Iranian Journal of Psychiatry 2010. 5(1):18-22.

Effect of Early Intervention with Omega-3 on Insulin Resistance in Patients Initiated on Olanzapine with either Sodium Valproate or Lithium: A randomized, Double-blind, Placebo-Controlled Trial.
Toktam Faghihi, Padideh Ghaeli, Adel Jahed, Javad Mahmoudi-Gharaei, Vandad Sharifi, Akhondzadeh Shahin

Abstract


 Objective: Metabolic side effects of the second generation (atypical) antipsychotics have been a forefront of attention since their availability. One common   concern   is   the   development   of   hyperglycemia   and   insulin resistance. The aim of this study was to evaluate the effect of early initiation of omega-3 fatty acids supplementation on glucose-insulin homeostasis in a group of psychiatric patients under treatment with olanzapine and sodium valproate or lithium combination.
Method: In a double-blind design, eligible participants with schizophrenia, bipolar I, and schizoaffective disorders who were initiated on olanzapine combination  with  sodium  valproate  or  lithium were randomly assigned to receive omega-3 or identical placebo capsules for 6 weeks. Fasting blood sugar (FBS), insulin and HbA1c  were measured at the baseline and at the end of the 6th  week. Homeostatic model assessment of insulin resistance (HOMA-IR), as a measure of insulin resistance, was also determined at the same times.
Results: At the end of the study, no significant difference was observed between the two arms in terms of FBS, fasting insulin, HbA1c and HOMA-IR. However, trends toward decreasing both fasting insulin levels (p= 0.06) and HOMA-IR  (p=  0.07)  were  noted  in  the  group  receiving  omega-3.  No significant  changes  in  the  outcome  variables  were  observed  from  the baseline to the final measurements in both groups.
Conclusion: This study noted that adding omega-3 fatty acids at the commencement of olanzapine combination therapy with valproate or lithium could not favorably influence glucose-insulin homeostasis. However, trends toward a decrease in insulin levels (p= 0.06) and HOMA-IR (p= 0.07) observed in patients receiving omega-3 suggest a possible beneficial role of this supplement in this population and, therefore, warrant further evaluation.


Keywords


Fasting blood sugar; Insulin Resistance; Lithium; Olanzapine; Omega-3; Sodium valproate

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References


Newcomer JW. Metabolic risk during antipsychotic treatment. Clin Ther 2004; 26: 1936-1946.

Haupt DW, Newcomer JW. Hyperglycemia and antipsychotic medications. J Clin Psychiatry 2001; 62: 15-26.

Castilla-Puentes R. Effects of psychotropics on glycosylated hemoglobin (HbA1c) in a cohort of bipolar patients. Bipolar Disord 2007; 9: 772-778.

Scheen AJ, De Hert MA. Abnormal glucose metabolism in patients treated with antipsychotics. Diabetes Metab 2007; 33: 169- 175.

Birkenaes AB, Opjordsmoen S, Brunborg C, Engh JA, Jonsdottir H, Ringen PA, et al. The level of cardiovascular risk factors in bipolar disorder equals that of schizophrenia: a comparative study. J Clin Psychiatry 2007; 68: 917-923.

Garcia-Portilla MP, Saiz PA, Benabarre A, Sierra P, Perez J, Rodriguez A, et al. The prevalence of metabolic syndrome in patients with bipolar disorder. J Affect Disord 2008; 106: 197-201.

Fiedorowicz JG, Palagummi NM, Forman- Hoffman VL, Miller DD, Haynes WG. Elevated prevalence of obesity, metabolic syndrome, and cardiovascular risk factors in bipolar disorder. Ann Clin Psychiatry 2008; 20: 131- 137.

Keck PE, McElroy SL. Bipolar disorder, obesity, and pharmacotherapy associated weight gain. J Clin Psychiatry 2003; 64: 1426- 1435.

Lieberman JA, Stroup TS, McEvoy JP, Swartz MS, Rosenheck RA, Perkins DO, et al. Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. N Engl J Med 2005; 22: 1209-1223.

Newcomer JW, Haupt DW. The metabolic effects of antipsychotic medications. Can J Psychiatry 2006; 51: 480-491.

Ebenbichler CF, Laimer M, Eder U, Mangweth B, Weiss E, Hofer A, et al. Olanzapine induces insulin resistance: results from a prospective study. J Clin Psychiatry 2003; 64: 1436-1439.

Torrent C, Amann B, Sanchez-Moreno J, Colom F, Reinares M, Comes M, et al. Weight gain in bipolar disorder: pharmacological treatment as a contributing factor. Acta Psychiatr Scand 2008; 118: 4-18.

Chengappa KN, Chalasani L, Brar JS, Parepally H, Houck P, Levine J. Changes in body weight and body mass index among psychitric patients receiving lithium, valproate or topiramate: an open label, nonrandomized chart review. Clin Ther 2002; 24: 1576-1584.

Pylvanen V, Pakarinen A, Knip M, Isojarvi J. Insulin-related metabolic changes during treatment with valproate in patients with epilepsy. Epilepsy Behav 2006; 8: 643-648.

Kim B, Kim SJ, Son JI, Joo YH. Weight change in the acute treatment of bipolar I disorder: a naturalistic observational study of psychiatric inpatients. J Affect Disord 2008; 105: 45-52.

Carpentier YA, Portois L, Malaisse WJ. N-3 fatty acids and the metabolic syndrome. Am J Clin Nutr 2006; 83 : 1499s-1504s.

Mozaffarian D, Rimm EB. Fish intake, contaminants, and human health. JAMA 2006; 296: 1885-1899.

Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 1985; 28: 412-419.

Friedberg CE, Janssen MJ, Heine RJ, Grobbee DE. Fish oil and glycemic control in diabetes. A meta-analysis. Diabetes Care 1998; 21: 494-500.

Nettleton JA, Katz R. N-3 long-chain polyunsaturated fatty acids in type 2 diabetes: a review. J Am Diet Assoc 2005; 105: 428- 440.

Milutinovic ZR, Perunicic G, Pljesa S, Gluvic Z, Sobajic S, Djuric I, et al. Effects of N-3 PUFAs supplementation on insulin resistance and inflammatory biomarkers in hemodialysis patients. Renal Failure 2007; 29: 321-329.

American Diabetes Association . Standards of Medical Care in Diabetes. Diabetes Care 2009; 32: s13-s61.


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