Posts Tagged ‘omega3 and depression’

Increased blood levels of the omega-3 fatty acid eicosapentaenoic acid (EPA) may reduce the severity of symptoms of depression, particularly in people taking antidepressants

Saturday, January 28th, 2012

Increased blood levels of the omega-3 fatty acid eicosapentaenoic acid (EPA) may reduce the severity of symptoms of depression, particularly in people taking antidepressants,
A study of 1390 subjects from Bordeaux in France reports that EPA levels in people with depressive symptoms were on average 0.16 per cent lower than in normal people, according to data published in this month’s issue
of the American Journal of Clinical Nutrition.

“This result adds to the growing body of evidence implicating long-chain PUFAs in mental disorders,” wrote the researchers from the Equipe
Epidemiologie de la Nutrition et des Comportements Alimentaires (INSERM U593) and the University of Bordeaux 2.

Numerous observational studies and uncontrolled trials have reported the benefits of fish oils and omega-3 fatty acids docosahexaenoic acid (DHA) and EPA on the behaviour and learning, especially in kids, as well for
improving the symptoms of depression.

“The novel finding of our survey was the significant association observed between plasma EPA and severity of the depressive symptomatology (DS) in aged subjects already taking antidepressant
medication,” added the researchers, led by Pascale Barberger-Gateau.

Study details

The researchers recruited 1390 subjects (average age 74.6, 65 per cent women). Symptoms of depressions were evaluated using the Center for Epidemiologic Studies Depression scale, while blood samples were taken
in order to measure fatty acid levels in the blood.

People with depression were older than control subjects without any symptoms of depression. They also performed less well on the Mini-Mental State Examination than their younger control comparisons.

No significant differences were observed between subjects when the researchers considered fatty acid percentages and ratios in relation to depression symptoms, except for EPA levels.

Indeed, plasma EPA was 0.85 per cent in the subjects with depression, compared to 1.01 per cent in healthy controls. This inverse association between EPA and depression was also observed when the researchers
considered people taking anti-depressive subjects.

Barberger-Gateau and co-workers added that the apparent benefits are “biologically plausible because several mechanisms underlying the association between fatty acids and brain disorders have already been
evoked.”

They called for additional studies to support the relationship between PUFA levels and symptoms of depression, elucidate the mechanism, and determine if higher omega-3 intake may influence the development of depression in later life.

“It will also be useful to determine whether clinically depressed patients with abnormally low EPA and/or DHA concentrations would benefit from supplementation,” concluded the researchers in the AJCN.

Building the science behind the benefits The Bordeaux study adds to a small but growing body of studies reporting benefits of the polyunsaturated fatty acids on mental health. Last year,
researchers from Norway reported that regular and long-term intake of omega-3 fatty acid-rich may protect people from symptoms of depression.

The study, published in the Journal of Affective Disorders, followed 21,835 subjects aged between 40 and 49 and 70 and 74 years, and found that the prevalence of depressive symptoms was 29 per cent lower in
regular omega 3 supplementation users than the rest of the population.

Moreover, a joint Anglo-Iranian study reported that depression ratings were cut by 50 per cent following daily one gram supplements of EPA, an effect similar to that obtained by the antidepressant drug fluoxetine,
according to findings published in the Australian and New Zealand Journal of Psychiatry.

“To our knowledge this is the first report of EPA monotherapy in major depressive disorder,” wrote the researchers from Tehran University of
Medical Sciences and Swallownest Court Hospital in Sheffield (UK).

When the researchers provided the omega-3 supplement EPA  in combination with fluoxetine, depression ratings were cut by 81 per cent.

Major depression may lead to Cardiovascular disease in older adults

Sunday, December 4th, 2011

Major depressive disorder (MDD) may lead to cardiovascular disease (CVD) in older adults, new research suggests.

Omega3 EPA is effective to treat medium to severe depression as well as that it offers unique cardio protective benefits

In secondary analysis of the Mechanisms and Outcomes of Silent Myocardial Ischemia (MOSMI) study, which included almost 900 participants with a mean age of 60 years, those with MDD showed a significantly slower short-term heart rate recovery time after exercising than their nondepressed counterparts.

According to the investigators, this delayed ability to return to a normal heart rate can be a powerful tool for predicting CV events and mortality.

“The delayed rate indicates a dysfunctional biological stress system, or a dysfunctional ‘flight or fight response,’ and we believe this can contribute to an increased risk for heart disease,” senior author Simon Bacon, PhD, codirector of the Montreal Behavioral Medicine Center and associate professor in the Department of Exercise Science at Concordia University, Montreal, Quebec, Canada,

The researchers note that the study’s results reinforce findings from previous research suggesting that those who suffer from MDD should be tested for CVD.

“Both of these health issues should be treated to minimize risk of severe consequences,” said Dr. Bacon.

The study was published in the November issue of Psychophysiology.

Dysfunctional Fight or Flight Response

According to the investigators, previous studies suggest that individuals suffering from depression may be twice as likely to suffer a heart attack as those who are not depressed.

In addition, a recent study reported  found that depression and previous suicide attempts were significant predictors of heart disease mortality in young adults.

“There have been 2 competing theories as to why depression is linked to CVD,” said lead author Jennifer Gordon, PhD candidate from the Psychology Department at McGill University in Montreal, in a release.

“Depressed people may have poorer health behaviors, which in turn lead to heart problems. The other possibility is physiological: a problem with the fight or flight response.”

In other words, it may be that people with depression have an autonomic nervous system (ANS) imbalance. The investigators note that heart rate variability is often used as a measure of ANS dysfunction.

“Our study is the first to examine the role of a dysfunctional fight or flight response in depression in a large population,” said Dr. Gordon.

The MOSMI trial was created to examine risk factors for silent ischemia and its effect on CV outcomes. For this analysis, the investigators evaluated data on 886 MOSMI participants (68.8% men; mean age, 60 years) who underwent a 2-day exercise stress test using a treadmill and a single photon emission computed tomography imaging protocol.

While at rest, at peak exercise point, and at 1 and 5 minutes postexercise, the participants had their heart rate and systolic and diastolic blood pressures measured.

The Primary Care Evaluation of Mental Disorders and Beck Depression Inventory II (BDI-II) were also administered to all patients, along with a questionnaire on sociodemographic data and medical history, including depressive symptoms and medication usage.

Slower Heart Rate Recovery

Overall, 5.8% of the participants were found to have MDD. These patients had a significantly slower heart rate recovery time at the 1-minute postexercise checkpoint compared with those who were not depressed (adjusted difference, 3.7 beats per minute; P = .026).

However, there were no significant differences between the 2 groups in heart rate recovery time at the 5-minute postexercise checkpoint.

“The classic fight or flight response is very adaptive over time. This means the system is easily activated but can also quickly shut itself off after a stress is removed. So it wasn’t surprising to see that the depressed patients’ heart rates were still quite elevated at the earlier mark, and not at the later mark,” Dr. Bacon said.

There were no significant between-group differences in either systolic or diastolic blood pressure recovery at either time.

In addition, BDI-II scores were found to not be predictive of CV recovery, suggesting that “subclinical levels of depression are not as reliably associated with ANS dysfunction,” write the researchers.

“This may explain some of the variance in previous studies examining the relation between depression and exercise recovery.”

Dr. Bacon said that overall, he would recommend that mental health clinicians who see patients with MDD should think about how the disorder affects other physical elements, and that cardiologists should consider asking about the mental health status in their heart patients.

“The key element here is to make sure these different disciplines have a little more awareness of what’s happening with the patient. Ultimately, what we want to do is make people’s lives better.”

Screening Essential

“There’s been a long-term interest in whether the autonomic dysregulation that people have found with depression could be the cause of both the development of heart disease and a worse prognosis in those with comorbid depression and heart disease,” Wayne Katon, MD, professor and vice chair in the Department of Psychiatry and Behavioral Sciences at the University of Washington Medical School in Seattle, told Medscape Medical News.

“This study is better than some of the other past studies because it measured major depression (not just depressive symptoms) and both long- and short-term return to normal heart rate. And they controlled for exercise capacity,” said Dr. Katon, who was not involved with this research.

He noted that most people with MDD have less exercise capacity, probably because the disorder is associated with an increased sedentary lifestyle.

“Many people with depression have inadequate treadmill tests. But this study used a type of test that was set up for people who were older and more sedentary. So they probably didn’t have to deal so much with people giving up and quitting before a good read could be recorded,” said Dr. Katon.

“Of course the study findings will need to be replicated, but it does suggest that depression is associated with at least short-term decreased ability of the heart to return to a normal rate.”

The main takeaway of this study, said Dr. Katon, is that patients with CVD should be screened for depression.

“We routinely screen for diabetes and other medical conditions because they worsen prognosis. Because there’s excellent evidence that depression also worsens prognosis, we should be screening for it,” he said.

“We’re also finding a bidirectionality between depression and chronic medical illness. So certainly screening our aging population for depression in general is important. And treating it better is essential.”

The study was supported by grants from the Heart and Stroke Foundation of Quebec and the Canadian Institutes of Health Research, and from the Canadian Hypertension Society

Omega-3 fatty acids for major depressive disorder associated with the menopausal transition: a preliminary open trial.

Sunday, October 23rd, 2011

Menopause – Omega-3 FA for Depression in Menopausal Transition
Freeman MP, Hibbeln JR, Silver M, et al. Omega-3 fatty acids for major depressive disorder associated with the menopausal transition: a preliminary open trial. Menopause.

OBJECTIVES: We sought to obtain preliminary data regarding the efficacy of omega-3 fatty acids for major depressive disorder associated with the menopausal transition. Secondary outcomes were assessed for vasomotor symptoms (or hot flashes).

METHODS: After a single-blind placebo lead-in, participants received 8 weeks of treatment with open-label omega-3 fatty acid capsules (eicosapentaenoic acid and docosahexaenoic acid, 2 g/d). The Montgomery-Asberg Depression Rating Scale (MADRS) was the primary outcome measure. Hot flashes were monitored prospectively using daily diaries and the Hot Flash Related Daily Interference Scale. Blood samples for plasma pretreatment and posttreatment essential fatty acid assays were obtained. Because of the small sample size, data were analyzed using nonparametric techniques.

RESULTS: Of 20 participants treated with omega-3 fatty acids, 19 (95%) completed the study. None discontinued because of adverse effects. The pretreatment and final mean MADRS scores were 24.2 and 10.7, respectively, reflecting a significant decrease in MADRS scores (P < 0.0001). The response rate was 70% (MADRS score decrease of ≥50%), and the remission rate was 45% (final MADRS score of ≤7). Responders had significantly lower pretreatment docosahexaenoic acid levels than nonresponders did (P = 0.03). Hot flashes were present in 15 (75%) participants. Among those with hot flashes at baseline, the number of hot flashes per day improved significantly from baseline (P = 0.02) and Hot Flash Related Daily Interference Scale scores decreased significantly (P = 0.006).

CONCLUSIONS: These data support further study of omega-3 fatty acids for major depressive disorder and hot flashes in women during the menopausal transition.

Meta-analysis of the effects of omega 3 fish oil eicosapentaenoic acid (EPA) in clinical trials in depression.

Wednesday, October 5th, 2011

J Clin Psychiatry. 2011 Sep 6.
Meta-analysis of the effects of eicosapentaenoic acid (EPA) in clinical trials in depression.
Sublette ME, Ellis SP, Geant AL, Mann JJ.
Source
New York State Psychiatric Institute, 1051 Riverside Drive, Unit 42, New York, NY, USA. 10032 es2316@columbia.edu.
Abstract
OBJECTIVE:
Randomized trials of omega-3 polyunsaturated fatty acid (PUFA) treatment for depression have differed in outcome. Recent meta-analyses ascribe discrepancies to differential effects of eicosapentaenoic acid (EPA) versus docosahexaenoic acid (DHA) and to diagnostic heterogeneity. This meta-analysis tests the hypothesis that EPA is the effective component in PUFA treatment of major depressive episodes.

DATA SOURCES:
PubMed/MeSH was searched for studies published in English from 1960 through June 2010 using the terms fish oils (MeSH) AND (depressive disorder [MeSH] OR bipolar depression) AND randomized controlled trial (publication type). The search was supplemented by manual bibliography review and examination of relevant review articles.

STUDY SELECTION:
The search yielded 15 trials involving 916 participants. Studies were included if they had a prospective, randomized, double-blinded, placebo-controlled study design; if depressive episode was the primary complaint (with or without comorbid medical conditions); if omega-3 PUFA supplements were administered; and if appropriate outcome measures were used to assess depressed mood.

DATA EXTRACTION:
Extracted data included study design, sample sizes, doses and percentages of EPA and DHA, mean ages, baseline and endpoint depression ratings and standard deviations for PUFA and placebo groups, and P values. The clinical outcome of interest was the standardized mean difference in the change from baseline to endpoint scores on a depression rating scale in subjects taking PUFA supplements versus subjects taking placebo.

DATA SYNTHESIS:
In a mixed-effect model, percentage of EPA in the supplements was the fixed-effect predictor, dichotomized into 2 groups: EPA < 60% or EPA ≥ 60% of the total EPA + DHA. Secondary analyses explored the relevance of treatment duration, age, and EPA dose.

RESULTS:
Supplements with EPA ≥ 60% showed benefit on standardized mean depression scores (effect size = 0.532; 95% CI, 0.277-0.733; t = 4.195; P < .001) versus supplements with EPA < 60% (effect size = -0.026; 95% CI, -0.200 to 0.148; t = -0.316; P = .756), with negligible contribution of random effects or heteroscedasticity and with no effects of treatment duration or age. Supplements with EPA < 60% were ineffective. Exploratory analyses supported a nonlinear model, with improvement determined by the dose of EPA in excess of DHA, within the range of 200 to 2,200 mg/d of EPA.

CONCLUSIONS:
Supplements containing EPA ≥ 60% of total EPA + DHA, in a dose range of 200 to 2,200 mg/d of EPA in excess of DHA, were effective against primary depression. Translational studies are needed to determine the mechanisms of EPA’s therapeutic benefit.

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.

Omega 3 essential fatty acid EPA and Psychological Distress In Women

Thursday, August 18th, 2011

Lucas M, Asselin G, Mérette C, et al. Ethyl-eicosapentaenoic acid for the treatment of psychological distress and depressive symptoms in middle-aged women. Am J Clin Nutr.
BACKGROUND: Psychological distress (PD) and depressive symptoms are commonly observed during menopausal transition. Studies suggest that omega-3 (n-3) fatty acids may help alleviate depression.

OBJECTIVE: The objective was to compare enriched ethyl-eicosapentaenoic acid (E-EPA) supplementation with placebo for the treatment of PD and depressive symptoms in middle-aged women.

DESIGN: Women with moderate-to-severe PD (n = 120) were randomly assigned to receive 1.05 g E-EPA/d plus 0.15 g ethyl-docosahexaenoic acid/d (n = 59) or placebo (n = 61) for 8 wk. The main outcomes were 8-wk changes in PD scores [Psychological General Well-Being Schedule (PGWB)] and depressive scales [20-item Hopkins Symptom Checklist Depression Scale (HSCL-D-20) and the 21-item Hamilton Depression Rating Scale (HAM-D-21)].

RESULTS: At baseline, women with PD were mildly to moderately depressed, and 24% met the major depressive episode (MDE) criteria of the Diagnostic and Statistical Manual of Mental Disorders, 4th edition. After 8 wk, outcomes improved in both groups, but no significant differences were noted between them. Stratification analyses for MDE diagnosis at baseline indicated that differences in adjusted 8-wk changes between the E-EPA group without MDE (n = 46) and the placebo group (n = 45) were 8.0 (95% CI: 0.6, 15.3; P = 0.034) for the PGWB, -0.2 (95% CI: -0.01, -0.4; P = 0.040) for the HSCL-D-20, and -2.7 (95% CI: -0.3, -5.1; P = 0.030) for the HAM-D-21. Differences in adjusted 8-wk changes between the E-EPA group with MDE (n = 13) and the placebo group (n = 16) were not significant.

CONCLUSIONS: To our knowledge, this is the first trial of n-3 supplementation in the treatment of PD and depressive symptoms in middle-aged women. In women with PD without MDE at baseline, the 8-wk changes in PD and depressive scales improved significantly more with E-EPA than with placebo.

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

Treatment of depression with omega3 – encouraging results from largest clinical study

Monday, November 15th, 2010

The study was published in the online Journal of Clinical Psychiatry.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. The study was supported by the European the Fondation du CHUM and the CRCHUM.

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). For eight weeks, half of the participants took three capsules per day of a fish oil supplement containing high concentrations of eicosapentaenoic acid (EPA). The other half took three identical capsules of a placebo consisting of sunflower oil, flavoured with a small quantity of fish oil. In contrast with typical clinical studies designed to assess the effectiveness of antidepressants, this study included a high proportion of patients with complex and difficult-to-treat conditions, including patients resistant to conventional antidepressant treatments and patients also suffering from an anxiety disorder. The aim was to assess the value of Omega-3 supplementation in a group of individuals more like those treated in outpatient clinics.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.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.

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