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ω-3 and major depression: a review

Published online by Cambridge University Press:  14 October 2013

Aline H. Mello
Affiliation:
Laboratory of Clinical and Experimental Pathophysiology, Post-Graduation Program in Health Sciences, Universidade do Sul de Santa Catarina, Tubarão, SC, Brazil
Aline Gassenferth
Affiliation:
Laboratory of Clinical and Experimental Pathophysiology, Post-Graduation Program in Health Sciences, Universidade do Sul de Santa Catarina, Tubarão, SC, Brazil
Luana R. Souza
Affiliation:
Laboratory of Clinical and Experimental Pathophysiology, Post-Graduation Program in Health Sciences, Universidade do Sul de Santa Catarina, Tubarão, SC, Brazil
Jucélia J. Fortunato
Affiliation:
Laboratory of Neuroscience, Post-Graduation Program in Health Sciences, Universidade do Sul de Santa Catarina, Tubarão, SC, Brazil
Gislaine T. Rezin*
Affiliation:
Laboratory of Clinical and Experimental Pathophysiology, Post-Graduation Program in Health Sciences, Universidade do Sul de Santa Catarina, Tubarão, SC, Brazil
*
Dr. Gislaine Tezza Rezin, Universidade do Sul de Santa Catarina, Av. José Acácio Moreira, 787, Tubarão, 88704-900, SC, Brazil. Tel: +55 48 3621-3363; Fax: +55 48 3621 3365; E-mail: gitezza@hotmail.com

Abstract

Background

The World Health Organization estimates that major depression affects about 350 million people all over the world and reports this disorder as the major contributor to the global burden of diseases. Despite the well-defined symptomatology, major depression is a heterogeneous psychiatric disorder whose pathophysiology is not clearly established. Although several treatments are available, most depressed patients do not achieve the complete remission of symptoms. Factors linked to the persistence of the disorder have been investigated, particularly those related to the way of life. Moreover, it has been suggested that nutritional aspects may influence its development. Among them, a diet rich in ω-3 has been associated with a reduced risk of major depression, although its deficiency is associated with depressive disorders.

Methods

This review provides a general view about evidences of the use of ω-3 in major depression cases.

Results

Several studies have demonstrated beneficial effects of ω-3 in the prevention and treatment of major depression. However, not all the results have shown significant statistical benefits.

Conclusions

More studies are necessary to clarify detailed mechanisms of the antidepressant effects of ω-3 and may explain the source of contradictions in results published until the moment.

Type
Original Articles
Copyright
Copyright © Scandinavian College of Neuropsychopharmacology 2013 

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References

1.Rouillon, F. Epidemiology of mood disorders. Rev Prat 2008;58:361365.Google ScholarPubMed
2.World Health Organization (WHO), 2012. Depression. Fact sheet No. 369/ October 2012. Available at http://www.who.int/mediacentre/factsheets/fs369/en/index.html. Accessed February 13, 2013.Google Scholar
3.Rakofsky, JJ, Holtzheimer, PE, Nemeroff, CB. Emerging targets for antidepressant therapies. Curr Opin Chem Biol 2009;13:291302.Google Scholar
4.Kamphuis, MH, Geerlings, MI, Tijhuis, MA, Kalmijn, S, Grobbee, DE, Kromhout, D. Depression and cardiovascular mortality: a role for n-3 fatty acids? Am J Clin Nutr 2006;84:15131517.Google Scholar
5.Hibbeln, JR. From homicide to happiness – a commentary on omega-3 fatty acids in human society. Cleave Award Lecture. Nutr Health 2007;19:919.CrossRefGoogle ScholarPubMed
6.Bodnar, LM, Wisner, KL. Nutrition and depression: implications for improving mental health among childbearing-aged women. Biol Psychiatry 2005;58:679685.CrossRefGoogle ScholarPubMed
7.Gertsik, L, Poland, RE, Bresee, C, Rapaport, MH. Omega-3 fatty acid augmentation of citalopram treatment for patients with major depressive disorder. J Clin Psychopharmacol 2012;32:6164.Google Scholar
8.Nemets, B, Stahl, Z, Belmaker, RH. Addition of omega-3 fatty acid to maintenance medication treatment for recurrent unipolar depressive disorder. Am J Psychiatry 2002;159:477479.Google Scholar
9.Peet, M, Horrobin, DF. A dose-ranging study of the effects of ethyl-eicosapentaenoate in patients with ongoing depression despite apparently adequate treatment with standard drugs. Arch Gen Psychiatry 2002;59:913919.Google Scholar
10.Quintana, DC, Calzado, YR, Cuevas, VM, Ferreiro, RM, Valmaña, MLA. Efecto del D-004, un extracto del fruto de Roystonea regia y omega-3 en el modelo de nado forzado em ratones. Rev Cubana Farm 2010;45:7986.Google Scholar
11.Silva, TM, Munhoz, RP, Alvarez, Cet al. Depression in Parkinson's disease: a double-blind, randomized, placebo-controlled pilot study of omega-3 fatty-acid supplementation. J Affect Disord 2008;111:351359.Google Scholar
12.Young, C, Martin, A. Omega-3 fatty acids in mood disorders: an overview. Rev Bras Psiquiatr 2003;25:184187.Google Scholar
13.Deligiannidis, KM, Freeman, MP. Complementary and alternative medicine for the treatment of depressive disorders in women. Psychiatr Clin North Am 2010;33:441463.Google Scholar
14.American Psychiatric Association (APA). Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), 4th edn. Washington, DC: American Psychiatric Association, 2000.Google Scholar
15.Zhang, X, Beaulieu, JM, Sotnikova, TD, Gainetdinov, RR, Caron, MG. Tryptophan hydroxylase-2 controls brain serotonin synthesis. Science 2004;305:217.Google Scholar
16.Cannon, TD, Keller, MC. Endophenotypes in the genetic analyses of mental disorders. Annu Rev Clin Psychol 2006;2:267290.Google Scholar
17.Stahl, SM. Psicofarmacologia: base neurocientífica e aplicações práticas, 2nd edn. Rio de Janeiro: Medsi, 2002.Google Scholar
18.Karege, F, Perret, G, Bondolfi, G, Schwald, M, Bertschy, G, Aubry, JM. Decreased serum brain-derived neurotrophic factor levels in major depressed patients. Psychiatry Res 2002;109:143148.Google Scholar
19.Gillespie, CF, Nemeroff, CB. Hypercortisolemia and depression. Psychosom Med 2005;67:2628.Google Scholar
20.Belmaker, RH, Agam, G. Major depressive disorder. N Engl J Med 2008;358:5568.Google Scholar
21.Marcos, B, Aisa, B, Ramírez, MJ. Functional interaction between 5-HT6 receptors and hypothalamic–pituitary–adrenal axis: cognitive implications. Neuropharmacology 2008;54:708714.Google Scholar
22.Madrigal, JL, Olivenza, R, Moro, MAet al. Glutathione depletion, lipid peroxidation and mitochondrial dysfunction are induced by chronic stress in rat brain. Neuropsychopharmacology 2001;24:420429.Google Scholar
23.Fattal, O, Budur, K, Vaughan, AJ, Franco, K. Review of the literature on major mental disorders in adult patients with mitochondrial diseases. Psychosomatics 2006;47:17.Google Scholar
24.Stanyer, L, Jorgensen, W, Hori, O, Clark, JB, Heales, SJ. Inactivation of brain mitochondrial Lon protease by peroxynitrite precedes electron transport chain dysfunction. Neurochem Int 2008;53:95101.Google Scholar
25.Jou, SH, Chiu, NY, Liu, CS. Mitochondrial dysfunction and psychiatric disorders. Chang Gung Med J 2009;32:370379.Google ScholarPubMed
26.Navarro, A, Boveris, A. The mitochondrial energy transduction system and the aging process. Am J Physiol Cell Physiol 2007;292:670686.Google Scholar
27.Boekema, EJ, Braun, HP. Supramolecular structure of the mitochondrial oxidative phosphorylation system. J Biol Chem 2007;282:14.Google Scholar
28.Aguiar, CC, Castro, TR, Carvalho, AF, Vale, OC, Sousa, FC, Vasconcelos, SM. Drogas antidepressivas. Acta Med Port 2011;24:9198.Google Scholar
29.Bateman, N. Antidepressants. Medicine 2012;40:100102.Google Scholar
30.Moreno, RA, Moreno, DH, Soares, MBM. Psicofarmacologia de antidepressivos. Rev Bras Psiquiatr 1999;21:2440.Google Scholar
31.Javitt, DC. Glutamate as a therapeutic target in psychiatric disorders. Mol Psychiatry 2004;9:984997.Google Scholar
32.Murck, H, Schubert, MI, Schmid, D, Schüssler, P, Steiger, A, Auer, DP. The glutamatergic system and its relation to the clinical effect of therapeutic-sleep deprivation in depression – an MR spectroscopy study. J Psychiatr Res 2009;43:175180.Google Scholar
33.Álamo, C, López-Muñoz, F, Armada, MJ. Agomelatina: un nuevo enfoque farmacológico en el tratamiento de la depresión con traducción clínica. Psiq Biol 2008;15:125139.Google Scholar
34.Bodinat, C, Guardiola-Lemaitre, B, Mocaër, E, Renard, P, Muñoz, C, Millan, MJ. Agomelatine, the first melatonergic antidepressant: discovery, characterization and development. Nat Rev Drug Discov 2010;9:628642.Google Scholar
35.Richards, D. Prevalence and clinical course of depression: a review. Clin Psychol Rev 2011;31:11171125.Google Scholar
36.Pompéia, C. Essencialidade dos ácidos graxos. In: Curi R, Pompéia C, Miyasaka CK, Procopio J, editors. Entendendo a gordura: os ácidos graxos. São Paulo: Manole, 2002. p. 2732.Google Scholar
37.Nahas, R, Sheikh, O. Complementary and alternative medicine for the treatment of major depressive disorder. Can Fam Physician 2011;57:659663.Google Scholar
38.Logan, AC. Neurobehavioral aspects of omega-3 fatty acids: possible mechanisms and therapeutic value in major depression. Altern Med Rev 2003;8:410425.Google Scholar
39.Martin, CA, Almeida, VV, Ruiz, MRet al. Ácidos graxos poliinsaturados ômega-3 e ômega-6: importância e ocorrência em alimentos. Rev Nutr 2006;19:761770.CrossRefGoogle Scholar
40.Brenna, JT. Efficiency of conversion of alpha-linolenic acid to long chain n-3 fatty acids in man. Curr Opin Clin Nutr Metab Care 2002;5:127132.Google Scholar
41.Freeman, MP. Omega-3 fatty acids in major depressive disorder. J Clin Psychiatry 2009;70:711.Google Scholar
42.Mischoulon, D. Update and critique of natural remedies as antidepressant treatments. Obstet Gynecol Clin North Am 2009;36:789807.Google Scholar
43.Agranoff, BW, Hajra, AK. Lipids. In: Siegel GJ, Albers RW, Agranoff BW, Katzman R, editors. Basic Neurochemistry: Molecular, Cellular and Medical Aspects. New York: Raven Press, 1994. p. 97115.Google Scholar
44.Bourre, JM. Acides gras ω-3 et troubles psychiatriques. Med Sci (Paris) 2005;21:216221.Google Scholar
45.Haag, M. Essential fatty acids and the brain. Can J Psychiatry 2003;48:195203.Google Scholar
46.Mazza, M, Pomponi, M, Janiri, L, Bria, P, Mazza, S. Omega-3 fatty acids and antioxidants in neurological and psychiatric diseases: an overview. Prog Neuropsychopharmacol Biol Psychiatry 2007;31:1226.Google Scholar
47.Farooqui, AA, Horrocks, LA, Farooqui, T. Glycerophospholipids in brain: their metabolism, incorporation into membranes, functions, and involvement in neurological disorders. Chem Phys Lipids 2000;106:129.Google Scholar
48.Freitas, JJS, Kietzer, KS. Ácidos graxos e sistema nervoso. In: Curi R, Pompéia C, Miyasaka CK, Procopio J, editors. Entendendo a gordura: os ácidos graxos. São Paulo: Manole, 2002. p. 469488.Google Scholar
49.Uauy, R, Peirano, P, Hoffman, D, Mena, P, Birch, D, Birch, E. Role of essential fatty acids in the function of the developing nervous system. Lipids 1996;31:167176.Google Scholar
50.Zimmer, L, Durand, G, Guilloteau, D, Chalon, S. n-3 polyunsaturated fatty acid deficiency and dopamine metabolism in the rat frontal cortex. Lipids 1999;34:251.Google Scholar
51.Sanders, TA, Mistry, M, Naismith, DJ. The influence of a maternal diet rich in linoleic acid on brain and retinal docosahexaenoic acid in the rat. Br J Nutr 1984;51:5766.Google Scholar
52.Nouvelot, A, Bourre, JM, Sezille, G, Dewailly, P, Jaillard, J. Changes in the fatty acid patterns of brain phospholipids during development of rats fed peanut or rapeseed oil, taking into account differences between milk and maternal food. Ann Nutr Metab 1983;27:173181.Google Scholar
53.Salem, N Jr. Omega-3 fatty acids: molecular and biochemical aspects. In: Spiller GA, Scala J, editors. New Protective Roles for Selected Nutrients. New York: Liss, 1989. p. 109228.Google Scholar
54.Holman, RT, Johnson, SB, Ogburn, PL. Deficiency of essential fatty acids and membrane fluidity during pregnancy and lactation. Proc Natl Acad Sci U S A 1991;88:48354839.Google Scholar
55.Gitlin, MJ, Pasnau, RO. Psychiatric syndromes linked to reproductive function in women: a review of current knowledge. Am J Psychiatry 1989;146:14131422.Google Scholar
56.Edwards, R, Peet, M, Shay, J, Horrobin, D. Omega-3 polyunsaturated fatty acid levels in the diet and in red blood cell membranes of depressed patients. J Affect Disord 1998;48:149155.Google Scholar
57.Hibbeln, JR. Fish consumption and major depression. Lancet 1998;351:1213.Google Scholar
58.Conklin, SM, Runyan, CA, Leonard, S, Reddy, RD, Muldoon, MF, Yao, JK. Age-related changes of n-3 and n-6 polyunsaturated fatty acids in the anterior cingulate cortex of individuals with major depressive disorder. Prostaglandins Leukot Essent Fatty Acids 2010;82:111119.Google Scholar
59.Sontrop, J, Campbell, MK. Omega-3 polyunsaturated fatty acids and depression: a review of the evidence and a methodological critique. Prev Med 2006;42:413.Google Scholar
60.Lakhan, SE, Vieira, KF. Nutritional therapies for mental disorders. Nutr J 2008;7:18.Google Scholar
61.Kidd, PM. Omega-3 DHA and EPA for cognition, behavior, and mood: clinical findings and structural-functional synergies with cell membrane phospholipids. Altern Med Rev 2007;12:207227.Google Scholar
62.Suominen-Taipale, AL, Partonen, T, Turunen, AW, Männistö, S, Jula, A, Verkasalo, PK. Fish consumption and omega-3 polyunsaturated fatty acids in relation to depressive episodes: a cross-sectional analysis. PLoS One 2010;5:111.Google Scholar
63.Maes, M, Smith, R, Scharpe, S. The monocyte-T-lymphocyte hypothesis of major depression. Psychoneuroendocrinology 1995;20:111116.Google Scholar
64.Song, C, Lin, A, Bonaccorso, Set al. The inflammatory response system and the availability of plasma tryptophan in patients with primary sleep disorders and major depression. J Affect Disord 1998;49:211219.Google Scholar
65.Maes, M, Smith, R, Christophe, A, Cosyns, P, Desnyder, R, Meltzer, H. Fatty acid composition in major depression: decreased 3 fractions in cholesteryl esters and increased C20:46/C20:53 ratio in cholesteryl esters and phospholipids. J Affect Disord 1996;38:3546.Google Scholar
66.Simopoulos, AP. Omega-3 fatty acids in inflammation and autoimmune diseases. J Am Coll Nutr 2002;21:495505.Google Scholar
67.Hibbeln, JR, Salem, N Jr. Dietary polyunsaturated fatty acids and depression: when cholesterol does not satisfy. Am J Clin Nutr 1995;62:19.Google Scholar
68.Delion, S, Chalon, S, Guilloteau, D, Besnard, JC, Durand, G. Alpha-linolenic acid dietary deficiency alters age-related changes of dopaminergic and serotoninergic neurotransmission in the rat frontal cortex. J Neurochem 1996;66:15821591.Google Scholar
69.Wu, A, Ying, Z, Gomez-Pinilla, F. Dietary omega-3 fatty acids normalize BDNF levels, reduce oxidative damage, and counteract learning disability after traumatic brain injury in rats. J Neurotrauma 2004;21:14571467.Google Scholar
70.Tanskanen, A, Hibbeln, JR, Hintikka, J, Haatainen, K, Honkalampi, K, Viinamäki, H. Fish consumption, depression, and suicidality in a general population. Arch Gen Psychiatry 2001;58:512513.Google Scholar
71.Li, Y, Dai, Q, Ekperi, LI, Dehal, A, Zhang, J. Fish consumption and severely depressed mood, findings from the first national nutrition follow-up study. Psychiatry Res 2011;190:103109.CrossRefGoogle ScholarPubMed
72.Peet, M, Murphy, B, Shay, J, Horrobin, D. Depletion of omega-3 fatty acid levels in red blood cell membranes of depressive patients. Biol Psychiatry 1998;43:315319.Google Scholar
73.Maes, M, Christophe, A, Delanghe, J, Altamura, C, Neels, H, Meltzer, HY. Lowered omega3 polyunsaturated fatty acids in sérum phospholipids and cholesteryl esters of depressed patients. Psychiatry Res 1999;85:275291.Google Scholar
74.Tiemeier, H, van Tuijl, HR, Hofman, A, Kiliaan, AJ, Breteler, MM. Plasma fatty acid composition and depression are associated in the elderly: the Rotterdam study. Am J Clin Nutr 2003;78:4046.Google Scholar
75.Frasure-Smith, N, Lesperance, F, Julien, P. Major depression is associated with lower omega-3 fatty acid levels in patients with recent acute coronary syndromes. Biol Psychiatry 2004;55:891896.Google Scholar
76.De Vriese, SR, Christophe, AB, Maes, M. Lowered serum n-3 polyunsaturated fatty acid (PUFA) levels predict the occurrence of postpartum depression: further evidence that lowered n-PUFAs are related to major depression. Life Sci 2003;73:31813187.Google Scholar
77.Otto, SJ, de Groot, RH, Hornstra, G. Increased risk of postpartum depressive symptoms is associated with slower normalization after pregnancy of the functional docosahexaenoic acid status. Prostaglandins Leukot Essent Fatty Acids 2003;69:237243.Google Scholar
78.Su, KP, Huang, SY, Chiu, CC, Shen, WW. Omega-3 fatty acids in major depressive disorder. A preliminary double-blind, placebo-controlled trial. Eur Neuropsychopharmacol 2003;13:267271.CrossRefGoogle ScholarPubMed
79.Nemets, H, Nemets, B, Apter, A, Bracha, Z, Belmaker, RH. Omega-3 treatment of childhood depression: a controlled, double-blind pilot study. Am J Psychiatry 2006;163:10981100.Google Scholar
80.Mischoulon, D, Best-Popescu, C, Laposata, Met al. A double-blind dose-finding pilot study of docosahexaenoic acid (DHA) for major depressive disorder. Eur Neuropsychopharmacol 2008;18:639645.Google Scholar
81.Jazayeri, S, Tehrani-Doost, M, Keshavarz, SAet al. Comparison of therapeutic effects of omega-3 fatty acid eicosapentaenoic acid and fluoxetine, separately and in combination, in major depressive disorder. Aust N Z J Psychiatry 2008;42:192198.Google Scholar
82.Marangell, LB, Martinez, JM, Zboyan, HA, Kertz, B, Kim, HF, Puryear, LJ. A double-blind, placebo-controlled study of the omega-3 fatty acid docosahexaenoic acid in the treatment of major depression. Am J Psychiatry 2003;160:996998.Google Scholar
83.Silvers, KM, Woolley, CC, Hamilton, FC, Watts, PM, Watson, RA. Randomised double-blind placebo-controlled trial of fish oil in the treatment of depression. Prostaglandins Leukot Essent Fatty Acids 2005;72:211218.Google Scholar
84.Rogers, PJ, Appleton, KM, Kessler, Det al. No effect of n-3 long-chain polyunsaturated fatty acid (EPA and DHA) supplementation on depressed mood and cognitive function: a randomised controlled trial. Br J Nutr 2008;99:421431.CrossRefGoogle ScholarPubMed
85.Llorente, AM, Jensen, CL, Voigt, RG, Fraley, JK, Berretta, MC, Heird, WC. Effect of maternal docosahexaenoic acid supplementation on postpartum depression and information processing. Am J Obstet Gynecol 2003;188:13481353.Google Scholar
86.Marangell, LB, Martinez, JM, Zboyan, HA, Chong, H, Puryear, LJ. Omega-3 fatty acids for the prevention of postpartum depression: negative data from a preliminary, open-label pilot study. Depress Anxiety 2004;19:2023.Google Scholar
87.Freeman, MP, Hibbeln, JR, Wisner, KL, Watchman, M, Gelenberg, AJ. An open trial of omega-3 fatty acids for depression in pregnancy. Acta Neuropsychiatr 2006;18:2124.Google Scholar
88.Freeman, MP, Hibbeln, JR, Wisner, KL, Brumbach, BH, Watchman, M, Gelenberg, AJ. Randomized dose-ranging pilot trial of omega-3 fatty acids for postpartum depression. Acta Psychiatr Scand 2006;113:3135.Google Scholar
89.Hibbeln, JR. Seafood consumption, the DHA content of mothers’ milk and prevalence rates of postpartum depression: a cross-national, ecological analysis. J Affect Disord 2002;69:1529.Google Scholar
90.Golding, J, Steer, C, Emmett, P, Davis, JM, Hibbeln, JR. High levels of depressive symptoms in pregnancy with low omega-3 fatty acid intake from fish. Epidemiology 2009;20:598603.Google Scholar
91.Rondanelli, M, Giacosa, A, Opizzi, Aet al. Effect of omega-3 fatty acids supplementation on depressive symptoms and on health-related quality of life in the treatment of elderly women with depression: a double-blind, placebo-controlled, randomized clinical trial. J Am Coll Nutr 2010;29:5564.Google Scholar
92.Tajalizadekhoob, Y, Sharifi, F, Fakhrzadeh, Het al. The effect of low-dose omega 3 fatty acids on the treatment of mild to moderate depression in the elderly: a double-blind, randomized, placebo-controlled study. Eur Arch Psychiatry Clin Neurosci 2011;261:539549.Google Scholar
93.McNamara, RK, Hahn, CG, Jandacek, Ret al. Selective deficits in the omega-3 fatty acid docosahexaenoic acid in the postmortem orbitofrontal cortex of patients with major depressive disorder. Biol Psychiatry 2007;62:1724.Google Scholar