Bipolar bozukluk manik atak tedavisine omega-3 ilavesinin remisyona ulaşma süresi, oksidatif stres ve antioksidan sistem üzerine etkisi
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Date
2008
Authors
Kaya, Berrin
Journal Title
Journal ISSN
Volume Title
Publisher
Uludağ Üniversitesi
Abstract
Omega-3 yağ asitlerinin nöron hücre zarının bütünlüğü ile nöronal sinyal transdüksiyonunundaki önemi bilinmektedir. Ayrıca, serbest radikallerin ve antioksidan sistem bozukluklarının sebep olduğu doku harabiyetinin pek çok psikiyatrik hastalığın patolojisinde rol aldığı düşünülmektedir. Bipolar bozukluk (BB) manik ataktaki hastaların tedavilerine omega-3 (w-3) yağ asitlerini ekleyerek, oksidatif stresin hücre zarındaki etkisinin azaltılması ve bunun da remisyon oranları ve remisyona ulaşma sürelerine etkisini değerlendirmek amacıyla bu çalışmayı planladık. DSM IV-TR'ye göre BB manik atak tanısı almış 24 hasta çalışmaya dahil edildi. Çalışmanın süresi 2 ay olarak belirlendi. Tüm hastalar antipsikotik tedavi (30 mg/gün olanzapin) aldı, rasgele yöntemle seçilen 11 hastanın tedavisine 1 gr/gün w-3 yağ asitleri (DHA+EPA) eklenerek 2 hasta grubu oluşturuldu. Süperoksid dismutaz (SOD), glutatyon peroksidaz (GPx), paraoksanaz (PON), aril esteraz (AE) aktiviteleri ve total antioksidan kapasite (TAK) ve malondialdehid (MDA) düzeyleri çalışmanın başlangıcında, 14, 28, 42 ve 56. günlerinde ve remisyon sağlandığı günde incelendi. Remisyon, Young Mani Derecelendirme Ölçek (YMRS ) puanı 7 olması olarak kabul edildi.Tedavilerine w-3 yağ asitleri eklenen grupta 3 hasta, eklenmeyen grupta ise 1 hastada remisyon sağlanamadı. Çalışmanın sonunda, remisyon oranları ve remisyona ulaşma süreleri açısından iki grup arasında fark bulunmadı. Çalışma sonunda başlangıca göre grup içi ve gruplar arasında oksidan-antioksidan sistem parametrelerinde anlamlı fark saptanmadı. Ancak, 14. gündeki SOD aktivitesi, 28. gün ve remisyon günündeki plasma MDA değerleri w-3 yağ asitlerini kullanan grupta daha yüksek bulundu Sırasıyla, p= 0,016 p=0,010 ve 0,029). Eritrosit MDA düzeyi ise sadece remisyon vizitinde w-3 yağ asitlerini kullanmayan grupta, kullanan gruba göre daha düşük bulundu (p=0,015). Yan etki görülme sıklığı açısından her iki grup arasında fark bulunmadı.Oksidatif stres ve antioksidan sistemle ilgili parametrelerde, manik epizod ve remisyon dönemindeki ölçümlerde gruplar arasında fark bulunamadı. BB'un temel belirleyicisi olan mani dönemlerinde tedaviye w-3 yağ asitlerinin eklenmesi ile gerek oksidatif stres parametreleri gerek etki ve yan etki yönünden avantajlı değişikliklerin elde edilememesi, oksidatif stres ile ilgili sistemlerdeki sorunun BB manik atakta depresyona benzer şekilde yaşanmadığı ve oksidatif stresle ilgili temel mekanizmalar ile tedavi yaklaşımları açısından unipolar depresyon ve BB'un pararel özellikler göstermediği şeklinde değerlendirilebilir.
Omega-3 fatty acids (w-3) have a crucial role of for sustaining the integrity of neuronal cell membrane and signal transduction. Furthermore, it is thought that, free radicals and antioxidant system disturbances may play a role in the etiology of several psychiatric disorders. In this study, we aimed to investigate the reduction of impact of oxidative stress on cell membrane by adding w-3 and its relevance to rates of remission and time to remission in patients with bipolar disorder manic episode (BD-ME). Twenty-four BD-ME patients, diagnosed according to DSM IV, were included. All patients received olanzapine 30 mg/day. Of the 24 patients, 11 patients were randomly assigned to receive also w-3 (DHA+EPA) 1 mg/day for 2 months. Activities of superoxide dismutase (SOD), glutathione peroxidase (GPx), paraoxonase (PON), and arylesterase (AE) and plasma levels of total antioxidant capacity (TAOC) and malondialdehyde (MDA) were measured before treatment, at the 14th , 28th ,42nd , 56th days of the study and the day of remission. Remission was defined as, score of 7 according to Young Mania Rating Scale (YMRS).Three patients with w-3 treatment and 1 patient without w-3 treatment did not remit at the end of the trial. There were no significant differences between two groups in terms of rates of remission and time to remission. At the end of the trial there were no significant differences within and between groups in terms of changes in the activities of oxidative-antioxidative system parameters. However, at day 14 activity of SOD, at day 28 and the day of remission plasma levels of MDA was significantly higher in the w-3 receiving group (p=0,016, p=0,01 and p=0,029, respectively). Red blood cell MDA activity was significantly lower in non- w-3 receiving group at remission day (p=0,015). Frequency of side-effects did not differ between groups.In this study it is found that oxidative-antioxidative system parameters did not differ at remission compared to manic episode and addition of w-3 did not cause a significant change in the parameters of oxidative-antioxidative system. Also, addition of w-3 did not develop any advantage in terms of frequency of side effects. Stemming from these results, it may argued that in BD-ME distortions in the systems involving oxidative stres are likely to differ from depression and unipolar depression and bipolar disorder do not exhibit similarities in terms of basic mechanisms and treatment approaches.
Omega-3 fatty acids (w-3) have a crucial role of for sustaining the integrity of neuronal cell membrane and signal transduction. Furthermore, it is thought that, free radicals and antioxidant system disturbances may play a role in the etiology of several psychiatric disorders. In this study, we aimed to investigate the reduction of impact of oxidative stress on cell membrane by adding w-3 and its relevance to rates of remission and time to remission in patients with bipolar disorder manic episode (BD-ME). Twenty-four BD-ME patients, diagnosed according to DSM IV, were included. All patients received olanzapine 30 mg/day. Of the 24 patients, 11 patients were randomly assigned to receive also w-3 (DHA+EPA) 1 mg/day for 2 months. Activities of superoxide dismutase (SOD), glutathione peroxidase (GPx), paraoxonase (PON), and arylesterase (AE) and plasma levels of total antioxidant capacity (TAOC) and malondialdehyde (MDA) were measured before treatment, at the 14th , 28th ,42nd , 56th days of the study and the day of remission. Remission was defined as, score of 7 according to Young Mania Rating Scale (YMRS).Three patients with w-3 treatment and 1 patient without w-3 treatment did not remit at the end of the trial. There were no significant differences between two groups in terms of rates of remission and time to remission. At the end of the trial there were no significant differences within and between groups in terms of changes in the activities of oxidative-antioxidative system parameters. However, at day 14 activity of SOD, at day 28 and the day of remission plasma levels of MDA was significantly higher in the w-3 receiving group (p=0,016, p=0,01 and p=0,029, respectively). Red blood cell MDA activity was significantly lower in non- w-3 receiving group at remission day (p=0,015). Frequency of side-effects did not differ between groups.In this study it is found that oxidative-antioxidative system parameters did not differ at remission compared to manic episode and addition of w-3 did not cause a significant change in the parameters of oxidative-antioxidative system. Also, addition of w-3 did not develop any advantage in terms of frequency of side effects. Stemming from these results, it may argued that in BD-ME distortions in the systems involving oxidative stres are likely to differ from depression and unipolar depression and bipolar disorder do not exhibit similarities in terms of basic mechanisms and treatment approaches.
Description
Keywords
Bipolar bozukluk, Omega-3, Manik atak, Oksidatif stres- antioksidan sistem, Bipolar disorder, Manic attack, Oxidative stress- antioxidative system
Citation
Kaya, B. (2008). Bipolar bozukluk manik atak tedavisine omega-3 yağ asitleri ilavesinin remisyona ulaşma süresi, oksidatif stres ve antioksidan sistem üzerine etkisi. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.