Bogus Headlines Distort Omega-3 Depression Study

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Bogus Headlines Distort Omega-3 Depression Study

 

Most news reports mis-reported the results of a new clinical trial ...

and didn't mention that omega-3s enhanced anti-depressants' effects in

two similar studies by Craig Weatherby

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The majority of numerous studies associate low blood levels of omega-3s

with greater risk of depression. Depression is a risk factor for death

or injury in people with CHD, so it makes sense to test the effects of

anti-depressants in patients who are diagnosed with depression. It also

makes sense to test the effects of nutrients with antidepressant

potential, such as omega-3s. And judging by the headlines that raced

around the world last week like Study fails to find omega 3 benefit for

depression youd think that a new study had found omega-3s ineffective

for alleviating depression. But most headlines misstated both the

purpose and outcome of the clinical trial published this month in the

Journal of the American Medical Association (JAMA). Despite what the

headlines implied, this trial only tested omega-3s as an adjunct to the

FDA-approved antidepressant drug Zoloft not as a stand-alone treatment

for depression. In fact, the study only showed that omega-3s from fish

oil did not add extra mood benefits to those conferred by an

antidepressant drug. Worse, virtually none of the many media reports

mentioned that two prior clinical trials found that omega-3s from fish

oil substantially increased the efficacy of various antidepressant

drugs. As the authors of a UK trial wrote seven years ago, Treatment

with [omega-3] EPA at a dosage of 1 gram per day was effective in

treating depression in patients who remained depressed despite adequate

standard therapy. (Peet M, Horrobin DF 2002) That same year, an Israeli

team penned this encouraging conclusion to their clinical study: Highly

significant benefits of the addition of the omega-3 fatty acid compared

with placebo were found by week 3 of treatment. (Nemets B et al. 2002)

Media has short memory on omega-3s and depressionAnd with regard to the

clinical record on omega-3s and depression, the memory spans of most

reporters and editors seem laughably short. From the headlines, youd

never know that the outcomes of a major clinical trial published just

two months back suggest that omega-3s can approximate the effects of

anti-depressant drugs for alleviating depression symptoms excepting

those who are also diagnosed with anxiety disorder (Fish Oil Rivals

Antidepressants in Clinical Trial [

http://newsletter.vitalchoice.com/e_article001512671.cfm?x=bfT6hQ1,b7b1jv7h

.. As that studys lead author, Francois Lesperance, M.D., told

Medscape Psychiatry, ... the level of improvement we saw in this

subgroup [i.e., people diagnosed with depression but not anxiety] is on

a par with what has typically been reported with pharmacologic [drug]

treatments. (Stein J 2009) And three years ago, the American Psychiatric

Associations Committee on Research on Psychiatric Treatments concluded

that omega-3s help prevent and alleviate depression (see Top Psych Panel

Says Omega-3s Deter Depression [

http://newsletter.vitalchoice.com/e_article000737996.cfm?x=b11,0,w

.. Importantly, there are plausible biological mechanisms by

which omega-3s could affect mood see How omega-3s might help, below. New

trial found no additional benefits from adding omega-3s to drug

treatmentResearchers from the Washington University School of Medicine

conducted a clinical trial randomized, double-blind, and

placebo-controlled in 122 patients diagnosed with major depression and

CHD (Carney RM et al. 2009). All of the participants took the

antidepressant drug sertraline (50 mg daily) better known as Zoloft or

Lustral for 10 weeks. Like Prozac, sertraline belongs to the newer class

of antidepressants called selective serotonin reuptake inhibitors

(SSRIs), which work (in part) by boosting brain levels of the

mood-elevating neurotransmitter serotonin. About half of the patients

also took 2 grams of omega-3s per day (930mg of EPA and 750mg of DHA),

while the others took inactive placebo capsules. The Washington

University team rated the participants levels of depression and anxiety

using standard psychiatric tests. The results showed no difference

between the drug+placebo and drug+omega-3 groups in terms of the

patients depression and anxiety test scores. Likewise, there was no

significant difference between the two groups in terms of their rates of

remission or their overall responses to sertraline (Zoloft/Lustral).

Possible reasons for the lack of added benefitBoth of the positive

trials published in 2002 involved otherwise healthy people whod been

diagnosed with major depression (Peet M, Horrobin DF 2002; Nemets B et

al. 2002). In contrast, the new JAMA trial involved people diagnosed

with both major depression and coronary heart disease (CHD): a mutually

reinforcing pair of conditions. And the authors themselves recognized

some limitations of their trial. They noted that it may have been too

short to reveal the full potential of adding omega-3s to sertraline, and

that the amounts and relative proportions of omega-3 fats (EPA and DHA)

in the fish oil used may not have been ideal. As they wrote, Whether

higher doses of EPA, DHA, or sertraline, a longer duration of treatment,

or the use of omega-3 as monotherapy (i.e., omega-3s taken alone,

without any drugs) can improve depression in patients with stable heart

disease remains to be determined. (Carney RM et al.

2009) How omega-3s might helpOmega-3s are essential to the proper

function of brain-cell membranes, and studies led by NIH clinical

researcher Joseph Hibbeln, M.D., suggest that dietary omega-3s raise

serotonin levels (Hibbeln JR et al. 1998). Dr. Hibbelns study found that

low levels of omega-3s in cell membranes were associated with low levels

of serotonin in people with aggression and impulse-control problems.

Among other effects, this could help explain the strong, well-documented

associations between higher omega-3 intakes and reduced risk of

depression. In addition, omega-3s and SSRI drugs alike foster growth of

cells in the brains hippocampus region, and connections between

hippocampus brain cells an effect associated with reduced depression

risk and symptom severity. In mouse studies, omega-3s and fluoxetine

(Prozac) both restore brain cells ability to take on new roles and form

new connections, which eases the symptoms of depression (Sahay A, Hen R

2008; Venna VR et al. 2009). The media distorted the meaning of the new

study published in JAMA and sadly, were not surprised, since dramatic,

negative headlines draw more attention than reasonable, nuanced news

reports. Sources

- Carney RM, Freedland KE, Rubin EH, Rich MW, Steinmeyer BC, Harris WS.

Omega-3 augmentation of sertraline in treatment of depression in

patients with coronary heart disease: a randomized controlled trial.

JAMA. 2009 Oct 21;302(15):1651-7.

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Keck PE Jr, Marangell LB, Richardson AJ, Lake J, Stoll AL. Omega-3 fatty

acids: evidence basis for treatment and future research in psychiatry. J

Clin Psychiatry. 2006 Dec;67(12):1954-67. Review.

- Hibbeln JR, Linnoila M, Umhau JC, Rawlings R, George DT, Salem N Jr.

Essential fatty acids predict metabolites of serotonin and dopamine in

cerebrospinal fluid among healthy control subjects, and early- and

late-onset alcoholics. Biol Psychiatry 1998; 44: 235-242.

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cross-national ecological analysis. World Rev Nutr Diet. 2001;88:41-6.

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maintenance medication treatment for recurrent unipolar depressive

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and treatment of mood disorders. Curr Opin Psychiatry. 2008

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- Peet M, Horrobin DF. A dose-ranging study of the effects of

ethyl-eicosapentaenoate in patients with ongoing depression despite

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- Sahay A, Hen R. Hippocampal neurogenesis and depression. Novartis

Found Symp. 2008;289:152-60; discussion 160-4, 193-5.

- Santarelli L, Saxe M, Gross C, Surget A, Battaglia F, Dulawa S,

Weisstaub N, Lee J, Duman R, Arancio O, Belzung C, Hen R. Requirement of

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Science. 2003 Aug 8;301(5634):805-9.

- Venna VR, Deplanque D, Allet C, Belarbi K, Hamdane M, Bordet

R. PUFA induce antidepressant-like effects in parallel to structural and

molecular changes in the hippocampus. Psychoneuroendocrinology. 2009

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