Top

Published in:

01-09-2020 | Antidepressant Drugs | Original Contribution

EPA and DHA as markers of nutraceutical treatment response in major depressive disorder

Authors: Kiki P. van der Burg, Lachlan Cribb, Joseph Firth, Diana Karmacoska, David Mischoulon, Gerard J. Byrne, Chad Bousman, Con Stough, Jenifer Murphy, Georgina Oliver, Michael Berk, Chee H. Ng, Jerome Sarris

Published in: European Journal of Nutrition | Issue 6/2020

Abstract

Purpose

Depression clinical trials are increasingly studying biomarkers to predict and monitor response to treatment. Assessment of biomarkers may reveal subsets of patients who are responsive to nutraceutical treatment, which may facilitate a personalized approach to treating depression.

Methods

This is a post hoc analysis of an 8-week, double-blind, randomized, controlled trial (n = 158) investigating a combination nutraceutical comprising Omega-3 (EPA 1 g/DHA 656 mg), SAMe, zinc, 5-HTP, folinic acid, and co-factors versus placebo for the treatment of Major Depressive Disorder. The study explored levels of polyunsaturated fatty acids, folate, vitamin B12, zinc, homocysteine, and BDNF as possible predictors and correlates of response to nutraceutical supplementation.

Results

Concentrations of EPA and DHA in red cell membranes increased in response to treatment and were significantly correlated with a decrease in depressive symptoms during active treatment (p = 0.003 and p = 0.029; respectively). Higher baseline levels of omega-6 fatty acid also correlated with depression reduction in the active treatment group ( p = 0.011). No other biomarkers were associated with a lessening of depressive symptoms.

Conclusion

Changes in fatty acid levels resulting from a nutraceutical combination containing EPA and DHA provide a response biomarker in treating depression.

Rush AJ (2007) Limitations in efficacy of antidepressant monotherapy. J Clin Psychiatry 68(Suppl 1):8–10PubMed

Sarris J, Logan AC, Akbaraly TN et al (2015) Nutritional medicine as mainstream in psychiatry. Lancet Psychiatry 2:271–274. https://doi.org/10.1016/S2215-0366(14)00051-0 CrossRefPubMed

Sarris J, Murphy J, Mischoulon D, et al (2016) Adjunctive nutraceuticals for depression: a systematic review and meta-analyses. Am J Psychiatry appiajp201615091228. https://doi.org/10.1176/appi.ajp.2016.15091228

Raison CL, Rutherford RE, Woolwine BJ et al (2013) A randomized controlled trial of the tumor necrosis factor antagonist infliximab for treatment-resistant depression: the role of baseline inflammatory biomarkers. Arch Gen Psychiatry. https://doi.org/10.1001/2013.jamapsychiatry.4 CrossRef

Rao TSS, Asha MR, Ramesh BN, Rao KSJ (2008) Understanding nutrition, depression and mental illnesses. Indian J Psychiatry 50:77–82. https://doi.org/10.4103/0019-5545.42391 CrossRefPubMedPubMedCentral

Venigalla H, Mekala HM, Hassan M et al (2017) An update on biomarkers in psychiatric disorders—are we aware, do we use in our clinical practice? Ment Health Fam Med 13:471–479

Sarris J, Byrne GJ, Stough C et al (2019) Nutraceuticals for major depressive disorder—more is not merrier: an 8-week double-blind, randomised, controlled trial. J Affect Disord 245:1007–1015. https://doi.org/10.1016/J.JAD.2018.11.092 CrossRefPubMed

Sarris J, Stough C, Bousman C et al (2015) An adjunctive antidepressant nutraceutical combination in treating major depression: study protocol, and clinical considerations. Adv Integr Med 2:49–55. https://doi.org/10.1016/j.aimed.2015.02.001 CrossRef

Rapaport MH, Nierenberg AA, Schettler PJ et al (2015) Inflammation as a predictive biomarker for response to omega-3 fatty acids in major depressive disorder: a proof-of-concept study. Mol Psychiatry. https://doi.org/10.1038/mp.2015.22 CrossRefPubMed

10.

Carney RM, Steinmeyer BC, Freedland KE et al (2016) Baseline blood levels of omega-3 and depression remission: a secondary analysis of data from a placebo-controlled trial of omega-3 supplements. J Clin Psychiatry. https://doi.org/10.4088/JCP.14m09660 CrossRefPubMedPubMedCentral

11.

Mazereeuw G, Herrmann N, Andreazza AC et al (2017) Oxidative stress predicts depressive symptom changes with omega-3 fatty acid treatment in coronary artery disease patients. Brain Behav Immun. https://doi.org/10.1016/j.bbi.2016.10.005 CrossRefPubMed

12.

Freeman MP, Hibbeln JR, Silver M et al (2011) Omega-3 fatty acids for major depressive disorder associated with the menopausal transition: a preliminary open trial. Menopause. https://doi.org/10.1097/gme.0b013e3181f2ea2e CrossRefPubMedPubMedCentral

13.

Ganança L, Galfalvy HC, Oquendo MA et al (2017) Lipid correlates of antidepressant response to omega-3 polyunsaturated fatty acid supplementation: a pilot study. Prostaglandins Leukot Essent Fat Acids. https://doi.org/10.1016/j.plefa.2017.03.004 CrossRef

14.

Martins JG (2009) Epa but not dha appears to be responsible for the efficacy of omega-3 long chain polyunsaturated fatty acid supplementation in depression: evidence from a meta-analysis of randomized controlled trials. J Am Coll Nutr. https://doi.org/10.1080/07315724.2009.10719785 CrossRefPubMed

15.

Lin P-Y, Huang S-Y, Su K-P (2010) A meta-analytic review of polyunsaturated fatty acid compositions in patients with depression. Biol Psychiatry 68:140–147. https://doi.org/10.1016/j.biopsych.2010.03.018 CrossRefPubMed

16.

Lai J, Moxey A, Nowak G et al (2012) The efficacy of zinc supplementation in depression: systematic review of randomised controlled trials. J Affect Disord 136:e31–e39. https://doi.org/10.1016/j.jad.2011.06.022 CrossRefPubMed

17.

Firth J, Teasdale SB, Allott K et al (2019) The efficacy and safety of nutrient supplements in the treatment of mental disorders: a meta-review of meta-analyses of randomized controlled trials. World Psychiatry 18(3):308–324CrossRef

18.

Syed EU (2013) Vitamin B12 supplementation in treating major depressive disorder: a randomized controlled trial. Open Neurol J. https://doi.org/10.2174/1874205x01307010044 CrossRefPubMedPubMedCentral

19.

Desseilles M, Witte J, Chang TE et al (2013) Massachusetts general hospital SAFER criteria for clinical trials and research. Harv Rev Psychiatry 21:269–274. https://doi.org/10.1097/HRP.0b013e3182a75cc7 CrossRefPubMed

20.

Zhou C, Zhong J, Zou B et al (2017) Meta-analyses of comparative efficacy of antidepressant medications on peripheral BDNF concentration in patients with depression. PLoS One. https://doi.org/10.1371/journal.pone.0172270 CrossRefPubMedPubMedCentral

21.

Wickham H (2009) Ggplot2: elegant graphics for data analysis. Springer, BerlinCrossRef

22.

van der Burg KP, Cribb L, Firth J, Karmacoska D, Sarris J (2019) Nutrient and genetic biomarkers of nutraceutical treatment response in mood and psychotic disorders: a systematic review. Nutr Neurosci. https://doi.org/10.1080/1028415X.2019.1625222 CrossRefPubMed

23.

Carney RM, Freedland KE, Rubin EH et al (2009) Omega-3 augmentation of sertraline in treatment of depression in patients with coronary heart disease: a randomized controlled trial. JAMA. https://doi.org/10.1001/jama.2009.1487 CrossRefPubMed

24.

Grosso G, Galvano F, Marventano S, Malaguarnera M, Bucolo C, Drago F, Caraci F (2014) Omega-3 fatty acids and depression: Scientific evidence and biological mechanisms. Oxid Med Cell Longev. 2014:313570. https://doi.org/10.1155/2014/313570 CrossRefPubMed

25.

Moylan S, Berk M, Dean OM et al (2014) Oxidative & nitrosative stress in depression: why so much stress?. Neurosci Biobehav, Rev

26.

Raison CL, Capuron L, Miller AH (2006) Cytokines sing the blues: inflammation and the pathogenesis of depression. Trends Immunol 27:24–31CrossRef

27.

Stark KD, Van Elswyk ME, Higgins MR et al (2016) Global survey of the omega-3 fatty acids, docosahexaenoic acid and eicosapentaenoic acid in the blood stream of healthy adults. Prog, Lipid ResCrossRef

28.

Lin PY, Huang SY, Su KP (2010) A meta-analytic review of polyunsaturated fatty acid compositions in patients with depression. Biol Psychiatry. https://doi.org/10.1016/j.biopsych.2010.03.018 CrossRefPubMed

29.

Sarris J, Murphy J, Mischoulon D et al (2016) Adjunctive nutrient nutraceuticals for depression: a systematic review and meta-analyses. Am J Psychiatry 173:575–587CrossRef

30.

Brown RD, Langshaw MR, Uhr EJ et al (2011) The impact of mandatory fortification of flour with folic acid on the blood folate levels of an Australian population. Med J Aust 194:65–67CrossRef

31.

Polyakova M, Stuke K, Schuemberg K et al (2015) BDNF as a biomarker for successful treatment of mood disorders: a systematic & quantitative meta-analysis. J Affect, Disord

32.

McIntyre RS, Subramaniapillai M, Lee Y et al (2019) Efficacy of adjunctive infliximab vs placebo in the treatment of adults with bipolar I/II depression: a randomized clinical trial. JAMA Psychiatry. https://doi.org/10.1001/jamapsychiatry.2019.0779 CrossRefPubMedPubMedCentral

33.

Lapillonne A, DeMar JC, Nannegari V, Heird WC (2002) The fatty acid profile of buccal cheek cell phospholipids is a noninvasive marker of long-chain polyunsaturated fatty acid status in piglets. J Nutr 132:2319–2323CrossRef

34.

Lopresti AL, Maker GL, Hood SD, Drummond PD (2014) A review of peripheral biomarkers in major depression: the potential of inflammatory and oxidative stress biomarkers. Prog Neuro-Psychopharmacol Biol Psychiatry 48:102–111CrossRef

35.

Miller AH, Raison CL (2016) The role of inflammation in depression: from evolutionary imperative to modern treatment target. Nat Rev Immunol 16:22CrossRef

Title: EPA and DHA as markers of nutraceutical treatment response in major depressive disorder
Authors: Kiki P. van der Burg
Lachlan Cribb
Joseph Firth
Diana Karmacoska
David Mischoulon
Gerard J. Byrne
Chad Bousman
Con Stough
Jenifer Murphy
Georgina Oliver
Michael Berk
Chee H. Ng
Jerome Sarris
Publication date: 01-09-2020
Publisher: Springer Berlin Heidelberg
Keywords: Antidepressant Drugs
Affective Disorder
Affective Disorder
Antidepressant Drugs
Biomarkers
Published in: European Journal of Nutrition / Issue 6/2020
Print ISSN: 1436-6207
Electronic ISSN: 1436-6215
DOI: https://doi.org/10.1007/s00394-019-02090-6

ACC 2024 Congress Coverage

Heart Failure Video

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

EPA and DHA as markers of nutraceutical treatment response in major depressive disorder

Abstract

Purpose

Methods

Results

Conclusion

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 6/2020

Cardiovascular responses to a glucose drink in young male individuals with overweight/obesity and mild alterations in glucose metabolism, but without impaired glucose tolerance

Modelling the impact of mandatory folic acid fortification of bread or flour in Ireland on the risk of occurrence of NTD-affected pregnancies in women of childbearing age and on risk of masking vitamin B12 deficiency in older adults

Co-ingestion of whey protein hydrolysate with milk minerals rich in calcium potently stimulates glucagon-like peptide-1 secretion: an RCT in healthy adults

Associations of sugar intake with anthropometrics in children from ages 2 until 8 years in the EU Childhood Obesity Project

Successful elevation of circulating acetate and propionate by dietary modulation does not alter T-regulatory cell or cytokine profiles in healthy humans: a pilot study

Phenolic extracts from whole wheat biofortified bread dampen overwhelming inflammatory response in human endothelial cells and monocytes: major role of VCAM-1 and CXCL-10

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page