Disorders - Bipolar Disorders
Liu, H. Y., Potter, M. P., Woodworth, K. Y., Yorks, D. M., Petty, C. R., Wozniak, J.
R., Faraone, S. V., Biederman, J.
Objective: A growing body of literature has documented pediatric bipolar disorder to be a severely impairing
form of psychopathology. However, concerns remain as to the inadequacy of the extant literature on its pharmacotherapy. Furthermore, treatment
studies have not been systematically reviewed for treatment effects on core and associated symptoms. Thus, a systematic evaluation and synthesis of
the available literature on the efficacy of antimanic pharmacotherapy for pediatric bipolar disorder on symptoms of mania, depression, and
attention-deficit/hyperactivity disorder was undertaken. Method: A systematic search was conducted through PubMed from 1989 through 2010 for open-
label and randomized controlled trials published in English on the pharmacotherapy of pediatric mania. Results: There have been 46 open-label (n =
29) and randomized (n = 17) clinical trials of antimanic agents in pediatric bipolar disorder encompassing 2,666 subjects that evaluated a range of
therapeutic agents, including traditional mood stabilizers, other anticonvulsants, second-generation antipsychotics, and naturopathic compounds. This
literature has documented that the available armamentarium has different levels of efficacy in the treatment of pediatric mania. Because all
psychotropic classes are associated with important adverse effects, a careful risk-benefit analysis is warranted when initiating pharmacologic
treatment with any of these compounds. In the limited data available, the effects of antimanic agents on depression and symptoms of attention-
deficit/hyperactivity disorder have been, in general, modest. Few studies have evaluated the effects of antimanic agents in children younger than 10
years. Conclusions: A substantial body of scientific literature has evaluated the safety and efficacy of various medicines and drug classes in the
treatment of mania in pediatric bipolar disorder. More work is needed to assess the safety and efficacy of psychotropic drugs in children younger
than 10 years, to further evaluate the efficacy of naturopathic compounds, and to further evaluate the effects of antimanic treatments for the
management of depression and attention-deficit/hyperactivity disorder. (copyright) 2011 American Academy of Child and Adolescent Psychiatry.
Journal of the American Academy of Child & Adolescent Psychiatry, 50(8) : 749-
762.e39
- Year: 2011
- Problem: Bipolar Disorders
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Atypical Antipsychotics (second
generation), Anticonvulsants/mood stabilisers (excl. lithium), Lithium
Vasudev, A., Macritchie, K., Vasudev,
K., Watson, S., Geddes, J., Young, AH.
Background: Oxcarbazepine, a keto derivative of the 'mood stabiliser' carbamazepine, may have efficacy in the
treatment of acute episodes of bipolar disorder. Potentially, it may offer pharmacokinetic advantages over carbamazepine.Objectives: To review the
efficacy and acceptability of oxcarbazepine compared to placebo and other agents in the treatment of acute bipolar episodes including mania, mixed
episodes and depression.Search methods: Electronic databases were searched up to 2 September 2011. Specialist journals and conference proceedings
were handsearched. Authors, experts in the field and pharmaceutical companies were contacted requesting information on published and unpublished
trials.Selection criteria: Randomised controlled trials (RCTs) which compared oxcarbazepine with placebo or alternative agents, where the stated
intent of intervention was the acute treatment of bipolar affective disorder were sought. Participants with bipolar disorder of either sex and of all
ages were included.Data collection and analysis: Data were extracted from the original reports individually by two review authors. For dichotomous
data, odds ratios (ORs) were calculated with 95% confidence intervals (CI). Continuous data were analysed using standardised mean differences (with
95% CI).Main results: Seven studies were included in the analysis (368 participants in total). All were on mania, hypomania, mixed episodes or
rapid-cycling disorder. Overall, their methodological quality was relatively low.There was no difference in the primary outcome analysis - a fall
of 50% or more on the Young Mania Rating Scale (YMRS) - between oxcarbazepine and placebo (N=1, n=110, OR =2.10, 95% CI 0.94 to 4.73) in one study,
conducted in children; no studies were available in adult participants.In comparison with other mood stabilisers, there was no difference between
oxcarbazepine and valproate as an antimanic agent using the primary outcome (50% or more fall in YMRS, OR=0.44, 95% CI 0.10 to 1.97, 1 study, n=60,
P=0.273) or the secondary outcome measure (differences in YMRS between the two groups, SMD=0.18, 95% CI -0.24 to 0.59, 2 studies, n=90, P=0.40). No
primary or secondary efficacy outcome measures were found comparing oxcarbazepine with lithium monotherapy.As an adjunctive treatment to lithium,
oxcarbazepine reduced depression rating scale scores more than carbamazepine in a group of manic participants on the Montgomery-Åsberg Depression
Rating Scale (MADRS) (SMD=- 1.12, 95% CI -1.71 to -0.53, 1 study, n=52, P=0.0002) and on the Hamilton Depression Rating Scale (HDRS) (SMD=- 0.77, 95%
CI -1.35 to -0.20, 1 study, n=52, P=0.008).There was a higher incidence of adverse effects, particularly neuropsychiatric, in participants randomised
to oxcarbazepine compared to those on placebo (1 study, n=115, 17% to 39% of participants on oxcarbazepine had at least one such event compared to 7%
to 10% on placebo).There was no difference in adverse events rates between oxcarbazepine and other mood stabilisers or haloperidol.Authors'
conclusions: Currently, there are insufficient trials of adequate methodological quality on oxcarbazepine in the acute treatment of bipolar disorder
to inform us on its efficacy and acceptability. Studies predominantly examine the treatment of mania: there are data from subgroup analysis on mixed
affective, hypomania and rapid-cycling states.From the few studies included in this review, oxcarbazepine did not differ in efficacy compared to
placebo in children and adolescents. It did not differ from other active agents in adults. It may have a poorer tolerability profile compared to
placebo. No data were found on outcomes relevant to patients and clinicians, such as length of hospital admission. There is a need for adequately
powered randomised controlled trials of good methodological quality to inform us of the therapeutic potential of oxcarbazepine across the spectrum of
acute episodes in bipolar disorder.
Cochrane Database of Systematic
Reviews, (12) : CD04856
- Year: 2011
- Problem: Bipolar Disorders
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Anticonvulsants/mood stabilisers (excl. lithium)
Zuddas, Alessandro, Zanni, Roberta, Usala,
Tatiana
In children and adolescents the Second Generation Antipsychotics (SGAs) represent the class of psychotropic drugs whose use has grown more
significantly in recent years: they are primarily used for treatment of patients with disruptive behavior disorders, mood disorders and pervasive
developmental disorders or mental retardation. In order to compare the efficacy and tolerability of antipsychotics against placebo or each other, a
systematic Medline/PubMed search for randomized, double blind studies on SGA in patients younger than 18 years of age at enrolment, was conducted.
Papers on schizophrenia, discussed in another article of this specific issue, were excluded by the efficacy analysis. A set of standard efficacy and
safety indices, such as treatment effect sizes (ES), the Numbers Needed to Treat (NNT) and Numbers Needed to Harm (NNH), was used to compare
medications. 32 studies analyzing efficacy and/or tolerability of SGAs in children and adolescents with bipolar, autistic or disruptive behavior
disorders, and Tourette syndrome were identified. SGAs efficacy on mania, extreme mood variability, irritability, aggression and disruptive behavior
appears to be greater than for psychotic symptoms in schizophrenia: average NNT was 2 - 5, whereas for schizophrenia it varies between 3 for
risperidone and 10 for olanzapine, quetiapine, and aripiprazole. As for schizophrenia, different SGAs show a similar efficacy for specific non-
psychotic disorders, but they significantly differ in their safety profile. In randomized studies, adverse effects were usually relatively minor,
easily predictable and manageable, whereas long-term open-label studies have indicated that some adverse event, such as the metabolic effects, may be
severe and potentially life threatening on the long-term. Taken together, these findings suggest that the choice of a specific treatment should be
guided primarily by the safety profile of specific antipsychotics, considering specific risk factors (i.e. obesity and BMI, family history of
diabetes or cardiovascular disorder, etc) for the single patient. (PsycINFO Database Record (c) 2013 APA, all rights reserved) (journal abstract)
European Neuropsychopharmacology, 21(8) : 600-
620
- Year: 2011
- Problem: Bipolar Disorders
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Atypical Antipsychotics (second
generation)
Sekhar, Susmit, Kalra, Bhupinder, Mendhekar, D. N., Tekur, Uma
This study was carried
out to compare the efficacy of intravenous sodium valproate with intramuscular haloperidol in patients with acute mania. A total of 30 patients
meeting DSM-IV criteria for acute manic episodes were enrolled. They were randomly assigned to 2 groups of 15 patients each. Both groups were treated
twice daily with haloperidol (10 mg, intramuscular) and sodium valproate (500 mg, intravenous). The patients were assessed on days 1, 5, 9, and 13.
Improvement in symptoms was assessed by reduction in the Young Mania Rating Scale (YMRS). Outcome criterions for analysis were latency of response
and remission; additional drugs were required for sedation. At the end of the 2-week study period, overall response rate in both the groups was
similar (P > .1). In comparison to haloperidol group, patients treated with sodium valproate showed faster response, and on day 5, significant
reduction in YMRS score was observed in the group treated with sodium valproate (P < .05). Total amount of lorazepam was less in patients treated
with sodium valproate. Extrapyramidal symptom episodes were observed in 60% of patients treated with haloperidol. Sodium valproate in the treatment
of acute mania is as efficacious as haloperidol but provides a faster response. It is safer compared to haloperidol.
Journal of Clinical Pharmacology, 50(6) : 688-692
- Year: 2010
- Problem: Bipolar Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Typical Antipsychotics (first generation), Anticonvulsants/mood stabilisers (excl. lithium)
Singh, M. K., Ketter, T. A., Chang, K. D.
The diagnosis of bipolar disorder (BD) in children is increasing, and often requires a comprehensive treatment plan to address a complex
array of symptoms and associated morbidities. Pharmacotherapy, in combination with psychotherapeutic interventions, is essential for the treatment
and stabilization of disrupted mood. Current evidence collectively demonstrates, by randomized controlled design, that atypical antipsychotics have
efficacy for the treatment of acute manic or mixed symptoms in children and adolescents with BD. Additional longitudinal and biological studies are
warranted to characterize the effects of atypical antipsychotics on all phases and stages of bipolar illness development in children and adolescents.
(copyright) 2010 Adis Data Information BV. All rights reserved.
Drugs, 70(4) : 433-442
- Year: 2010
- Problem: Bipolar Disorders
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Atypical Antipsychotics (second
generation)
Youngstrom, J. K., Freeman, A., Carpenter Song, E., Feeny, N., Youngstrom, E. A.
Objective: This project evaluates changes in mood and behavioral functioning and qualitative interviews
following cognitive behavioral treatment (CBT) or treatment as usual (TAU) in a diverse sample of youths with research diagnoses of bipolar disorder.
Methods: Investigated effectiveness of manualized CBT for youth ages 7-18 years with bipolar spectrum disorders (bipolar I disorder, bipolar II
disorder, bipolar disorder not otherwise specified, and cyclothymia) treated in community mental health. Clients were assessed via the Kiddie
Schedule for Affective Disorders and Schizophrenia and randomly assigned to CBT or TAU. Nineteen CBT and 25 TAU cases were evaluated prior to
treatment, after treatment, and four months later. Age ranged from 7 to 17 years; participants are 73% African-American, 16% European- American, 7%
Latin-American, and 5% Other ethnicities; 52% are male. Mood and behavioral ratings were completed by: parent, youths age 11 or older, and clinician
interview. Qualitative semistructured interviews were conducted with a subset of clients and guardians about skills, therapist alliance, and barriers
to treatment. Results: CBT and TAU groups improved significantly with large effect size reductions in mood severity by parents and clinicians (ps <
0.05). Outcomes were not significantly different between CBT and TAU as rated by clinicians, parents, or youths, (ps > 0.05). In qualitative
interviews, both CBT and TAU groups reported strong clinical relationships, characterized by open and supportive communication. Communication skills
and de-escalation techniques were reportedly most useful skills. Conclusion: Similarities across qualitative interviews revealed possible reasons
similarities in amount of improvement. The dimensions of treatment considered by clients/guardians to be most helpful - strong clinical relationships
and improved communication skills - cross-cut both CBT and TAU approaches.
Bipolar Disorders, 12 : 59
- Year: 2010
- Problem: Bipolar Disorders
- Type: Controlled clinical trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)
McCormack, Paul L.
Olanzapine is an atypical antipsychotic that, in addition to
its use in adults, is now indicated for the treatment of schizophrenia, and manic or mixed episodes associated with bipolar I disorder in adolescents
aged 13-17 years. In a randomized, double-blind, multicentre, 6-week trial in adolescents aged 13-17 years with schizophrenia, the least squares mean
reduction from baseline to 6 weeks in the Brief Psychiatric Rating Scale for Children (BPRS-C) total score (primary endpoint) was significantly
greater with olanzapine than with placebo. In a randomized, double-blind, multicentre, 3-week trial in adolescents, aged 13-17 years, with manic or
mixed episodes associated with bipolar I disorder, the mean reduction from baseline to 3 weeks in the Adolescent Structured Young Mania Rating Scale
(YMRS) total score (primary endpoint) was significantly greater with olanzapine than with placebo. In extensions of each of the pivotal placebo-
controlled trials in schizophrenia and bipolar mania, open-label treatment with olanzapine for up to 26 weeks produced significant reductions from
baseline to endpoint in BPRS-C and YMRS total scores, respectively. Oral olanzapine was generally well tolerated in adolescents with schizophrenia or
bipolar mania. Sedation and weight gain were the most common adverse events in placebo-controlled trials. Extrapyramidal symptoms were reported by
10% of olanzapine recipients compared with 6% of placebo recipients. Olanzapine-treated adolescents were likely to experience greater increases in
bodyweight, sedation, blood lipids, serum prolactin and liver transaminase levels than olanzapine-treated adults. Therefore, careful consideration of
risk-benefit is recommended before using olanzapine in adolescents.
CNS Drugs, 24(5) : 443-
452
- Year: 2010
- Problem: Bipolar Disorders
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Atypical Antipsychotics (second
generation)
Pavuluri, M. N., Henry, D. B., Findling, R. L., Parnes, S., Carbray, J. A., Mohammed, T., Janicak, P. G., Sweeney, J. A.
Objective: To determine the relative effects of
risperidone and divalproex in pediatric mania. Methods: This is a double-blind, randomized, outpatient clinical trial with 66 children and
adolescents (mean age = 10.9 (plus or minus) 3.3 years; age range = 8-18 years) with mania who were randomly assigned to either risperidone (0.5-2
mg/day, n = 33) or divalproex (60-120 (mu)g/mL, n = 33) for a six-week period. Measures included the Young Mania Rating Scale (YMRS) and Child
Depression Rating Scale-Revised (CDRS-R). Results: Mixed-effects regression models, with interaction between time and the active drug as predictors,
found that the risperidone group had more rapid improvement than the divalproex group (p < 0.05), although final scores did not differ significantly
between groups. Mixed models using only those subjects who completed the six-week study found similar results. The response rate on YMRS was 78.1%
for risperidone and 45.5% for divalproex (p < 0.01). The remission rate for risperidone was 62.5%, compared with 33.3% for divalproex (p < 0.05).
Improvement on the CDRS-R was significantly higher for the risperidone group relative to the divalproex group (p < 0.05). There were no significant
differences between groups in safety, but subject retention was significantly higher at study endpoint in the risperidone group (p < 0.01). Dropout
rate was 24% in the risperidone group and 48% in the divalproex group, with increased irritability being the most common reason for dropout in the
latter. There was no significant weight gain in either group. Conclusion: Results suggest that risperidone was associated with more rapid improvement
and greater reduction in manic symptoms compared to divalproex. Although the results suggest that both drugs are safe, risperidone's lower attrition
rate and lower rate of adverse events may suggest better toleration. Clinical trials with larger samples are required to confirm these preliminary
findings. (copyright) 2010 John Wiley and Sons A/S.
Bipolar
Disorders, 12(6) : 593-605
- Year: 2010
- Problem: Bipolar Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Atypical Antipsychotics (second
generation), Anticonvulsants/mood stabilisers (excl. lithium)
Correll, C.
U., Sheridan, E. M., DelBello, M. P.
Objective: To compare antipsychotic and mood stabilizer (MS) efficacy and tolerability in youth and adults with bipolar mania. Methods:
Medline/PubMed search for studies including: (i) youth (< 18 years) or adults ((greater-than or equal to) 18 years); (ii) bipolar I disorder; (iii)
double-blind, randomized, placebo-controlled trial (DB-RPCT); (iv) (less-than or equal to) 12 weeks of treatment; and (v) calculable effect sizes
(ES) and/or numbers needed to treat/harm (NNT/NNH) (plus or minus) 95% confidence intervals (CI). Non-overlapping 95% CIs determined significant
group differences. Results: We identified nine DB-RPCTs in youth (n = 1,609), 5 evaluating second-generation antipsychotics (SGAs) (n = 1,140) and 4
evaluating MSs (n = 469). We also identified 23 DB-RPCTs in adults (n = 6,501), 14 including SGAs (n = 3,297), 5 using haloperidol as an active
comparator (n = 580), and 11 including MSs (n = 2,581). Young Mania Rating Scale scores improved significantly more with SGAs than MSs in youth (ES =
0.65, CI: 0.53-0.78 versus 0.24, CI: 0.06-0.41) and adults (ES = 0.48, CI: 0.41-0.55 versus 0.24, CI: 0.17-0.31). After excluding topiramate studies,
SGAs had larger ES than MSs only in youth (ES = 0.65, CI: 0.53-0.78 versus 0.20, CI: 0.02-0.39), but not adults (ES = 0.48, CI: 0.41-0.55 versus
0.46, CI: 0.37-0.55). However, in adults SGAs had significantly larger ES regarding Clinical Global Impressions scores than MSs, even without
topiramate (ES = 0.75, CI: 0.68-0.82 versus 0.24, CI: 0.07-0.41). Rates of response, remission, and discontinuation due to any reason compared to
placebo were similar between medication and age groups, except for more favorable NNTs for remission with SGAs than MSs in adults after excluding
topiramate. SGAs caused more weight gain than MSs in youth (ES = 0.53, CI: 0.41-0.66 versus 0.10, CI: -0.12-0.33), but not in adults (ES = 0.13, CI:
0.05-0.22 versus 0.00, CI: -0.08-0.08). However, results were heterogeneous and not significant in either age group after excluding topiramate.
Nevertheless, SGA-related weight gain was significantly greater in youth than adults. In youth, SGA-related somnolence was greater than with MSs (NNH
= 4.7, CI: 3.9-6.0 versus 9.5, CI: 6.3-23.5), and more likely than in adults (NNH = 7.1, CI: 6.1-8.8). Conversely, youth experienced less akathisia
with SGAs than adults (NNH = 20.4, CI: 14.1-36.5 versus 10.2, CI: 8.1-13.7), likely due to lower doses/slower titration. Conclusions: In treating
mania, potentially greater short-term efficacy compared to placebo with SGAs versus MS needs to be balanced against increased adverse events,
especially in youth. (copyright) 2010 The Authors. Journal compilation (copyright) 2010 John Wiley & Sons A/S.
Bipolar Disorders, 12(2) : 116-141
- Year: 2010
- Problem: Bipolar Disorders
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Atypical Antipsychotics (second
generation), Anticonvulsants/mood stabilisers (excl. lithium)
Hasty, M. K., Conus, P., Cotton, S. M., Macneil, C. A., Berk,
M.
Bipolar disorder is a highly
recurrent illness, and many young people experience one or more relapses in the years following their initial episode. Understanding the early course
of illness and predictors of relapse may help to inform prognosis and improve treatment following recovery from a first episode of mania.
Identification of risk factors for recurrence, particularly those that are modifiable, is particularly relevant for psychological interventions aimed
at relapse prevention. Therefore, the aim of this study was to examine the course of illness in young people following treatment for first episode
psychotic mania and identify factors associated with relapse in this population. Seventy-four patients with first episode mania who were treated at
the Early Psychosis Prevention and Intervention Centre in Melbourne, Australia and enrolled in a randomized controlled trial (RCT) comparing acute
treatment using either olanzapine or chlorpromazine in combination with lithium were prospectively followed up for 18 months. The design of the RCT
allowed us to closely monitor the timing of symptom recurrences and changes to treatment and to examine the association of clinical variables and
medication status with relapse. Results from logistic regression and survival analyses will be presented.
Bipolar Disorders, 12 : 26
- Year: 2010
- Problem: Bipolar Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Typical Antipsychotics (first generation), Atypical Antipsychotics (second
generation), Lithium
Goldstein,
B. I., Bukstein, O. G.
Objective: The burden of substance use disorders (SUDs) among
adults with bipolar disorder is well documented. Comparatively less is known regarding comorbid SUD among youth with bipolar disorder. This article
aims to integrate the extant literature on this topic and to suggest strategies for delaying or preventing SUD among youth with bipolar disorder.
Data Sources and Study Selection: Relevant studies in English were identified using PubMed and MEDLINE (1950-February 2009). Search terms were
bipolar disorder cross-referenced with child, adolescent, or youth, and alcohol, drug, or substance, and abuse, dependence, or disorder. Articles
were selected on the basis of containing data regarding both bipolar disorder and SUD. The search was supplemented by manually reviewing reference
lists from the identified publications. Data Synthesis: Epidemiologic and clinical studies demonstrate that youth-onset bipolar disorder confers even
greater risk of SUD in comparison with adultonset bipolar disorder. Recent studies of youth with bipolar disorder have not identified childhood SUD
(0%); however, the prevalence of SUD escalates during adolescence (16%-39%). Substance use disorder among bipolar youth is associated with legal and
academic difficulties, pregnancy, and suicidality. Few studies have addressed interventions for this population, although studies are underway.
Because bipolar disorder onset most commonly precedes SUD among youth (55%-83%), there is a window of opportunity for prevention. Conclusions:
Pending the results of ongoing treatment studies, several strategies are suggested for curtailing the burden of SUD in youth with bipolar disorder.
These include screening for substance use among bipolar youth beginning at age 10 irrespective of other risk factors, education and intervention at
the family level, and implementation of preventive interventions that have been successful in other populations. (copyright) Copyright 2010
Physicians Postgraduate Press, Inc.
Journal of Clinical Psychiatry, 71(3) : 348-358
- Year: 2010
- Problem: Bipolar Disorders
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Psychological Interventions
(any)
Gracious, B. L., Chirieac, M. C., Costescu, S., Finucane, T. L., Youngstrom,
E. A., Hibbeln, J. R.
Objectives: This clinical trial evaluated whether supplementation with flax oil, containing the omega-3 fatty acid (alpha)-linolenic acid
((alpha)-LNA), safely reduced symptom severity in youth with bipolar disorder. Methods: Children and adolescents aged 6-17 years with symptomatic
bipolar I or bipolar II disorder (n = 51), manic, hypomanic, mixed, or depressed, were randomized to either flax oil capsules containing 550 mg
(alpha)-LNA per 1 gram or an olive oil placebo adjunctively or as monotherapy. Doses were titrated to 12 capsules per day as tolerated over 16 weeks.
Primary outcomes included changes in the Young Mania Rating Scale, Child Depression Rating Scale-Revised, and Clinical Global Impressions-Bipolar
ratings using Kaplan-Meier survival analyses. Results: There were no significant differences in primary outcome measures when compared by treatment
assignment. However, clinician-rated Global Symptom Severity was negatively correlated with final serum omega-3 fatty acid compositions: %(alpha)-LNA
(r = -0.45, p < 0.007), % eicosapentaenoic acid (EPA) (r = -0.47, p < 0.005); and positively correlated with final arachidonic acid (AA) (r = 0.36, p
< 0.05) and docosapentaenoic acid (DPA) n-6 (r = 0.48, p < 0.004). The mean duration of treatment for (alpha)-LNA was 11.8 weeks versus 8 weeks for
placebo; however, the longer treatment duration for (alpha)-LNA was not significant after controlling for baseline variables. Subjects discontinued
the study for continued depressive symptoms. Conclusions: Studies of essential fatty acid supplementation are feasible and well tolerated in the
pediatric population. Although flax oil may decrease severity of illness in children and adolescents with bipolar disorder who have meaningful
increases in serum EPA percent levels and/or decreased AA and DPA n-6 levels, individual variations in conversion of (alpha)-LNA to EPA and
docosahexaenoic acid as well as dosing burden favor the use of fish oil both for clinical trials and clinical practice. Additionally, future research
should focus on adherence and analysis of outcome based on changes in essential fatty acid tissue compositions, as opposed to group randomization
alone. (copyright) 2010 The Authors. Journal compilation (copyright) 2010 John Wiley & Sons A/S.
Bipolar Disorders, 12(2) : 142-
154
- Year: 2010
- Problem: Bipolar Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Complementary & Alternative
Interventions (CAM), Fish oil (Omega-3 fatty acids), Omega 3 fatty
acids (e.g. fish oil, flax oil)