High Potency Omega 3 Fatty Acids

There is a lot of uncertainty about the effectiveness of using Omega 3 fatty acids as a treatment for Bipolar Disorder. The few studies that have been performed have shown mixed results. The other issue to consider is the dose. Most of the Bipolar studies have a wide range of dosing, in some cases as much as 10 grams a day, which is a very large dose compared with what we use to treat unipolar depression. Another concern that we have about the Omega 3 Fatty Acids is that we have documented cases of people with Bipolar Disorder cycling to mania when they take them.

The recommendation would be that if you have a patient with Bipolar I or Bipolar II, and you are going to use Omega 3s, you should use them in conjunction with a mood stabilizer. The goal of adding Omega 3s should be primarily to alleviate depressive symptoms, because in studies that have looked in detail at using Omega 3s in bipolar treatments, it appears that it is really the depressive symptoms, rather than the manic symptoms, that benefit the most from the use of Omega 3s. The recommendation would be to keep your patient on the mood stabilizer, and start Omega 3s at the dose of about 1 gram per day. Depending on how well tolerated it is, and what results you see, you can increase the dose gradually to the range of about 3 grams a day. If you are not getting results by then, it may not be worthwhile to try and push the Omega 3s to higher doses. Since it works in about the same timeframe as regular antidepressants, the patient should be willing to stay on it for at least six to eight weeks before we see results.

David Mischoulon, MD
Director of Research, Depression Cilnical Research Program
Massachusetts General Hospital
Assistant Professor of Psychiatry
Harvard Clinic School