Detection and treatment of long-chain omega-3 fatty acid deficiency in adolescents with SSRI-resistant major depressive disorder
Robert K. McNamara
PharmaNutrition
Volume 2, Issue 2, April 2014, Pages 38–46
Highlights
• SSRI-resistant adolescent MDD patients exhibit robust erythrocyte long-chain omega-3 (LCn−3) fatty acid deficits.
• Fish oil supplementation significantly increases erythrocyte LCn−3 fatty acid levels in MDD patients.
• Fish oil supplementation is safe and well-tolerated and may augment SSRI efficacy.
• Additional studies are warranted to further evaluate adjunctive fish oil supplementation as an option for SSRI-resistant MDD patients.
Summary:
In a combined study involving a case-control analysis and an open-label fish oil trial, involving SSRI-resistant adolescents with major depressive disorder (MDD), baseline DHA levels were found to be significantly lower in patients (n=20), as compared to healthy controls (n=20). Subjects received fish oil in either a low-dose (2.4 g/d, n=7) or high-dose (16.2 g/d, n=7), for a period of 10 weeks. Significant increases in erythrocyte EPA and DHA composition were found. Subjects in the high-dose fish oil group were found to have significant reductions (=40%) in depressive symptoms, in the intent-to-treat sample and a trend towards reduction in the low-dose group (-20%). Remission of symptoms was found in 100% of subjects in the high-dose group and 40% of patients in the low-dose group. The authors conclude that, “These preliminary findings demonstrate that adolescents with SSRI-resistant depression exhibit robust DHA deficits, and suggest that adjunctive FO supplementation is well-tolerated and effective for increasing LCn-3 fatty acid status and augmenting SSRI antidepressant effects.”
Abstract
Residual depressive symptoms are commonly observed in adolescents with major depressive disorder (MDD) following treatment with selective serotonin reuptake inhibitors (SSRIs). This study combined a case–control analysis and an open-label fish oil (FO) trial to investigate the relationship between long-chain omega-3 (LCn−3) fatty acid status and residual depressive symptoms in SSRI-resistant adolescent MDD patients. Baseline erythrocyte docosahexaenoic acid (DHA) (−28%, p = 0.0003), but not eicosapentaenoic acid (EPA) (−18%, p = 0.2), was significantly lower in patients (n = 20) compared with healthy controls (n = 20). Patients receiving 10-week low-dose (2.4 g/day, n = 7) and high-dose (16.2 g/day, n = 7) FO exhibited significant increases in erythrocyte EPA and DHA composition. In the intent-to-treat sample, depressive symptoms decreased significantly in the high-dose group (n = 7, −40%, p < 0.0001), and there was a trend in the low-dose group (n = 10, −20%, p = 0.06). Symptom remission was observed in 40% of patients in the low-dose group and 100% of patients in the high-dose group. There were no significant changes in vital signs and adverse events were rated as mild or moderate in severity. These preliminary findings demonstrate that adolescents with SSRI-resistant depression exhibit robust DHA deficits, and suggest that adjunctive FO supplementation is well-tolerated and effective for increasing LCn−3 fatty acid status and augmenting SSRI antidepressant effects.