A Cochrane review [Abstract] 1 included 2 studies with a total of 292 subjects. Four studies were conducted in outpatient settings with patients meeting criteria for either bipolar I or bipolar II. The other study involved acute patients hospitalised for bipolar disorder and manic episode. All were adjunctive trials, but the other treatments varied considerably. Studies used EPA and DHA in combination as provided by fish oils, two others used pure ethyl EPA while one used pure DHA from an algal source. Similarly, doses ranged from 1g/day to 9.6g/day. Only one study, involving 75 participants, provided data for analysis, and showed a benefit of active treatment over control for depression symptom levels (WMD -3.93, 95% CI -7.00 to -0.86) and Clinical Global Impression scores (WMD -0.75, 95% CI -1.33 to -0.17) but not for mania (WMD -2.81, 95% CI -7.68 to 1.90). No serious adverse effects were reported in the five studies.
Comment: The quality of evidence is downgraded by imprecise results (few patients and wide confidence intervals) and study quality (several issues).
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