Department of Psychiatry, Faculty of Medicine, The University of Melbourne, Richmond, Victoria, Australia.
J Clin Psychiatry. 2012 Jan;73(1):81-6. doi: 10.4088/JCP.10r06710. Epub 2011 Aug 9.
Studies using augmentation of pharmacotherapies with omega-3 in bipolar disorder have been conducted; however, to date a specific meta-analysis in this area has not been published. Thus, we present the significant findings from meta-analyses of omega-3 in the treatment of bipolar depression and bipolar mania.
PubMed, CINAHL, Web of Science, and Cochrane Library databases were searched for clinical trials up to September 1, 2010, using the search terms bipolar disorder OR bipolar depression OR bipolar mania OR mania OR hypomania OR cyclothymia with the search terms omega 3 OR essential fatty acids OR polyunsaturated fatty acids OR DHA OR EPA OR fish oil OR flax oil. Clinical trial registries and gray literature (published or unpublished data not readily accessible via main databases) were also searched.
The analysis included randomized controlled studies 4 weeks or longer, with a sample size > 10, written in English, using omega-3 for diagnosed bipolar depression or mania. No criteria were set for age, gender, or ethnicity.
A random-effects model was used. The model analyzed the standard mean difference between treatment and placebo between baseline and endpoint, combining the effect size (Hedges g) data. Funnel plot and heterogeneity analyses (I²) were also performed.
The findings of 5 pooled datasets (n = 291) on the outcome of bipolar depression revealed a significant effect in favor of omega-3 (P = .029), with a moderate effect size of 0.34. On the outcome of mania, 5 pooled datasets (n = 291) revealed a nonsignificant effect in favor of omega-3 (P = .099), with an effect size of 0.20. Minor heterogeneity between studies on the outcome of bipolar depression was found (I² = 30%; P = .213), which was not present on the outcome of bipolar mania (I² = 0%; P = .98). Funnel plot symmetry suggested no significant likelihood of publication bias. Meta-regression analysis between sample size and effect size, however, revealed that studies with smaller sample sizes had larger effect sizes (P = .05).
The meta-analytic findings provide strong evidence that bipolar depressive symptoms may be improved by adjunctive use of omega-3. The evidence, however, does not support its adjunctive use in attenuating mania.
已有研究尝试在双相障碍的药物治疗中加入ω-3 以增强疗效，但目前尚未有专门针对该领域的荟萃分析。因此，我们对 ω-3 治疗双相抑郁和双相躁狂的荟萃分析结果进行了总结。
检索了截至 2010 年 9 月 1 日的PubMed、CINAHL、Web of Science 和 Cochrane 图书馆数据库，使用的检索词为双相障碍或双相抑郁或双相躁狂或躁狂或轻躁狂或环性心境障碍与ω-3 或必需脂肪酸或多不饱和脂肪酸或 DHA 或 EPA 或鱼油或亚麻籽油。还检索了临床试验注册处和灰色文献（通过主要数据库不易获得的已发表或未发表的数据）。
分析纳入了随机对照研究，持续时间≥4 周，样本量>10，采用 ω-3 治疗确诊的双相抑郁或躁狂。未设定年龄、性别或种族标准。
采用随机效应模型。该模型分析了治疗组和安慰剂组在基线和终点之间的标准均数差值，结合效应量（Hedges g）数据。还进行了漏斗图和异质性分析（I²）。
5 项汇总数据集（n=291）关于双相抑郁结局的结果显示，ω-3 治疗组有显著的疗效（P=0.029），效应量为 0.34。关于躁狂结局的 5 项汇总数据集（n=291）显示，ω-3 治疗组无显著疗效（P=0.099），效应量为 0.20。关于双相抑郁结局的研究之间存在较小的异质性（I²=30%；P=0.213），而关于双相躁狂结局的研究则不存在异质性（I²=0%；P=0.98）。漏斗图对称性表明不存在显著的发表偏倚可能性。然而，样本量与效应量之间的元回归分析显示，样本量较小的研究具有更大的效应量（P=0.05）。
荟萃分析结果提供了强有力的证据，表明ω-3 辅助治疗可能改善双相抑郁症状。但目前的证据并不支持其辅助治疗用于减轻躁狂。
