Table 2.
Bipolar disorders.
| Study Design | Country | No. | Age Group | Disease | Daily Dosage (g/d) | Duration | Rating Scale | End Point | |
|---|---|---|---|---|---|---|---|---|---|
| Wozniak et al., 2007 [59] | Open label trial | USA | 20 | 6–17 years | - Bipolar spectrum disorder | 1290 mg–4300 mg/d n-3 PUFAs | 8 weeks | - YMRS - BPRS - SANS - MADRS |
8.9 ± 2.9 point reduction in the YMRS scores (p < 0.001). |
| Clayton et al., 2009 [61] | Open label trial | Australia | 18 | mean age = 16.1 ± 0.81 years | - Bipolar spectrum disorder | 360 mg/day EPA and 1560 mg/day DHA | 6 weeks | - YMRS - HAM-D - C-GAS) - CBCL-PR, |
Clinician ratings of YMRS and HAM-D were significantly lower (p = 0.004 and p = 0.002) and C-GAS significantly higher (p < 0.001) following supplementation. |
| Fristad et al., 2015 [64] | Randomised controlled trial | USA | 23 | 7–14 years | - BP-NOS - CYC |
2000 mg/day of n-3 PUFAs versus placebo and IF-PEP versus AM using a 2 · 2 design (O3 + PEP: n = 5; O3 + AM: n = 5; placebo + PEP: n = 7; placebo + AM: n = 6) | 12 weeks | - K-SADS - KDRS - KMRS - CDRS-R - YMRS |
Manic symptoms improved over time without significant treatment effects. Effect of IF-PEP on child depression compared with AM was medium (d = 0.63, CDRS-R) to large (d = 1.24, KDRS). Effect of n-3 PUFAs on depression was medium (d = 0.48, KDRS). |
| Vesco et al., 2018 [68] | Randomised controlled trial | USA | 95 | 7–14 years | - BP-NOS or CYC (n = 23) - MDD (n= 72) | - 1.87 g/d n3-PUFAs in monotherapy - PEP monotherapy - PEP + n3-PUFAs |
12 week | - BRIEF - GEC - BRI - YMRS |
PUFAs supplementation were associated with significant improvements in executive functions and in dysphoric mood, irritability, and self-esteem. |
| Fristad et al., 2021 [67] | Naturalistic follow-up study | USA | 38 | 11–19 years | - BP-NOS or CYC (n = 13) - MDD (n = 25) | 2–5 years after participation in randomised clinical trials (RCTs) Fristad et al., 2015 | - Mental Health Services and Medication Grids - CDRS - YMRS - BRIEF - CGAS - The OATS Family Experience Assessment—Child and Parent Report (FEA) |
Compared to baseline depressive symptoms, participants had significantly lower CDRS-R scores at follow-up, with a small effect size and were functioning better (CGAS scores) with a medium effect size. Manic symptom severity, executive functioning, and global functioning remained comparable to end of RCT. The majority of parents and youth reported improved youth emotion regulation skills and family communication. |
BPRS: Brief Psychosis Rating Scale; BRI: Behaviour Regulation; BRIEF: Behaviour Rating Inventory of Executive Functioning; CBCL-PR: Child Behaviour Checklist—Parent Report; CDRS: Children’s Depression Rating Scale; CDSS: Calgary Depression Scale for Schizophrenia; C-GAS: Global Assessment Scale for Children; CGI-S Clinical Global Impressions scale; GAF: Global Assessment of functioning; GEC: Global Executive Composite; HAM-D: Hamilton Depression Rating Scale; K-SADS: Kiddie Schedule for Affective Disorders ( KRDS Depression; KMRS: mania); MADRS: Montgomery–Åsberg Depression Rating Scale; PANSS: Positive and Negative Syndrome Scale; SANS: Schedule for Assessment of Negative Symptoms; SCID-I/P: The Structured Clinical Interview for DSM-IV Axis I Disorders; YMRS: Young Mania Rating Scale.