Benefits of Fish Oil: Can It Help Bipolar Disorder?

Bipolar disorder is a mental health condition characterized by extreme changes in mood, energy, and activity levels, which range from elevated or irritated manic episodes to depressive episodes, according to the National Institute of Mental Health (NIMH). Standard treatment includes both drugs (mood stabilizers, antidepressants, and antipsychotic medications) and psychotherapy to manage these episodes that may occur throughout life.

Because of the growing knowledge about the role that omega-3 fatty acids (or lack thereof) plays in brain health and mental disorders, researchers have investigated whether omega-3s may help with bipolar disorder, too. Omega-3 fatty acids are a group of essential fatty acids that have to be consumed in your diet via food or supplements.

Fish oil — the oil that comes from fish and seafood — is rich in omega-3s, namely EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid); you can also get it via supplements. Both EPA and DHA get turned into building blocks for brain cells once metabolized, according to the National Center for Complimentary and Integrative Health (NCCIH).

Evidence to explain the role fish oil (and the omega-3s in them) play in bipolar disorder is still, however, fairly preliminary.

“We have more than 30 clinical trials that have shown EPA-DHA omega-3s benefit depression. But we do not have that type of data with bipolar disorder,” says Shebani Sethi Dalai, MD, founding director of the metabolic psychiatry clinic and clinical assistant professor at Stanford University School of Medicine in California. “It is something being studied more.”

Here’s what you should know about the available research.

Does Fish Oil Help People With Bipolar Disorder Manage Symptoms?

Researchers suspect omega-3 fatty acids, including fish oil, may potentially be valuable in the treatment of mental health conditions because there is a growing recognition that inflammation may play a role in mood disorders (omega-3s have anti-inflammatory effects), Dr. Sethi Dalai says. There is also evidence to suggest that people who have low levels of omega-3s in their blood have more severe bipolar symptoms, notes an October 2016 review in the Journal of Clinical Psychiatry.

But more robust research is needed to determine how omega-3s or fish oil specifically affect mania, and if these supplements could even bring on symptoms of mania if taken in the absence of mood stabilizing drugs, Sethi Dalai says. “Having omega-3s for depression in bipolar disorder may be helpful, but we don’t know what it does for mania.”

More clinical trials are needed to determine if this is a safe supplement for bipolar disorder, she says.

RELATED: 7 Triggers That Can Cause a Bipolar Episode

What Does the Existing Science Tell Us About Why Fish Oil Helps With Bipolar Disorder?

Research, including a review published in August 2016 in the Journal of Clinical Medicine, suggests that omega-3 supplements may be useful for relieving depression symptoms in bipolar disorder, but overall the evidence is mixed. What’s more, the doses given (0.5 to 6-plus grams per day) and type of omega-3 (DHA-EPA or the other type of omega-3 fatty acid, alpha-linolenic acid [ALA]) varied so widely among studies that it’s difficult to pin down exactly what dose and preparation is most effective.

Another potential benefit of fish oil or other omega-3s for bipolar disorder might be in preventing early psychosis, says Ken Duckworth, MD, chief medical officer at the National Alliance on Mental Illness (NAMI). Psychosis, according to the U.S. National Library of Medicine, is abnormal thinking and perceptions that make a patient lose touch with reality. Delusions and hallucinations are common in psychosis — and both can occur in people with bipolar disorder or schizophrenia.

A trial published in February 2020 in Biological Psychiatry that included 218 young people (mean age was 19 years old) at high risk of developing early psychosis (as determined using an established measure of psychosis risk) suggests that intervening with omega-3s through either fish oil supplements or food might help restore abnormally low levels of this nutrient or decrease inflammation, thereby affecting progression of the disorder to psychosis.

But it was unclear from the data whether the supplements or food sources of omega-3s accounted for higher omega-3 blood levels, explains G. Paul Amminger, MD, PhD, study author and professorial fellow at the Centre for Youth Mental Health at The University of Melbourne in Australia. Dr. Amminger says that this research, while not conclusive, gives clinicians an option to consider fish oil supplementation on patients at high-risk of psychosis on an individual basis.

Should I Try Fish Oil to Help With Bipolar Disorder?

Even though fish oil and other omega-3 supplements are available over-the-counter, you’ll want to talk to your doctor about if they’re right for you. “There are risks and benefits to every single drug. Nutritional supplements are no different,” Sethi Dalai says.

And it’s important to note that fish oil supplements can interact with other medications you’re on, rendering those medications either less effective or harmful to your health. And it’s important to note that you should not replace regular medications for bipolar disorder or any other condition with supplements.

RELATED: Foods to Avoid if You Have Bipolar Disorder

Still, your physician might determine that, under careful observation, a fish oil or omega-3 supplement might be useful for you. In that case, your physician may recommend one that contains at least 60 percent EPA, which is the EPA-DHA ratio that research suggests is needed to in order to be effective in mental health conditions.

And if you want to make sure you’re getting a healthy amount of fish oil via diet, aim to eat 8 ounces of seafood per week (about two to three servings), according to the NCCIH. Supplements often deliver much higher amounts of fish oil or other omega-3s than what you find in food, which is why supplements, but not necessarily food, can be risky, says Sethi Dalai.

According to Sethi Dalai, the bottom line is: “Omega-3 fatty acids are promising as a natural treatment for mood disorders. We need more research about how they work, their effectiveness, proper dose, and long-term safety before we can make recommendations for people with mental conditions.”

How Much Fish Oil Is Good for Your Mental Health?

Even though research has yet to answer some of the specific questions about the benefits of fish oil for bipolar disorder, there is stronger evidence that a diet that includes sufficient omega-3 fatty acid intake is good for mental health overall. An all-around healthy diet, preferably a Mediterranean-style eating pattern, may help support mental health, according to the 2016 Psychiatric Clinics of North America paper.

Dr. Duckworth, however, cautions against overestimating the potential of any dietary intervention to prevent or reverse a mental health problem. At this point there’s no research to back up the idea that eating certain foods alone can replace a medication prescribed for a mental illness or treatment from a psychotherapist, he says. “I think it’s only part of your toolbox.”

If you have specific questions about whether more fish oil (or other types of omega-3s) might benefit you, talk with your healthcare provider about whether a dietary change or a supplement is a good idea. And remember, if you’re considering a supplement, check in with your provider about dose and potential interactions with other medications you may be taking.

RELATED: Why Bipolar Disorder Is Often Wrongly Diagnosed

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