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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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