Monday, January 15, 2007

TO READ: Should I Start Omega-3's?
A bipolar friend of mine was recently stunned to discover that along with my other meds I don't take an omega-3 fatty acid supplement. She claims great results from taking omega-3-containing fish oil pills - several grams of them - every day for her depression. So am I missing the boat here? I know omega-3's were hot news a few years ago, but what's the evidence say now? My psychiatrist and I set out to discover the latest conclusions on their usefulness.

Although omega-3's were previously widely touted (notably, in The Omega-3 Connection, a 2001 book by expert Andrew Stoll), the latest reviews of all the published studies in this field seem to reach the same conclusion: Maybe they're useful; the verdict is still out.

To summarize extremely briefly, people got very excited when population studies found that people in parts of the world where lots of fish is eaten have lower rates of depression than in regions where fish is a smaller part of the diet. The unsaturated omega-3 fatty acids found in high levels in fish oil could logically play a biochemical role in the brain, and some studies have indicated that depressed people have particularly low levels of omega-3's. Sounds promising in theory, but when psychiatrists around the world eagerly began to study the effects of fish oil supplements for their patients, things got complicated.... In 2006, at least three groups of scientists did careful statistical reviews, each of at least 12 published studies (see Am J Psychiatry 2006; 163:6, June 2006; World J Biol Psychiatry 2006; 7(4): 223-230; and American Journal of Clinical Nutrition, December 2006). Every one concluded the same thing: We don't know yet if omega-3's are really effective.

Yes, there are some quite positive studies, but there are others that contradict them, showing no significant correlation at all between omega-3's and depression improvement. And, the studies are not all easily comparable either - some look at major (unipolar) depression, some at bipolar depression, some at other psychiatric conditions; the doses used haven't been standardized; they use different lengths of treatment; and some used omega-3's alone while others used them to augment antidepressant therapy. All of these things require a good deal of further study before we can say with certainty whether and how to use these supplements.

So, what am I going to do? Well, no negative side effects have come up in my reading or talking with friends; my internist says I could start taking some anyway for general heart health; and I really, really don't want to have another serious depression coming my way.... So, yes, I think I'll give a moderate dose (a few grams a day) a try for a month or two. If I don't feel any problem with it, great; if I actually think I feel better or can prolong my remission, fabulous! Meanwhile, I'll keep an eye on the literature in this field and be open to altering my plan. Stay tuned.

1 comment:

Byron said...

I was good talking to you today. The results of the studies aren't too surprising. One thing I can attest to is the oils are good for the digestion, good for the skin and can eliminate dandruff. Flaxseed oil will make the hair gummy, using the old name, linsead oil, would explain it. Downing handfulls of capsules is unappealing and it's ten times as expensive. I just swig it straight out of the bottle. Cod liver oil is a tradition preventitive for skin conditions and rickets and when fresh isn't bad, of course it has vitamins A and D. Good flaxseed is tasty, but some people say it's not good for you. My current favorite is walnut oil. I don't take these regularly enough to say if they work on the mood and my mood is too cut up anyway. Give it a good maybe.
I think there is a great over-reliance on the six weak double blind experiment for mood disorders. Efficacy is determined in clinical practice, hopefully with talented observers. There is the basic fallacy of trying to quatify the qualitative and many many minor fallacies, I should have written my essay.
Sorry for going on too long.