JAMA: Eating fish oil makes you depressed easily?

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JAMA: Eating fish oil makes you depressed easily?

The largest clinical trial to date shows that supplementing 1 gram of fish oil daily increases the risk of depression or clinical depression-related symptoms by 13%.

In recent years, depression has gradually received widespread attention from everyone, and our cognition of depression is no longer just a simple and crude summary of “low mood” and “bad mood”. Worldwide, there are approximately 280 million people with depression. Among all adults and adults over 60 years old, 5% and 5.7% are depression patients, respectively [1].

Regardless of any disease, prevention is as important as treatment, and is an important way to reduce the number of patients. In the prevention of depression, nutritional supplementation is considered to be an effective, safe and widely applicable method.

At present, Omega-3 fatty acids are recommended by some guidelines and expert consensus to prevent recurrence in patients with major depression who are at high risk of recurrence [2,3], but for ordinary people, whether Omega-3 fatty acids have the same potential is not yet Knowable.

A paper published today in JAMA magazine [4] gives the answer: no. (Ruthless.jpg)

The results of this trial showed that compared with placebo, Omega-3 supplements not only failed to reduce the risk of depression or clinical depression-related symptoms , but increased by 13%. This is currently the largest trial of its kind.

JAMA: Eating fish oil makes you depressed easily?

The trial called VITAL-DEP included 18,353 adult participants over the age of 50, of whom 16,657 were at risk of depression but no history of depression, and 1,696 were at risk of recurrence of depression, although they had a history of depression However, there was no seizure within 2 years before enrollment.

Participants were randomly divided into an Omega-3 treatment group (9171 people) and a placebo group (9182 people).

The median follow-up time of the trial was 5.3 years. 90.3% of the participants completed the trial. There is no significant difference in baseline characteristics.

There were 651 cases of depression or clinical depression-related symptoms in the Omega-3 treatment group, with an incidence rate of 13.9/1000 person-years, and 583 cases in the placebo group, with an incidence rate of 12.3/1000 person-years.

After adjusting for multiple influencing factors , compared to placebo, Omega-3 treatment groups depression clinical depression-related symptoms or increased risk of 13% (p = 0.03).

According to the cumulative incidence curve, about 2 years after enrollment, the incidence of the two groups began to differ.

JAMA: Eating fish oil makes you depressed easily?

The incidence of total depression or clinical depression-related symptoms (A), new incidence (B), and recurrence (C) in the Omega-3 group (yellow) and placebo group (black )

However, there was no significant difference in the overall follow-up process and year-to-year comparison of the changes in the emotional scores of the 8 Patient Health Questionnaire (PHQ-8) Depression Scale.

It is worth noting that the researchers divided the participants into subgroups based on different influencing factors, such as gender, age, race, baseline docosahexaenoic acid (DHA) and eicosapentaenoic acid ( EPA) levels, as well as the weekly intake of fish and seafood, among these different subgroups, only the female Omega-3 group had a 26% increase in risk compared with the placebo group (p=0.03) , and the rest There was no significant difference between subgroup Omega-3 and placebo.

There was no significant difference in safety between the Omega-3 group and the placebo group.

The incidence of major cardiovascular events, all-cause death, suicide, gastrointestinal bleeding, ecchymosis, and stomach discomfort or pain were similar.

Overall, this study shows that in adults over 50, Omega-3 supplements do not reduce the risk of depression or clinical depression-related symptoms, but have a small increase, especially in women.

The researchers believe that this study has multiple advantages, including a large sample size, long-term double-blind treatment and follow-up, high racial and ethnic diversity, and multivariate and biomarker data.

Of course, the assessment of increased risk also has the limitations of related studies.

Moreover, the participants in the trial are rarely severely deficient in Omega-3, and although the blood Omega-3 level increased by 55% after supplementation, Researchers are not sure whether they can cross the blood-brain barrier, and these factors may interfere with the results.

In addition, the Omega-3 supplement in the trial is 1g fish oil daily, which contains 465mg EPA and 375mg DHA. This dose may also be insufficient.

Therefore, although this study does not support supplementation with Omega-3 as a preventive measure for depression in the general population, this is not the end of this type of study.

In the future, the exploration of different doses, whether oral supplementation will be invalid due to the inability to cross the blood-brain barrier, and why there is a significant increase in risk in the female subgroup, and whether it is related to hormone levels, these issues need more Research to explain one by one.

References:

[1] https://www.who.int/news-room/fact-sheets/detail/depression

[2] Guu T W, Mischoulon D, Sarris J, et al. International Society for Nutritional Psychiatry Research Practice Guidelines for Omega-3 fatty acids in the treatment of major depressive disorder[J]. Psychotherapy and psychosomatics, 2019, 88(5): 263-273.

[3] Guu T W, Mischoulon D, Sarris J, et al. A multi-national, multi-disciplinary Delphi consensus study on using Omega-3 polyunsaturated fatty acids (n-3 PUFAs) for the treatment of major depressive disorder[J]. Journal of affective disorders, 2020, 265: 233-238.

[4] https://jamanetwork.com/journals/jama/article-abstract/2787320

JAMA: Eating fish oil makes you depressed easily?

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