PracticeUpdate Conference Series European Congress of Psychiatry 2019

Nutraceuticals Might Be Effective Adjunctive Therapy for Bipolar Disorder Literature review suggests possible benefits for omega-3 fatty acids, amino acids andmicronutrients. N utraceuticals might be an effective adjunc- tive therapy for people with bipolar disorder, according to a poster presented at EPA 2019.

Most of the studies showed significant effects of omega-3 fatty acids, amino acids and micro- nutrients on core symptoms of bipolar disorders, such as depression or mania. As for probiotics, the researchers found no significant differences between them and placebo. According to their study, use of nutraceuticals appeared to be safe. The study was not definitive but, in their conclusion, Dr. Fusar-Poli and colleagues stated that “the use of nutraceuticals in the treatment of bipolar disorder might be useful add-on to psychopharmacological therapy.” They also noted that “given the growing interests of both [the] scientific community and psy- chiatric patients towards the use of complementary and alternative therapies, the implementation of further [randomized controlled trials] to evaluate the efficacy of nutraceuticals should be promoted.” “Over half of the bipolar patients I’ve cared for in my career have engaged in a form of nutraceuti- cal treatment at some point,” noted Dennis Butler, PhD, Professor Emeritus of Family Medicine at the Medical College of Wisconsin in Milwaukee, in a comment on the study for Elsevier’s PracticeUpdate . “As a young clinician, I hypothesized this was part of the bipolar symptom profile; as I gained expe- rience, I considered that nutraceutical treatment was a healthy attempt to engage in treatment or, conversely, a reaction to therapeutic stagnation or medication side effects. Unaware of any evidence of clinical efficacy, I entertained the likelihood of a placebo effect. Unfortunately, the patients did not understand the criteria for a good study and frequently failed to adhere to consistent dosing or selection of nutraceutical agents! “Although the review does not reach the standards of a meta-analysis,’ he continued, “the authors con- firm there is a growing and valid literature in this area and that omega-3 fatty acids, amino acids and micronutrients may have a useful role in adjunc- tive therapy, possibly potentiating the effects of standard pharmacologic therapy. Until there is stronger evidence, primary care physicians need to ask their bipolar patients how or if they are using alternative or complementary treatments. Bipolar patients have access to an alternative world via the internet and informal support groups that pro- mote both unproven as well as potentially helpful nutraceutical treatments.”

Laura Fusar-Poli, MD, PhD and six other research- ers at the University of Catania in Italy noted that the possible role of nutrient deficiencies in the eti- ology of psychiatric diseases, such as depression or anxiety, has been the focus of several studies. They also commented that, in some conditions, nutraceuticals such as omega-3 fatty acids, vita- mins, minerals, amino acids or probiotics seem to potentiate the effects of standard pharmacologic therapy. Dr. Fusar-Poli and colleagues conducted a sys- tematic review to evaluate the efficacy and safety of nutraceuticals for patients with bipolar disorder. Their search took place in August 2018, and there were no time restrictions to it. They focused on randomized controlled trials that evaluated the efficacy of nutraceuticals in addition to standard care in patients with bipolar disorder, and they compared this to standard care alone or placebo plus standard care. The investigators found 27 articles that met their criteria. These articles covered trials that tested the following nutraceuticals: omega-3 fatty acids and similar (12 articles), amino acids and derivatives (9 articles), vitamins and minerals (9 articles), and probiotics (1 article).

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PRACTICEUPDATE CONFERENCE SERIES • EPA 2019 18