Posts Tagged ‘medication for depression’

Long-Chain Omega-3 Fatty Acid Deficiency in Mood Disorders: Rationale for Treatment and Prevention.

Saturday, September 10th, 2011

Source

Department of Psychiatry, Division of Bipolar Disorders Research, University of Cincinnati College of Medicine, Cincinnati, OH 45219-0516, USA. robert.mcnamara@uc.edu.

Abstract

Major recurrent mood disorders including major depressive disorder (MDD) and bipolar disorder (BD) are associated with significant psychosocial morbidity and excess premature mortality primarily attributable to suicide and coronary heart disease. Limited efficacy and adverse side-effects associated with psychotropic medications used in the treatment of MDD and BD highlight the urgent need to develop safe and efficacious treatments or treatment adjuncts. A body of evidence now indicates that long-chain omega-3 (LCn-3) fatty acid deficiency is a feature associated with MDD and BD. The etiology of LCn-3 deficits in MDD and BD patients may be attributable to both genetic and environmental factors. Dietary LCn-3 supplementation is safe and well-tolerated with chronic administration and corrects LCn-3 deficiency in MDD and BD patients. LCn-3 supplementation has been found to augment the therapeutic efficacy of psychotropic medications in the treatment of mood symptoms and to reduce suicidality. Preliminary studies also suggest that LCn-3 supplementation is efficacious as monotherapy in the treatment and prevention of psychopathology in children and adolescents. LCn-3 supplementation may also be associated with reduced risk for developing coronary heart disease. The overall cost-benefit ratio associated with LCn-3 supplementation provides a strong rationale to diagnose and treat LCn-3 deficiency in MDD and BD patients, and to prevent LCn-3 deficiency in subjects at high risk for developing these disorders.

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]

Scientific research reveals brain alterations linking omega 3 fish oil deficit with depression

Thursday, May 26th, 2011

The link between deficits of omega-3 poly-unsaturated fatty acids (AGPO-3) and the onset of depressive disorders is not new in the medical field. However, what has not been known until now is the brain mechanism by which diet can condition mental health to a certain extent. Research undertaken by scientists in Bordeaux (France) and at the Faculty of Medicine and Odontology of the University of the Basque Country (UPV/EHU) and published in Nature Neuroscience, provides new clues to understanding this phenomenon.

The name of the research work, ‘Omega-3 nutritional deficiencies annul the neuronal functions of the endocannabinoid system’ describes the research findings, endocannabinoid system being linked to the onset of depressive disorders.

According to Doctor Susana Mato, researcher in the Ramón y Cajal programme, attached to the Neurosciences Department of the Faculty of Medicine and Odontology at the UPV/EHU and member of the Neurobiology Group, “we have observed that, in mice subjected to a diet low in omega-3 poly-unsaturated fatty acids, they have lower AGPO-3 brain levels, and this fact is associated with an alteration in the functioning of the endocannabinoid system”. More concretely, the researcher points to the confirmation of “the existence of a deficit in the signalling of the CB1 cannabinoid receptor in the prefrontal cortex of the brain. This protein — the CB1 cannabinoid receptor — has been linked, over the last decade and in various studies, to depressive disorders.”

Doctor Rafael Rodríguez-Puertas, research worker responsible for the Neurochemical and Neurodegeneration team at the Faculty of Medicine and Odontology at the UPV/EHU, points out that “certain forms of synaptic plasticity — a change in the efficiency of neuronal communication — measured by the brain’s endocannabinoid system, disappear specifically from certain zones of the brains of mice with AGPO-3 deficit”.

Despite several example in the scientific literature referring to the existence of a link between the low presence of AGPO-3 in the diet and depressive disorders, Susana Mato recognises that “little more is known about how modern Western diets, poor in AGPO-3, affect brain function and what might be the reason for a greater rate of depression associated with a deficit of these fatty acids”.

As doctor Rodríguez-Puertas points out, “thanks to the results of this research new possibilities are opened up for undertaking deeper research, such as how diet modifies the functioning of the brain in general and the endocannabinoid system in particular, and how this is linked to mental disorders”.

It also, “reinforces the idea that manipulating the endocannabinoid system can be useful for the treatment of depressive disorders, although the data we have up to now is very green for us to say what would be the ideal way to do so”, pointed out Dr Mato.

Collaboration amongst European researchers

The research work started with two French teams located in Bordeaux and led respectively by doctors Olivier J Manzoni and Sophie Layé. They have been working for a number of years with mice which show low levels of AGPO-3 in their brain, due to a low diet in these fatty acids.

“Dr Manzoni’s team discovered that the synaptic plasticity of the neuronal connections, which is mediated by endocannabinoids, disappears in these animals”, pointed out Dr S. Mato. To this end, in 2008, they made contact with researchers at the Faculty of Medicine at the UPV/EHU in order to obtain their collaboration in undertaking new research in order to identify possible change sin the expression and activity of the cannabinoid receptors.

In fact, in order to draw conclusions from the study, it has been necessary to employ a large number of research techniques, amongst which were “the analysis of the brain’s fatty acids, electrophysiology, autoradiography of receptors, the western blot (for quantification of proteins), the determination of levels of endocannabinoids and behaviour tests”, listed Doctor Rodríguez-Puertas. “In fact”, continued the researcher, “in our research team we are experts in the autoradiography of receptors technique and in anatomically identifying the activation of the receptors of the endocannabinoid system”.

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