April 7, 2005 – Dr François Lespérance is a physician and associate professor in the Department of Psychiatry at the Center hospitalier de l’Université de Montréal. For several years, he has been interested in the increasingly clear link between depression and the risk of heart disease, as well as the dual role that omega-3s can play in the prevention and treatment of these conditions. Here is the state of knowledge in the matter, according to him.
Two recent meta-analyzes found that between three months and two years after depression, the risk of cardiac death doubles1 and that the occurrence of depression increases the risk of coronary heart disease by 50% in patients who previously had good cardiovascular health2.
In addition, the results of recent epidemiological studies indicate a very precise correlation between a low consumption of marine products (rich in omega-3) and a higher annual prevalence of major depression.3; same finding for the lifetime prevalence of bipolar disorder4. In addition, most epidemiological studies that have looked at the correlation between blood levels of omega-3s and depression have found that depressed patients have a higher level of EPA + DHA (two omega-3s). lower than those of unaffected patients. “Such a correlation is also very clear in the case of coronary heart disease. It is therefore logical to think that both depression and heart disease can be linked to an omega-3 deficiency ”explains Dr Lespérance.
Other markers of coronary heart disease are also associated with depression according to preliminary work: the increase in the inflammatory response and the level of C reactive protein, for example. The most interesting hypothesis, according to Dr The expectation is that internal physiological stresses caused by heart disease, like external psychological stresses, create disturbances that can lead to or intensify depression.
The benefits of omega-3s
Moreover, as a doctor and professor in a department of psychiatry, Dr Lespérance is well aware of the limits of antidepressant drugs: “Although they provide an average of 60% improvement and 30% remission after eight weeks, the remission rate after one year is only 11%. Indeed, some patients tolerate antidepressants poorly, which causes the medication to stop after eight weeks in 20% of them and in half of them after three months. Not to mention those who refuse to be treated with these drugs. “
In addition to recalling the positive results obtained during several preliminary studies thanks to EPA supplementation5-7, Dr Lespérance believes that the results of pilot studies carried out by his team in 2004 are promising. They focused on 63 subjects suffering from depression and made it possible to verify the feasibility of a larger trial which should begin next fall. These data indicate that taking 1 g of EPA per day reduced depressive symptoms, anxiety levels, and hostility, both in patients taking an antidepressant and in those not taking it. In addition, 42% of subjects reported no adverse effects after four weeks, and in the remainder, the effects mentioned were minor: fishy aftertaste or belching (26%), diarrhea or loose stools (12%), heartburn or pain (3%). Only 10% of participants stopped treatment.
Dr Lespérance specifies that, to obtain adequate statistical power, a study on depression should include at least 300 subjects. In fact, the placebo effect which manifests itself in trials on depressed subjects is so great that one runs the risk of concluding, perhaps wrongly, that a drug or a supplement is ineffective because of ‘an insufficient number of patients. According to him, this is what happened in a study published in 2001 in the Journal of American Medical Association. This trial involved 200 subjects and concluded that St. John’s Wort was ineffective in treating major depression.8.
Although the evidence for the beneficial effects of marine-derived omega-3s on mood disorders, including depression, is nowhere near as extensive and compelling as that for coronary heart disease, that is all. a new field of research that has opened up in recent years and it shows promise for patients who need alternatives to antidepressants.
These words of Dr Lespérance was gathered on March 15, 2005, in Quebec, during a conference day organized by the Lucie and André Chagnon Chair for the advancement of an integral approach to health.9 and by the Institute of Nutraceuticals and Functional Foods (INAF), with financial support from the Natural Health Products Directorate of Health Canada.
Françoise Ruby – PasseportSanté.net
1. Barth J, Schumacher M, Herrmann-Lingen C. Depression as a risk factor for mortality in patients with coronary heart disease: a meta-analysis. Psychosom Med. 2004 Nov-Dec; 66 (6): 802-13.
2. Rugulies R. Depression as a predictor for coronary heart disease. a review and meta-analysis. Am J Prev Med. 2002 Jul; 23 (1): 51-61. Review.
3. Hibbeln JR. Fish consumption and major depression. Lancet. 1998 Apr 18; 351 (9110): 1213.
4. Noaghiul S, Hibbeln JR. Cross-national comparisons of seafood consumption and rates of bipolar disorders. Am J Psychiatry. 2003 Dec; 160 (12): 2222-7.
5. 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 Aug; 13 (4): 267-71.
6. 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 Oct; 59 (10): 913-9.
7. 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 (3): 477-479.
8. Shelton RC, Keller MB, Gelenberg A, Dunner DL, and athe. Effectiveness of St John’s wort in major depression: a randomized controlled trial. JAMA. 2001 Apr 18; 285 (15): 1978-86.
9. Please note that the Lucie and André Chagnon Foundation supports the Lucie and André Chagnon Chair for the advancement of an integral approach to health as well as PasseportSanté.net.
