CONVENTIONAL TREATMENTS VERSUS OMEGA-3 SUPPLEMENTS

Patients who suffer from major depression are typically treated with medication rather than psychotherapy. However, only one out of three patients undergoes complete remission of his or her symptoms. Lespérance notes that “if medication does not yield results after 8 weeks, therapeutic alternatives need to be considered in consultation with a physician.”

One viable alternative may well be treatment with omega-3, fatty acids which for the most part come from fatty fish (such as  salmon, tuna and halibut) and other seafood. Among other things, they have anti-inflammatory properties. Since depression has been shown to be linked to inflammatory processes, they have stimulated interest among researchers. Indeed, research has shown that omega-3 blood levels are lower in depressed people than in healthy people. The objective of Lespérance’s study was to determine whether omega-3 supplements could provide relief of depressive symptoms in the short term.

For a period of eight weeks, the 432 patients in his study were administered omega-3 (roughly 1000mg of highly purified EPA) or a placebo. The results revealed that omega-3 is indeed an acceptable solution. It is well tolerated and, more importantly, it works, especially with patients without anxiety disorders. In Lespérance’s view, omega-3 fatty acid supplements should be considered for patients who do not have related anxiety disorders and who are intolerant to antidepressors or reluctant to take them, particularly if they do not suffer from severe depression.

Although encouraged by these results, which were published in the Journal of Clinical Psychiatry, Lespérance notes that other randomized studies are needed to validate them. In particular, the efficacy of omega-3 supplements will have to be compared to conventional medication. Plans for these studies are already underway.

CLINICAL BENEFITS

“When I see patients who are reluctant to take antidepressors, I inform them about their advantages and disadvantages. But I also offer them the possibility beginning with omega-3,” explains Lespérance. He also notes that  even though the scientific evidence the potential be-nefits of omega-3 supplements is not as solid as is the case for  conventional anitdepressor drugs, it is worth trying them in a highly-purified EPA form as an alternative to conventional  therapy. Indeed, the results of his study have been viewed favourably by other specialists: “The study was well received by  psychiatrists because it documents a new treatment option.” Far from rejec-ting conventional drugs, Lespérance is pleased with the fact that he has been able to add another weapon to his therapeutic arsenal.

A UNIQUE STUDY

In Lespérance’s view, phase 3 clinical trials of the efficacy of antidepressors always exclude a substantial portion of depressed patients, who are typically treated as outpatients. As such, his study targeted chronically depressed patients,  those with concomitant anxiety disorders and those who do not respond to conventional anti-depressors or who experience undesirable side effects.

Given that omega-3 is a natural product extracted from fish and not a patented drug, securing funding for they study represented a challenge. After being refused by conventional funding agencies, Lespérance and his colleagues Drs Nancy Frasure-Smith and Élise St-André turned for help to Isodis Natura, an industrial manufacturer of dietary supplements,  including fatty acids such as omega-3. In addition to receiving supplements and placebos, the research team was awarded a grant that covered 70% of its study costs. The balance of the funding was provided by the CHUM Foundation and the CRCHUM.

Still, the research team behind this pan-Canadian multicentric study had to display considerable creativity to be able to conduct the study at a per-recruited-patient cost of less than 25% of the industry norm for phase three clinical trials.

Indeed, with 432 patients, including 280 recruited at the CRCHUM, the study set a record for a randomized clinical trial to evaluate a non-conventional antidepressor. More importantly, the researchers had complete control over all phases of the project, from its design to the publication of findings.

A STICH IN TIME?

What about treating depression before it occurs? “Eat three “fatty-fish” meals a week or take
500 mg of omega-3 per day,”  says Dr Lespérance, who, by the way, follows his own recommendation. A convincing argument indeed!