Psychiatry & Psychology

Treating Psychiatric Disorders - Something Smells Fishy

July 03, 2008 | By Jennifer Gibson, PharmD | Share, Save, and Bookmark | 6 Comments

Psychiatry and Psychology Category Could the treatment of psychiatric and mood disorders be as simple as eating more fish? Fish oil contains, specifically docosahexanoic acid (DHA) and eicosapentaenoic acid (EPA), which are known to have positive cardiovascular outcomes. Fish oil intake, through diet or supplementation, has noteworthy effects on lowering total cholesterol, lowering LDL (”bad” cholesterol), and increasing HDL (”good” cholesterol). In addition to the cardiovascular benefits of fish oil, there may be neurological, psychiatric, and emotional benefits, as well.

Omega-3 fatty acids are components of the cell membranes of the brain and central nervous system. These fatty acids promote cellular function, maintain membrane structure, and act as messengers in the nervous system. DHA is essential for physical brain growth and development and EPA corresponds to the evolution of mood and behaviors. Consequently, adequate levels of omega-3 fatty acids are vital to optimal neurological functioning.

Fish Oil Fatty acids are essential to brain growth as early as the pre- and postnatal period, and are particularly important in behavior management, mood development, and sensory functioning in infants. These fatty acids, available naturally in colostrum and breast milk, are now added to many infant formulas to support brain and visual function.

Western diets are traditionally low in omega-3 fatty acid consumption. A review of studies relating to diet and psychological development concludes that this may, in part, contribute to the incidence and prevalence of psychiatric and neurodegenerative conditions in today’s society. The mechanism has not been clearly deciphered, but many psychiatric illnesses are associated with increased oxidative stress and pro-inflammatory conditions in the central nervous system. DHA and EPA have anti-inflammatory and antioxidant properties that may confer the neurological benefits of fatty acids.

Many studies have reported that depression is associated with low levels of omega-3 fatty acids, including perinatal and postpartum depression in mothers. Treatment of these disorders with fatty acid supplementation has elicited positive outcomes and shows promise as a viable treatment option for depressive disorders. Additionally, DHA and EPA supplementation benefits ADHD, autism, dyslexia, premenstrual syndrome, dysmenorrhea, bipolar disorder, schizophrenia, and borderline personality disorder.

Some research has shown a connection between low omega-3 fatty acid levels and substance abuse patients, as well as domestic violence perpetrators. A recent study reported that substance abusers showed a strong correlation between low levels of omega-3 fatty acids and anger and anxiety. When these substance abusers received fatty acid supplements, their anger and anxiety levels were reduced. Interestingly, an increase in EPA correlated to decreased anxiety, and increased DHA levels correlated to reduced anger. In a similar study, substance abusers treated with fatty acid supplements experienced reduced anger up to 3 months after the treatment was stopped. Omega-3 fatty acids also decrease the amount of corticotropin-releasing hormone in the central nervous system. This hormone plays a key role in fear and anxiety, components of violent behavior in perpetrators of domestic violence. Low levels of omega-3 fatty acids lead to increased hormones that play a role in violent behavior.

Additionally, omega-3 fatty acids may have a protective effect in acute and chronic neurological injury and diseases, possibly resulting from the anti-inflammatory and antioxidant effects of the fatty acids and their metabolites. Cognitive impairment and decline are also associated with low levels of DHA and EPA, and mental functioning was maintained in middle-aged patients when adequate levels of fish oils were consumed. Increased levels of EPA and DHA are also linked to a decreased incidence of dementia, including a decreased risk of Alzheimer’s disease.

Omega-3 fatty acid supplementation may prove to be effective treatment for many groups of patients suffering from psychiatric and emotional disorders, as well as neurological injury. Supplementation offers very few risks or adverse effects, and may be a safe treatment option for children, pregnant women, and patients with treatment-resistant psychiatric and mood disorders. More research is needed to further clarify the widespread clinical value of fish oil and omega-3 fatty acids.

References

BORSONELO, E., GALDUROZ, J. (2008). The role of polyunsaturated fatty acids (PUFAs) in development, aging and substance abuse disorders: Review and propositions. Prostaglandins, Leukotrienes and Essential Fatty Acids, 78(4-5), 237-245. DOI: 10.1016/j.plefa.2008.03.005

BUYDENSBRANCHEY, L., BRANCHEY, M. (2008). Long-chain n-3 polyunsaturated fatty acids decrease feelings of anger in substance abusers. Psychiatry Research, 157(1-3), 95-104. DOI: 10.1016/j.psychres.2007.01.004

BUYDENSBRANCHEY, L., BRANCHEY, M., HIBBELN, J. (2008). Associations between increases in plasma n-3 polyunsaturated fatty acids following supplementation and decreases in anger and anxiety in substance abusers. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 32(2), 568-575. DOI: 10.1016/j.pnpbp.2007.10.020

Dyall, S.C., Michael-Titus, A.T. (2008). Neurological Benefits of Omega-3 Fatty Acids. NeuroMolecular Medicine DOI: 10.1007/s12017-008-8036-z

HIBBELN, J., BISSETTE, G., UMHAU, J., GEORGE, D. (2004). Omega-3 status and cerebrospinal fluid corticotrophin releasing hormone in perpetrators of domestic violence. Biological Psychiatry, 56(11), 895-897. DOI: 10.1016/j.biopsych.2004.08.021

Tsaluchidu, S., Cocchi, M., Tonello, L., Puri, B.K. (2008). Fatty acids and oxidative stress in psychiatric disorders. BMC Psychiatry, 8(Suppl 1), S5. DOI: 10.1186/1471-244X-8-S1-S5

Umhau, J.C., Dauphinais, K.M., Patel, S.H., Nahrwold, D.A., Hibbeln, J.R., Rawlings, R.R., George, D.T. (2006). The relationship between folate and docosahexaenoic acid in men. European Journal of Clinical Nutrition, 60(3), 352-357. DOI: 10.1038/sj.ejcn.1602321

Tags: anger, anxiety, brain, development, DHA, docosahexanoic acid, eicosapentaenoic acid, EPA, fatty, Fish, Mood, oil, omega 3 fatty acids, substance, supplementation, treatment

6 Comments

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Strix
July 04, 2008 | Permalink

I agree about the necessity of DHA. However, DHA from fish is not ideal as it is almost impossible to find “clean” sources any longer. Algae-based DHA is readily available and is just as effective. From algae is where the fish get it, anyway; a person consuming the fish is simply getting second-hand DHA.

The human body is effecient at converting DHA to EPA as well: so other plant sources consumed regularly — which should be in one’s diet anyway, such as walnuts, seeds (chia, hemp and flax), and dark leafy greens — are readily available in any market and can also serve as a source.

If cost is an issue in regard to algae oils (fish oils are cheap for a reason), I would think people would value the health of their brain of ALL things above a cost, and cut back in other areas, if need be. The availability of algae-based oils, however, is wider and the cost going down; so it’s becoming more doable.
This non-fish source is perfect for those with seafood allergies as well as vegans and vegetarians,and any other persons unwilling or unable to consume fish.

Pepe
July 07, 2008 | Permalink

Conversion between EPA and DHA is low. If you prefer to use vegetarian sources, you will need to use two products: one for DHA and one for EPA. Unfortunately, EPA from algae is not available in many countries. (You can buy online but shipping costs are high)

If you cannot get both, you should use fish oil. Both EPA and DHA are necessary and work together in your body.

Gretchen Vannice, MS, RD
July 07, 2008 | Permalink

Nice review of the roles for EPA and DHA in mental health, and all recent findings. Published in the Lancet in the mid-90’s was a ‘epi’ look at all this…….. Increased incidence of depression correlates with the decrease in omega-3 intake in the US over the last 80 years. The studies looking at violence around the world also correlate with omega-3 levels.

We used to get more EPA and DHA in our diet, and a lot less omega-6 fats. What’s happening today is first, we are underconsuming omega-3 fats (they are essential nutrients) and second, we are overconsuming omega-6 fats (e.g. soybean and corn oils). While both omega-3 and omega-6 fats are considered essential fats (humans can’t make them, we must eat them) it’s the imbalance that is further increasing our need for omega-3s.

I disagree with the comment on DHA from algae sources for several reasons. First, several studies indicate that DHA alone (from algae) doesn’t work as well in humans (postnatal depression, attention defiicts, etc). In most studies, people have better results with both EPA and DHA. Man evolved eating fish, providing both EPA and DHA. According to the experts, DHA does not retro-convert to EPA very well. To suggest that better fish oil isn’t pure is misinformation.

The manufacturing of fish oil has evolved to offer highly purified fish oil, and the concerns present with some of our fish supply, disappear. The problem with the fish oil industry is that the mass product on the market (aka cheap, poor tasting fish oil) is not very fresh or pure but it’s very cheap to buy - often from the Chinese market - and sell. It’s a huge disservice to the public who doesn’t know the difference.

There are excellent brands of fish oil available in retail stores (e.g. Minami Nutrition) and online (e.g. PharmaOmega.com). These are highly concentrated, fresh and purified fish oils……..and one capsule can give you more than what the daily US recommendations will be. I’ll end my post here, but the other issue to consider is dose.

Dose is the difference. The dose is determined by your reason for taking omega-3s (general nutrition, disease prevention or therapeutic application) and your family history, health status and diet. I wonder how many Americans are consuming one capsule of fish oil, consuming less than 120 mg EPA and DHA (while dealing with bad taste burps) but believe they are taking a “therapeutic dose” (2000 mg/day minimum is recommended to reduce triglycerides). Many doctors don’t know the difference in quality, or the importance of dose, either (I’m doing what I can to educate them).

Omega-3 levels influence mental health, and we need them. Finally, don’t be confused with omega-3 from plant sources – they are not a substitute for fish sources. In December 2006, the American Psychiatric Assoc sub-committee on omega-3s made the recommendation that anyone with a history of mental health conditions consume at least 1 gram (1000 mg) of EPA and DHA omega-3s. Another note of interest, there are no known contraindications for taking omega-3s (good quality) with anti-depressant meds. This makes good sense, given that omega-3s are nutritionally essential fats that belong in our diet. In fact, omega-3s may help the meds work better. Up to 3 grams per day is considered GRAS. I could go on but will really stop here………..thank you for reading.
Gretchen Vannice, MS, RD