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Hi! David Rosenberg here with another CAP Smart Take that I believe is especially relevant. These authors investigated whether the addition of fish oil to cognitive–behavioral therapy management for youth with major depressive disorder is more effective than cognitive–behavior therapy alone in a placebo-controlled, double-blind, multicenter trial. This is crucial, as depression rates in youth—encompassing adolescents and young adults—are rising significantly. In colleges and universities, depression and anxiety rates are higher than ever. One significant predictor of depression and anxiety in college and adulthood is depression during youth. Up to one-third of all patients with depression don’t respond to any current treatment, and the majority of those who do respond only do so partially, continuing to have functional impairments. Standard treatments for depression include pharmacology—SSRIs, SNRIs, and other antidepressants—and cognitive–behavioral therapy. There is a belief that combining cognitive–behavioral therapy with medication might be more effective. However, some patients do well on medication alone, some on cognitive–behavior therapy alone, and others benefit most from a combination. Presently, we don’t have reliable predictors for treatment response.
There are studies suggesting that adding fish oil to adult depression treatment can be beneficial. This prompts the question: Can it enhance treatments such as antidepressants and cognitive–behavioral therapy? Yet, studies in younger patients are scarce. In this study, authors examined adolescents and young adults aged 15–25. Specifically, they looked at the potential effects of long chain omega-3 polyunsaturated fatty acids (n-3 PUFAs)—commonly known as fish oil—on depression in youth. They studied patients aged 15–25 with major depressive disorder seeking care at 1 of 3 government-funded mental health services in Australia. Patients were randomly assigned to receive either fish oil—consisting of 840 mg of eicosapentaenoic acid and 560 mg of docosahexaenoic acid—or placebo capsules, in addition to cognitive–behavioral therapy. All participants were offered biweekly 50-minute cognitive–behavioral therapy sessions during the intervention period, and the primary outcome was the change in depressive symptoms. Additionally, erythrocyte (red blood cell) n-3 PUFA levels were measured before and after the intervention.
The results? Of the 233 patients aged 15–25, 115 were assigned to the fish oil group and 118 to the placebo group. There was no significant difference in depressive symptom changes between the groups. Moreover, erythrocyte PUFA levels did not correlate with depression severity at any time. Fortunately, both groups had similar adverse event rates, indicating that fish oil was well-tolerated.
In conclusion, this placebo-controlled trial found no evidence supporting the use of fish oil for treating adolescents and young adults with major depressive disorder. Although this doesn’t provide a definitive answer, further research is necessary. Factors like family history of depression, prior treatment responses, and medication during the trial need further exploration. In our clinic, cognitive–behavioral therapy for depression is typically offered weekly for the first 12 weeks, which suggests therapy intensity might be an essential determinant. Comorbidities can also complicate matters. Although this study raises many questions, it’s evident that it is comprehensive and essential. As it stands, there isn’t compelling evidence to suggest that fish oil enhances treatment response in young individuals with major depressive disorder undergoing cognitive–behavioral management.
Abstract
Background: Clinical trials suggest that long-chain omega-3 polyunsaturated fatty acids (n-3 PUFAs) (fish oil) may reduce depressive symptoms in adults with major depressive disorder. Therefore, n-3 PUFAs may be a potential treatment for depression in youth.
Methods: Participants were 15- to-25 year-old individuals with major depressive disorder who sought care in one of three government-funded mental health services for young people in metropolitan Melbourne, Perth, or Sydney, Australia. Participants were randomly assigned in a double-blind, parallel-arm design to receive either fish oil (840 mg of eicosapentaenoic acid and 560 mg of docosahexaenoic acid) or placebo capsules as adjunct to cognitive behavioral case management. All participants were offered 50-minute cognitive behavioral case management sessions every 2 weeks delivered by qualified therapists (treatment as usual) at the study sites during the intervention period. The primary outcome was change in the interviewer-rated Quick Inventory of Depressive Symptomatology, Adolescent Version, score at 12 weeks. Erythrocyte n-3 PUFA levels were assessed pre-post intervention.
Results: A total of 233 young people were randomized to the treatment arms: 115 participants to the n-3 PUFA group and 118 to the placebo group. Mean change from baseline in the Quick Inventory of Depressive Symptomatology score was -5.8 in the n-3 PUFA group and -5.6 in the placebo group (mean difference, 0.2; 95% CI, -1.1 to 1.5; p = .75). Erythrocyte PUFA levels were not associated with depression severity at any time point. The incidence and severity of adverse events were similar in the two groups.
Conclusions: This placebo-controlled trial and biomarker analysis found no evidence to support the use of fish oil for treatment in young people with major depressive disorder.
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Reference
Amminger, G. P., Rice, S., Davey, C. G., Quinn, A. L., Hermens, D. F., Zmicerevska, N., Nichles, A., Hickie, I., Incerti, L., Weller, A., Joseph, S., Hilton, Z., Pugh, C., Rayner, M., Reid, N., Ratheesh, A., Yung, A. R., Yuen, H. P., Mackinnon, A., Hetrick, S., … Lin, A. (2023). The addition of fish oil to cognitive behavioral case management for youth depression: A randomized, double-blind, placebo-controlled, multicenter clinical trial. Biological Psychiatry, S0006-3223(23)01369-0.
