Supplementation in psychiatric practice
Epidemiological studies have observed an inverse correlation between per capita fish consumption and the prevalence of major depression, postnatal depression and bipolar spectrum disorders. There are also reports of an association between low long-chain omega-3 polyunsaturated fatty acids (LC-PUFAs) and the prevalence of suicidal ideation and suicide attempts. Furthermore, the high mortality rate among mood disorder and psychotic patients is partly attributable to cardiovascular disease-related disorders, whose risk factors (inflammation, hypertriglyceridemia, coronary artery disease, etc.) appear to be associated with an omega-3 LC-PUFA deficiency, based on the results of numerous studies.
In the last three decades, translational studies have associated deficiencies in omega-3 LC-PUFA, particularly docosahexaenoic acid (DHA), with the physiopathology and possible cause of various psychiatric disorders. Controlled studies show that patients with different psychiatric disorders (major depressive disorder, bipolar disorder, schizophrenia, anxiety and attention deficit hyperactivity disorder (ADHD)) show lower red blood cell (RBC) levels of EPA/DHA compared to healthy subjects with similar characteristics. These RBC concentrations could be dose-dependently increased by supplementation with fish oil (containing EPA and DHA). Neuroimaging studies show a possible link between low omega-3 LC-PUFA status and a deficiency in corticolimbic structure and functional integrity in patients with psychiatric disorders, as well as a positive association between increased omega-3 LC-PUFA consumption (and thus increased red blood cell EPA and DHA) and increased cortical grey matter volume in various corticolimbic regions (anterior cingulate cortex, hippocampus and amygdala) in which psychiatric patients show deficient volume.
Supplementation with dietary omega-3 LC-PUFAs could be effective in: reducing inattention in children and adolescents with ADHD; the treatment of positive and negative symptoms in patients at risk of schizophrenia; preventing onset of psychosis in at-risk youths; and reducing symptoms of depression and mania.
The limited efficacy and adverse secondary effects of conventional psychotropic drugs highlight the need to improve algorithms in current treatment. Given the increase in EPA and DHA status with dietary supplementation with fish oil (which is safe and well tolerated in patients), the latter may be effective in reducing psychiatric symptoms in these patients, while producing no notable adverse effects, and carrying out routine tests on blood fatty acid levels could be very useful in psychiatric patients. Detecting omega-3 LC-PUFA deficiency and treating it via supplementation (in monotherapy or as an adjuvant, depending on the disorder) would provide improvements in the treatment of these patients.
Messamore E, McNamara RK. Detection and treatment of omega-3 fatty acid deficiency in psychiatric practice: Rationale and implementation. Lipids Health Dis. 2016 Feb 10;15(1):25. doi: 10.1186/s12944-016-0196-5.