Fatty acid diet intervention may stabilize mood among patients with bipolar disorder

A nutrition intervention focused on fatty acids may stabilize mood, energy, irritability and pain among individuals with bipolar disorder, according to data presented at the American Society of Clinical Psychopharmacology Annual Meeting.

“Mood fluctuation and instability is an understudied area in bipolar disorder,” Sarah Shahriar, BS, research assistant at The Pennsylvania State University’s Mood Disorders Lab, told Healio Psychiatry. “With this research, we intended to add to the growing knowledge of how well-tolerated interventions may improve the day-to-day mood stability of patients with bipolar disorder. Through prior work looking at the biological systems that influence mood in bipolar disorder, we used a nutritional intervention to make a hypothesis-driven change in the inflammatory system.”

In a poster presentation, Shahriar and colleagues noted that mania in bipolar disorder impairs mood stability, and effective medications for mania reduce turnover of polyunsaturated fatty acid omega-6 precursor arachidonic acid. They sought to determine whether a high omega-3, low omega-6 (H3-L6) nutrition intervention would significantly reduce variability in daily mood symptoms, energy and impulsivity compared with the usual U.S. omega6 and omega-3 fatty acid intake levels, which was the control diet.

The researchers enrolled participants with a DSM-4 diagnosis of bipolar 1 or 2 disorder who were symptomatic with hypomanic or depressive symptoms. They randomly assigned 82 participants to the H3-L6 intervention or the control diet, stratifying assignment according to gender. Those in the intervention group received 12 weeks of group-specific study foods and oils, intensive dietary counseling, access to a website with recipes and guidance for restaurant eating. Shahriar and colleagues captured responses using a visual analogue scale in an ecological momentary assessment paradigm on a smartphone, which measured changes in day-to-day mood, energy, valance of thoughts, impulsive thoughts and actions, anxiety, irritability and pain symptoms.

Participant completion rate was 68% for the H3-L6 group and 73% for the control diet group. The researchers conducted statistical analysis using multilevel modeling of variability in the symptoms scores during the intervention period, and they controlled for variability at baseline.

Results showed no significant difference in mean levels of mood and pain symptoms before or after the intervention either within groups or between groups. Further, the researchers observed no between-group differences in standard deviation of self-rated symptoms; however, multilevel analysis revealed differences between groups in within-subject variability across the 12-week intervention period. After controlling for baseline symptoms, they observed significant reductions in mood, energy, irritability and pain among the H3-L6 group that were greater than those among the control diet group (all, P < .001). Impulsive thoughts were the only symptoms with a significantly greater reduction in the control diet group compared with the H3-L6 group (P = .004).

“We were very pleased to find that there was a reduction in the variability of mood, energy, pain and irritability in the intervention group,” Shahriar told Healio Psychiatry. “However, although the findings are exciting, further studies are needed, and we understand that this is simply another reason to continue the research in how bipolar disorder treatment may be augmented through an H3-L6 diet.”