.Addition of omega-3 fatty acid to maintenance medication treatment for recurrent unipolar depressive disorder

Ministry of Health Mental Health Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel.
American Journal of Psychiatry (Impact Factor: 12.3). 04/2002; 159(3):477-9.
Source: PubMed


Studies have reported that countries with high rates of fish oil consumption have low rates of depressive disorder. The authors studied a specific omega-3 fatty acid, the ethyl ester of eicosapentaenoic acid (E-EPA), as an adjunct to treatment for depressive episodes occurring in patients with recurrent unipolar depressive disorder who were receiving maintenance antidepressant therapy.
Twenty patients with a current diagnosis of major depressive disorder participated in a 4-week, parallel-group, double-blind addition of either placebo or E-EPA to ongoing antidepressant therapy. Seventeen of the patients were women, and three were men.
Highly significant benefits of the addition of the omega-3 fatty acid compared with placebo were found by week 3 of treatment.
It is not possible to distinguish whether E-EPA augments antidepressant action in the manner of lithium or has independent antidepressant properties of its own.

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Available from: Robert H Belmaker, Apr 24, 2014
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    • "Two studies that implemented a placebo run-in phase to exclude responders during this phase reported a significant improvement in depression in the omega-3 FA compared to placebo910. Three studies that did not implement a placebo run-in phase: two showed a significant improvement in the omega-3 FA group78and one did no show a difference between groups[25]. There was no significant difference in quality of life (MCS or PCS) between groups. "
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    ABSTRACT: Multiple sclerosis is the most common chronic disabling disease in the central nervous system in young to middle aged adults. Depression is common in multiple sclerosis (MS) affecting between 50–60% of patients. Pilot studies in unipolar depression report an improvement in depression when omega-3 fatty acids are given with antidepressants. The objective of this study was to investigate whether omega-3 fatty acid supplementation, as an augmentation therapy, improves treatment-resistant major depressive disorder (MDD) in people with MS. We performed a randomized, double-blind, placebo-controlled pilot study of omega-3 fatty acids at six grams per day over three months. The primary outcome was a 50% or greater improvement on the Montgomery-Asberg Depression Rating Scale (MADRS). Thirty-nine participants were randomized and thirty-one completed the 3-month intervention. Improvement on MADRS between groups was not significantly different at the 3-month end point with 47.4% in the omega-3 fatty acid group and 45.5% in the placebo group showing 50% or greater improvement (p = 0.30). Omega-3 fatty acids as an augmentation therapy for treatment-resistant depression in MS was not significantly different than placebo in this pilot trial. Omega-3 fatty acid supplementation at the dose given was well-tolerated over 3 months.
    Full-text · Article · Jan 2016 · PLoS ONE
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    • "The search for alternative therapies for the treatment of neuropathic pain [15] and depression associated with diabetes is recquired, since the conventional therapies present low adhesion [16], responsiveness [4] and may also alter blood glucose levels [17] [18]. In this way, omega-3 polyunsaturated fatty acids (-3- PUFA), as linolenic acid (LNA), eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), have been suggested as adjuvant therapy of depression [19] [20] [21], pain [22] [23] [24] and also for mood disorders [25] [26], among others [for review see: Ref. [27]]. Regarding the possible mechanism of action of -3-PUFA, especially in regard to its antidepressant-like effect, it has been associated with a hippocampal brain derived neurotrophic factor (BDNF) up-regulation [28] [29] and also with other biological functions [30]. "
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    ABSTRACT: Neuropathic pain and depression are very common comorbidities in diabetic patients. As the pathophysiological mechanisms are very complex and multifactorial, current treatments are only symptomatic and often worsen the glucose control. Thus, the search for more effective treatments are extremely urgent. In this way, we aimed to investigate the effect of chronic treatment with fish oil (FO), a source of omega-3 polyunsaturated fatty acid, over the mechanical allodynia and in depressive-like behaviors in streptozotocin-diabetic rats. It was observed that the diabetic (DBT) animals, when compared to normoglycemic (NGL) animals, developed a significant mechanical allodynia since the second week after diabetes induction, peaking at fourth week which is completlely prevented by FO treatment (0.5, 1 or 3g/Kg). Moreover, DBT animals showed an increase of immobility frequency and a decrease of swimming and climbing frequencies in modified forced swimming test (MFST) since the second week after diabetes injection, lasting up at the 4th week. FO treatment (only at a dose of 3g/Kg) significantly decreased the immobility frequency and increased the swimming frequency, but did not induce significant changes in the climbing frequency in DBT rats. Moreover, it was observed that DBT animals had significantly lower levels of BDNF in both hippocampus and pre frontal cortex when compared to NGL rats, which is completely prevented by FO treatment. In conclusion, our study demonstrates that FO treatment was able to prevent the mechanical allodynia and the depressive-like behaviors in DBT rats, which seems to be related to its capacity of BDNF level restoration.
    Full-text · Article · Nov 2015 · Behavioural brain research
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    • "In regards to omega - 3 fatty acids , although their supplementation has been reported to exert beneficial effects in mood disorders ( presumably due to its anti - inflammatory properties ) , a recent meta - analysis of 13 separate RCTs demonstrated no significant effect on MDD ( Nemets et al . , 2002 ; Su et al . , 2003 ; Bloch and Hannestad , 2012 ) ."
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    ABSTRACT: Major depressive disorder (MDD) is a mood disorder of multifactorial origin affecting millions of people worldwide. The alarming estimated rates of prevalence and relapse make it a global public health concern. Moreover, the current setback of available antidepressants in the clinical setting is discouraging. Therefore, efforts to eradicate depression should be directed towards understanding the pathomechanisms involved in the hope of finding cost-effective treatment alternatives. The pathophysiology of MDD comprises the breakdown of different pathways, including the hypothalamus-pituitary-adrenal (HPA) axis, the glutamatergic system, and monoaminergic neurotransmission, affecting cognition and emotional behavior. Inflammatory cytokines have been postulated to be the possible link and culprit in the disruption of these systems. In addition, evidence from different studies suggests that impairment of glial functions appears to be a major contributor as well. Thus, the intricate role between glia, namely microglia and astrocytes, and the central nervous system's (CNSs) immune response is briefly discussed, highlighting the kynurenine pathway as a pivotal player. Moreover, evaluations of different treatment strategies targeting the inflammatory response are considered. The immuno-modulatory properties of vitamin D receptor (VDR) suggest that vitamin D is an attractive and plausible candidate in spite of controversial findings. Further research investigating the role of VDR in mood disorders is warranted.
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