; 60(9):1020-2. DOI: 10.1016/j.biopsych.2006.03.056
Source: PubMed

ABSTRACT The results of pilot trials suggest that omega-3 fatty acids may have efficacy in the treatment of mood symptoms in bipolar disorder.
We conducted a 4-month, randomized, placebo-controlled, adjunctive trial of ethyl-eicosapentanoate (EPA) 6 g/day in the treatment of bipolar depression and rapid cycling bipolar disorder. Subjects were receiving mood-stabilizing medications at therapeutic doses or plasma concentrations. The measures of efficacy were early study discontinuation, changes from baseline in depressive symptoms (Inventory for Depressive Symptomology total score) and in manic symptoms (Young Mania Rating Scale total score), and manic exacerbations ("switches"). We also measured side effects and bleeding time, a biomarker of drug action.
Overall, there were no significant differences on any outcome measure between the EPA and placebo groups.
This study did not find overall evidence of efficacy for adjunctive treatment with EPA 6 g/day in outpatients with bipolar depression or rapid cycling bipolar disorder.

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Available from: Susan L Mcelroy, Sep 28, 2015
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    • "The most of RCTs used the Hamilton Depression Rating Scale [46], [48], [49], [54], [57], [58], [63], [65], [69], [75]–[84], 10 studies [46], [49], [56], [68], [79], [85]–[89] used the Beck Depression Inventory, and 13 studies [47], [50], [54], [62], [64], [67], [77], [84], [90]–[94] the Montgomery-Asberg Depression Scale as the main outcome measure. Among the studies not included in the quantitative analysis,due to lack of data, one was conducted on patients with obsessive-compulsive disorder [57] and one on patients with chronic fatigue syndrome [56], both reporting no relevant effects of omega-3 fatty acids compared with placebo; four studies conducted in bipolar depressed patients [58], [59], [61], [63] reporting that there were no significant differences on any outcome measure between the EPA and placebo groups; one study on diabetes mellitus patients with MDD [62] reporting no effect of omega-3 fatty acids on depression severity; and one on older adults with mild cognitive impairment suggesting that increased intakes of DHA and EPA can reduce depressive symptoms and the risk of progressing to dementia [60]. "
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    ABSTRACT: Despite omega-3 polyunsaturated fatty acids (PUFA) supplementation in depressed patients have been suggested to improve depressive symptomatology, previous findings are not univocal. To conduct an updated meta-analysis of randomized controlled trials (RCTs) of omega-3 PUFA treatment of depressive disorders, taking into account the clinical differences among patients included in the studies. A search on MEDLINE, EMBASE, PsycInfo, and the Cochrane Database of RCTs using omega-3 PUFA on patients with depressive symptoms published up to August 2013 was performed. Standardized mean difference in clinical measure of depression severity was primary outcome. Type of omega-3 used (particularly eicosapentaenoic acid [EPA] and docosahexaenoic acid [DHA]) and omega-3 as mono- or adjuvant therapy was also examined. Meta-regression analyses assessed the effects of study size, baseline depression severity, trial duration, dose of omega-3, and age of patients. Meta-analysis of 11 and 8 trials conducted respectively on patients with a DSM-defined diagnosis of major depressive disorder (MDD) and patients with depressive symptomatology but no diagnosis of MDD demonstrated significant clinical benefit of omega-3 PUFA treatment compared to placebo (standardized difference in random-effects model 0.56 SD [95% CI: 0.20, 0.92] and 0.22 SD [95% CI: 0.01, 0.43], respectively; pooled analysis was 0.38 SD [95% CI: 0.18, 0.59]). Use of mainly EPA within the preparation, rather than DHA, influenced final clinical efficacy. Significant clinical efficacy had the use of omega-3 PUFA as adjuvant rather than mono-therapy. No relation between efficacy and study size, baseline depression severity, trial duration, age of patients, and study quality was found. Omega-3 PUFA resulted effective in RCTs on patients with bipolar disorder, whereas no evidence was found for those exploring their efficacy on depressive symptoms in young populations, perinatal depression, primary disease other than depression and healthy subjects. The use of omega-3 PUFA is effective in patients with diagnosis of MDD and on depressive patients without diagnosis of MDD.
    PLoS ONE 05/2014; 9(5):e96905. DOI:10.1371/journal.pone.0096905 · 3.23 Impact Factor
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    • "This is supported by the findings that preformed DHA corrects erythrocyte and cortical DHA deficits in patients with peroxisomal biogenesis disorders (Martinez et al., 2000; Moser et al., 1999). Moreover, this may explain in part why supplementation with DHA in addition to EPA (Stoll et al., 1999), but not EPA alone (Keck et al., 2006), is efficacious in the treatment of mood symptoms in BD patients. Additionally, increasing erythrocyte DHA to levels observed in the Japanese population (6.8%, Itomura et al., 2008), where the lifetime prevalence rates if MDD and BD are among the lowest in the world, may represent an appropriate target for future primary and secondary prevention trials (McNamara, 2009). "
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    ABSTRACT: Epidemiological and controlled intervention trials suggest that omega-3 (n-3) fatty acid deficiency represents a reversible risk factor for recurrent affective disorders. However, there is limited comparative information available regarding the n-3 fatty acid status and associated mood symptoms in medication-free patients with major depressive disorder (MDD) and bipolar disorder (BD). The fatty acid composition of erythrocyte membranes from adult male and female healthy controls (n=20) and medication-free patients with MDD (n=20) and BD (n=20) was determined by gas chromatography. Associations with depression and mania symptom severity scores were investigated. After correction for multiple comparisons, both MDD (-20%) and BD (-32%) patients exhibited significantly lower erythrocyte docosahexaenoic acid (DHA, 22:6n-3) composition relative to healthy controls, and there was a trend for lower DHA in BD patients relative to MDD patients (-15%, p=0.09). There were no gender differences for DHA in any group. Other n-3 fatty acids, including eicosapentaenoic acid (EPA, 20:5n-3) and docosapentanoic acid (22:5n-3), and n-6 fatty acids, including arachidonic acid (AA, 20:4n-6), were not different. Erythrocyte DHA composition was inversely correlated with indices of delta-9 desaturase activity (18:1/18:0), and associated elevations in oleic acid (18:1n-9) composition, and delta-6 desaturase activity (20:3/18:2). DHA composition was not significantly correlated with depression or mania symptom severity scores. Data regarding diet and life style factors (cigarette smoking) were not available to evaluate their contribution to the present findings. Male and female patients with MDD and BD exhibit selective erythrocyte DHA deficits relative to healthy controls, and this deficit was numerically greater in BD patients. Selective DHA deficits are consistent with impaired peroxisome function, which has implications for n-3 fatty acid interventions aimed at preventing or reversing this deficit.
    Journal of Affective Disorders 10/2010; 126(1-2):303-11. DOI:10.1016/j.jad.2010.03.015 · 3.38 Impact Factor
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    • "Imipramine: 50–150 mg (Continued) Table III. (Continued) Medication Category of Evidence (CE) Recommendation Grade (RG) Critical references and comments Dose ranges or maximum dosages used in studies Inositol ϩ lithium or valproate D 5 (Evins et al. 2006; Nierenberg et al. 2006) Inositol: up to 22 g Omega 3 fatty acids ϩ lithium or valproate D 5 (Frangou et al. 2006; Keck et al. 2006 "
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    ABSTRACT: These guidelines are based on a first edition that was published in 2002, and have been edited and updated with the available scientific evidence until September 2009. Their purpose is to supply a systematic overview of all scientific evidence pertaining to the treatment of acute bipolar depression in adults. The data used for these guidelines have been extracted from a MEDLINE and EMBASE search, from the clinical trial database, from recent proceedings of key conferences, and from various national and international treatment guidelines. Their scientific rigor was categorised into six levels of evidence (A-F). As these guidelines are intended for clinical use, the scientific evidence was finally assigned different grades of recommendation to ensure practicability. We identified 10 pharmacological monotherapies or combination treatments with at least limited positive evidence for efficacy in bipolar depression, several of them still experimental and backed up only by a single study. Only one medication was considered to be sufficiently studied to merit full positive evidence. Although major advances have been made since the first edition of this guideline in 2002, there are many areas which still need more intense research to optimize treatment. The majority of treatment recommendations is still based on limited data and leaves considerable areas of uncertainty.
    The World Journal of Biological Psychiatry 02/2010; 11(2):81-109. DOI:10.3109/15622970903555881 · 4.18 Impact Factor
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