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'''Omega-3 polyunsaturated fatty acids''' (PUFA) include eicosapentaeoic acid (EPA) and docosahexaenoic acid (DHA). They are believed to be protective in cardiovascular disease due to their anti-infammatory properties.
 
'''Omega-3 polyunsaturated fatty acids''' (PUFA) include eicosapentaeoic acid (EPA) and docosahexaenoic acid (DHA). They are believed to be protective in cardiovascular disease due to their anti-infammatory properties.
  
==Omega-3 in mental health==
+
This article summarizes current evidence for use of omega-3 fatty acids in psychiatry.
  
===Aults===
+
==Omega Acids physiology==
Recent large meta-analysis of large number of trials of PUFA for different indications revealed the following (1):
+
* ω-3 (DHA, EPA) and ω-6 fatty acids are '''highly-unsaturated fatty acids''';
* significant clinical benefit of omega-3 treatment compared to placebo in adults with major depressive disorder (MDD) and bipolar disorder
+
** their precursors, α-linoleic acid and linoleic acid, respectively, are '''essential''' nutrients (can't be synthesized ''de novo'').
* significant clinical benefit of omega-3 treatment compared to placebo in adults with depressive symtpoms, but without MDD.
+
* DHA and arachidonic acid (an ω-6) are critical for the development of central nervous system.
* EPA (not DHA) is responsible for clinical efficasy.  
+
** polyunsaturated fatty acids must be a part of maternal diet along with other micronutrients.
There was no benefit in prevention of depression, or treatment of peripartum depression, schizophrenia, or demential.
+
* DHA and EPA have established role in prevention of cardiovascular disease and stroke.
 +
 
 +
== Dietary considerations==
 +
* '''Linoleic acid''', the precursor for omega-6, is abundant in Western diet (soybean, corn, and sunflower oils), with typical intake being often excessive at 12-17 g/day.
 +
* '''α-liloleic acid''', the precursor for omega-3 DHA and EPA, is abundant in leafy vegetables, nuts, seeds, and seafood.
 +
* enzymes involved in the metabolic conversion to omega-3 and omega-6 overlap; excessive intake of linoleic acid omega-6 may inhibit synthesis of omega-3  EPA and DHA.
 +
 
 +
==ω-3 in mental health==
 +
 
 +
===Adults===
 +
Recent large meta-analysis of large number of placebo-controlled trials of PUFA for different indications revealed the following (1):
 +
* significant clinical benefit of ω-3 treatment in major depressive disorder (MDD) and bipolar disorder
 +
* significant clinical benefit of ω-3 treatment in depressive symtpoms in adults without MDD.
 +
* EPA (not DHA) is believed to be responsible for mental health benefits.  
 +
* There was no benefit in '''prevention of depression''', or treatment of peripartum depression, schizophrenia, or dementia.
  
 
===Children and Adolescents===
 
===Children and Adolescents===
* A study of '''adolescents at risk for psychosis''', omega-3 fatty acids significantly reduced positive
+
* A study of '''adolescents at risk for psychosis''', omega-3 fatty acids significantly reduced positive symptoms, negative symptoms, and improved functioning, but had no significant effect on depressive symptoms. (2)
symptoms, negative symptoms, and improved functioning, but had no significant effect on depressive symptoms. (2)
+
 
* A small RCT of '''depressed pre-teens''' found positive effect of omega-3 fatty acids in improving the mood.(3)
 
* A small RCT of '''depressed pre-teens''' found positive effect of omega-3 fatty acids in improving the mood.(3)
 
* Among children and adolescents with '''autism''' omega-3 fatty acids reduced severe tantrums, aggression, or self-injurious behavior at 6 weeks. (4)
 
* Among children and adolescents with '''autism''' omega-3 fatty acids reduced severe tantrums, aggression, or self-injurious behavior at 6 weeks. (4)
 +
* Two randomized, placebo-controlled trials demonstrated modest improvement in symptoms of inattention and hyperactivity in schoolchildren. (5,6)
 +
 +
==Safety and Side Effects==
 +
Omega-3 supplementation is considered generally safe by the FDA at doses up to 3 g/day.
 +
Common side effects (1-10%) include dyspepsia, diarrhea, (GI) bleeding, and nausea
 +
* there is a recommendation to stop take PUFA a week before surgery due to risk of bleeding.
 +
Chronic treatment with PUFA may contribute to '''vitamin E deficiency''' and concurrent supplementation is recommended.
  
 
==References==
 
==References==
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4. Amminger GP et.al. Omega-3 fatty acids supplementation in children with autism: a double-blind randomized, placebo-controlled pilot study.Biol Psychiatry. 2007 Feb 15;61(4):551-3. PMID:16920077
 
4. Amminger GP et.al. Omega-3 fatty acids supplementation in children with autism: a double-blind randomized, placebo-controlled pilot study.Biol Psychiatry. 2007 Feb 15;61(4):551-3. PMID:16920077
{{stub}}
+
 
[[Category:Content]]
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5. Nemets H et. al. AM J Psychiatry 2006; 163
 +
 
 +
6. Sinn N et al. J Dev Behav Pediatrics 2007; 28
 +
 
 +
{{completeness}}
 +
[[Category:Medications]]

Latest revision as of 01:13, 7 September 2015

Introduction

Omega-3 polyunsaturated fatty acids (PUFA) include eicosapentaeoic acid (EPA) and docosahexaenoic acid (DHA). They are believed to be protective in cardiovascular disease due to their anti-infammatory properties.

This article summarizes current evidence for use of omega-3 fatty acids in psychiatry.

Omega Acids physiology

  • ω-3 (DHA, EPA) and ω-6 fatty acids are highly-unsaturated fatty acids;
    • their precursors, α-linoleic acid and linoleic acid, respectively, are essential nutrients (can't be synthesized de novo).
  • DHA and arachidonic acid (an ω-6) are critical for the development of central nervous system.
    • polyunsaturated fatty acids must be a part of maternal diet along with other micronutrients.
  • DHA and EPA have established role in prevention of cardiovascular disease and stroke.

Dietary considerations

  • Linoleic acid, the precursor for omega-6, is abundant in Western diet (soybean, corn, and sunflower oils), with typical intake being often excessive at 12-17 g/day.
  • α-liloleic acid, the precursor for omega-3 DHA and EPA, is abundant in leafy vegetables, nuts, seeds, and seafood.
  • enzymes involved in the metabolic conversion to omega-3 and omega-6 overlap; excessive intake of linoleic acid omega-6 may inhibit synthesis of omega-3 EPA and DHA.

ω-3 in mental health

Adults

Recent large meta-analysis of large number of placebo-controlled trials of PUFA for different indications revealed the following (1):

  • significant clinical benefit of ω-3 treatment in major depressive disorder (MDD) and bipolar disorder
  • significant clinical benefit of ω-3 treatment in depressive symtpoms in adults without MDD.
  • EPA (not DHA) is believed to be responsible for mental health benefits.
  • There was no benefit in prevention of depression, or treatment of peripartum depression, schizophrenia, or dementia.

Children and Adolescents

  • A study of adolescents at risk for psychosis, omega-3 fatty acids significantly reduced positive symptoms, negative symptoms, and improved functioning, but had no significant effect on depressive symptoms. (2)
  • A small RCT of depressed pre-teens found positive effect of omega-3 fatty acids in improving the mood.(3)
  • Among children and adolescents with autism omega-3 fatty acids reduced severe tantrums, aggression, or self-injurious behavior at 6 weeks. (4)
  • Two randomized, placebo-controlled trials demonstrated modest improvement in symptoms of inattention and hyperactivity in schoolchildren. (5,6)

Safety and Side Effects

Omega-3 supplementation is considered generally safe by the FDA at doses up to 3 g/day. Common side effects (1-10%) include dyspepsia, diarrhea, (GI) bleeding, and nausea

  • there is a recommendation to stop take PUFA a week before surgery due to risk of bleeding.

Chronic treatment with PUFA may contribute to vitamin E deficiency and concurrent supplementation is recommended.

References

1. Grosso G, et al. (2014) Role of Omega-3 Fatty Acids in the Treatment of Depressive Disorders: A Comprehensive Meta-Analysis of Randomized Clinical Trials. PLoS ONE 9(5): e96905.

2. Amminger GP, et al.(2010) Long-chain omega-3 fatty acids for indicated prevention of psychotic disorders: a randomized, placebo-controlled trial. Arch Gen Psychiatry 67:146–154.

3. Nemets H et.al. Omega-3 treatment of childhood depression: a controlled, double-blind pilot study. Am J Psychiatry. 2006 Jun;163(6):1098-100. PMID:16741212

4. Amminger GP et.al. Omega-3 fatty acids supplementation in children with autism: a double-blind randomized, placebo-controlled pilot study.Biol Psychiatry. 2007 Feb 15;61(4):551-3. PMID:16920077

5. Nemets H et. al. AM J Psychiatry 2006; 163

6. Sinn N et al. J Dev Behav Pediatrics 2007; 28


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