Psychotic disorders not treated by Omega-3 when patents take anti-depressants and get therapy

Created July 2018

NEURAPRO: a multi-centre RCT of omega-3 polyunsaturated fatty acids versus placebo in young people at ultra-high risk of psychotic disorders—medium-term follow-up and clinical course

npj Schizophrenia (2018)4:11; doi:10.1038/s41537-018-0052-x

B. Nelson1,2, G. P. Amminger1,2,3, H. P. Yuen1,2, C. Markulev1,2, S. Lavoie1,2, M. R. Schafer1,3, J. A. Hartmann1,2, N. Mossaheb4,

M. Schlogelhofer , S. Smesny5,1. B. Hickie6, G. Berger7, E. Y. H. Chen8, L. de Haan9, D. H. Nieman9, M. Nordentoft10, A. Riecher-Rossler11, S. Verma12, A. Thompson1,13,14, A. R. Yung1,15,16 and P. D. McGorry1,2

The study speculated as to why no benefit was found "The failure to replicate the original study may have been due the lack of efficacy of omega-3 PUFA in this patient population. However, other possible reasons are that the lower than expected transition rate (~11% across groups) prevented a test of the efficacy of this treatment and that the other treatments received in both groups (cognitive-behavioural case management (CBCM) and antidepressant medication) may have introduced a ceiling effect beyond which omega-3 PUFA, even if effective, could not be shown to confer additional benefit" Note: Omega-3 may not have as much efficacy for those with poor guts (need probiotics) Items in both categories Depression and Omega-3 are listed here: {category} --- Depression appears to also be treated by Vitamin D, Magnesium, Zinc, St. John's Wort * Anti-depression medication about as good as big increase in vitamin D – meta-analysis of flawless data April 2014 * Vitamin D depression RCT canceled: too many were taking Vitamin D supplements, etc. Feb 2018 * Depression is associated with low Magnesium – meta-analysis April 2015 * Depression – is it reduced by Vitamin D and or Omega-3 – RCT 2019 future * Unipolar depression treated by Omega-3, Zinc, and probably Vitamin D – meta-analysis Oct 2017 * Depression treated somewhat by Omega-3 (St. John's Wort better) – RAND org reviews 2015 Probably a combination would help more than just a single one

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This study reports a medium-term follow-up of a randomised, double-blind, placebo-controlled trial of omega-3 polyunsaturated fatty acids (PUFA) in ultra-high risk for psychosis (UHR) patients. Primary outcomes of interest were transition to psychosis and symptomatic and functional outcome. A secondary aim was to investigate clinical predictors of medium-term outcome. Three hundred four UHR participants were recruited across 10 specialised early psychosis services in Australia, Asia, and Europe. The intervention consisted of 1.4 g/daily of omega-3 PUFA or placebo, plus up to 20 sessions of cognitive-behavioural case management (CBCM), over the 6-month study period, with participants receiving further CBCM sessions on basis of need between months 6-12. Mean time to follow-up was 3.4 (median = 3.3; SD = 0.9) years. There was a modest increase in transitions between 12-month and medium-term follow-up (11-13%) and substantial improvement in symptoms and functioning between baseline and follow-up, with no differences between the treatment groups. Most improvement had been achieved by end of the intervention. 55% of the sample received mental health treatment between end of intervention and follow-up. Omega-3 PUFA did not provide additional benefits to good quality psychosocial intervention over the medium term. Although most improvement had been achieved by end of intervention the substantial rates of post-intervention mental health service use indicate longer-term clinical need in UHR patients. The post-intervention phase treatment or the longer-term effect of CBCM, or a combination of the two, may have contributed to maintaining the gains achieved during the intervention phase and prevented significant deterioration after this time.

Tags: Depression Omega-3