Detection and treatment of omega-3 fatty acid deficiency in psychiatric practice: Rationale and implementation

Abstract

A body of translational evidence has implicated dietary deficiency in long-chain omega-3 (LCn-3) fatty acids, including eicosapenaenoic acid (EPA) and docosahexaenoic acid (DHA), in the pathophysiology and potentially etiology of different psychiatric disorders. Case-control studies have consistently observed low erythrocyte (red blood cell) EPA and/or DHA levels in patients with major depressive disorder, bipolar disorder, schizophrenia, and attention deficit hyperactivity disorder. Low erythrocyte EPA + DHA biostatus can be treated with fish oil-based formulations containing preformed EPA + DHA, and extant evidence suggests that fish oil supplementation is safe and well-tolerated and may have therapeutic benefits. These and other data provide a rationale for screening for and treating LCn-3 fatty acid deficiency in patients with psychiatric illness. To this end, we have implemented a pilot program that routinely measures blood fatty acid levels in psychiatric patients entering a residential inpatient clinic. To date over 130 blood samples, primarily from patients with treatment-refractory mood or anxiety disorders, have been collected and analyzed. Our initial results indicate that the majority (75 %) of patients exhibit whole blood EPA + DHA levels at ≤ 4 percent of total fatty acid composition, a rate that is significantly higher than general population norms (25 %). In a sub-set of cases, corrective treatment with fish oil-based products has resulted in improvements in psychiatric symptoms without notable side effects. In view of the urgent need for improvements in conventional treatment algorithms, these preliminary findings provide important support for expanding this approach in routine psychiatric practice.

Fig. 1

Comparison of mean EPA + DHA levels in adult patients with acute coronary syndrome (ACS) residing in the U.S. (erythrocytes, n = 768) [119], first-episode bipolar disorder (BD) (erythrocytes, n = 40) [130] and adolescent MDD (erythrocytes, n = 20) [134] patients residing in the Cincinnati area, psychiatric patients admitted to the inpatient clinic at The Lindner Center of HOPE, Cincinnati (whole blood, n = 131), normative values from a cohort subjects residing in the U.S. (whole blood, n = 27,414, http://www.omegaquant.com/fatty-acids-regularly-measured/), and adults residing in Japan (erythrocytes, n = 456) [124]. Proposed ‘risk zones’ for sudden cardiac death derived from prospective longitudinal studies are indicated [118]. Note that psychiatric patients exhibit EPA + DHA levels that are similar to patients with ACS and place them at high risk for sudden cardiac arrest. It is proposed that similar ‘risk zones’ be adopted in psychiatric practice to identify patients requiring corrective LCn-3 fatty acid supplementation

Fig. 2

a The percentage of subjects residing in the U.S. (n = 27,426) and psychiatric patients admitted to the inpatient clinic at The Lindner Center of HOPE (n = 131) with an ‘omega-3 index’ (whole blood EPA + DHA) of ≤4.0 % of total fatty acid composition. b Histogram comparing ‘omega-3 index’ (EPA + DHA) frequency distribution of the psychiatric patient sample to the OmegaQuant reference sample. Note that the majority (75 %) of psychiatric patients exhibit whole blood EPA + DHA levels at ≤4 percent of total fatty acid composition, a rate that is significantly greater than general U.S. population norms (25 %, ***P ≤ 0.0001, Chi-Square)