Clinical Case
This post on the potential benefits of Omega-3 for depression treatment
we will start from the clinical case review. While once case does not prove the
solution is efficient, it will give some insight on how it can help, at least
in one stand-alone case.
21-year-old male student with a 7-year history of unremitting depressive
symptoms has been admitted for trial of the Omega-3 in his treatment plan. At
age 19 years, pharmacotherapy was commenced owing to increasing illness severity,
with prominent low self-esteem, insomnia, sadness, inner tension, poor
appetite, poor concentration, increasing social phobia, lethargy, pessimistic thoughts,
and suicidal thoughts. During the following year there was no response to a
variety of antidepressants, hypnotics, and antipsychotic medication; his condition
continued to deteriorate. A 2-month trial involving the addition of lithium
carbonate to his anti-depressant treatment was unsuccessful.
The patient was then referred to one of the trial developers Basant K. Puri, Hammersmith Hospital,
London. At this time, he was actively suicidal, although he had been taking paroxetine
hydrochloride (20-30 mg/d) for
10 months. His symptoms met the DSM-IV criteria for “major depressive disorder, recurrent.” His score on the Montgomery-Asberg
Depression Rating Scale (MADRS)
was 32. Owing to very good parental support,
it was decided not to admit the patient compulsorily to the hospital, despite
the severity of his illness and the very high suicide risk. He agreed to take pure
ethyl-EPA at a dose of 4 g/d (Omega-3 part).
Administration of ethyl-EPA led to a rapid improvement, including
cessation of the previously unremitting severe suicidal ideation, within 1
month. Social phobia also improved dramatically. There was a progressive
benefit, and after 9 months, his symptoms had disappeared altogether, giving
the patient a MADRS score of zero. Both he and his mother reported how different
he had become. He no longer had any suicidal thoughts and was actively making
plans for his future studies and career. The patient reported no adverse effects
of the medication.
Background
While the case results are very impressing, the one success story cannot
be accepted as background for practical recommendations to include Omega-3
Fatty Acids in your daily diet, especially if you do have depression. However, this
suggestion is getting more and more scientific validation from the respectable
sources.
Omega-3 fatty acids are a type of good fat which is required for normal
brain function. Our bodies can't make omega-3s on their own, so we must obtain
them through our diet. Studies have linked depression with low dietary intake
of omega-3 fatty acids. In countries with higher fish consumption, such as
Japan and Taiwan, the depression rate is 10 times lower than in North American.
Postpartum depression is also less common.
Latest studies suggest that people whose diets contain dramatically more
of one kind of polyunsaturated fatty acid than another may be at greater risk
for both clinical depression and certain inflammatory diseases. For example, the
report, published 2007 in the journal Psychosomatic Medicine, suggests
that we need to balance out our intake of omega-6 and omega-3 fatty acids. The
current typical American diet contains 20 times more omega-6 than omega-3, a
ratio that researchers say should be lowered to 4-to-1, or even 2-to-1.
Also, multiple studies suggest that omega-3's together with antidepressants
may be much more effective than antidepressants alone.
How Does EPA Work?
EPA is part of the Omega
3 chain of ecosanoids and is most commonly found in fatty fish such as fresh
salmon, mackerel, pilchards and sardines. While the benefits of high grade EPA have been well
documented, the scientific community still don t know exactly how EPA works on
the brain. One theory released by Dr Basant Puri (lead developer of the
clinical trial, we mentioned earlier) is that it eases the passage of the
signals over the tiny gaps in the brain called synapses. Another theory was
that the high grade EPA actually worked similarly to lithium and had
anti-depressant properties of its own.
Until recently it was widely accepted in the medical community that once
a human reached maturity that the adult brain could not grow anymore. However, a
paper, released by Dr. Puri, proves that was inaccurate. Dr. Puri scanned a 21
year patient before treating him with high grade Pure EPA. After the course of
treatment he rescanned the young man, only to find that the grey matter of the
brain had increased in size.
There is also a theory
that omega-3 fatty acids are of great assistance to neuronal membranes.
Omega-3 fatty acids can alter membrane fluidity by displacing cholesterol from
the membrane. An optimal fluidity, influenced by EFAs, is required for
neurotransmitter binding and the signaling within the cell. EFAs can act as
sources for second messengers within and between neurons.
Omega-3
fatty acids may also have significant influence in major depression via cytokine modulation. A
growing body of research has documented an association between depression and
the production these proinflammatory immune chemicals. Psychological stress can
cause an elevation of these cytokines. And Omega-3 fatty acids, and EPA in particular, are
well documented inhibitors of proinflammatory cytokines
Sources
Cold water fish such as salmon, sardines, and anchovies are the richest
food source of omega-3 fatty acids. But instead of eating more fish which
contain mercury, PCBs, and other chemicals, fish oil capsules are considered a
cleaner source of omega-3 fatty acids. Many companies filter their fish oil so
that these chemicals are removed.
Fish oil capsules are sold in health food stores, drug stores, and
online. Most brands should be stored in the fridge to prevent the oil from
going rancid. When comparing brands, the key active components for depression
are EPA and DHA.
Dosage
Andrew
Stoll, Ph.D., Harvard researcher on Omega 3 and depression recommends 4 grams
of EPA per day for those with depression. The advice of 4 grams of EPA fish oil
for depression each day is quite a bit but important to refill what has been
missing in our diet.
Generally, practitioners are recommending 2-4 grams of EPA a day.
Precautions
Fish oil capsules may interact with blood-thinning drugs such as warfarin
and aspirin. Side effects may include indigestion and bleeding. Fish oil should
not be taken 2 weeks before or after surgery. Fish oil can also cause a fishy
aftertaste. To prevent this, try taking the fish oil just before meals.
Sources and Additional Recommendations:
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