EPA Proves to be a Viable Alternative to Prozac
Recently, a study came out showing that EPA was a viable alternative to Prozac and furthermore, that taking the two together proved even more superior results in resolving or improving unipolar depression. Read on:
Unipolar depressive disorder was ranked as the fourth highest global burden of disease in 2000. For the ages 15-44 they generated the second highest burden. If current trends for epidemiological and demographic transition continue, depression would become the highest ranking cause of disease in the developed regions and the second leading cause of disability-adjusted life years lost worldwide. A systematic review of the treatment of depression comparing placebo with antidepressants demonstrated that 56% to 60% of patients responded well to antidepressants. Overall, 19% to 34% of patients will become treatment resistant.
Complementary and alternative treatments are commonly used by patients with depression as is the use of dietary supplementation. Little is known however about the interaction between drugs and supplements and from a clinical perspective this is very important to establish. Omega-3 fatty acids (ω- 3 FAs) such as eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) are the two key long-chain polyunsaturated fatty acids (LC-PUFA) and deficiencies are considered to have important implications for depression. Studies have reported that long term consumption of ω- 3 FAs in adolescents, adults and the elderly are inversely linked to depression in the Island of Crete. Furthermore, several countries have provided evidence of a negative correlation between fish consumption and major depressive disorder (Hibbeln, 1998). Edwards et al. (1998) demonstrated that the severity of depression negatively correlated with the red blood cell membranes of ω- 3 FAs and their dietary intake with depressed patients. Evidence to date although inconsistent, suggests that ω- 3 FAs may have therapeutic benefits to unipolar depression. Research has reported that an elevated ratio of ω- 6/ω- 3 FAs can predict the risk of suicide behaviour in depressed patients. Recent reviews of the effects of ω- 3 FAs to improve depression have suggested more research trials are required (Appleton et al., 2006). Yet contrasting evidence supports a protective effect of ω- 3 intake in both mood disorders, bipolar and unipolar depression and recommended that trials are needed to establish which FA is optimal in different disorders.
Patients aged 20-59 years of age were referred from the Roozbeh Psychiatric Hospital in Tehran, Iran to take part in this study. Written informed consent was obtained and the protocol adhered to the guidelines of the Declaration of Helsinki and was approved by the Ethical Committee of Tehran University of Medical Sciences. The patients met the DSM-IV criteria for major depressive disorder without psychotic features based on the semi-structured interview. Scores were less than 15 on the 17 item Hamilton Depression Scale and patients were free of medication for at least 6 weeks prior to recruitment. Exclusion criteria also included consumption of ω- 3 supplementation and dietary intake of more than 1 portion of oily fish weekly.
Soft gel capsules containing 550 mg of ethyl-EPA (500 mg of pure EPA and 11 mg vitamin E as antioxidant) were supplied. The placebo contained 550 mg of rapeseed oil, 11 mg of vitamin E and was identical to the active capsule. Participants (approximately 15 in each group) were randomly allocated into 3 groups to receive 2 capsules (i) (1000 mg) of EPA plus fluoxetine placebo, (ii) 1 fluoxetine capsule (20 mg fluoxetine) plus ethyl-EPA placebo, or (iii) 2 ethyl-EPA soft gels (1000 mg EPA) plus 1 fluoxetine capsule (20 mg fluoxetine) for 8 weeks. The study was double blind and because the fluoxetine capsule and EPA gel were not identical a double dummy model was used to blind patients and physician. Psychiatric assessments were carried out at weeks 2, 4, 6, and 8. Compliance was set at 90% of consumption of the medication.
Analysis of covariance (ANCOVA) for HDRS at week 8 was performed on the data. Baseline HDRS, age of onset and number of previous episodes were covariates. Treatment, age of onset and baseline HDRS had a significant effect on HDRS at week 8. The fluoxetine + EPA combination was significantly better than fluoxetine or EPA alone. Fluoxetine and EPA appeared to be equally effective in controlling depressive symptoms. ANCOVA for HDRS at week 2 were not significant. Treatment was shown to have an effect at both weeks 4 and 6 (p = 0.016, 0.02 respectively). Response rates ( > 50% decrease in baseline HDRS) were 50%, 56% and 81% in the fluoxetine, EPA and combination groups respectively. Repeated measure analyses of variance were carried out to test for significant differences in depressive scores within each group over time. When all groups were combined together there was a significant effect of time within each group starting at week 2 (in al cases p < 0.05).
This study had limitations in that it contained a small sample size and lacked a placebo group yet the findings suggest that EPA had equal therapeutic benefits to fluoxetine but was more superior as an adjunctive treatment with fluoxetine. The authors concluded that the consumption of dietary supplements may be more acceptable to patients than antidepressants. Furthermore, because major depression is also a risk factor for cardiovascular disease, supplementation with EPA may be of mutual benefit, reducing inflammatory cytokines and controlling depressive symptoms.
SOURCE: Jazayeri, S., Tehrani-Doost, M., Keshavarz, S. A., Hosseini, M., Djazayery, A., Amini, H., Jalali, M. & Peet, M. (2008). 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, 42, 192-198.