BPD Patients Respond To Omega-3 Fatty Acids

Yes, this is a fish tale—but one perhaps worth believing since it is based on science: Some nutrients commonly found in seafood can dramatically influence mental health.

During the past several years, evidence has been mounting that the omega-3 fatty acids often present in fish can be used to prevent and treat depression and bipolar disorder (Psychiatric News, August 3, 2001). Now a pilot study suggests that they can help combat borderline personality disorder as well.

The study was conducted by Mary Zanarini, Ed.D., an associate professor of psychology at Harvard University Medical School, and Frances Frankenburg, M.D., an associate professor of psychiatry at Boston University School of Medicine. They reported their findings in the January American Journal of Psychiatry.

Zanarini and Frankenburg recruited women for their study through ads placed in Boston newspapers. The ads asked questions such as, “Are you extremely moody? Do you often feel out of control? Are your relationships painful and difficult?” Women who responded to these ads were then screened by phone to see whether they met DSM-IV criteria for borderline personality disorder and asked about their medical and psychiatric backgrounds. Any women who were medically ill, taking psychotropic medications, abusing substances, suicidal, already using omega-3 fatty acid supplements, or eating more than one or two servings of fatty fish a week were excluded from the study.

Those women who appeared to be suitable subjects for the study were invited for face-to-face interviews in which study procedures were explained and two semistructured diagnostic interviews were administered. One was the Structured Clinical Interview for DSM-IV Axis I disorders. The other was the Revised Diagnostic Interview for Borderlines. Candidates were included in the study if they met the criteria in both instruments for borderline personality disorder and did not have, nor had ever had, schizophrenia, schizoaffective disorder, or bipolar I or II disorder or were currently in the midst of a major depressive episode.

The final study sample consisted of 30 women who were, on average, 26 years of age, white, and functioning in the lower of the “fair” range of the Global Assessment of Functioning Scale.

In an eight-week study period, 20 of the 30 subjects received daily two 500 mg capsules of an omega-3 fatty acid called E-EPA (ethyl-eicosapentaenoic acid). The remaining 10 subjects received a placebo daily—two capsules containing mineral oil.

The investigators then assessed the levels of depression and aggression in the two subject groups both at the start and end of the study and monitored the subjects getting an omega-3 fatty acid supplement for possible side effects.

At the end of the study, the researchers compared the treatment group’s initial levels of depression and aggression with their final levels. They did the same with the placebo group. They found that while depression and aggression levels had declined in the placebo group from the start of the study to the end, they had dropped even more so in the treatment group—a statistically significant difference. They also found that the omega-3 fatty acid tested was well tolerated.

Thus, Zanarini and Frankenburg concluded that the omega-3 fatty acid used—E-EPA—“may be a safe and effective form of monotherapy for women with moderately severe borderline personality disorder.”

Zanarini told Psychiatric News that she and Frankenburg will next seek funding from the National Institute of Mental Health to pursue a larger study of E-EPA’s efficacy.

Psychiatric News also asked Zanarini whether there is any scientific evidence that might explain how the omega-3 fatty acids counter depression and aggression in borderline patients. “The mechanism of action of omega-3 fatty acids is unknown,” she replied. “Perhaps it works, at least in part, through its ability to lead to [cell] membrane stabilization [in the brain].”

Indeed, “the brain is made up of at least 60 percent lipids, so these findings by Zanarini and Frankenburg make a lot of sense,” Hyla Cass, M.D., an assistant clinical professor of psychiatry at the University of California at Los Angeles and a nutrition authority, told Psychiatric News.

The study was funded by the National Alliance for Research on Schizophrenia and Depression.

The study, “Omega-3 Fatty Acid Treatment of Women With Borderline Personality Disorder: A Double-Blind, Placebo-Controlled Pilot Study,” is posted on the Web at http://ajp.psychiatryonline.org/cgi/content/full/160/1/167?. ▪