EPA shown to be as effective as an antidepressant drug
- 05-16-2008, 04:57 AM
EPA shown to be as effective as an antidepressant drug
"Omega-3 fatty acids are well known to provide a wealth of health benefits. One of these fatty acids, EPA, has begun to shine in its role of mood regulation. In particular, studies with EPA have found that it has benefits in depression and mental disorders. In 2000, depressive disorders ranked as the fourth highest among all diseases and the second highest in people from 15-44 years of age.
A new study published in the Australian and New Zealand Journal of Psychiatry compared the effects of EPA in depression to those of the antidepressant drug fluoxetine (Jazayeri et al. 2008;42(3):192-198). 48 patients who were diagnosed with major depressive disorder were given either 1000 mg EPA or 20 mg fluoxetine or both for 8 weeks. At the end of the study, it appeared that EPA was at least as effective in controlling symptoms of depression as the drug, and both together were especially effective. There was a response rate of 50% to fluoxetine, 56% to EPA and 81% to the combination. Due to ethical reasons, this double-blind study could not use a placebo control group. However, since the effectiveness of the combination treatment was greater than either alone, it is unlikely that there was a significant placebo effect.
This study supports many others that have found benefits for EPA supplementation in depression. There are several theories for this. Depression has been proposed to be caused by an excessive production of cytokines (molecular signals in the inflammation response). In particular, the cytokine IFNy can lower levels of serotonin by activating enzymes that metabolize tryptophan, serotonin's precursor, and decrease its availability. EPA has been found to decrease the production of IFNy. Other potential factors in depression are the complex interactions between the serotonin system and the metabolism of arachidonic acid, another fatty acid. EPA has strong effects on processes that involve arachidonic acid. Therefore, EPA supplementation appears to be a promising way to deal with mental disorders such as depression."
Advanced Orthomolecular Research - Canada
- 05-16-2008, 05:45 PM
Too bad they couldnt use a placebo, most depression is mental and evironmental instead of chemical imbalances.
I believe it. Epa is in fish oil, thats the EPA/DHA combo right? And arent all those scandinavian countrys always the happiest ones? I think the "happiest countrys" list just came out and it was like iceland, finland, etc at the top of the list.
05-16-2008, 09:59 PM
EPA & DHA from Omega 3's - especially EPA, has incredible health benefits. On the mood, on the heart, on the joints, hell I could go on forever. I dose 15-20 grams of Carlsons Finest Fish Oil every day & since I've done so my mood has definitely been better.
05-17-2008, 03:28 PM
hmmm...regardless of whether or not there was a difference between the independent variables in this study, no placebo means no control. I wouldn't put too much credence into this study. Still, fascinating none the less.
05-20-2008, 01:40 AM
05-20-2008, 10:38 AM
05-20-2008, 10:40 AM
05-20-2008, 05:49 PM
If you need more let me know I have tons. I've use liquid fish oil which is very high in both EPA & DHA and it's improved my mood tremendously. The benefits of EPA & DHA are countless but doctors recommend 2-4 grams per day of EPA & DHA. This is pretty much only possible through a quality liquid fish oil. I get Carlson's Very Finest which is high in EPA & DHA and take 15-20 grams per day - which gives me about 2-3 grams of EPA & DHA. Taking fish oil capsules you'd have to take 10-20 per day to get the proper amount of EPA & DHA.
05-20-2008, 06:55 PM
Here's a fun read.
Pharmaceutical-Grade EPA, not DHA, for Healthy Mood and Thought Patterns
The common thinking on the different functions of the different omega-3s is: EPA for the heart, DHA for the brain.
There’s a reasonable-sounding argument behind this notion, based on the fact that DHA (docosahexaenoic acid, or 22:6w3) is a major component of the brain, while there’s only a tiny amount of EPA (eicosapentaenoic acid, or 20:5w3) in the nervous system. So when research started
to show that countries and individuals who consumed more fish seemed more resistant to depression, schizophrenia, seasonal affective disorder (SAD), and bipolar disorder, almost everyone leapt to the conclusion that the seaborne secret just had to be DHA.
Not that it made any practical difference, of course: after all, nearly all EPA and DHA supplements come in the form of concentrated fish oil softgels with a significant amount of both fatty acids. So, the assumption was, you could get both benefits in one pill by just taking a common fish oil supplement.
Nice-sounding theory. But, as a series of randomized, placebo-controlled, clinical trials have shown, dead wrong.
Running our expectations through the spin cycle, resent research has revealed that DHA is, at best, useless when it comes to supporting the health of your thought patterns and outlook on the world. Worse: DHA may even be counterproductive. Surprisingly, EPA turns out to be the real slayer of the “Noonday Demons.”
DHA: Brain Fat? Or Fat Chance?
• In one trial, researchers tested the effects of pure DHA on victims of clinical depression. For six weeks, people suffering with major depression took a supplement containing either pure DHA (two grams (2000 milligrams) a day or an inactive stand-in oil for six weeks. At the end of the trial, DHA had exerted no detectable effect whatsoever.
• In an even more pointed failure, researchers ran a trial to see if DHA supplements could prevent the depression and deficits in information processing associated with postpartum depression. This seemed like an especially good opportunity for DHA to strut its stuff, because women’s levels of DHA usually decline late in their pregnancies, and they remain depressed for months after the birth of their child. Instead, the results were a complete flop. Women taking DHA supplements were no less depressed, and no better able to process information, than were women taking an inert fatty acid softgel, even though their DHA levels were much higher.
• A third trial sought to lay plain the differing effects of EPA and DHA on thought patterns and mental functioning – focusing this time on people suffering from schizophrenia. Forty-five people diagnosed with the disease were randomly assigned to begin using either two grams of high-EPA oil, the same amount of high-DHA oil, or a corn oil placebo, with no one knowing who was taking what.
The results in the DHA group were surprising. At best, they had gotten no better than people on the dummy pill. And overall, in fact, the subjects administered DHA appeared to fare worse than in the placebo group. Although the differences did not reach the statistical level of significance, there was actually a higher percentage of people taking DHA who were either treading water or showing further decay at the end of the trial than was seen with the placebo. On top of this, whereas the severity of so-called “positive” symptoms (delusions, psychoses, etc) had fallen by an average of 13.7% in patients taking the placebo, it was only reduced by 3.3% in DHA-treated subjects. In other words, it appears that patients get more relief from their “positive” symptoms if they take an inactive dummy pill than if they take DHA – suggesting that DHA may even interfere with the progress that they could otherwise make if they just continue with their conventional treatment.
It was a whole different picture in the pure EPA group. Every single one of the people who had taken the EPA-only supplement got better, with an even split between the number of people showing considerable improvements (more than 25%) on their symptom scores and the number showing more minor improvements.
• To make sure the results hadn’t been some kind of wild fluke, the same group initiated a second trial to confirm the powers of EPA-only supplements. For three months, 30 relapsing schizophrenia sufferers who were not already taking drugs for their conditions took either straight EPA or placebo capsules as their sole encapsulated support – unless, during the course of the trial, their doctors deemed it clinically imperative to put them on antipsychotics, in which case the patients’ safety came first and medication was permitted. But no one would know who was getting EPA, and who was taking the stand-in oil capsules. At the end of the trial, 100% of the people taking the dummy pill had been forced to go on an antipsychotic drug – versus only 57% of the EPA users.
The Power of EPA Confirmed
Since then, three more randomized, placebo-controlled trials have been performed using highly purified EPA supplements to help people with schizophrenia – and two such trials have been performed in victims of clinical depression. There have also been an additional two studies in schizophrenics, and an additional one in victims of depression, using either very high doses of omega-3 supplements containing mostly EPA (but still including some DHA), or such a supplement combined with antioxidants.
All but one of these eight trials showed that the EPA-containing supplements brought relief from these mental torments – and in that one trial, the problem seems to have been the use of excessively high doses.
• In one trial, for instance, 20 patients with major depressive disorder were randomly given either 2 grams of pure EPA or a matching stand-in for four weeks. Even in this short period, sixty percent of the people taking pure EPA experienced a remarkable 50% or greater reduction in their scores of depression, versus just ten percent of people taking the placebo. On average, the relief was clocked as a remarkable 12.4 point improvement on the Hamilton depression scale scores in EPA users – versus just a 1.6 point improvement among people stuck with the lookalike pills.
• Another double-blind trial compared the effects of EPA to the antidepressant drug fluoxetine in patients with major depressive disorder. EPA supplements were found to be as effective as the drug, with a response rate of 50% to fluoxetine, 56% to EPA and 81% to a combination of both.
Summarizing the evidence from these reports, the lead researcher in the trial which originally identified the opposing effects of EPA and DHA concluded that “In both schizophrenia and depression, the studies indicate that DHA is, if anything, rather worse than placebo in its effects on symptomology. Only EPA has given significant positive benefits.”
Harvard Medical School performed a double-blind, placebo-controlled trial using high-dose fish oil supplements in 30 people trapped in bipolar disorder (“manic depression”) in 1999, using the amount of long-chain omega-3s found in 32 standard fish oil capsules. At the end of the study, 86% of the people who had been taking the megadose EPA-containing oil were still free of relapse – versus only 38% of the people taking the placebo. Based on the research showing that DHA is at best an empty filler, and may even undermine the effects of EPA in schizophrenia and depression, the reason that the study required so much omega-3 may be that the high content of DHA in the supplement would have forced people to take still higher amounts of EPA to make it effective. Dr. Andrew Stoll, the lead investigator in the Harvard bipolar trial, says that his “clinical observation” is that “too much DHA relative to EPA may cause a worsening of mood. I therefore recommend using a supplement with as high an EPA content as possible”.
Borderline Personality Disorder (BPD)
Having seen the convincing results experienced by EPA users with other disorders of the mind and personality, scientists initiated a pilot randomized, double-blind, placebo-controlled trial of EPA in 30 women plagued by BPD. The results were not earth-shattering – but they were significant. While symptoms improved in both groups, BPD sufferers taking the pure EPA supplements experienced greater reductions in both depression (about 15% more improved) and aggression (a 10% additional improvement) than did victims taking the placebo.
While the responses were not overwhelming, they were real – and it’s worth remembering that BPD doesn’t respond well to conventional drug therapies, either. Any relief from the nightmare of this disease represents an advance. Additionally, the dose in this pilot study may not have been optimal, and the authors called for “Studies assessing different doses of E-EPA for longer periods of time in larger samples”.
What’s the Story on these Morning Glories?
What is the key function of EPA in the brain that underlies its ability to support the health of the mind? The truth is, we don’t know – at least, not with certainty. But we do have a good working hypothesis. Pioneering essential fatty acid researcher Ralph Holman put the core insight succinctly: “DHA is structure. EPA is function.”
DHA is an essential structural component of nerve cells, needed in large amounts to build the brain during embryonic and childhood development. But once the brain and nervous system has matured, the developed brain’s day-to-day DHA needs are minimal.
By contrast, although only a small amount of EPA is present in brain cell membranes at any given time, that small quantity is continuously being used up, necessitating ongoing replacement. EPA is quickly “turned over” as the brain ceaselessly releases EPA from its cell membranes for use in “signal transduction,” conveying neurochemical messages within neurons just as neurotransmitters like serotonin and dopamine carry messages between them. EPA also fine-tunes and balances the signaling carried out by the brain’s main omega-6 fat, arachidonic acid (AA). Because EPA is biochemically consumed in the process of carrying out its signal transduction role, the brain has a need for a large, steady supply of new EPA to keep functioning optimally.
The reason why DHA might actually worsen symptoms in people with mood and thought pattern disorders is less clear, but may simply be a matter of displacement. There’s only so much “room” available for unsaturated fatty acids in the phospholipids of the brain’s cellular membranes, and taking extra DHA (which is already plentiful in the brain) may squeeze out EPA by competing with it for the limited number of spots available to be filled when these phospholipids are being biosynthesized. Taking EPA supplements, by contrast, guarantees that the brain can meet its needs for a continuous, reliable supply of EPA, ensuring that adequate EPA is available when the brain needs it for signal transduction.
However it works, the evidence is clear. People looking to harness the power of omega-3 fatty acids for the health of their brains should look to supplements rich in EPA – and with as little DHA as possible.
The Wonky Well
Clinical depression, schizophrenia, bipolar disorder, and borderline personality disorder are serious illnesses which require qualified medical diagnosis and treatment. For people suffering with these disorders, the new research on EPA is very good news: with physician guidance, it suggests, high doses of this biologically essential orthomolecule in purified form may complement the conventional therapies already prescribed by their doctors.
Fortunately, of course, most of us do not suffer from such extreme psychic disturbances. But that doesn’t mean that our minds are as clear, our feelings as stable, our responses to the world as reasonable, or our outlooks on life as bright as they could be – or should be, for our own health and happiness. We don’t just want to be “non-insane,” in other words: we want to be dynamically engaged with life, grasping the world in both hands and squeezing forth its sweet nectar. The good news, this research suggests, is that when not encumbered by DHA, pharmaceutical-grade EPA supplements can open your brain to the real possibilities around you, shattering the “mind forg’d manacles” that are holding you back from experiencing life’s joys to their fullest.
Peet M, Brind J, Ramchand CN, Shah S, Vankar GK. Two double-blind placebo-controlled pilot studies of eicosapentaenoic acid in the treatment of schizophrenia. Schizophr Res. 2001 Apr 30;49(3):243-51.
Peet M, Horrobin DF. A dose-ranging study of the effects of ethyl-eicosapentaenoate in patients with ongoing depression despite apparently adequate treatment with standard drugs. Arch Gen Psychiatry. 2002 Oct;59(10):913-9.
Peet M. Eicosapentaenoic acid in the treatment of schizophrenia and depression: rationale and preliminary double-blind clinical trial results. Prostaglandins Leukot Essent Fatty Acids. 2003 Dec;69(6):477-85.
Jazayeri S, Tehrani-Doost M, Keshavarz SA, Hosseini M, Djazayery A, Amini H , Jalali M and Peet M. Comparison of therapeutic effects of omega-3 fatty acid eicosapentaenoic acid and fluoxetine, separately and in combination, in major depressive disorder. Australian and New Zealand Journal of Psychiatry. 2008;42;3:192-198.
Stoll AL, Locke CA, Marangell LB, Severus WE. Omega-3 fatty acids and bipolar disorder: a review. Prostaglandins Leukot Essent Fatty Acids. 1999 May-Jun;60(5-6):329-37.
Zanarini MC, Frankenburg FR. Omega-3 Fatty acid treatment of women with borderline personality disorder: a double-blind, placebo-controlled pilot study. Am J Psychiatry. 2003 Jan;160(1):167-9.
05-20-2008, 06:57 PM
05-20-2008, 07:04 PM
Am J Clin Nutr. 2008 May;87(5):1156-62. Links
Plasma eicosapentaenoic acid is inversely associated with severity of depressive symptomatology in the elderly: data from the Bordeaux sample of the Three-City Study.Féart C, Peuchant E, Letenneur L, Samieri C, Montagnier D, Fourrier-Reglat A, Barberger-Gateau P.
INSERM U593, Equipe Epidémiologie de la Nutrition et des Comportements Alimentaires, Bordeaux, France. [email protected]
BACKGROUND: Depressive symptoms are commonly observed in elderly people, and nutritional factors such as polyunsaturated fatty acids (PUFAs) have been proposed as potential protective determinants of depressive disorders. OBJECTIVE: The objective was to analyze the relation between plasma fatty acids and severity of depressive symptomatology (DS) in French elderly community dwellers. DESIGN: The study population (mean age: 74.6 y) consisted of 1390 subjects from Bordeaux (France) included in the Three-City Study cohort. DS was evaluated by using the Center for Epidemiologic Studies Depression scale. The use of antidepressant drugs was recorded. The proportion of each plasma fatty acid was determined. Cross-sectional analysis of the association between plasma fatty acids and severity of DS was performed by multilinear regression. RESULTS: Compared with control subjects, subjects with DS were older, were more often women, were more often widowed or single, were of lower income, were receiving antidepressant treatment more frequently, had a lower incidence of hypercholesterolemia, and had lower Mini-Mental State Examination scores (mean: -1.1 point; P < 0.0001). Plasma eicosapentaenoic acid (EPA) was lower in the subjects with DS than in the control subjects (0.85% compared with 1.01%; P = 0.001). There were no significant differences in any other fatty acid. When adjusted for potential confounders, such as sociodemographic characteristics and health indicators, plasma EPA was inversely associated with the severity of DS (beta = -0.170, P = 0.040) in subjects taking antidepressants. CONCLUSION: Higher plasma EPA was associated with a lower severity of DS in elderly subjects, especially those taking antidepressants.
Aust N Z J Psychiatry. 2008 Mar;42(3):192-8. Links
Comparison of therapeutic effects of omega-3 fatty acid eicosapentaenoic acid and fluoxetine, separately and in combination, in major depressive disorder.Jazayeri S, Tehrani-Doost M, Keshavarz SA, Hosseini M, Djazayery A, Amini H, Jalali M, Peet M.
Department of Nutrition and Biochemistry, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
OBJECTIVE: To compare therapeutic effects of eicosapentaenoic acid (EPA), fluoxetine and a combination of them in major depression. METHOD: Sixty outpatients with a diagnosis of major depressive disorder based on DSM-IV criteria and a score >or=15 in the 17-item Hamilton Depression Rating Scale (HDRS) were randomly allocated to receive daily either 1000 mg EPA or 20 mg fluoxetine, or their combination for 8 weeks. Double dummy technique was used to double blind the study. Patients were assessed at 2 week intervals. Change in HDRS was the primary outcome measure. RESULTS: Analysis of covariance for HDRS at week 8 across treatment groups was performed in 48 patients who completed at least 4 weeks of the study, with the last observation carried forward. Treatment, age of onset and baseline HDRS had a significant effect on HDRS at week 8. EPA + fluoxetine combination was significantly better than fluoxetine or EPA alone from the fourth week of treatment. Fluoxetine and EPA appear to be equally effective in controlling depressive symptoms. Response rates (>or=50% decrease in baseline HDRS) were 50%, 56% and 81% in the fluoxetine, EPA and combination groups, respectively. CONCLUSIONS: In the present 8 week trial EPA and fluoxetine had equal therapeutic effects in major depressive disorder. EPA + fluoxetine combination was superior to either of them alone.
Neuro Endocrinol Lett. 2007 Dec;28(6):875-80.Links
Why fish oils may not always be adequate treatments for depression or other inflammatory illnesses: docosahexaenoic acid, an omega-3 polyunsaturated fatty acid, induces a Th-1-like immune response.Maes M, Mihaylova I, Kubera M, Bosmans E.
Clinical Research Center for Mental Health, Antwerp, Belgium. [email protected]
BACKGROUND: We have shown that a depletion of omega3 polysaturated fatty acids (PUFAs) plays a role in the pathophysiology of depression, in part because omega3 PUFAs have anti-inflammatory effects. omega3 PUFAs are frequently employed to treat depression. Most if not all antidepressants have negative immunoregulatory effects by decreasing the production of proinflammatory cytokines, such as interferon-gamma (IFNgamma) and/or increasing that of anti-inflammatory cytokines, such as interleukin10 (IL-10). AIM: The aim of the present study was to examine the immunoregulary effects of the omega3 PUFAs, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), and the omega6 PUFA, arachidonic acid (AA), on the production of interferon-gamma (IFNgamma), interleukin-10 (IL-10) and tumor necrosis factor-alpha (TNFalpha). METHODS: This study examines the ex vivo effects of EPA (4.5 microM, 9 microM, 18 microM and 45 microM), DHA (1.3 microM, 3 microM, 6 microM and 13 microM) and AA (8 microM, 16 microM, 32 microM and 80 microM) on the LPS + PHA-stimulated production of IFNgamma, IL-10 and TNFalpha, and on the IFNgamma/IL-10 production ratio. Results: We found that EPA did not have any significant effects on the above cytokines. DHA significantly increased the IFNgamma/IL-10 production ratio, caused by a greater reduction in IL-10 than in IFNgamma. AA significantly decreased TNFalpha production. DISCUSSION: The results show that DHA induces a Th-1-like immune response and that AA has anti-inflammatory effects by decreasing the production of TNFalpha. Thus, the immune effects of omega3 PUFAs are not compatible with what is expected from antidepressive substances. The results of the present study show that treatment with fish oils, containing DHA, should be avoided in the treatment of depression. Toward this end, highly concentrated and pure EPA seems to be indicated.
Expert Opin Investig Drugs. 2007 Oct;16(10):1627-38. Links
Omega-3 fatty acid eicosapentaenoic acid. A new treatment for psychiatric and neurodegenerative diseases: a review of clinical investigations.Song C, Zhao S.
University of Prince Edward Island, Department of Biomedical Sciences, AVC, 550 University Avenue, Charlottetown, PE, Canada. [email protected]
Decreased n-3 fatty acid levels have been reported in patients with depression, schizophrenia or Alzheimer's disease. Recently, eicosapentaenoic acid (EPA) has been used to treat several psychiatric and neurodegenerative diseases due to its anti-inflammatory and neuroprotective effects. A total of six out of seven clinical trials have shown that EPA significantly improved depressive symptoms when compared with the placebo-treated populations. Several investigations have also reported that EPA could effectively treat schizophrenia. A case report and a clinical trial have shown that EPA was beneficial for the management of most symptoms of Huntington's disease, while a more extensive clinical investigation has demonstrated that EPA could only improve motor functions. Further clinical studies are required to fully explore the effects of EPA on other neurodegenerative diseases. The limitations of previous studies and further research directions have also been discussed.
If you would like more studies let me know.
05-20-2008, 07:10 PM
05-20-2008, 07:11 PM
I asked to post a link which lead to your statement above that DHA 'hinders' the effects of EPA. It says that nowhere in anything you posted. The one link says DHA 'may not' support antidepressant properties. EPA is obviously more beneficial than DHA - that's proven time & time again. DHA still has many benefits. However all that aside and back to the original statement of DHA hindering positive effects. Please post the proof, thanks.
05-20-2008, 09:17 PM
""The results of the present study show that treatment with fish oils, containing DHA, should be avoided in the treatment of depression. Toward this end, highly concentrated and pure EPA seems to be indicated.""
Thats a direct quote from one of the studies above. If you read the articles I linked (which are referenced) I'm sure you better understand the dynamics that fatty acids have on each other. The reason pure EPA works so well is because there is no DHA in it to hinder its effects.
However some common sense is needed here. Take any 2 fats and what happens? You displace each other and inhibits each others effects to a degree.
I posted 2 referenced articles and several studies. You have yet to post studies or articles to support your claim.
05-20-2008, 09:20 PM
05-20-2008, 09:34 PM
05-20-2008, 09:36 PM
05-20-2008, 09:38 PM
05-20-2008, 09:39 PM
05-20-2008, 09:44 PM
Well i guess it depends on your definition of "effective" treatment. Medication is a quick fix, it is in no way a treatment.
And a serious medical disorder is polio, not depression. Sorry, most people are depressed every day, its called life. The ones that cant handle it would have been weeded out through natural selection less than 100 years ago, modern medicine is the illusion of control.
Why do you think aids meds work so well? Because they are an "effective" treatment? No because they make money. If pharmacuetical companys were in the business of treatment we would have cured cancer and aids. But the moneys not in the cure, its in the treatment.
05-20-2008, 09:54 PM
You sir simply disgust me.
Many wonderful human beings have contributed much to mankind have suffered from depression and mental illness. They deserve respect and understanding. Not to be downgraded as lessor human beings.
05-20-2008, 09:56 PM
05-20-2008, 09:58 PM
05-20-2008, 10:16 PM
While talk therapy can be helpful to suggest solely that to someone who has pondered suicide is insane and contrary to any field of healthcare I respect.
Ideally once the person as stabilized supplementation is vital to reduce the occurance of relapse. And in time reduction or removal of drugs if indicated can be done.
Your generalization is a poor defense since if i was a nutritionist promoting EPA you could make the same claim that profit motivates me. And you would be wrong. I had the interest, desire, and ability to help people and so I came into this field.
05-22-2008, 04:08 PM
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