Role of Omega-3 fatty acids in preventing metabolic disturbances in patients on olanzapine plus either sodium valproate or lithium: a randomized double-blind placebo-controlled trial

Abstract

BackgroundMetabolic and cardiovascular side effects have been noted with the use of second generation antipsychotics (SGAs) and mood stabilizers. Since Omega-3 fatty acids have been known to prevent some cardiovascular risks, this preliminary study was designed to evaluate the cardiovascular benefits of omega-3 when added to the combinations of olanzapine with mood stabilizers.MethodsThis study was a randomized, double-blind, placebo-controlled, within-subject trial in adult psychiatric patients who were receiving olanzapine combined with lithium (Li) or valproate sodium (VPA). Omega-3 as fish oil with less than 1 g/day of EPA/DHA or its placebo was added to patients’ olanzapine and mood stabilizer regimens for 6 weeks. Metabolic parameters including anthropometric variables, lipid profile, metabolic syndrome indices, C-reactive protein, fibrinogen and lipoprotein (a) [(Lp) (a)] were assessed for participants.ResultsForty one participants completed this study; 20 patients received omega-3 and 21 patients received placebo, added to their regimen of SGA and mood stabilizer. Omega-3 addition did not modulate anthropometric, metabolic syndrome and lipid parameter changes in 6 weeks. However, fibrinogen levels significantly decreased, Lp (a) did not increase and non-high-density lipoprotein cholesterol (non-HDL-C) did not go beyond its target level after omega-3 supplementation. Additionally, a significant inter-group effect was noted for Lp(a).ConclusionsThis study suggests that use of short-term omega-3 supplementation added to a combined regimen of olanzapine and mood stabilizer may have a small modulating effect on some cardiovascular risk factors. Trials in longer periods of time and with larger number of patients are needed to further evaluate the effects of omega-3 supplements on preventing cardiovascular risk factors.This trial is registered at irct.ir and its Identifier is as following: IRCT138712231764N1

The Effects of Omega-3 Fatty Acids Supplementation on Gene Expression Involved in the Insulin and Lipid Signaling Pathway in Patients with Polycystic Ovary Syndrome

“…Data on omega-3 fatty acids effects on Lp(a) are limited. In another study, 1 g/day omega-3 supplementation added to a combined regimen of olanzapine and mood stabilizer among adult psychiatric patients for 6 weeks did not affect Lp(a) levels 40 . However, in previous 2 studies, a favorable effect of omega-3 fatty acids supplementation on decreasing levels of serum Lp(a) was reported in hypertensive and CVD patients 41 42 .…”

A potential role for adjunctive omega-3 polyunsaturated fatty acids for depression and anxiety symptoms in recent onset psychosis: Results from a 16 week randomized placebo-controlled trial for participants concurrently treated with risperidone

“…Prior omega-3 metabolic studies with antipsychotic-treated participants have been limited. Two investigations (Fetter et al, 2013;Freeman et al, 2015) reported positive effects but other studies have found no omega-3 effects (Emsley et al, 2008;Faghihi et al, 2012) or positive effects on triglycerides but increases in total and LDL cholesterol (Caniato et al, 2006). More research is needed on omega-3 metabolic effects and, if present, their effect on the risk-to-benefit assessment for omega-3s treatment.…”

Omega-3 fatty acids in first-episode schizophrenia - a randomized controlled study of efficacy and relapse prevention (OFFER): rationale, design, and methods

“…Antipsychotic-induced dyslipidemia was successfully treated with n-3 PUFA supplementation [ 29 ]. Short term (6 weeks) n-3 supplementation was able to modulate cardiometabolic risk factors in patients treated with olanzapine and either valproate or lithium [ 30 ]. Berger et al report that ethyl-EPA supplementation used as add-on therapy in patients with schizophrenia was associated with a 20% reduction in the use of antipsychotics, reduced percentage of patients experiencing the extrapyramidal side effects, constipation and the sexual side effects of antipsychotic therapy [ 26 ].…”