Posts Tagged ‘alternative to prozac’

A study of the safety and harms of antidepressant drugs for older people: a cohort study using a large primary care database

Thursday, October 20th, 2011

he aim of this study was to establish the relative safety and balance of risks for antidepressant treatment in older people.

The cohort study included 60,746 patients aged 65 years and over diagnosed with depression. The study was based in 570 general practices in the UK supplying data to the QResearch database.

The study objectives were to:

* determine relative and absolute risks of predefined adverse events in older people with depression, comparing classes of antidepressant drugs:
o tricyclic and related antidepressants (TCAs)
o selective serotonin reuptake inhibitors (SSRIs)
o monoamine oxidase inhibitors (MAOIs)
o other antidepressants
o commonly prescribed individual drugs with non-use of antidepressant drugs
* directly compare the risk of adverse events for SSRIs with TCAs;
* determine associations with dose and duration of antidepressant medication;
* describe patterns of antidepressant use in older people with depression; and
* estimate costs of antidepressant medication and primary care visits.

There were 13 predefined outcome measures:

* all-cause mortality
* sudden cardiac death
* suicide
* attempted suicide/self-harm
* myocardial infarction
* stroke/transient ischaemic attack (TIA)
* falls
* fractures
* upper gastrointestinal bleeding
* epilepsy/seizures
* road traffic accidents
* adverse drug reactions
* hyponatraemia

Here’s what the study found:

* The associations with the adverse outcomes were significantly different between the classes of antidepressant drugs for seven outcomes
* SSRIs were associated with the highest adjusted hazard ratios (HRs) for falls [1.66, 95% confidence interval (CI) 1.58 to 1.73] and hyponatraemia (1.52, 95% CI 1.33 to 1.75)
* The group of other antidepressants was associated with the highest HRs for all-cause mortality (1.66, 95% CI 1.56 to 1.77), attempted suicide/self-harm (5.16, 95% CI 3.90 to 6.83), stroke/TIA (1.37, 95% CI 1.22 to 1.55), fracture (1.63, 95% CI 1.45 to 1.83) and epilepsy/seizures (2.24, 95% CI 1.60 to 3.15) compared with when antidepressants were not being used
* TCAs did not have the highest HR for any of the outcomes
* There were also significantly different associations between the individual drugs for seven outcomes, with trazodone, mirtazapine and venlafaxine associated with the highest rates for several of these outcomes
* The mean incremental cost (for all antidepressant prescriptions) ranged between £51.58 (amitriptyline) and £641.18 (venlafaxine) over the 5-year post-diagnosis period.

The authors concluded:

This study found associations between use of antidepressant drugs and a number of adverse events in older people.

There was no evidence that SSRIs or drugs in the group of other antidepressants were associated with a reduced risk of any of the adverse outcomes compared with TCAs; however, they may be associated with an increased risk for certain outcomes. Among individual drugs trazodone, mirtazapine and venlafaxine were associated with the highest rates for some outcomes. Indication bias and residual confounding may explain some of the study findings.

The risks of prescribing antidepressants need to be weighed against the potential benefits of these drugs.

CAC Coupland, P Dhiman, G Barton, R Morriss, A Arthur, T Sach and J Hippisley-Cox. A study of the safety and harms of antidepressant drugs for older people: a cohort study using a large primary care database (PDF). Health Technology Assessment 2011; Vol. 15: No. 28.

Deficiency of Omega 3 fish oil in the diet may explain high rates of depression

Friday, July 15th, 2011

Deficiency of Dietary Omega-3 May Explain Depressive Behaviors
— How maternal essential fatty acid deficiency impact on its progeny is poorly understood. Dietary insufficiency in omega-3 fatty acid has been implicated in many disorders. Researchers from Inserm and INRA and their collaborators in Spain collaboration, have studied mice fed on a diet low in omega-3 fatty acid. They discovered that reduced levels of omega-3 had deleterious consequences on synaptic functions and emotional behaviours.

TakeOmega has the highest levels of EPA per capsule available globally , EPA has been found to be as effective as Prozac in the treatment of medium to severe depression . It is manufactured entirely in the UK and each capsules has over 950mg Omega 3 , other brands are as low as 15% in active ingredients.
Details of this work are available in the online version of the journal Nature Neuroscience.
In industrialized nations, diets have been impoverished in essential fatty acids since the beginning of the 20th century. The dietary ratio between omega-6 polyunsaturated fatty acid and omega-3 polyunsaturated fatty acid omega-3 increased continuously over the course of the 20th century. These fatty acids are “essential” lipids because the body cannot synthesize them from new. They must therefore be provided through food and their dietary balance is essential to maintain optimal brain functions.
Olivier Manzoni (Head of Research Inserm Unit 862, “Neurocentre Magendie,” in Bordeaux and Unit 901 “Institut de Neurobiologie de la Méditerranée” in Marseille), and Sophie Layé (Head of Research at INRA Unit 1286, “Nutrition et Neurobiologie Intégrative” in Bordeaux) and their co-workers hypothesized that chronic malnutrition during intra-uterine development, may later influence synaptic activity involved in emotional behaviour (e.g. depression, anxiety) in adulthood.
To verify their hypotheses, the researchers studied mice fed a life-long diet imbalanced in omega-3 and omega-6 fatty acids. They found that omega-3 deficiency disturbed neuronal communication specifically. The researchers observed that only the cannabinoid receptors, which play a strategic role in neurotransmission, suffer a complete loss of function. This neuronal dysfunction was accompanied by depressive behaviours among the malnourished mice.
Among omega-3 deficient mice, the usual effects produced by cannabinoid receptor activation, on both the synaptic and behavioural levels, no longer appear. Thus, the CB1R receptors lose their synaptic activity and the antioxidant effect of the cannabinoids disappears.
Consequently, the researchers discovered that among mice subjected to an omega-3 deficient dietary regime, synaptic plasticity, which is dependent on the CB1R cannabinoid receptors, is disturbed in at least two structures involved with reward, motivation and emotional regulation: the prefrontal cortex and the nucleus accumbens. These parts of the brain contain a large number of CB1R cannabinoid receptors and have important functional connections with each other.
“Our results can now corroborate clinical and epidemiological studies which have revealed associations between an omega-3/omega-6 imbalance and mood disorders,” explain Olivier Manzoni and Sophie Layé

Omega3 fish oil EPA as effective as Prozac in the treatment of medium to major depression

Sunday, July 10th, 2011

EPA Plus Prozac Better Than Either Treatment Alone for Major Depression

Long-chain omega-3 polyunsaturated fatty acids (n-3 LC-PUFAs) have been used as an adjunct therapy in treating patients with major depressive disorder with mixed, but often encouraging, results. A meta-analysis of placebo-controlled trials concluded that n-3 PUFAs have significant antidepressant effects, but there are insufficient data to distinguish whether combined treatment with the two major n-3 LC-PUFAs in fish oils, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), or each fatty acid given individually provides greater benefit. Studies have tended to find positive results with EPA rather than DHA and a rationale for this observation has been suggested. In most, if not all, trials to date, n-3 LC-PUFAs have been provided in conjunction with current antidepressant medications. Difficulties with patient compliance, unwanted or adverse side effects of medications and resistance to treatment make treating depression especially challenging.

In this study, Shima Jazayeri and colleagues at the Tehran University of Medical Sciences in Iran sought to evaluate the effectiveness of fluoxetine (Prozac), EPA or a combination of them in patients with major depressive disorder as indicated by Hamilton Depression Rating Scale scores of 15 or greater. Patients did not have other psychiatric disorders or any other significant medical problems or substance abuse. They were not taking n-3 PUFA supplements nor eating more than one serving of fish/week. All participants were free of medication for at least 6 weeks prior to enrolment.

Sixty patients were recruited from referrals to the Roozbeh Psychiatric Hospital in Tehran and randomized to consume 20 mg of fluoxetine or 1 g EPA or a combination daily for 8 weeks. Each participant consumed either a fluoxetine placebo or a rapeseed oil placebo to mimic the type of capsules taken in each group. No placebo-only group was included for ethical reasons. Patients were assessed by the Hamilton Scales at baseline and every 2 weeks thereafter. Of the 60 patients enrolled, 48 completed at least 4 weeks of the study.

Over the course of the 8-week study, all patient groups exhibited significant reductions in their Hamilton depression scores as early as 2 weeks from baseline. Scores for patients treated with fluoxetine or EPA did not differ throughout the study. At 4 and 6 weeks, those consuming both EPA and fluoxetine showed a significantly greater improvement in their Hamilton ratings (as determined by analysis of covariance) compared with either treatment alone. Depression scores continued to improve from the 4th to the 8th week. Response rates for achieving at least a 50% reduction in depression score were 50% for fluoxetine, 56% for EPA and 81% for those taking both fluoxetine and EPA. More adverse events occurred in the fluoxetine and combination groups than in the EPA group and ranged from gastro-intestinal effects, anxiety and decreased appetite to single reports of tremor, nightmare and constipation.

These results suggest a greater improvement in depression with the combination of EPA and fluoxetine, but the effects of either one alone may have been no different from a placebo, had there been one. Other studies have reported a placebo effect of trial participation. This study supports those that have reported significant improvement in depression using a modest dose (1 g/day) of EPA as an adjunct treatment to current medication.

Jazayeri S, Tehrani-Doost M, Keshavarz SA, Hosseini M, Djazayery A, Amini H, Jalali M, Peet M. Comparison of therapeutic effects of omega-3 fatty acid eicosapentaenoic acid and fluoxetine, separately and in combination, in major depressive disorder. Aust N Z J Psychiatry 2008;42:192-198. [PubMed]

Omega 3 Fish Oil and Depression , Mental Health as used in NHS

Monday, March 21st, 2011

Recent studies have shown that 1000mg EPA  omega 3 fish oil is as effective as Prozac in the treatment of medium to severe depression . When used together with the anti depressant it was even more effective than either treatment separately .
Forth Valley HealthBoard  recommend the brand takeomega 3  fish oil both as an adjunctive and primary therapy in medium to severe depression as well as other mental health disorders such as PTSD, OCD .
The reason they use and recommend Takeomega 3 fish oil  is primarily due to the fact this is the highest concentration currently available at just under 90% it also offers 750mg EPA per capsule with minimal quantities of DHA . The product is also manufactured in MHRA licensed facilities .

Forth Valley HealthBoard  Omega 3 Fish Oil Depression

Depression study confirms effectiveness of EPA as anti depressant treatment

Tuesday, March 15th, 2011

The use of Omega-3 supplements is effective among patients with major depression who do not have anxiety disorders, according to a study directed by Dr. François Lespérance of the Centre de recherche du Centre hospitalier at the Université de Montréal (CRCHUM), head of CHUM’s Department of Psychiatry and a professor at the Université de MontréalThe study was published June 15 in the online Journal of Clinical Psychiatry.Take Omega3 is the ideal formulation to treat depression due to each capsule containing 750mg EPA and 50mg DHA it is an 85% concentrate which is the highest currently available.

This was the largest study ever conducted assessing Omega-3’s efficacy in treating major depression. It was carried out in conjunction with researchers from centres affiliated with the UdM’s Réseau universitaire intégré de santé (RUIS), from McGill University, Université Laval in Quebec City and Queen’s University in Kingston, Ontario.

Initial analyses failed to clearly demonstrate the effectiveness of Omega-3 for all patients taking part in the study. Other analyses, however, revealed that Omega-3 improved depression symptoms in patients diagnosed with depression unaccompanied by an anxiety disorder. Efficacy for these patients was comparable to that generally observed with conventional antidepressant treatment.

From October 2005 to January 2009, 432 male and female participants with major unipolar depression were recruited to take part in this randomized, double-blind study (neither patients nor researchers knew which capsules patients received)Some 11% of men and 16% of women in Canada will suffer from major depression at some point in their lives, making this disorder one of our society’s leading public health issues. Depression, which is now the world’s fourth leading cause of morbidity and death is expected to move up to the number two position by 2020. “Despite significant progress in neuroscience over the past two decades, depression is difficult to treat,” Dr. Lespérance noted. In view of the large number of patients who stop taking their medications in the first few months of treatment and those who refuse such treatment due to fear of stigmatization or side effects, it comes as no surprise that a large number of patients suffering from major depression use alternative treatments offered outside the healthcare system. “Many of these treatments have not been adequately evaluated. That is why it was important to assess the efficacy of Omega-3, one of the most popular alternative approaches,” he added.

Epidemiological and neurobiological studies have suggested that a relative deficit in polyunsaturated fatty acids of the Omega-3 group may predispose individuals to psychological disorders such as depression. Further, several preliminary clinical studies based on small numbers of patients have suggested that Omega-3 supplements with high concentrations of EPA can help to reduce symptoms of depression among patients who fail to respond to an initial antidepressant treatment. These studies have not, however, convinced the entire scientific community. A broader study was needed to acquire further knowledge about the properties and efficacy of high-quality Omega-3 supplements among patients suffering from major depression.udy.

It is important to note that the study assessed use of Omega-3 for eight weeks, at doses of 1050 mg of EPA and 150 mg of DHA each day. It is currently unknown whether taking higher doses or taking supplements over a longer period would yield different results.

These encouraging results show that use of EPA is effective among patients with unipolar depression unaccompanied by an anxiety disorder. Additional research directly comparing Omega-3 with conventional antidepressants could more clearly confirm their usefulness for patients suffering from depression

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