Marine omega-3s could be a promising add-on therapy for improving symptoms of borderline personality disorder (BPD), new research suggests.
A meta-analysis of four randomized controlled trials showed that additional omega-3 polyunsaturated fatty acids (PUFAs) significantly reduced the overall severity of BPD symptoms, particularly influencing dysregulation and impulsive behavior.
“In view of the mechanisms of action and the advantageous side effect profile, this is it [analysis] suggests that omega-3s could be considered as an add-on treatment for patients with BPD, senior author Roel JT Mocking MD, PhD, resident in psychiatry and postdoc at the Academisch Medisch Centrum, Amsterdam, told Medscape Medical News.
The results were recently published online in the Journal of Clinical Psychiatry.
“There are several effective treatments, but not all patients respond adequately,” indicating an urgent need for additional treatment options, Mocking said.
He noted that although “several previous studies showed promising effects of omega-3 fatty acids” in patients with BPD, these studies were relatively small, ruling out more definitive overall conclusions.
The current researchers wanted to combine the results of the previous studies to produce a combined estimate of the overall effectiveness of omega-3 fatty acid use in patients with BP, with the intention of “helping clinicians and those with borderline personality disorder make decisions” whether to add omega-3s to their treatment. “
The analyzed four studies with a total of 137 patients. Three of the studies included patients diagnosed with BPD; one included people with recurrent self-harm, most of whom were also diagnosed with BPD.
Omega-3 fatty acids were used as monotherapy in one study. In the other studies, they were used as add-on therapy to other drugs such as antidepressants, benzodiazepines and / or valproic acid. None of the studies included patients taking antipsychotics.
The type of omega-3 PUFAs were derived from marine rather than vegetable sources.
Three studies compared omega-3 fatty acids with placebo. One study compared valproic acid monotherapy with valproic acid plus omega-3 fatty acids and did not include a placebo group.
Significantly decreasing effect
Random effects meta-analyzes showed an “overall significant decreasing effect” of omega-3 fatty acids on the overall severity of BPD symptoms (standardized difference between the mean values [SDM], .54; 95% CI, 0.91-0.17; P = 0.004) in the omega-3 group compared to the control group with a medium effect size.
The investigators add that there was “no relevant heterogeneity” (P = .45).
The effects of omega-3 fatty acid supplementation on specific symptom areas are shown in the table below.
|Symptom domain||Studies||SDM (95% CI)||P value||Quality of evidence|
|Affective dysregulation||4th||.74 (1.21 – .27)||.002 *||Moderate|
|Impulsive behavior disorder||3||.45 (.84 – .059)||.02 *||Moderate|
|Cognitive Perceptual Symptoms||2||.30 (.96 – .36)||.38||Low|
|Global functionality||2||.70 (1.80 – .40)||.21||Very low|
|* Significant effect|
Although the heterogeneity was “more pronounced” in the symptom range of affective dysregulation, it did not reach statistical significance, the researchers found.
The domains of impulsive behavior disorder and cognitive perceptual symptoms had “no relevant heterogeneity”. On the other hand, there is “substantial heterogeneity” in the globally functioning symptom group.
Omega-3 fatty acids “have a variety of bioactive functions in the brain. For example, they form essential components of the membrane of brain cells and thereby influence the structure and function of the brain. They also affect the level of inflammation in the brain, ”said Taunt.
“Since we cannot synthesize these omega-3 fatty acids ourselves, we are dependent on our diet. The main food source for omega-3 fatty acids is oily fish. However, since the industrial revolution we have been eating less and less oily fish and risking omega-3 fatty acid deficiency, which leads to brain dysfunction, “he added.
Mocking found that the mechanisms of action of omega-3 fatty acids differ from other treatments for BPD, such as psychotherapy, antidepressants, or antipsychotics.
This “indicates that they could be combined to increase overall effectiveness,” he said.
Commenting on the study for Medscape Medical News, Roger McIntyre, MD, Professor of Psychiatry and Pharmacology at the University of Toronto, Toronto, Canada and Head of the Department of Psychopharmacology in Mood Disorders said that the benefits of omega-3 are “on.” Impulsivity and Mood “Symptoms are particularly important as these are some of the most debilitating aspects of BPD and lead to the use of services such as emergency rooms, primary care, and specialty care.”
“Impulsiveness often suggests suicidality,” he noted.
McIntyre, who is also chairman and executive director of the Brain and Cognition Discovery Foundation in Toronto and was not involved in the study, called the effect size “pretty reasonable”.
“The mechanistic story is very strong about anti-inflammatory effects, which specifically implies mood and cognition. In other words, inflammation is strongly linked to mood and cognitive difficulties,” he said.
However, McIntyre also pointed out several significant challenges including “Assuring the quality of the fish oil product purchase because it is not adequately regulated”. It is also unclear which people are more likely to benefit from it.
For example, major depressive disorder data has shown that “fish oils are not as effective as we hoped, but are particularly effective in people with initial elevations in markers of inflammation,” McIntyre said.
“In other words, is there a way to identify a biomarker / signature or phenomenology that is more likely to identify a subset of people with BPD who might benefit from omega-3s?” he asked.
Mocking and the other investigators do not report any relevant financial relationships. McIntyre has received research grants from CIHR / GACD / Chinese National Natural Research Foundation and speaker / consultancy fees from Lundbeck, Janssen, Purdue, Pfizer, Otsuka, Allergan, Takeda, Neurocrine, Sunovion, Eisai, Minerva, Intra-Cellular, and Abbvie. McIntyre is also the CEO of AltMed.
J Clin Psychiatry. Published online May 4, 2021. Executive summary
Visit us on Facebook and Twitter to learn more about Medscape Psychiatry.