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. 2014 Apr 1;2(2):38-46.
doi: 10.1016/j.phanu.2014.02.002.

Detection and Treatment of Long-Chain Omega-3 Fatty Acid Deficiency in Adolescents with SSRI-Resistant Major Depressive Disorder

Robert K McNamara  1 , Jennifer Strimpfel  1 , Ronald Jandacek  2 , Therese Rider  2 , Patrick Tso  2 , Jeffrey A Welge  1 , Jeffrey R Strawn  1 , Melissa P Delbello  1
Affiliations

Detection and Treatment of Long-Chain Omega-3 Fatty Acid Deficiency in Adolescents with SSRI-Resistant Major Depressive Disorder

Robert K McNamara et al. PharmaNutrition. .

Abstract

Residual depressive symptoms are commonly observed in adolescents with major depressive disorder (MDD) following treatment with selective serotonin reuptake inhibitors (SSRIs). This study combined a case-control analysis and an open-label fish oil (FO) trial to investigate the relationship between long-chain omega-3 (LCn-3) fatty acid status and residual depressive symptoms in SSRI-resistant adolescent MDD patients. Baseline erythrocyte docosahexaenoic acid (DHA)(-28%, p=0.0003), but not eicosapentaenoic acid (EPA)(-18%, p=0.2), was significantly lower in patients (n=20) compared with healthy controls (n=20). Patients receiving 10-week low-dose (2.4 g/d, n=7) and high-dose (16.2 g/d, n=7) FO exhibited significant increases in erythrocyte EPA and DHA composition. In the intent-to-treat sample, depressive symptoms decreased significantly in the high-dose group (n=7, -40%, p<0.0001), and there was a trend in the low-dose group (n=10, -20%, p=0.06). Symptom remission was observed in 40% of patients in the low-dose group and 100% of patients in the high-dose group. There were no significant changes in vital signs and adverse events were rated as mild or moderate in severity. These preliminary findings demonstrate that adolescents with SSRI-resistant depression exhibit robust DHA deficits, and suggest that adjunctive FO supplementation is well-tolerated and effective for increasing LCn-3 fatty acid status and augmenting SSRI antidepressant effects.

Keywords: Adolescents; Docosahexaenoic acid; Eicosapentaenoic acid; Erythrocyte; Major depressive disorder (MDD); Omega-3 fatty acids.

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Figures

Figure 1
Figure 1
Flow diagram illustrating the sequence of subject recruitment and attrition.
Figure 2
Figure 2
Mean depression symptom severity scores (CDRS-R total score) in MDD patients treated with low-dose (2.4 g/d, n=10) or high-dose (16.2 g/d, n=7) FO over the 10 week trial. B = baseline, E = mean endpoint score including the last available CDRS-R score carried forward for the n=3 patients in the low-dose group with early termination on weeks 3, 6, and 9. Dotted line demarks symptom remission (CDRS-R total score of 28).
See this image and copyright information in PMC

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