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Omega-3 in Bipolar Disorder — MRCPsych Paper B MCQ

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ModerateMood DisordersOmega-3 in Bipolar DisorderMRCPsych Paper B

A 40-year-old woman with bipolar I disorder is receiving standard treatment and asks whether an over-the-counter omega-3 fatty acid supplement should be added to treat bipolar symptoms and prevent relapse. Which statement best reflects current evidence and UK clinical practice?

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Correct answer: A — Do not recommend it routinely; efficacy remains unestablished, despite possible small benefits for depressive symptoms.

Omega-3 fatty acids are not routinely recommended as a treatment for bipolar disorder. Small pooled trials have suggested a modest adjunctive effect on bipolar depressive symptoms, but findings are limited and inconsistent, and there is no established antimanic effect. A subsequent 52-week trial found little evidence that adjunctive EPA plus DHA prevented relapse. NICE CG185 does not include omega-3 among its recommended treatments for bipolar depression or maintenance; lithium remains the first-line long-term pharmacological treatment. Omega-3 therefore should not replace lithium or other evidence-based pharmacological and psychological interventions. It has not been shown consistently to precipitate mania, so option D is also incorrect.

Reference: NICE. Bipolar disorder: assessment and management (CG185), recommendations, updated 2025. https://www.nice.org.uk/guidance/cg185/chapter/Recommendations; McPhilemy G et al. A 52-week prophylactic randomised control trial of omega-3 polyunsaturated fatty acids in bipolar disorder. Bipolar Disorders. 2021. https://pubmed.ncbi.nlm.nih.gov/33340432/