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Conti S, Perdixi E, Bernini S, Jesuthasan N, Severgnini M, Prinelli F. Adherence to Mediterranean diet is inversely associated with depressive symptoms in older women: findings from the NutBrain Study. Br J Nutr 2024; 131:1892-1901. [PMID: 38361447 DOI: 10.1017/s0007114524000461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
Data on the association of the Mediterranean diet (MD) with depressive symptoms in older people at high risk of depression are scarce. This study aimed to investigate the cross-sectional association of the adherence to the MD and its components with depressive symptoms in an Italian cohort of older men and women. A total of 325 men and 473 women aged 65–97 years (2019–2023) answered a 102-item semi-quantitative FFQ, which was used to calculate the Mediterranean diet score (MDS). Depressive symptoms were assessed using the Centre for Epidemiological Studies Depression Scale; subjects with a score of 16 or more were considered to have depression. Multivariable logistic regression was used for statistical analysis. The occurrence of depressive symptoms was 19·8 % (8·0 % men, 27·9 % women). High adherence to MDS (highest tertile) significantly reduced the odds of having depressive symptoms by 54·6 % (OR 0·454, 95 % CI 0·266, 0·776). In sex-stratified analysis, the reduction was evident in women (OR 0·385, 95 % CI 0·206, 0·719) but not in men (OR 0·828, 95 % CI 0·254, 2·705). Looking at the association of MDS components with depressive symptoms, we found an inverse significant association with fish consumption and the MUFA:SFA ratio above the median only in women (OR 0·444, 95 % CI 0·283, 0·697 and OR 0·579, 95 % CI 0·345, 0·971, respectively). High adherence to the MDS, and a high fish intake and MUFA:SFA ratio were associated with lower depressive symptoms in women only. Future longitudinal studies are needed to confirm these findings and to explore the underlying biological mechanisms.
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Affiliation(s)
- Silvia Conti
- Institute of Biomedical Technologies - National Research Council, Via Fratelli Cervi 93, 20054 Segrate, MI, Italy
- Neuropsychology Lab/Centre for Cognitive Disorders and Dementia IRCCS Mondino Foundation, Via Mondino 2, 27100 Pavia, Italy
| | - Elena Perdixi
- Neuropsychology Lab/Centre for Cognitive Disorders and Dementia IRCCS Mondino Foundation, Via Mondino 2, 27100 Pavia, Italy
- Department of Neurology, IRCCS Humanitas Clinical and Research Centre, Via Alessandro Manzoni 56, 20089 Rozzano, MI, Italy
| | - Sara Bernini
- Neuropsychology Lab/Centre for Cognitive Disorders and Dementia IRCCS Mondino Foundation, Via Mondino 2, 27100 Pavia, Italy
- Clinical Neuroscience Unit of Dementia, Dementia Research Centre, IRCCS Mondino Foundation, Via Mondino 2, 27100 Pavia, Italy
| | - Nithiya Jesuthasan
- Institute of Biomedical Technologies - National Research Council, Via Fratelli Cervi 93, 20054 Segrate, MI, Italy
| | - Marco Severgnini
- Institute of Biomedical Technologies - National Research Council, Via Fratelli Cervi 93, 20054 Segrate, MI, Italy
| | - Federica Prinelli
- Institute of Biomedical Technologies - National Research Council, Via Fratelli Cervi 93, 20054 Segrate, MI, Italy
- Neuropsychology Lab/Centre for Cognitive Disorders and Dementia IRCCS Mondino Foundation, Via Mondino 2, 27100 Pavia, Italy
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Fu J, Zhang E, Yu W, Wang W, Sun Y, Dong L, Zhang Y, Sun G, Li Z, Luo Q, Yang J. Comparative Analysis of the Biochemical Composition, Amino Acid, and Fatty Acid Contents of Diploid, Triploid, and Tetraploid Crassostrea gigas. Molecules 2024; 29:2671. [PMID: 38893545 PMCID: PMC11173691 DOI: 10.3390/molecules29112671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 06/01/2024] [Accepted: 06/01/2024] [Indexed: 06/21/2024] Open
Abstract
Tetraploid oysters are artificially produced oysters that do not exist in nature. The successful breeding of 100% triploid oysters resolved the difficulties of traditional drug-induced triploids, such as the presence of drug residues and a low triploid induction rate. However, little is known concerning the biochemical composition and nutrient contents of such tetraploids. Therefore, we investigated compositional differences among diploid, triploid, and tetraploid Crassostrea gigas as well as between males and females of diploids and tetraploids. The findings indicated that glycogen, EPA, ∑PUFA, and omega-3 contents were significantly higher in triploid oysters than in diploids or tetraploids; tetraploid oysters had a significantly higher protein content, C14:0, essential amino acid, and flavor-presenting amino acid contents than diploids or triploids. For both diploid and tetraploids, females had significantly higher levels of glutamate, methionine, and phenylalanine than males but lower levels of glycine and alanine. In addition, female oysters had significantly more EPA, DHA, omega-3, and total fatty acids, a result that may be due to the fact that gonadal development in male oysters requires more energy to sustain growth, consumes greater amounts of nutrients, and accumulates more proteins. With these results, important information is provided on the production of C. gigas, as well as on the basis and backing for the genetic breeding of oysters.
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Affiliation(s)
- Jingjing Fu
- School of Agriculture, Ludong University, Yantai 264025, China; (J.F.); (E.Z.); (Y.S.); (Y.Z.); (G.S.); (Z.L.)
| | - Enshuo Zhang
- School of Agriculture, Ludong University, Yantai 264025, China; (J.F.); (E.Z.); (Y.S.); (Y.Z.); (G.S.); (Z.L.)
| | - Wensong Yu
- Yantai Marine Economic Research Institute, Yantai 264003, China;
| | - Weijun Wang
- School of Agriculture, Ludong University, Yantai 264025, China; (J.F.); (E.Z.); (Y.S.); (Y.Z.); (G.S.); (Z.L.)
- College of Fisheries and Life Science, Shanghai Ocean University, Shanghai 201306, China;
- Yantai Haiyu Marine Technology Co., Ltd., Yantai 264000, China;
| | - Youmei Sun
- School of Agriculture, Ludong University, Yantai 264025, China; (J.F.); (E.Z.); (Y.S.); (Y.Z.); (G.S.); (Z.L.)
| | - Luyao Dong
- College of Fisheries and Life Science, Shanghai Ocean University, Shanghai 201306, China;
| | - Yousen Zhang
- School of Agriculture, Ludong University, Yantai 264025, China; (J.F.); (E.Z.); (Y.S.); (Y.Z.); (G.S.); (Z.L.)
| | - Guohua Sun
- School of Agriculture, Ludong University, Yantai 264025, China; (J.F.); (E.Z.); (Y.S.); (Y.Z.); (G.S.); (Z.L.)
| | - Zan Li
- School of Agriculture, Ludong University, Yantai 264025, China; (J.F.); (E.Z.); (Y.S.); (Y.Z.); (G.S.); (Z.L.)
| | - Qihao Luo
- Yantai Haiyu Marine Technology Co., Ltd., Yantai 264000, China;
| | - Jianmin Yang
- School of Agriculture, Ludong University, Yantai 264025, China; (J.F.); (E.Z.); (Y.S.); (Y.Z.); (G.S.); (Z.L.)
- Yantai Haiyu Marine Technology Co., Ltd., Yantai 264000, China;
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Dinas PC, Karaventza M, Liakou C, Georgakouli K, Bogdanos D, Metsios GS. Combined Effects of Physical Activity and Diet on Cancer Patients: A Systematic Review and Meta-Analysis. Nutrients 2024; 16:1749. [PMID: 38892682 PMCID: PMC11175154 DOI: 10.3390/nu16111749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 05/29/2024] [Accepted: 05/31/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND The purpose of our systematic review was to examine the effects of any physical activity/exercise intervention combined with any diet/nutrition intervention on any biological/biochemical index, quality of life (QoL), and depression in breast, lung, colon and rectum, prostate, stomach, and liver cancer patients and/or cancer survivors. METHODS A systematic review and meta-analysis were undertaken, using PRISMA guidelines and the Cochrane Handbook. The systematic review protocol can be found in the PROSPERO database; registration number: CRD42023481429. RESULTS We found moderate-quality evidence that a combined intervention of physical activity/exercise and nutrition/diet reduced body mass index, body weight, fat mass, insulin, homeostatic model assessment for insulin resistance, C-reactive protein, triglycerides, and depression, while it increased high-density lipoprotein, the physical component of QoL, and general functional assessment of cancer therapy. CONCLUSIONS We conclude that a combined intervention of physical activity/exercise and diet/nutrition may decrease body weight, fat mass, insulin levels, and inflammation, and improve lipidemic profile, the physical component of QoL, and depression in cancer patients and survivors. These outcomes indicate a lower risk for carcinogenesis; however, their applicability depends on the heterogeneity of the population and interventions, as well as the potential medical treatment of cancer patients and survivors.
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Affiliation(s)
- Petros C. Dinas
- Department of Nutrition and Dietetics, School of Physical Education, Sport Science and Dietetics, University of Thessaly, 42130 Trikala, Greece; (on behalf of the Students of Module 5104 (Introduction to Systematic Reviews)); (M.K.); (K.G.); (G.S.M.)
- FAME Laboratory, School of Physical Education, Sport Science and Dietetics, University of Thessaly, 42131 Trikala, Greece
| | | | - Marianthi Karaventza
- Department of Nutrition and Dietetics, School of Physical Education, Sport Science and Dietetics, University of Thessaly, 42130 Trikala, Greece; (on behalf of the Students of Module 5104 (Introduction to Systematic Reviews)); (M.K.); (K.G.); (G.S.M.)
| | - Christina Liakou
- School of Physical Education, Sport Science and Dietetics, University of Thessaly, 42131 Trikala, Greece;
| | - Kalliopi Georgakouli
- Department of Nutrition and Dietetics, School of Physical Education, Sport Science and Dietetics, University of Thessaly, 42130 Trikala, Greece; (on behalf of the Students of Module 5104 (Introduction to Systematic Reviews)); (M.K.); (K.G.); (G.S.M.)
| | - Dimitrios Bogdanos
- Department of Internal Medicine, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41110 Larissa, Greece;
| | - George S. Metsios
- Department of Nutrition and Dietetics, School of Physical Education, Sport Science and Dietetics, University of Thessaly, 42130 Trikala, Greece; (on behalf of the Students of Module 5104 (Introduction to Systematic Reviews)); (M.K.); (K.G.); (G.S.M.)
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Lu Y, Qiao D, Mi G. Clinical impacts of n-3 fatty acids supplementation on depression symptoms: an umbrella review of meta-analyses. Br J Nutr 2024; 131:841-850. [PMID: 37886879 DOI: 10.1017/s000711452300226x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
Several meta-analyses investigating the efficacy of n-3 PUFA in alleviating depression symptoms have reported conflicting findings. In the present study, we aimed to perform an umbrella meta-analysis to provide a definite conclusion. A comprehensive systematic search of PubMed, Scopus, Embase, Web of Science and Cochrane Central Library was performed up to June 2021. Meta-analysis studies evaluating the effects of n-3 PUFA on depression symptoms were included. The quality of the included meta-analyses was assessed using AMSTAR questionnaire. Out of 101 studies, twenty-two studies with twenty-six effect sizes (ES) were eligible for inclusion. Sixteen ES showed significant improving effect of n-3 supplementation on depression symptoms among which eleven ES had small ES. The other studies observed no significant effect. Available evidence suggests that n-3 PUFA (EPA, DHA) supplementation could be considered as an effective add-on therapeutic approach in relieving depression symptoms.
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Affiliation(s)
- Yi Lu
- Department of Physical Therapy, Shandong Mental Health Center, Shandong University, Jina, Shandong250014, People's Republic of China
| | - Dongdong Qiao
- Department of Psychology, Shandong Mental Health Center, Shandong University, Jina, Shandong250014, People's Republic of China
| | - Guolin Mi
- Department of Psychosomatic Medicine, Shandong Mental Health Center, Shandong University, Jina, Shandong250014, People's Republic of China
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Sublette ME, Daray FM, Ganança L, Shaikh SR. The role of polyunsaturated fatty acids in the neurobiology of major depressive disorder and suicide risk. Mol Psychiatry 2024; 29:269-286. [PMID: 37993501 DOI: 10.1038/s41380-023-02322-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 10/19/2023] [Accepted: 11/07/2023] [Indexed: 11/24/2023]
Abstract
Long-chain polyunsaturated fatty acids (LC-PUFAs) are obtained from diet or derived from essential shorter-chain fatty acids, and are crucial for brain development and functioning. Fundamentally, LC-PUFAs' neurobiological effects derive from their physicochemical characteristics, including length and double bond configuration, which differentiate LC-PUFA species and give rise to functional differences between n(omega)-3 and n-6 LC-PUFAs. LC-PUFA imbalances are implicated in psychiatric disorders, including major depression and suicide risk. Dietary intake and genetic variants in enzymes involved in biosynthesis of LC-PUFAs from shorter chain fatty acids influence LC-PUFA status. Domains impacted by LC-PUFAs include 1) cell signaling, 2) inflammation, and 3) bioenergetics. 1) As major constituents of lipid bilayers, LC-PUFAs are determinants of cell membrane properties of viscosity and order, affecting lipid rafts, which play a role in regulation of membrane-bound proteins involved in cell-cell signaling, including monoaminergic receptors and transporters. 2) The n-3:n-6 LC-PUFA balance profoundly influences inflammation. Generally, metabolic products of n-6 LC-PUFAs (eicosanoids) are pro-inflammatory, while those of n-3 LC-PUFAs (docosanoids) participate in the resolution of inflammation. Additionally, n-3 LC-PUFAs suppress microglial activation and the ensuing proinflammatory cascade. 3) N-3 LC-PUFAs in the inner mitochondrial membrane affect oxidative stress, suppressing production of and scavenging reactive oxygen species (ROS), with neuroprotective benefits. Until now, this wealth of knowledge about LC-PUFA biomechanisms has not been adequately tapped to develop translational studies of LC-PUFA clinical effects in humans. Future studies integrating neurobiological mechanisms with clinical outcomes may suggest ways to identify depressed individuals most likely to respond to n-3 LC-PUFA supplementation, and mechanistic research may generate new treatment strategies.
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Affiliation(s)
- M Elizabeth Sublette
- Department of Psychiatry, Columbia University, New York, NY, USA.
- Molecular Imaging & Neuropathology Area, New York State Psychiatric Institute, New York, NY, USA.
| | - Federico Manuel Daray
- University of Buenos Aires, School of Medicine, Institute of Pharmacology, Buenos Aires, Argentina
- National Scientific and Technical Research Council, Buenos Aires, Argentina
| | - Licínia Ganança
- Clínica Universitária de Psiquiatria e Psicologia Médica, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
- Departamento de Psiquiatria e Saúde Mental, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - Saame Raza Shaikh
- Nutritional Obesity Research Center, Department of Nutrition, Gillings School of Global Public Health and School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Kim OY, Song J. Important roles of linoleic acid and α-linolenic acid in regulating cognitive impairment and neuropsychiatric issues in metabolic-related dementia. Life Sci 2024; 337:122356. [PMID: 38123015 DOI: 10.1016/j.lfs.2023.122356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 12/02/2023] [Accepted: 12/13/2023] [Indexed: 12/23/2023]
Abstract
Metabolic syndrome (MetS), which is characterized by insulin resistance, high blood glucose, obesity, and dyslipidemia, is known to increase the risk of dementia accompanied by memory loss and depression. The direct pathways and specific mechanisms in the central nervous system (CNS) for addressing fatty acid imbalances in MetS have not yet been fully elucidated. Among polyunsaturated acids, linoleic acid (LA, n6-PUFA) and α-linolenic acid (ALA, n3-PUFA), which are two essential fatty acids that should be provided by food sources (e.g., vegetable oils and seeds), have been reported to regulate various cellular mechanisms including apoptosis, inflammatory responses, mitochondrial biogenesis, and insulin signaling. Furthermore, inadequate intake of LA and ALA is reported to be involved in neuropathology and neuropsychiatric diseases as well as imbalanced metabolic conditions. Herein, we review the roles of LA and ALA on metabolic-related dementia focusing on insulin resistance, dyslipidemia, synaptic plasticity, cognitive function, and neuropsychiatric issues. This review suggests that LA and ALA are important fatty acids for concurrent treatment of both MetS and neurological problems.
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Affiliation(s)
- Oh Yoen Kim
- Department of Food Science and Nutrition, Dong A University, Busan, Republic of Korea; Department of Health Sciences, Graduate School of Dong-A University, Busan, Republic of Korea.
| | - Juhyun Song
- Department of Anatomy, Chonnam National University Medical School, Seoul, Republic of Korea.
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Huang N, Wang F, Li S, Zhai X, Ma W, Liu K, Sheerah HA, Cao J, Eshak ES. Associations of eicosapentaenoic acid and docosahexaenoic acid intakes with cardiovascular and all-cause mortality in patients with diabetes: Result from National Health and Nutrition Examination Survey 1999-2008. Front Cardiovasc Med 2023; 9:1031168. [PMID: 36698925 PMCID: PMC9868810 DOI: 10.3389/fcvm.2022.1031168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 12/02/2022] [Indexed: 01/12/2023] Open
Abstract
Introduction The evidence on eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) intake status and long-term mortality among people with diabetes is scarce. This study aimed to investigate the relationship between EPA and DHA intakes with all-cause and cause-specific mortality in adults with diabetes. Methods This study included 2,991 adults with diabetes from the National Health and Nutrition Examination Survey (NHANES) 1999-2008. Death outcomes were ascertained by linkage to the database records through 31 December 2015. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for mortality from all causes, cardiovascular disease (CVD), and coronary heart disease (CHD) in patients with diabetes. Results Among 2,991 patients with diabetes, the mean age was 61.9 years (55.2% males). During the mean follow-up duration of 9.4 years, a total of 1,091 deaths were documented, of which 273 were due to CVD, including 227 CHD deaths. EPA and DHA intakes were associated with lower mortality risks, especially that of CVD. After adjusting for demographic, major lifestyle factors, overall dietary intake patterns, and history of hypertension and dyslipidemia, the multivariable HRs (95% CIs) of mortality risk comparing Q4 to Q1 of EPA intake were 0.55 (0.33-0.92; P-trend = 0.019) for CHD, 0.55 (0.36-0.83; P-trend = 0.005) for CVD, and 0.91 (0.70-1.18; P-trend = 0.264) for all-cause. The respective HRs (95% CIs) comparing Q4 to Q1 of DHA were 0.60 (0.37-0.98; P-trend = 0.051) for CHD, 0.58 (0.38-0.89; P-trend = 0.014) for CVD, and 0.92 (0.72-1.18; P-trend = 0.481) for all-cause. In subgroup analysis, we found that the association trends of EPA and DHA intakes with death risk remained robust among patients with diabetes, especially among those who are old, female, those with higher BMI, and dyslipidemia patients with CVD and CHD. Discussion In the USA, higher EPA and DHA intakes were associated with a lower risk of CHD and CVD mortality in patients with diabetes. Our study supports the benefits of adequate EPA and DHA intakes in promoting the health of patients with diabetes.
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Affiliation(s)
- Nian Huang
- School of Public Health, Wuhan University, Wuhan, China
| | - Fang Wang
- Department of Biostatistics, School of Public Health, Xuzhou Medical University, Xuzhou, Jiangsu, China,Center for Medical Statistics and Data Analysis, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Shiyang Li
- School of Public Health, Wuhan University, Wuhan, China
| | - Xiaobing Zhai
- Faculty of Applied Sciences, Center for Artificial Intelligence Driven Drug Discovery, Macao Polytechnic University, Macao, Macau SAR, China
| | - Wenzhi Ma
- School of Public Health, Wuhan University, Wuhan, China
| | - Keyang Liu
- Public Health, Department of Social Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Haytham A. Sheerah
- Health Promotion and Health Education Research Chair, King Saud University, Riyadh, Saudi Arabia,Health Promotion Center, Riyadh, Saudi Arabia
| | - Jinhong Cao
- School of Management, Hubei University of Chinese Medicine, Wuhan, China,Research Center for the Development of Traditional Chinese Medicine, Hubei Province Project of Key Research Institute of Humanities and Social Sciences at Universities, Wuhan, China,*Correspondence: Jinhong Cao,
| | - Ehab S. Eshak
- Public Health and Community Medicine, Faculty of Medicine, Minia University, Minya, Egypt,Advanced Clinical Epidemiology, Medical Data Science Unit, Public Health, Graduate School of Medicine, Osaka University, Osaka, Japan,Public Health, School of Health, Calvin University, Grand Rapids, MI, United States
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Kristoffersen AE, Nilsen JV, Stub T, Nordberg JH, Wider B, Mora D, Nakandi K, Bjelland M. Use of Complementary and Alternative Medicine in the context of cancer; prevalence, reasons for use, disclosure, information received, risks and benefits reported by people with cancer in Norway. BMC Complement Med Ther 2022; 22:202. [PMID: 35906578 PMCID: PMC9336131 DOI: 10.1186/s12906-022-03606-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 04/22/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Research exploring the use of specific Complementary and Alternative Medicine (CAM) modalities by Norwegian cancer patients is sparse. The aims of this study were therefor to map the different CAM modalities cancer patients use and further investigate their rationale for use, communication about use, self-reported benefits and harms, and their sources of information about the different modalities.
Methods
In cooperation with the Norwegian Cancer Society (NCS), we conducted an online cross-sectional study among members of their user panel with present or previously cancer (n = 706). The study was carried out in September/October 2021 using a modified cancer-specific version of the International Questionnaire to Measure Use of Complementary and Alternative Medicine (I-CAM-Q). In total, 468 members, 315 women and 153 men, agreed to participate resulting in a response rate of 67.2%. The study was reported in accordance with the National Research Center in Complementary and Alternative Medicine’s (NAFKAM) model of reporting CAM use.
Results
A large proportion of the participants (79%, n = 346) had used some form of CAM with a mean of 3.8 modalities each (range 1-17); 33% (n = 143) had seen a CAM provider, 52% (n = 230) had used natural remedies, while 58% (n = 253) had used self-help practices. Most of the participants used CAM to increase their quality of life, cope with the cancer disease or for relaxation/well-being (64%-94%), mostly with high satisfaction and low rates of adverse effects. Few used CAM to treat cancer or prevent it from spreading (16%, n = 55). The main information sources were health care providers (47%), the internet (47%), and family and friends (39%). More than half (59%) of the cancer patients discussed their use of at least one CAM modality with a physician.
Conclusions
The results of this survey will provide health professionals with more in-depth insight into the patterns of CAM use by cancer patients and facilitate better-informed discussions with their patients. Considering the high use of CAM, reliable information provision supporting cancer care providers’ knowledge and health literacy among patients as well as good communication are crucial. The cooperation between the NCS and NAFKAM provides an example of how to address these issues.
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Pita P, Gribble MO, Antelo M, Ainsworth G, Hyder K, van den Bosch M, Villasante S. Recreational fishing, health and well-being: findings from a cross-sectional survey. ECOSYSTEMS AND PEOPLE (ABINGDON, ENGLAND) 2022; 18:530-546. [PMID: 36540670 PMCID: PMC9762678 DOI: 10.1080/26395916.2022.2112291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 08/05/2022] [Indexed: 06/17/2023]
Abstract
We evaluated the associations between marine recreational fishing, stress, seafood consumption, and sleep quality in a cross-sectional questionnaire-based survey of a convenience sample of 244 fishers recruited in 2019 in Spain. Fishers' stress levels were moderate, with a mean stress index score of 36.4 units on a scale from 14 (very low stress) to 70 (very high). Their average emotional condition was positive, with a mean index of negative affect of 7.8 units on a scale from 5 (very low negative affect) to 25 (very high). Seafood intake was low, with a mean index of seafood in diets of 38.0 units on a scale from 20 (very low seafood consumption) to 160 (very high). Fishers' perceived quality of night sleep was good because the mean index of sleep problems was 39.5 units on a scale from 21 (very low sleep problems) to 107 (very high). Each hour of self-reported monthly fishing activity was associated with 0.016 units of lower stress score. Thus, the most engaged fishers reported up to 15.4% lower stress score than less avid fishers. Since recreational fishing is a highly accessible outdoor activity for people in older age groups, it is possible that public health could be improved by access to sustainably managed recreational fisheries. Fishing engagement was positively associated with seafood intake. Each hour of fishing per month was associated with one-unit higher seafood consumption. The higher seafood consumption observed among avid recreational fishers compared with less avid fishers might have health implications.
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Affiliation(s)
- Pablo Pita
- Cross-Research in Environmental Technologies (CRETUS), University of Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
- Campus Do Mar, International Campus of Excellence, Spain
| | - Matthew O. Gribble
- Gangarosa Department of Environmental Health, Emory University Rollins School of Public Health, Atlanta, GA, USA
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Manel Antelo
- Campus Do Mar, International Campus of Excellence, Spain
- Faculty of Economics and Business Administration, University of Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - Gillian Ainsworth
- Cross-Research in Environmental Technologies (CRETUS), University of Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
- Campus Do Mar, International Campus of Excellence, Spain
| | - Kieran Hyder
- Centre for Environment, Fisheries & Aquaculture Science, Suffolk, UK
- School of Environmental Sciences, University of East Anglia, Norwich, UK
| | - Matilda van den Bosch
- School of Population and Public Health, The University of British Columbia, Vancouver, BC, Canada
- Department of Forest and Conservation Sciences, The University of British Columbia, Vancouver, BC, Canada
- ISGlobal, Parc de Recerca Biomèdica de Barcelona, Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
- Centro de Investigación Biomédica en Red Instituto de Salud Carlos III, Madrid, Spain
| | - Sebastián Villasante
- Cross-Research in Environmental Technologies (CRETUS), University of Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
- Campus Do Mar, International Campus of Excellence, Spain
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Song J, Zhou B, Kan J, Liu G, Zhang S, Si L, Zhang X, Yang X, Ma J, Cheng J, Liu X, Yang Y. Gut microbiota: Linking nutrition and perinatal depression. Front Cell Infect Microbiol 2022; 12:932309. [PMID: 36093196 PMCID: PMC9459161 DOI: 10.3389/fcimb.2022.932309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 08/09/2022] [Indexed: 11/13/2022] Open
Abstract
Perinatal depression is a mood disorder that is reported in women during pregnancy (prenatal) and after childbirth (postnatal). The onset of perinatal depression is associated with changes in reproductive hormones, stress hormones and neurosteroids. These chemical compounds can be modulated by the gut microbiota, which may affect maternal mental health during the perinatal period via the gut-brain-axis. Recent studies suggest that nutritional and dietary interventions (vitamin D, ω-3 fatty acids, iron, and fiber) effectively prevent or mitigate maternal depression and anxiety, but their efficacy is confounded by various factors, including the gut microbiota. Probiotics are efficacious in maintaining microbiota homeostasis, and thus, have the potential to modulate the development of perinatal mood disorders, despite no evidence in human. Therefore, clinical trials are warranted to investigate the role of probiotic supplementation in perinatal depression and behavioral changes. This article reviews the interplay between nutrition, gut microbiota and mood and cognition, and the evidence suggesting that probiotics affect the onset and development of perinatal depression.
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Affiliation(s)
- Jia Song
- Affiliated Wuhan Mental Health Center, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bi Zhou
- Affiliated Wuhan Mental Health Center, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Juntao Kan
- Nutrilite Health Institute, Shanghai, China
| | | | - Sheng Zhang
- Affiliated Wuhan Mental Health Center, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Liang Si
- Affiliated Wuhan Mental Health Center, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xianping Zhang
- Affiliated Wuhan Mental Health Center, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xue Yang
- Affiliated Wuhan Mental Health Center, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Junhua Ma
- Affiliated Wuhan Mental Health Center, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Junrui Cheng
- Ingredion Incorporated, Bridgewater, NJ, United States
| | - Xiaobo Liu
- Affiliated Wuhan Mental Health Center, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- *Correspondence: Yongde Yang, ; Xiaobo Liu,
| | - Yongde Yang
- Affiliated Wuhan Mental Health Center, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- *Correspondence: Yongde Yang, ; Xiaobo Liu,
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11
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Yang R, Wang L, Jin K, Cao S, Wu C, Guo J, Chen J, Tang H, Tang M. Omega-3 Polyunsaturated Fatty Acids Supplementation Alleviate Anxiety Rather Than Depressive Symptoms Among First-Diagnosed, Drug-Naïve Major Depressive Disorder Patients: A Randomized Clinical Trial. Front Nutr 2022; 9:876152. [PMID: 35903448 PMCID: PMC9315396 DOI: 10.3389/fnut.2022.876152] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 05/25/2022] [Indexed: 11/13/2022] Open
Abstract
Background Omega-3 polyunsaturated fatty acids (n-3 PUFAs) augmentation of antidepressants has shown great potential in the prevention and treatment of major depressive disorders (MDD). Objective To investigate the effect of n-3 PUFAs plus venlafaxine in patients with first-diagnosed, drug-naïve depression. Method A total of 72 outpatients with first-diagnosed depression were recruited. The daily dose of 2.4 g/day n-3 PUFAs or placebo plus venlafaxine was used for over 12 weeks. The outcomes were assessed by the Hamilton depression scale (HAMD), Hamilton anxiety scale (HAMA), Beck depression inventory (BDI), and Self-rating anxiety scale (SAS). Results Both groups exhibited improvement on clinical characteristics at week 4 and week 12 compared with baseline. The rate of responders for anxiety in n-3 PUFAs group (44.44%) was significantly higher than that in placebo group (21.21%) at week 4 (χ2 = 4.182, p = 0.041), while week 12 did not show a difference (χ2 = 0.900, p = 0.343). The rate of responders for depression at both week 4 (χ2 = 0.261, p = 0.609) and week 12 (χ2 = 1.443, p = 0.230) showed no significant difference between two groups. Further analysis found that Childhood Trauma Questionnaire (CTQ) had positive correlation with HAMA (r = 0.301, p = 0.012), SAS (r = 0.246, p = 0.015), HAMD (r = 0.252, p = 0.038) and BDI (r = 0.233, p = 0.022) with Pearson correlation analysis. Social Support Rating Scale (SSRS) had negative correlation with SAS (r = -0.244, p = 0.015) and BDI (r = -0.365, p = 0.000). Conclusion This trial found that n-3 PUFAs supplementation in favor of venlafaxine alleviated the anxiety symptoms rather than depressive symptoms at the early stage of treatment (4 weeks) for first-diagnosed, drug-naïve depressed patients. However, the advantage disappeared in long-term treatment. Furthermore, childhood abuse and social support are closely related to the clinical and biological characteristics of depression. Both childhood trauma and lack of social support might be predictors of poor prognosis in depression. Clinical Trial Registration [clinicaltrials.gov], identifier [NCT03295708].
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Affiliation(s)
- Rong Yang
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Lu Wang
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, China National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Kun Jin
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, China National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Song Cao
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, China National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Chujun Wu
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, China National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Jimin Guo
- Department of Microbiology, Immunology and Molecular Genetics, University of California, Los Angeles, Los Angeles, CA, United States
| | - Jindong Chen
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, China National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Hui Tang
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, China National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Mimi Tang
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
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12
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Baba H, Kito S, Nukariya K, Takeshima M, Fujise N, Iga J, Oshibuchi H, Kawano M, Kimura M, Mizukami K, Mimura M. Guidelines for diagnosis and treatment of depression in older adults: A report from the Japanese Society of mood disorders. Psychiatry Clin Neurosci 2022; 76:222-234. [PMID: 35274788 DOI: 10.1111/pcn.13349] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 02/18/2022] [Accepted: 02/22/2022] [Indexed: 11/30/2022]
Abstract
The Committee for Treatment Guidelines of Mood Disorders, Japanese Society of Mood Disorders, published a Japanese guideline for the treatment of late-life depression in 2020. Based on that guideline, the present guideline was developed and revised to incorporate the suggestions of global experts and the latest published evidence. In the diagnosis of late-life depression, it is important to carefully differentiate it from bipolar disorders, depressive states caused by physical and organic brain disease, drug effects, and dementia, and to determine the comorbidity between late-life depression and dementia. It is necessary to fully understand the clinical characteristics and psychosocial background of late-life depression, evaluate the patient's condition, and provide basic interventions based on these factors. Problem-solving therapy, reminiscence therapy/life review therapy, and behavioral activation therapy, and other forms of psychotherapy can reduce depressive symptoms. In terms of pharmacotherapy, newer antidepressants or non-tricyclic antidepressants are recommended for late-life depression, and it is recommended that the efficacy of least the minimal effective dosage should first be determined. Switching antidepressants and aripiprazole augmentation can be used to treatment-resistant therapy. Electroconvulsive therapy and repetitive transcranial magnetic stimulation have demonstrated usefulness for late-life depression. Exercise therapy, high-intensity light therapy, and diet therapy also show some effectiveness and are useful for late-life depression. Continuation therapy should be maintained for at least 1 year after remission.
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Affiliation(s)
- Hajime Baba
- Department of Psychiatry, Juntendo University Koshigaya Hospital, Saitama, Japan.,Department of Psychiatry & Behavioral Science, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shinsuke Kito
- Department of Psychiatry, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan.,Department of Psychiatry, Jikei University School of Medicine, Tokyo, Japan
| | - Kazutaka Nukariya
- Department of Psychiatry, Jikei University School of Medicine, Tokyo, Japan.,Department of Psychiatry, Jikei University School of Medicine, Kashiwa Hospital, Chiba, Japan
| | - Minoru Takeshima
- Department of Psychiatry, Meishin-kai Shibata Hospital, Toyama, Japan.,Department of Psychiatry, Tokyo Medical University, Tokyo, Japan
| | - Noboru Fujise
- Health Care Center, Kumamoto University, Kumamoto, Japan
| | - Junichi Iga
- Department of Neuropsychiatry, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Hidehiro Oshibuchi
- Department of Psychiatry, Tokyo Women's Medical University, Tokyo, Japan.,Department of Child Psychiatry, Kanagawa Children's Medical Center, Kanagawa, Japan
| | | | - Mahiko Kimura
- Department of Neuropsychiatry, Nippon Medical School, Chiba Hokusoh Hospital, Chiba, Japan
| | - Katsuyoshi Mizukami
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tokyo, Japan
| | - Masaru Mimura
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
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13
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Cussotto S, Delgado I, Oriolo G, Kemper J, Begarie D, Dexpert S, Sauvant J, Leboyer M, Aouizerate B, Martin-Santos R, Schaefer M, Capuron L. Low omega-3 polyunsaturated fatty acids predict reduced response to standard antidepressants in patients with major depressive disorder. Depress Anxiety 2022; 39:407-418. [PMID: 35357051 DOI: 10.1002/da.23257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 02/07/2022] [Accepted: 03/17/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Major depressive disorder (MDD) is characterized by a high rate of treatment resistance. Omega (ω)-3 polyunsaturated fatty acids (PUFAs) were shown to correlate with depressive phenotype both in rodents and in humans. However, few studies to date have investigated the role of PUFAs in antidepressant response. The primary aim of this study was to assess the link between baseline PUFA composition and changes in depressive symptoms as well as antidepressant response in a multicenter study of depressed patients. METHODS Sixty depressed adults who met criteria for MDD according to DSM-IV-TR were recruited. Neuropsychiatric evaluations occurred at baseline and after 4 and 8 weeks of treatment with standard antidepressants, including escitalopram (N = 45), sertraline (N = 13) and venlafaxine (N = 2). At study endpoint, patients were stratified into responders (R) or non-responders (NR) based on their MADRS (Montgomery-Åsberg Depression Rating Scale) score. Baseline PUFA levels were assessed and their association with clinical response was determined. RESULTS Lower ω-3 PUFA levels were associated to worse baseline symptomatology. Baseline levels of PUFAs were significantly different between R and NR, with R exhibiting lower docosahexaenoic acid (DHA), eicosapentaenoic acid (EPA) and ω-3 index; and higher ω-6/ω-3 ratio than NR before the start of antidepressant treatment. DHA levels as well as the ω-3 index and ω-6/ω-3 ratio significantly predicted response to antidepressants at study endpoint. CONCLUSIONS These results show that baseline levels of PUFAs predict later response to standard antidepressants in depressed subjects. They suggest that PUFA intake and/or metabolism represent a novel modifiable tool for the management of unresponsive depressed patients.
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Affiliation(s)
- Sofia Cussotto
- University of Bordeaux, INRAE, Bordeaux INP, NutriNeuro, UMR 1286, Bordeaux, France
| | - Inês Delgado
- University of Bordeaux, INRAE, Bordeaux INP, NutriNeuro, UMR 1286, Bordeaux, France
| | - Giovanni Oriolo
- Department of Psychiatry and Psychology, Hospital Clinic, IDIBAPS, CIBERSAM, Barcelona, Spain.,Department of Medicine, Institute of Neuroscience, University of Barcelona, Barcelona, Spain
| | - Jonas Kemper
- Department of Psychiatry, Psychotherapy, Psychosomatics, and Addiction Medicine, Evang. Kliniken Essen-Mitte, Essen, Germany
| | - Diane Begarie
- Departement de Biologie, École Normale Supérieure de Lyon, Université Claude Bernard Lyon I, Université de Lyon, Lyon, France
| | - Sandra Dexpert
- University of Bordeaux, INRAE, Bordeaux INP, NutriNeuro, UMR 1286, Bordeaux, France
| | - Julie Sauvant
- University of Bordeaux, INRAE, Bordeaux INP, NutriNeuro, UMR 1286, Bordeaux, France
| | - Marion Leboyer
- INSERM, U955, Translational Neuro-Psychiatry lab, Institut Mondor de Recherche Biomédicale, Créteil, France.,AP-HP, Département Universitaire d'Addictologie et Psychiatrie des Hôpitaux Henri Mondor University Hospital, Université Paris Est Créteil, Créteil, France
| | - Bruno Aouizerate
- University of Bordeaux, INRAE, Bordeaux INP, NutriNeuro, UMR 1286, Bordeaux, France.,CH Charles Perrens, Pôle de Psychiatrie Générale et Universitaire, Centre de référence régional des pathologies anxieuses et dépressives, Bordeaux, France
| | - Rocío Martin-Santos
- Department of Psychiatry and Psychology, Hospital Clinic, IDIBAPS, CIBERSAM, Barcelona, Spain.,Department of Medicine, Institute of Neuroscience, University of Barcelona, Barcelona, Spain
| | - Martin Schaefer
- Department of Psychiatry, Psychotherapy, Psychosomatics, and Addiction Medicine, Evang. Kliniken Essen-Mitte, Essen, Germany.,Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Lucile Capuron
- University of Bordeaux, INRAE, Bordeaux INP, NutriNeuro, UMR 1286, Bordeaux, France
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14
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Susai SR, Sabherwal S, Mongan D, Föcking M, Cotter DR. Omega-3 fatty acid in ultra-high-risk psychosis: A systematic review based on functional outcome. Early Interv Psychiatry 2022; 16:3-16. [PMID: 33652502 DOI: 10.1111/eip.13133] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 01/12/2021] [Accepted: 01/31/2021] [Indexed: 12/27/2022]
Abstract
AIM Among different types of poly unsaturated fatty acids, omega-3 fatty acids (FA) play a substantial role in brain development and functioning. This review was designed to evaluate and synthesize available evidence regarding omega-3 FAs and functional outcome in the ultra-high-risk (UHR) population. METHODS An electronic search in PubMed, EMBASE, PSYCINFO and COCHRANE search engines has been performed for all articles published until January 2019. The studies that have data regarding omega-3 FAs and functional outcome in UHR population were included. RESULTS Out of 397 nonduplicate citations, 19 articles met selection criteria. These articles were from four different primary studies, namely the Program of Rehabilitation and Therapy (PORT), the North American Prodromal Longitudinal Studies (NAPLS), Vienna High Risk study (VHR) and the NEURAPRO. The data from the NAPLS study found a positive correlation between functional improvement and frequency of dietary intake omega-3 FA. Moreover, among the erythrocyte omega-3 FA only eicosapentaenoic acid (EPA) showed a positive correlation with functional score. The VHR study found long-term improvement in functional outcome in omega-3 group compared to control, whereas such difference was noticed in the NEURAPRO. In the VHR study both omega-3 and omega-6 together predicted the functional improvement at 12 weeks. CONCLUSIONS The number of studies available remains insufficient and more studies with standardized outcome measures in a clinically comparable UHR population would be of more value to understand the clinical benefits of omega-3 FA in the UHR population.
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Affiliation(s)
- Subash Raj Susai
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Sophie Sabherwal
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - David Mongan
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Melanie Föcking
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - David R Cotter
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland
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15
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Okereke OI, Vyas CM, Mischoulon D, Chang G, Cook NR, Weinberg A, Bubes V, Copeland T, Friedenberg G, Lee IM, Buring JE, Reynolds CF, Manson JE. Effect of Long-term Supplementation With Marine Omega-3 Fatty Acids vs Placebo on Risk of Depression or Clinically Relevant Depressive Symptoms and on Change in Mood Scores: A Randomized Clinical Trial. JAMA 2021; 326:2385-2394. [PMID: 34932079 PMCID: PMC8693224 DOI: 10.1001/jama.2021.21187] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
IMPORTANCE Marine omega-3 fatty acid (omega-3) supplements have been used to treat depression but their ability to prevent depression in the general adult population is unknown. OBJECTIVE To test effects of omega-3 supplementation on late-life depression risk and mood scores. DESIGN, SETTING, AND PARTICIPANTS A total of 18 353 adults participated in the VITAL-DEP (Vitamin D and Omega-3 Trial-Depression Endpoint Prevention) ancillary study to VITAL, a randomized trial of cardiovascular disease and cancer prevention among 25 871 US adults. There were 16 657 at risk of incident depression (no previous depression) and 1696 at risk of recurrent depression (previous depression, but not for the past 2 years). Randomization occurred from November 2011 through March 2014; randomized treatment ended on December 31, 2017. INTERVENTIONS Randomized 2 × 2 factorial assignment to vitamin D3 (2000 IU/d), marine omega-3 fatty acids (1 g/d of fish oil, including 465 mg of eicosapentaenoic acid and 375 mg of docosahexaenoic acid) or placebo; 9171 were randomized to omega-3 and 9182 were randomized to matching placebo. MAIN OUTCOMES AND MEASURES Prespecified coprimary outcomes were risk of depression or clinically relevant depressive symptoms (total of incident + recurrent cases); mean difference in mood score (8-item Patient Health Questionnaire [PHQ-8] depression scale). RESULTS Among 18 353 participants who were randomized (mean age, 67.5 [SD, 7.1] years; 49.2% women), 90.3% completed the trial (93.5% among those alive at the end of the trial); the median treatment duration was 5.3 years. The test for interaction between the omega-3 and the vitamin D agents was not significant (P for interaction = .14). Depression risk was significantly higher comparing omega-3 (651 events, 13.9 per 1000 person-years) with placebo (583 events, 12.3 per 1000 person-years; hazard ratio [HR], 1.13; 95% CI, 1.01-1.26; P = .03). No significant differences were observed comparing omega-3 with placebo groups in longitudinal mood scores: the mean difference in change in PHQ-8 score was 0.03 points (95% CI, -0.01 to 0.07; P = .19). Regarding serious and common adverse events, the respective prevalence values in omega-3 vs placebo groups were major cardiovascular events (2.7% vs 2.9%), all-cause mortality (3.3% vs 3.1%), suicide (0.02% vs 0.01%), gastrointestinal bleeding (2.6% vs 2.7%), easy bruising (24.8% vs 25.1%), and stomach upset or pain (35.2% vs 35.1%). CONCLUSIONS AND RELEVANCE Among adults aged 50 years or older without clinically relevant depressive symptoms at baseline, treatment with omega-3 supplements compared with placebo yielded mixed results, with a small but statistically significant increase in risk of depression or clinically relevant depressive symptoms but no difference in mood scores, over a median follow-up of 5.3 years. These findings do not support the use of omega-3 supplements in adults to prevent depression. TRIAL REGISTRATION ClinicalTrials.gov Identifiers: NCT01696435 and NCT01169259.
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Affiliation(s)
- Olivia I. Okereke
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Chirag M. Vyas
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston
| | - David Mischoulon
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Grace Chang
- Department of Psychiatry, VA Boston Healthcare System, Brockton, Massachusetts
| | - Nancy R. Cook
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
- Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Alison Weinberg
- Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Vadim Bubes
- Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Trisha Copeland
- Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Georgina Friedenberg
- Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - I-Min Lee
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
- Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Julie E. Buring
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
- Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Charles F. Reynolds
- Department of Psychiatry, UPMC and University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - JoAnn E. Manson
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
- Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
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16
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Appleton KM, Voyias PD, Sallis HM, Dawson S, Ness AR, Churchill R, Perry R. Omega-3 fatty acids for depression in adults. Cochrane Database Syst Rev 2021; 11:CD004692. [PMID: 34817851 PMCID: PMC8612309 DOI: 10.1002/14651858.cd004692.pub5] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Major depressive disorder (MDD) is highly debilitating, difficult to treat, has a high rate of recurrence, and negatively impacts the individual and society as a whole. One potential treatment for MDD is n-3 polyunsaturated fatty acids (n-3PUFAs), also known as omega-3 oils, naturally found in fatty fish, some other seafood, and some nuts and seeds. Various lines of evidence suggest a role for n-3PUFAs in MDD, but the evidence is far from conclusive. Reviews and meta-analyses clearly demonstrate heterogeneity between studies. Investigations of heterogeneity suggest different effects of n-3PUFAs, depending on the severity of depressive symptoms, where no effects of n-3PUFAs are found in studies of individuals with mild depressive symptomology, but possible benefit may be suggested in studies of individuals with more severe depressive symptomology. Hence it is important to establish their effectiveness in treating MDD. This review updates and incorporates an earlier review with the same research objective (Appleton 2015). OBJECTIVES To assess the effects of n-3 polyunsaturated fatty acids (also known as omega-3 fatty acids) versus a comparator (e.g. placebo, antidepressant treatment, standard care, no treatment, wait-list control) for major depressive disorder (MDD) in adults. SEARCH METHODS We searched the Cochrane Central Register of Controlled trials (CENTRAL), Ovid MEDLINE, Embase and PsycINFO together with trial registries and grey literature sources (to 9 January 2021). We checked reference lists and contacted authors of included studies for additional information when necessary. SELECTION CRITERIA We included studies in the review if they: used a randomised controlled trial design; provided n-3PUFAs as an intervention; used a comparator; measured depressive symptomology as an outcome; and were conducted in adults with MDD. Primary outcomes were depressive symptomology (continuous data collected using a validated rating scale) and adverse events. Secondary outcomes were depressive symptomology (dichotomous data on remission and response), quality of life, and non-completion of studies. DATA COLLECTION AND ANALYSIS We used standard methodological procedures as expected by Cochrane. We assessed the certainty of the evidence using GRADE criteria. MAIN RESULTS The review includes 35 relevant studies: 34 studies involving a total of 1924 participants investigated the impact of n-3PUFA supplementation compared to placebo, and one study involving 40 participants investigated the impact of n-3PUFA supplementation compared to antidepressant treatment. For the placebo comparison, n-3PUFA supplementation resulted in a small to modest benefit for depressive symptomology, compared to placebo: standardised mean difference (SMD) (random-effects model) -0.40 (95% confidence interval (CI) -0.64 to -0.16; 33 studies, 1848 participants; very low-certainty evidence), but this effect is unlikely to be clinically meaningful. An SMD of 0.40 represents a difference between groups in scores on the HDRS (17-item) of approximately 2.5 points (95% CI 1.0 to 4.0), where the minimal clinically important change score on this scale is 3.0 points. The confidence intervals include both a possible clinically important effect and a possible negligible effect, and there is considerable heterogeneity between studies. Sensitivity analyses, funnel plot inspection and comparison of our results with those of large well-conducted trials also suggest that this effect estimate may be biased towards a positive finding for n-3PUFAs. Although the numbers of individuals experiencing adverse events were similar in intervention and placebo groups (odds ratio (OR) 1.27, 95% CI 0.99 to 1.64; 24 studies, 1503 participants; very low-certainty evidence), the confidence intervals include a small decrease to a modest increase in adverse events with n-3PUFAs. There was no evidence for a difference between n-3PUFA and placebo groups in remission rates (OR 1.13, 95% CI 0.74 to 1.72; 8 studies, 609 participants, low-certainty evidence), response rates (OR 1.20, 95% CI 0.80 to 1.79; 17 studies, 794 participants; low-certainty evidence), quality of life (SMD -0.38 (95% CI -0.82 to 0.06), 12 studies, 476 participants, very low-certainty evidence), or trial non-completion (OR 0.92, 95% CI 0.70 to 1.22; 29 studies, 1777 participants, very low-certainty evidence). The evidence on which these results are based was also very limited, highly heterogeneous, and potentially biased. Only one study, involving 40 participants, was available for the antidepressant comparison. This study found no differences between treatment with n-3PUFAs and treatment with antidepressants in depressive symptomology (mean difference (MD) -0.70, 95% CI -5.88 to 4.48), rates of response to treatment (OR 1.23, 95% CI 0.35 to 4.31), or trial non-completion (OR 1.00, 95% CI 0.21 to 4.71). Confidence intervals are however very wide in all analyses, and do not rule out important beneficial or detrimental effects of n-3PUFAs compared to antidepressants. Adverse events were not reported in a manner suitable for analysis, and rates of depression remission and quality of life were not reported. AUTHORS' CONCLUSIONS At present, we do not have sufficient high-certainty evidence to determine the effects of n-3PUFAs as a treatment for MDD. Our primary analyses may suggest a small-to-modest, non-clinically beneficial effect of n-3PUFAs on depressive symptomology compared to placebo; however the estimate is imprecise, and we judged the certainty of the evidence on which this result is based to be low to very low. Our data may also suggest similar rates of adverse events and trial non-completion in n-3PUFA and placebo groups, but again our estimates are very imprecise. Effects of n-3PUFAs compared to antidepressants are very imprecise and uncertain. More complete evidence is required for both the potential positive and negative effects of n-3PUFAs for MDD.
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Affiliation(s)
| | - Philip D Voyias
- North Bristol NHS Trust, Bristol, UK
- University of Bristol, Bristol, UK
| | - Hannah M Sallis
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- MRC Integrative Epidemiology Unit (IEU) at the University of Bristol, Bristol, UK
- School of Psychological Science, University of Bristol, Bristol, UK
| | - Sarah Dawson
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Cochrane Common Mental Disorders, University of York, York, UK
| | - Andrew R Ness
- NIHR Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Rachel Churchill
- Cochrane Common Mental Disorders, University of York, York, UK
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Rachel Perry
- NIHR Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK
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17
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Schroder JD, de Araújo JB, de Oliveira T, de Moura AB, Fries GR, Quevedo J, Réus GZ, Ignácio ZM. Telomeres: the role of shortening and senescence in major depressive disorder and its therapeutic implications. Rev Neurosci 2021; 33:227-255. [PMID: 34388328 DOI: 10.1515/revneuro-2021-0070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 07/17/2021] [Indexed: 11/15/2022]
Abstract
Major depressive disorder (MDD) is one of the most prevalent and debilitating psychiatric disorders, with a large number of patients not showing an effective therapeutic response to available treatments. Several biopsychosocial factors, such as stress in childhood and throughout life, and factors related to biological aging, may increase the susceptibility to MDD development. Included in critical biological processes related to aging and underlying biological mechanisms associated with MDD is the shortening of telomeres and changes in telomerase activity. This comprehensive review discusses studies that assessed the length of telomeres or telomerase activity and function in peripheral blood cells and brain tissues of MDD individuals. Also, results from in vitro protocols and animal models of stress and depressive-like behaviors were included. We also expand our discussion to include the role of telomere biology as it relates to other relevant biological mechanisms, such as the hypothalamic-pituitary-adrenal (HPA) axis, oxidative stress, inflammation, genetics, and epigenetic changes. In the text and the discussion, conflicting results in the literature were observed, especially considering the size of telomeres in the central nervous system, on which there are different protocols with divergent results in the literature. Finally, the context of this review is considering cell signaling, transcription factors, and neurotransmission, which are involved in MDD and can be underlying to senescence, telomere shortening, and telomerase functions.
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Affiliation(s)
- Jessica Daniela Schroder
- Laboratory of Physiology Pharmacology and Psychopathology, Graduate Program in Biomedical Sciences, Federal University of the Southern Frontier, Rodovia SC 484 - Km 02, Fronteira Sul, Postal Code: 89815-899Chapecó, SC, Brazil
| | - Julia Beatrice de Araújo
- Laboratory of Physiology Pharmacology and Psychopathology, Graduate Program in Biomedical Sciences, Federal University of the Southern Frontier, Rodovia SC 484 - Km 02, Fronteira Sul, Postal Code: 89815-899Chapecó, SC, Brazil
| | - Tacio de Oliveira
- Laboratory of Physiology Pharmacology and Psychopathology, Graduate Program in Biomedical Sciences, Federal University of the Southern Frontier, Rodovia SC 484 - Km 02, Fronteira Sul, Postal Code: 89815-899Chapecó, SC, Brazil
| | - Airam Barbosa de Moura
- Laboratory of Translational Psychiatry, Graduate Program in Health Sciences, University of Southern Santa Catarina, Av. Universitária, 1105 - Bairro Universitário Postal Code: 88806-000Criciúma, SC, Brazil
| | - Gabriel Rodrigo Fries
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, Translational Psychiatry Program, The University of Texas Health Science Center at Houston (UTHealth), 1941 East Road BBSB 3142, Houston77054, TX, USA.,Neuroscience Graduate Program, Graduate School of Biomedical Sciences, The University of Texas Health Science Center at Houston (UTHealth), 1941 East Road, BBSB 3142, Houston77054, TX, USA.,Center for Precision Health, School of Biomedical Informatics, The University of Texas Health Science Center at Houston, 1941 East Road, BBSB 3142, Houston77054, TX, USA
| | - João Quevedo
- Laboratory of Translational Psychiatry, Graduate Program in Health Sciences, University of Southern Santa Catarina, Av. Universitária, 1105 - Bairro Universitário Postal Code: 88806-000Criciúma, SC, Brazil.,Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, Translational Psychiatry Program, The University of Texas Health Science Center at Houston (UTHealth), 1941 East Road BBSB 3142, Houston77054, TX, USA.,Neuroscience Graduate Program, Graduate School of Biomedical Sciences, The University of Texas Health Science Center at Houston (UTHealth), 1941 East Road, BBSB 3142, Houston77054, TX, USA.,Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, Center of Excellence on Mood Disorders, The University of Texas Health Science Center at Houston (UTHealth), 1941 East Road, BBSB 3142, Houston77054, TX, USA
| | - Gislaine Zilli Réus
- Laboratory of Translational Psychiatry, Graduate Program in Health Sciences, University of Southern Santa Catarina, Av. Universitária, 1105 - Bairro Universitário Postal Code: 88806-000Criciúma, SC, Brazil
| | - Zuleide Maria Ignácio
- Laboratory of Physiology Pharmacology and Psychopathology, Graduate Program in Biomedical Sciences, Federal University of the Southern Frontier, Rodovia SC 484 - Km 02, Fronteira Sul, Postal Code: 89815-899Chapecó, SC, Brazil.,Laboratory of Translational Psychiatry, Graduate Program in Health Sciences, University of Southern Santa Catarina, Av. Universitária, 1105 - Bairro Universitário Postal Code: 88806-000Criciúma, SC, Brazil
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Tkachev A, Stekolshchikova E, Bobrovskiy DM, Anikanov N, Ogurtsova P, Park DI, Horn AKE, Petrova D, Khrameeva E, Golub MS, Turck CW, Khaitovich P. Long-Term Fluoxetine Administration Causes Substantial Lipidome Alteration of the Juvenile Macaque Brain. Int J Mol Sci 2021; 22:ijms22158089. [PMID: 34360852 PMCID: PMC8348031 DOI: 10.3390/ijms22158089] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 07/13/2021] [Accepted: 07/16/2021] [Indexed: 12/13/2022] Open
Abstract
Fluoxetine is an antidepressant commonly prescribed not only to adults but also to children for the treatment of depression, obsessive-compulsive disorder, and neurodevelopmental disorders. The adverse effects of the long-term treatment reported in some patients, especially in younger individuals, call for a detailed investigation of molecular alterations induced by fluoxetine treatment. Two-year fluoxetine administration to juvenile macaques revealed effects on impulsivity, sleep, social interaction, and peripheral metabolites. Here, we built upon this work by assessing residual effects of fluoxetine administration on the expression of genes and abundance of lipids and polar metabolites in the prelimbic cortex of 10 treated and 11 control macaques representing two monoamine oxidase A (MAOA) genotypes. Analysis of 8871 mRNA transcripts, 3608 lipids, and 1829 polar metabolites revealed substantial alterations of the brain lipid content, including significant abundance changes of 106 lipid features, accompanied by subtle changes in gene expression. Lipid alterations in the drug-treated animals were most evident for polyunsaturated fatty acids (PUFAs). A decrease in PUFAs levels was observed in all quantified lipid classes excluding sphingolipids, which do not usually contain PUFAs, suggesting systemic changes in fatty acid metabolism. Furthermore, the residual effect of the drug on lipid abundances was more pronounced in macaques carrying the MAOA-L genotype, mirroring reported behavioral effects of the treatment. We speculate that a decrease in PUFAs may be associated with adverse effects in depressive patients and could potentially account for the variation in individual response to fluoxetine in young people.
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Affiliation(s)
- Anna Tkachev
- V. Zelman Center for Neurobiology and Brain Restoration, Skolkovo Institute of Science and Technology, 121205 Moscow, Russia; (A.T.); (E.S.); (N.A.); (P.O.); (D.P.)
| | - Elena Stekolshchikova
- V. Zelman Center for Neurobiology and Brain Restoration, Skolkovo Institute of Science and Technology, 121205 Moscow, Russia; (A.T.); (E.S.); (N.A.); (P.O.); (D.P.)
| | - Daniil M. Bobrovskiy
- Faculty of Bioengineering and Bioinformatics, Moscow State University, 119234 Moscow, Russia;
| | - Nickolay Anikanov
- V. Zelman Center for Neurobiology and Brain Restoration, Skolkovo Institute of Science and Technology, 121205 Moscow, Russia; (A.T.); (E.S.); (N.A.); (P.O.); (D.P.)
| | - Polina Ogurtsova
- V. Zelman Center for Neurobiology and Brain Restoration, Skolkovo Institute of Science and Technology, 121205 Moscow, Russia; (A.T.); (E.S.); (N.A.); (P.O.); (D.P.)
| | - Dong Ik Park
- Proteomics and Biomarkers, Max Planck Institute of Psychiatry, 80804 Munich, Germany;
| | - Anja K. E. Horn
- Institute of Anatomy and Cell Biology, Ludwig-Maximilians University, 80336 Munich, Germany;
| | - Daria Petrova
- V. Zelman Center for Neurobiology and Brain Restoration, Skolkovo Institute of Science and Technology, 121205 Moscow, Russia; (A.T.); (E.S.); (N.A.); (P.O.); (D.P.)
| | - Ekaterina Khrameeva
- Center of Life Sciences, Skolkovo Institute of Science and Technology, 121205 Moscow, Russia
- Correspondence: (E.K.); (M.S.G.); (C.W.T.); (P.K.)
| | - Mari S. Golub
- California National Primate Research Center, University of California, Davis, CA 95616, USA
- Correspondence: (E.K.); (M.S.G.); (C.W.T.); (P.K.)
| | - Christoph W. Turck
- Proteomics and Biomarkers, Max Planck Institute of Psychiatry, 80804 Munich, Germany;
- Correspondence: (E.K.); (M.S.G.); (C.W.T.); (P.K.)
| | - Philipp Khaitovich
- V. Zelman Center for Neurobiology and Brain Restoration, Skolkovo Institute of Science and Technology, 121205 Moscow, Russia; (A.T.); (E.S.); (N.A.); (P.O.); (D.P.)
- Correspondence: (E.K.); (M.S.G.); (C.W.T.); (P.K.)
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LC R, EM B, DB H, H S, AR P. A pilot randomized controlled trial testing supplements of omega-3 fatty acids, probiotics, combination or placebo on symptoms of depression, anxiety and stress. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2021. [DOI: 10.1016/j.jadr.2021.100141] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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20
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Branchi I, Poggini S, Capuron L, Benedetti F, Poletti S, Tamouza R, Drexhage HA, Penninx BWJH, Pariante CM. Brain-immune crosstalk in the treatment of major depressive disorder. Eur Neuropsychopharmacol 2021; 45:89-107. [PMID: 33386229 DOI: 10.1016/j.euroneuro.2020.11.016] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 10/04/2020] [Accepted: 11/30/2020] [Indexed: 02/08/2023]
Abstract
A growing number of studies are pointing out the need for a conceptual shift from a brain-centered to a body-inclusive approach in mental health research. In this perspective, the link between the immune and the nervous system, which are deeply interconnected and continuously interacting, is one of the most important novel theoretical framework to investigate the biological bases of major depressive disorder and, more in general, mental illness. Indeed, depressed patients show high levels of inflammatory markers, administration of pro-inflammatory drugs triggers a depressive symptomatology and antidepressant efficacy is reduced by excessive immune system activation. A number of molecular and cellular mechanisms have been hypothesized to act as a link between the immune and brain function, thus representing potential pharmacologically targetable processes for the development of novel and effective therapeutic strategies. These include the modulation of the kynurenine pathway, the crosstalk between metabolic and inflammatory processes, the imbalance in acquired immune responses, in particular T cell responses, and the interplay between neural plasticity and immune system activation. In the personalized medicine approach, the assessment and regulation of these processes have the potential to lead, respectively, to novel diagnostic approaches for the prediction of treatment outcome according to the patient's immunological profile, and to improved efficacy of antidepressant compounds through immune modulation.
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Affiliation(s)
- Igor Branchi
- Center for Behavioral Sciences and Mental Health, Istituto Superiore di Sanità, Viale Regina Elena, 299, 00161 Rome, Italy.
| | - Silvia Poggini
- Center for Behavioral Sciences and Mental Health, Istituto Superiore di Sanità, Viale Regina Elena, 299, 00161 Rome, Italy
| | - Lucile Capuron
- University of Bordeaux, INRAE, Bordeaux INP, NutriNeuro, UMR 1286, Bordeaux, France
| | - Francesco Benedetti
- Division of Neuroscience, Psychiatry and Clinical Psychobiology Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy; University Vita-Salute San Raffaele, Milano, Italy
| | - Sara Poletti
- Division of Neuroscience, Psychiatry and Clinical Psychobiology Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy; University Vita-Salute San Raffaele, Milano, Italy
| | - Ryad Tamouza
- Département Medico-Universitaire de Psychiatrie et d'Addictologie (DMU ADAPT), Laboratoire Neuro-psychiatrie translationnelle, AP-HP, Université Paris Est Créteil, INSERM U955, IMRB, Hôpital Henri Mondor, Fondation FondaMental, F-94010 Créteil, France
| | - Hemmo A Drexhage
- Department of Immunology, ErasmusMC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Brenda W J H Penninx
- Department of Psychiatry, Amsterdam UMC, Department of Amsterdam Public Health Research Institute and Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Carmine M Pariante
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
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- Département Medico-Universitaire de Psychiatrie et d'Addictologie (DMU ADAPT), Laboratoire Neuro-psychiatrie translationnelle, AP-HP, Université Paris Est Créteil, INSERM U955, IMRB, Hôpital Henri Mondor, Fondation FondaMental, F-94010 Créteil, France
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21
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Wolters M, von der Haar A, Baalmann AK, Wellbrock M, Heise TL, Rach S. Effects of n-3 Polyunsaturated Fatty Acid Supplementation in the Prevention and Treatment of Depressive Disorders-A Systematic Review and Meta-Analysis. Nutrients 2021; 13:nu13041070. [PMID: 33806078 PMCID: PMC8064470 DOI: 10.3390/nu13041070] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/17/2021] [Accepted: 03/23/2021] [Indexed: 12/19/2022] Open
Abstract
N-3 polyunsaturated fatty acids (PUFAs) have been suggested to affect depressive disorders. This review aims to determine the effect of n-3 PUFAs on depressive symptoms in people with or without diagnosed depression. Medline, PsycINFO, and Cochrane CENTRAL databases were searched for randomized controlled trials (RCTs) assessing the association between n-3 PUFAs and depressive symptoms or disorders as outcomes. A random-effects meta-analysis of standardized mean difference (SMD) with 95% confidence intervals (CI) was performed. Twenty-five studies (7682 participants) were included. Our meta-analysis (20 studies) indicated that n-3 PUFA supplementation lowered depressive symptomology as compared with placebo: SMD = −0.34, 95% CI: −0.55, −0.12, I2 = 86%, n = 5836, but a possible publication bias cannot be ruled out. Subgroup analyses indicated no statistically significant difference by treatment duration of <12 vs. ≥12 weeks, presence of comorbidity, or severity of depressive symptoms. Nevertheless, beneficial effects were seen in the subgroups of studies with longer treatment duration and with no depression and mild to moderate depression. Subgroup analysis by eicosapentaenoic acid (EPA) dosage revealed differences in favor of the lower EPA dosage. Sensitivity analysis including studies with low risk of bias seems to confirm the overall result. Supplementation of n-3 PUFA appears to have a modest beneficial effect on depressive symptomology, although the quality of evidence is still insufficient.
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22
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Personalized Medicine Using Neuroimmunological Biomarkers in Depressive Disorders. J Pers Med 2021; 11:jpm11020114. [PMID: 33578686 PMCID: PMC7916349 DOI: 10.3390/jpm11020114] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 02/08/2021] [Accepted: 02/08/2021] [Indexed: 02/07/2023] Open
Abstract
Major depressive disorder (MDD) is associated with increased suicidal risk and reduced productivity at work. Neuroimmunology, the study of the immune system and nervous system, provides further insight into the pathogenesis and outcome of MDD. Cytokines are the main modulators of neuroimmunology, and their levels are somewhat entangled in depressive disorders as they affect depressive symptoms and are affected by antidepressant treatment. The use of cytokine-derived medication as a treatment option for MDD is currently a topic of interest. Although not very promising, cytokines are also considered as possible prognostic or diagnostic markers for depression. The machine learning approach is a powerful tool for pattern recognition and has been used in psychiatry for finding useful patterns in data that have translational meaning and can be incorporated in daily clinical practice. This review focuses on the current knowledge of neuroimmunology and depression and the possible use of machine learning to widen our understanding of the topic.
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van der Wurff ISM, von Schacky C, Bergeland T, Leontjevas R, Zeegers MP, Kirschner PA, de Groot RHM. Effect of one year krill oil supplementation on depressive symptoms and self-esteem of Dutch adolescents: A randomized controlled trial. Prostaglandins Leukot Essent Fatty Acids 2020; 163:102208. [PMID: 33232912 DOI: 10.1016/j.plefa.2020.102208] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 10/29/2020] [Accepted: 11/07/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Observational studies have shown a relationship between omega-3 long-chain polyunsaturated fatty acids (n-3 LCPUFA) and depression in adolescents. However, n-3 LCPUFA supplementation studies investigating the potential improvement in depressive feelings in adolescents from the general population are missing. METHODS A one-year double-blind, randomized, placebo controlled krill oil supplementation trial was conducted in two cohorts. Cohort I started with 400 mg eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) or placebo, after three months this increased to 800 mg EPA and DHA per day, whilst cohort II started with this higher dose. Omega-3 Index (O3I) was monitored via finger-prick blood measurements. At baseline, six and 12 months participants completed the Centre for Epidemiologic Studies Depression Scale (CES-D) and the Rosenberg Self Esteem questionnaire (RSE). Adjusted mixed models were run with treatment allocation/O3I as predictor of CES-D and RSE scores. RESULTS Both intention-to-treat and assessing the change in O3I analyses did not show significant effects on CES-D or RSE scores. CONCLUSION There is no evidence for less depressive feelings, or higher self-esteem after one year of krill oil supplementation. However, due to a lack of adherence and drop-out issues, these results should be interpreted with caution.
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Affiliation(s)
- I S M van der Wurff
- Faculty of Educational Sciences, Open University of the Netherlands, the Netherlands, Heerlen 6419 AT, the Netherlands.
| | - C von Schacky
- Omegametrix, Martinsried 82 152, Germany; Preventive Cardiology, Medical Clinic and Poli-Clinic I, Ludwig Maximilians-University Munich, 80336 Munich, Germany
| | - T Bergeland
- Aker BioMarine Antarctic AS, Lysaker NO-1327, Norway (former)
| | - R Leontjevas
- Faculty of Psychology, Open University of the Netherlands, 6419 AT Heerlen, The Netherlands
| | - M P Zeegers
- Nutrition and Translational Research in Metabolism (School NUTRIM), Maastricht University, 6200 MD Maastricht, The Netherlands; Care and Public Health Research Institute (School CAPHRI), Maastricht University, 6200 MD Maastricht, The Netherlands
| | - P A Kirschner
- Faculty of Educational Sciences, Open University of the Netherlands, the Netherlands, Heerlen 6419 AT, the Netherlands; Expertise Centre for Effective Learning, Thomas More University of Applied Sciences, Mechelen, Belgium; University of Oulu, Oulu, Finland
| | - R H M de Groot
- Faculty of Educational Sciences, Open University of the Netherlands, the Netherlands, Heerlen 6419 AT, the Netherlands; Nutrition and Translational Research in Metabolism (School NUTRIM), Maastricht University, 6200 MD Maastricht, The Netherlands
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Emery S, Häberling I, Berger G, Baumgartner N, Strumberger M, Albermann M, Nalani K, Schmeck K, Erb S, Bachmann S, Wöckel L, Müller-Knapp U, Contin-Waldvogel B, Rhiner B, Walitza S, Hersberger M, Drechsler R. Verbal Memory Performance in Depressed Children and Adolescents: Associations with EPA but Not DHA and Depression Severity. Nutrients 2020; 12:nu12123630. [PMID: 33255819 PMCID: PMC7761519 DOI: 10.3390/nu12123630] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 11/13/2020] [Accepted: 11/23/2020] [Indexed: 02/08/2023] Open
Abstract
Omega-3 polyunsaturated fatty acids (n-3 PUFAs) have been described as positively associated with cognitive functioning. Current meta-analyses have identified eicosapentaenoic acid (EPA) as potentially more effective than docosahexaenoic acid (DHA). An especially vulnerable subgroup that might benefit from these beneficial effects are depressed youths. In this study, we examined associations between red blood cell (RBC) DHA and EPA levels and depression severity and verbal memory performance in a sample of 107 moderately (n = 63) and severely (n = 44) depressed youths. The findings showed that youths with high RBC EPA levels had steeper learning curves compared to those with moderate or low RBC EPA levels (Pillai's Trace = 0.195, p = 0.027, ηp2 = 0.097). No associations between RBC DHA levels or depression severity and verbal memory performance were observed. Our results further confirm previous findings indicating a more important role of EPA compared to DHA in relation to cognitive functioning. Future research should further investigate the differential role of EPA and DHA concerning cognitive functioning in depressed youths. Evidence supporting beneficial supplementation effects could potentially establish a recommendation for a natural and easily accessible intervention for cognitive improvement or remission.
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Affiliation(s)
- Sophie Emery
- Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric Hospital, University of Zurich, 8032 Zurich, Switzerland; (I.H.); (G.B.); (N.B.); (M.A.); (S.W.); (R.D.)
- Correspondence:
| | - Isabelle Häberling
- Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric Hospital, University of Zurich, 8032 Zurich, Switzerland; (I.H.); (G.B.); (N.B.); (M.A.); (S.W.); (R.D.)
| | - Gregor Berger
- Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric Hospital, University of Zurich, 8032 Zurich, Switzerland; (I.H.); (G.B.); (N.B.); (M.A.); (S.W.); (R.D.)
| | - Noemi Baumgartner
- Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric Hospital, University of Zurich, 8032 Zurich, Switzerland; (I.H.); (G.B.); (N.B.); (M.A.); (S.W.); (R.D.)
| | - Michael Strumberger
- Research Department of Child and Adolescent Psychiatry, Psychiatric University Hospitals Basel, University of Basel, 4002 Basel, Switzerland; (M.S.); (K.S.); (L.W.)
| | - Mona Albermann
- Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric Hospital, University of Zurich, 8032 Zurich, Switzerland; (I.H.); (G.B.); (N.B.); (M.A.); (S.W.); (R.D.)
| | - Kristin Nalani
- Clinic for Psychosomatic Medicine and Psychiatry, University Hospital Zurich, 8091 Zurich, Switzerland;
| | - Klaus Schmeck
- Research Department of Child and Adolescent Psychiatry, Psychiatric University Hospitals Basel, University of Basel, 4002 Basel, Switzerland; (M.S.); (K.S.); (L.W.)
| | - Suzanne Erb
- Child and Adolescent Psychiatric Services St. Gallen, 9004 St. Gallen, Switzerland;
| | - Silke Bachmann
- Department of Psychiatry, University Hospitals of Geneva, 1226 Thônex, Switzerland;
- Department of Psychiatry Psychotherapy, Psychosomatic Medicine, Medical Faculty of Martin Luther University, 06112 Halle, Germany
| | - Lars Wöckel
- Research Department of Child and Adolescent Psychiatry, Psychiatric University Hospitals Basel, University of Basel, 4002 Basel, Switzerland; (M.S.); (K.S.); (L.W.)
- Clienia Littenheid AG, 9573 Littenheid, Switzerland
| | - Ulrich Müller-Knapp
- Child and Adolescent Psychiatry Klinik Sonnenhof, 9608 Ganterschwil, Switzerland;
| | | | - Bruno Rhiner
- Child and Adolescent Psychiatric Services Thurgau, 8570 Weinfelden, Switzerland;
| | - Susanne Walitza
- Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric Hospital, University of Zurich, 8032 Zurich, Switzerland; (I.H.); (G.B.); (N.B.); (M.A.); (S.W.); (R.D.)
- Neuroscience Center Zurich, University of Zurich and ETH Zurich, 8057 Zurich, Switzerland
- Center for Integrative Human Physiology Zurich, University of Zurich, 8057 Zurich, Switzerland;
| | - Martin Hersberger
- Center for Integrative Human Physiology Zurich, University of Zurich, 8057 Zurich, Switzerland;
- Division of Clinical Chemistry and Biochemistry, University Children’s Hospital Zurich, 8032 Zurich, Switzerland
| | - Renate Drechsler
- Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric Hospital, University of Zurich, 8032 Zurich, Switzerland; (I.H.); (G.B.); (N.B.); (M.A.); (S.W.); (R.D.)
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Nobis A, Zalewski D, Waszkiewicz N. Peripheral Markers of Depression. J Clin Med 2020; 9:E3793. [PMID: 33255237 PMCID: PMC7760788 DOI: 10.3390/jcm9123793] [Citation(s) in RCA: 92] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 11/09/2020] [Accepted: 11/19/2020] [Indexed: 12/22/2022] Open
Abstract
Major Depressive Disorder (MDD) is a leading cause of disability worldwide, creating a high medical and socioeconomic burden. There is a growing interest in the biological underpinnings of depression, which are reflected by altered levels of biological markers. Among others, enhanced inflammation has been reported in MDD, as reflected by increased concentrations of inflammatory markers-C-reactive protein, interleukin-6, tumor necrosis factor-α and soluble interleukin-2 receptor. Oxidative and nitrosative stress also plays a role in the pathophysiology of MDD. Notably, increased levels of lipid peroxidation markers are characteristic of MDD. Dysregulation of the stress axis, along with increased cortisol levels, have also been reported in MDD. Alterations in growth factors, with a significant decrease in brain-derived neurotrophic factor and an increase in fibroblast growth factor-2 and insulin-like growth factor-1 concentrations have also been found in MDD. Finally, kynurenine metabolites, increased glutamate and decreased total cholesterol also hold promise as reliable biomarkers for MDD. Research in the field of MDD biomarkers is hindered by insufficient understanding of MDD etiopathogenesis, substantial heterogeneity of the disorder, common co-morbidities and low specificity of biomarkers. The construction of biomarker panels and their evaluation with use of new technologies may have the potential to overcome the above mentioned obstacles.
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Affiliation(s)
- Aleksander Nobis
- Department of Psychiatry, Medical University of Bialystok, pl. Brodowicza 1, 16-070 Choroszcz, Poland; (D.Z.); (N.W.)
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Thesing CS, Milaneschi Y, Bot M, Brouwer IA, Owens M, Hegerl U, Gili M, Roca M, Kohls E, Watkins E, Visser M, Penninx BWJH. Supplementation-induced increase in circulating omega-3 serum levels is not associated with a reduction in depressive symptoms: Results from the MooDFOOD depression prevention trial. Depress Anxiety 2020; 37:1079-1088. [PMID: 32845021 PMCID: PMC7693241 DOI: 10.1002/da.23092] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 04/29/2020] [Accepted: 07/29/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND There is ambiguity on how omega-3 (n-3) polyunsaturated fatty acids (PUFAs) are associated with depression, and what the temporality of the association might be. The present study aimed to examine whether (intervention-induced changes in) n-3 PUFA levels were associated with (changes in) depressive symptoms. METHODS Baseline, 6- and 12-month follow-up data on 682 overweight and subclinically depressed persons from four European countries that participated in the MooDFOOD depression prevention randomized controlled trial were used. Participants were allocated to four intervention groups: (a) placebos, (b) placebos and food-related behavioral activation therapy (F-BA), (c) multinutrient supplements (fish oil and multivitamin), and (d) multinutrient supplements and F-BA. Depressive symptoms were measured using the inventory of depressive symptomatology. PUFA levels (µmol/L) were measured using gas chromatography. Analyses were adjusted for sociodemographics, lifestyle, and somatic health. RESULTS Increases in n-3 PUFA, docosahexaenoic acid, and eicosapentaenoic acid levels over time were significantly larger in the supplement groups than in placebo groups. Change in PUFA levels was not significantly associated with the change in depressive symptoms (β = .002, SE = 0.003, p = .39; β = .003, SE = 0.005, p = .64; β = .005, SE = 0.005, p = .29; β = -.0002, SE = 0.0004, p = .69). Baseline PUFA levels did not modify the intervention effects on depressive symptoms. CONCLUSIONS In overweight and subclinical depressed persons, multinutrient supplements led to significant increases in n-3 PUFA levels over time, which were not associated with changes in depressive symptoms. Multinutrient supplements do not seem to be an effective preventive strategy in lowering depressive symptoms over time in these at-risk groups.
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Affiliation(s)
- Carisha S. Thesing
- Department of Psychiatry, Amsterdam Public Health Research Institute de Boelelaan, Amsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Yuri Milaneschi
- Department of Psychiatry, Amsterdam Public Health Research Institute de Boelelaan, Amsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Mariska Bot
- Department of Psychiatry, Amsterdam Public Health Research Institute de Boelelaan, Amsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Ingeborg A. Brouwer
- Department of Health Sciences, Faculty of Science and the Amsterdam Public Health research instituteVrije Universiteit AmsterdamAmsterdamthe Netherlands
| | - Matt Owens
- Department of PsychologyUniversity of ExeterExeterUnited Kingdom
| | - Ulrich Hegerl
- Department of Psychiatry, Psychosomatics, and PsychotherapyGoethe‐Universität FrankfurtFrankfurt a.M.Germany
| | - Margalida Gili
- Institut Universitari d'Investigació en Ciències de la Salut, Idisba, RediappUniversity of Balearic IslandsPalma de MallorcaSpain
| | - Miquel Roca
- Institut Universitari d'Investigació en Ciències de la Salut, Idisba, RediappUniversity of Balearic IslandsPalma de MallorcaSpain
| | - Elisabeth Kohls
- Department of Psychiatry and Psychotherapy, Medical FacultyUniversity of LeipzigLeipzigGermany
| | - Ed Watkins
- Department of PsychologyUniversity of ExeterExeterUnited Kingdom
| | - Marjolein Visser
- Department of Health Sciences, Faculty of Science and the Amsterdam Public Health research instituteVrije Universiteit AmsterdamAmsterdamthe Netherlands
| | - Brenda W. J. H. Penninx
- Department of Psychiatry, Amsterdam Public Health Research Institute de Boelelaan, Amsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
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Nutraceuticals and probiotics in the management of psychiatric and neurological disorders: A focus on microbiota-gut-brain-immune axis. Brain Behav Immun 2020; 90:403-419. [PMID: 32889082 DOI: 10.1016/j.bbi.2020.08.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 08/20/2020] [Accepted: 08/26/2020] [Indexed: 12/12/2022] Open
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Dragano NR, Monfort-Pires M, Velloso LA. Mechanisms Mediating the Actions of Fatty Acids in the Hypothalamus. Neuroscience 2020; 447:15-27. [DOI: 10.1016/j.neuroscience.2019.10.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 10/02/2019] [Accepted: 10/03/2019] [Indexed: 12/12/2022]
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van der Wurff IS, Meyer BJ, de Groot RH. Effect of Omega-3 Long Chain Polyunsaturated Fatty Acids (n-3 LCPUFA) Supplementation on Cognition in Children and Adolescents: A Systematic Literature Review with a Focus on n-3 LCPUFA Blood Values and Dose of DHA and EPA. Nutrients 2020; 12:nu12103115. [PMID: 33053843 PMCID: PMC7599612 DOI: 10.3390/nu12103115] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 10/05/2020] [Accepted: 10/06/2020] [Indexed: 02/06/2023] Open
Abstract
Omega-3 long chain polyunsaturated fatty acids (n-3 LCPUFA) supplementation in the cardiovascular field is effective if a certain Omega-3 index (O3I) is achieved or the daily n-3 LCPUFA dose is high enough. Whether this applies to studies on cognition in children and adolescents is unclear. The aims of the current review were to investigate whether: (1) a certain O3I level and (2) a minimum daily n-3 LCPUFA dose are required to improve cognition in 4-25 year olds. Web of Science and PubMed were searched. Inclusion criteria: placebo controlled randomized controlled trial; participants 4-25 years; supplementation with docosahexaenoic acid (DHA) and/or eicosapentaenoic acid (EPA); assessing cognition; in English and ≥10 participants per treatment arm. Thirty-three studies were included, 21 in typically developing participants, 12 in those with a disorder. A positive effect on cognitive measures was more likely in studies with an increase in O3I to >6%. Half of the studies in typically developing children with daily supplementation dose ≥450 mg DHA + EPA showed improved cognition. For children with a disorder no cut-off value was found. In conclusion, daily supplementation of ≥450 mg DHA + EPA per day and an increase in the O3I to >6% makes it more likely to show efficacy on cognition in children and adolescents.
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Affiliation(s)
- Inge S.M. van der Wurff
- Conditions for Lifelong Learning, Faculty of Educational Sciences, Open University of the Netherlands, 6419 Heerlen, The Netherlands;
| | - Barbara J. Meyer
- School of Medicine, Lipid Research Centre, Molecular Horizons, Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW 2522, Australia;
| | - Renate H.M. de Groot
- Conditions for Lifelong Learning, Faculty of Educational Sciences, Open University of the Netherlands, 6419 Heerlen, The Netherlands;
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, 6200 Maastricht, The Netherlands
- Correspondence: ; Tel.: +31-45-576-2909
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Kagan I, Mesilati-Stahy R, Green P, Singer P. Effect of Supplemental Enteral Fish Oil on the Development of Psychological Complications in Critically Ill Multiple-Trauma Patients: 6 Months' Follow-Up. JPEN J Parenter Enteral Nutr 2020; 45:1567-1580. [PMID: 33029789 DOI: 10.1002/jpen.2025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 09/29/2020] [Accepted: 10/01/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) is common in intensive care unit (ICU) patients. Defic it intake of ω-3 polyuns aturated fatty ac ids (PUFAs) may be as sociated with developm ent of PTSD. METHODS This study randomized mechanically ventilated patients suffering from multiple trauma (n = 150) into 2 groups: a study and a control group that received enteral feeding with or without fish oil. Fifty-one patients were interviewed 6 months after discharge from the ICU. Psychometric parameters of PTSD were assessed by questionnaires. The fatty acid composition of erythrocyte membranes was performed by homogenization of the cells in hexane-isopropanol. RESULTS No differences were found in baseline characteristics between the groups. Erythrocyte membrane composition showed significantly higher concentrations of ω-3 fatty acids in the study group. Anxiety and depression symptoms were correlated with an increase in eicosapentaenoic acid (EPA) on days 4 and 8 for depression and EPA on day 4 and docosahexaenoic acid (DHA) on day 8 for anxiety. Total ω-3 content was positively correlated with anxiety and depression as well. An inverse correlation was found between DHA and EPA in the treatment group and with the total ω-3 and DHA in the control group for the Brief Illness Perceptions Questionnaire. CONCLUSION Administration of an ω-3 PUFA-enriched diet during the ICU stay did not prevent development of PTSD in trauma patients 6 months after discharge from ICU.
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Affiliation(s)
- Ilya Kagan
- Department of Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Ronit Mesilati-Stahy
- Department of Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Petah Tikva, Israel
- Laboratory of Nutrition and Metabolism Research, Felsenstein Medical Research Center, Sackler Faculty of Medicine, Tel Aviv University, Rabin Medical Center-Beilinson Campus, Petah Tikva, Israel
- Faculty of Agriculture, Rehovot, Jerusalem University, Petah Tikva, Israel
| | - Pnina Green
- Laboratory of Nutrition and Metabolism Research, Felsenstein Medical Research Center, Sackler Faculty of Medicine, Tel Aviv University, Rabin Medical Center-Beilinson Campus, Petah Tikva, Israel
| | - Pierre Singer
- Department of Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Petah Tikva, Israel
- Laboratory of Nutrition and Metabolism Research, Felsenstein Medical Research Center, Sackler Faculty of Medicine, Tel Aviv University, Rabin Medical Center-Beilinson Campus, Petah Tikva, Israel
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31
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Diet, Stress and Mental Health. Nutrients 2020; 12:nu12082428. [PMID: 32823562 PMCID: PMC7468813 DOI: 10.3390/nu12082428] [Citation(s) in RCA: 128] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 07/25/2020] [Accepted: 08/04/2020] [Indexed: 12/14/2022] Open
Abstract
Introduction: There has long been an interest in the effects of diet on mental health, and the interaction of the two with stress; however, the nature of these relationships is not well understood. Although associations between diet, obesity and the related metabolic syndrome (MetS), stress, and mental disorders exist, causal pathways have not been established. Methods: We reviewed the literature on the relationship between diet, stress, obesity and psychiatric disorders related to stress. Results: Diet and obesity can affect mood through direct effects, or stress-related mental disorders could lead to changes in diet habits that affect weight. Alternatively, common factors such as stress or predisposition could lead to both obesity and stress-related mental disorders, such as depression and posttraumatic stress disorder (PTSD). Specific aspects of diet can lead to acute changes in mood as well as stimulate inflammation, which has led to efforts to assess polyunsaturated fats (PUFA) as a treatment for depression. Bidirectional relationships between these different factors are also likely. Finally, there has been increased attention recently on the relationship between the gut and the brain, with the realization that the gut microbiome has an influence on brain function and probably also mood and behavior, introducing another way diet can influence mental health and disorders. Brain areas and neurotransmitters and neuropeptides that are involved in both mood and appetite likely play a role in mediating this relationship. Conclusions: Understanding the relationship between diet, stress and mood and behavior could have important implications for the treatment of both stress-related mental disorders and obesity.
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Guu TW, Mischoulon D, Sarris J, Hibbeln J, McNamara RK, Hamazaki K, Freeman MP, Maes M, Matsuoka YJ, Belmaker RH, Jacka F, Pariante C, Berk M, Marx W, Su KP. International Society for Nutritional Psychiatry Research Practice Guidelines for Omega-3 Fatty Acids in the Treatment of Major Depressive Disorder. PSYCHOTHERAPY AND PSYCHOSOMATICS 2020; 88:263-273. [PMID: 31480057 DOI: 10.1159/000502652] [Citation(s) in RCA: 83] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Accepted: 08/11/2019] [Indexed: 11/19/2022]
Abstract
Major depressive disorder (MDD) is a complex mental illness with unmet therapeutic needs. The antidepressant effects of ω-3 polyunsaturated fatty acids (n-3 PUFAs) have been widely reported. The subcommittee of the International Society for Nutritional Psychiatry Research organized an expert panel and conducted a literature review and a Delphi process to develop a consensus-based practice guideline for clinical use of n-3 PUFAs in MDD. The guideline focuses on 5 thematic areas: general concepts, acute treatment strategy, depression recurrence monitoring and prevention, use in special populations, and potential safety issues. The key practice guidelines contend that: (1) clinicians and other practitioners are advised to conduct a clinical interview to validate clinical diagnoses, physical conditions, and measurement-based psychopathological assessments in the therapeutic settings when recommending n-3 PUFAs in depression treatment; (2) with respect to formulation and dosage, both pure eicosapentaenoic acid (EPA) or an EPA/docosahexaenoic acid (DHA) combination of a ratio higher than 2 (EPA/DHA >2) are considered effective, and the recommended dosages should be 1-2 g of net EPA daily, from either pure EPA or an EPA/DHA (>2:1) formula; (3) the quality of n-3 PUFAs may affect therapeutic activity; and (4) potential adverse effects, such as gastrointestinal and dermatological conditions, should be monitored, as well as obtaining comprehensive metabolic panels. The expert consensus panel has agreed on using n-3 PUFAs in MDD treatment for pregnant women, children, and the elderly, and prevention in high-risk populations. Personalizing the clinical application of n-3 PUFAs in subgroups of MDD with a low Omega-3 Index or high levels of inflammatory markers might be regarded as areas that deserve future research.
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Affiliation(s)
- Ta-Wei Guu
- Departments of Psychiatry and Mind-Body Interface Laboratory (MBI-Lab), China Medical University Hospital, Taichung, Taiwan.,Division of Psychiatry, Departments of Internal Medicine, China Medical University Beigang Hospital, Yunlin, Taiwan
| | - David Mischoulon
- Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jerome Sarris
- NICM, Health Research Institute, Western Sydney University, Westmead, New South Wales, Australia.,Department of Psychiatry, The Melbourne Clinic, Professorial Unit, Melbourne University, Melbourne, Victoria, Australia
| | - Joseph Hibbeln
- Section on Nutritional Neuroscience, National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland, USA
| | - Robert K McNamara
- Department of Psychiatry, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Kei Hamazaki
- Department of Public Health, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Marlene P Freeman
- Clinical Trials Network and Institute, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Michael Maes
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Yutaka J Matsuoka
- Division of Health Care Research, Center for Public Health Sciences, National Cancer Center Japan, Tokyo, Japan
| | - R H Belmaker
- Ben Gurion University of the Negev, Beersheba, Israel
| | - Felice Jacka
- IMPACT SRC, Food and Mood Centre, School of Medicine, Faculty of Health, Deakin University, Sydney, New South Wales, Australia
| | - Carmine Pariante
- Stress, Psychiatry and Immunology Laboratory, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Michael Berk
- Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia
| | - Wolfgang Marx
- IMPACT SRC, Food and Mood Centre, School of Medicine, Faculty of Health, Deakin University, Sydney, New South Wales, Australia
| | - Kuan-Pin Su
- Departments of Psychiatry and Mind-Body Interface Laboratory (MBI-Lab), China Medical University Hospital, Taichung, Taiwan, .,College of Medicine, China Medical University, Taichung, Taiwan,
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Bear TLK, Dalziel JE, Coad J, Roy NC, Butts CA, Gopal PK. The Role of the Gut Microbiota in Dietary Interventions for Depression and Anxiety. Adv Nutr 2020; 11:890-907. [PMID: 32149335 PMCID: PMC7360462 DOI: 10.1093/advances/nmaa016] [Citation(s) in RCA: 100] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 12/16/2019] [Accepted: 02/17/2020] [Indexed: 12/12/2022] Open
Abstract
There is emerging evidence that an unhealthy dietary pattern may increase the risk of developing depression or anxiety, whereas a healthy dietary pattern may decrease it. This nascent research suggests that dietary interventions could help prevent, or be an alternative or adjunct therapy for, depression and anxiety. The relation, however, is complex, affected by many confounding variables, and is also likely to be bidirectional, with dietary choices being affected by stress and depression. This complexity is reflected in the data, with sometimes conflicting results among studies. As the research evolves, all characteristics of the relation need to be considered to ensure that we obtain a full understanding, which can potentially be translated into clinical practice. A parallel and fast-growing body of research shows that the gut microbiota is linked with the brain in a bidirectional relation, commonly termed the microbiome-gut-brain axis. Preclinical evidence suggests that this axis plays a key role in the regulation of brain function and behavior. In this review we discuss possible reasons for the conflicting results in diet-mood research, and present examples of areas of the diet-mood relation in which the gut microbiota is likely to be involved, potentially explaining some of the conflicting results from diet and depression studies. We argue that because diet is one of the most significant factors that affects human gut microbiota structure and function, nutritional intervention studies need to consider the gut microbiota as an essential piece of the puzzle.
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Affiliation(s)
- Tracey L K Bear
- School of Food and Advanced Technology, Massey University, Palmerston North, New Zealand
- Riddet Institute, Massey University, Palmerston North, New Zealand
- The New Zealand Institute for Plant and Food Research Limited, Palmerston North, New Zealand
| | - Julie E Dalziel
- Riddet Institute, Massey University, Palmerston North, New Zealand
- AgResearch Ltd Grasslands Research Centre, Palmerston North, New Zealand
| | - Jane Coad
- School of Food and Advanced Technology, Massey University, Palmerston North, New Zealand
| | - Nicole C Roy
- Riddet Institute, Massey University, Palmerston North, New Zealand
- AgResearch Ltd Grasslands Research Centre, Palmerston North, New Zealand
- High-Value Nutrition National Science Challenge, Auckland, New Zealand
| | - Christine A Butts
- The New Zealand Institute for Plant and Food Research Limited, Palmerston North, New Zealand
| | - Pramod K Gopal
- Riddet Institute, Massey University, Palmerston North, New Zealand
- The New Zealand Institute for Plant and Food Research Limited, Palmerston North, New Zealand
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Yonezawa K, Kusumoto Y, Kanchi N, Kinoshita H, Kanegae S, Yamaguchi N, Ozawa H. Recent trends in mental illness and omega-3 fatty acids. J Neural Transm (Vienna) 2020; 127:1491-1499. [DOI: 10.1007/s00702-020-02212-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 05/19/2020] [Indexed: 01/24/2023]
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35
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Zhang J, Tao N, Qian X, Wang X, Wang M. Evaluation of antioxidative capacity and lipidomics profiling of big eye tuna (
Thunns obesus
) head soup with different colloidal particle size. Int J Food Sci Technol 2020. [DOI: 10.1111/ijfs.14588] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Jing Zhang
- College of Food Science and Technology Shanghai Ocean University Shanghai201306 China
| | - Ningping Tao
- College of Food Science and Technology Shanghai Ocean University Shanghai201306 China
- Shanghai Engineering Research Center of Aquatic‐Product Processing & Preservation Shanghai201306China
| | - Xueli Qian
- College of Food Science and Technology Shanghai Ocean University Shanghai201306 China
| | - Xichang Wang
- College of Food Science and Technology Shanghai Ocean University Shanghai201306 China
- Shanghai Engineering Research Center of Aquatic‐Product Processing & Preservation Shanghai201306China
| | - Mingfu Wang
- College of Food Science and Technology Shanghai Ocean University Shanghai201306 China
- School of biological sciences The University of Hong Kong Pokfulam Road Hong Kong999077China
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Carabelli B, Delattre AM, Waltrick APF, Araújo G, Suchecki D, Machado RB, de Souza LER, Zanata SM, Zanoveli JM, Ferraz AC. Fish-oil supplementation decreases Indoleamine-2,3-Dioxygenase expression and increases hippocampal serotonin levels in the LPS depression model. Behav Brain Res 2020; 390:112675. [PMID: 32407816 DOI: 10.1016/j.bbr.2020.112675] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 04/07/2020] [Accepted: 04/24/2020] [Indexed: 10/24/2022]
Abstract
AIM To test the hypothesis that the antidepressant-like effect of omega-3 polyunsaturated fatty acids is related to the Indoleamine-2,3-Dioxygenase (IDO) inhibition. METHODS Animals were supplemented for 50 days with 3.0 g/kg of Fish Oil (FO) or received water (Control group - C), via gavage. At the end of this period, both groups were injected with LPS 24 h before the modified forced swim test (MFST) and the open field. To assess the possible involvement of IDO in the FO effects, we performed two independent experiments, using two IDO inhibitors: the direct inhibitor 1-methyl-DL-tryptophan (1-MT) and the anti-inflammatory drug minocycline (MINO), administered 23 h, 5 h and 1 h before the tests. After the tests, the animals' hippocampi were removed for quantification of serotonin (5-HT) and its metabolite 5-hydroxyindoleacetic acid (5-HIAA) by HPLC, and for IDO expression by western blot. RESULTS LPS induced a depressive-like state in the animals, and this effect was blocked by 1-MT, MINO and FO. Regardless of IDO inhibition, FO supplemented animals displayed an antidepressant-like response by increasing swimming and decreasing immobility frequencies in the MFST when compared to the control group. The immune challenge induced an over-expression of IDO and reduced hippocampal 5-HT levels, both of which were reversed by MINO and FO. CONCLUSION FO induced a pronounced antidepressant-like effect and prevented LPS-induced depressive-like behavior, and this effect was related to decreased IDO expression and increased 5-HT levels in the hippocampus.
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Affiliation(s)
- Bruno Carabelli
- Departamento de Fisiologia, Universidade Federal do Paraná, Curitiba, PR, Brazil.
| | - Ana Márcia Delattre
- Departamento de Fisiologia, Universidade Federal do Paraná, Curitiba, PR, Brazil
| | | | - Giulia Araújo
- Departamento de Fisiologia, Universidade Federal do Paraná, Curitiba, PR, Brazil
| | - Deborah Suchecki
- Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | | | | | - Silvio M Zanata
- Departamento de Patologia, Universidade Federal do Paraná, Curitiba, PR, Brazil
| | | | - Anete Curte Ferraz
- Departamento de Fisiologia, Universidade Federal do Paraná, Curitiba, PR, Brazil
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Bidirectional longitudinal associations of omega-3 polyunsaturated fatty acid plasma levels with depressive disorders. J Psychiatr Res 2020; 124:1-8. [PMID: 32087424 DOI: 10.1016/j.jpsychires.2020.02.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 02/10/2020] [Accepted: 02/11/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Temporality of the association of low omega-3 polyunsaturated fatty acid (n-3 PUFA) plasma levels with depression remains questionable. To determine the underlying nature of these associations, this study examined the bidirectional longitudinal associations of n-3 PUFA plasma levels with (presence, onset and course of) depressive disorders and symptoms. METHODS Baseline (n = 2912, 28.6% with current depressive disorder) and 6-year follow-up data (n = 1966, 13.0% with current depressive disorder) of the Netherlands Study of Depression and Anxiety (NESDA) were used. Depression diagnoses and symptoms were based on psychiatric interviews and self-report questionnaires. N-3 PUFA levels (ratio of total fatty acids (mmol%)), were assessed using nuclear magnetic resonance. RESULTS Using two waves of data, n-3 PUFA levels were lower among depressed persons, as compared to healthy controls (Beta = -0.047, SE = 0.011, p < .001). Nevertheless, baseline n-3 PUFA levels were not consistently associated with subsequent change in depressive symptoms, onset or remission of depressive disorders over 6 years. Furthermore, the difference in n-3 PUFA levels detected at baseline between depressed and non-depressed participants tended to dissipate over 6 years (depression-by-time estimate: p = .011). Finally, subjects depressed both at baseline and at 6-year follow up had consistently lower n-3 PUFA levels over the entire follow-up as compared to those who had never been depressed. Change in depressive disorders across waves was not consistently accompanied by change in n-3 PUFA levels over time. LIMITATIONS No data on intermediate time points and EPA levels were available. CONCLUSIONS Despite significant cross-sectional associations between n-3 PUFA plasma levels and depressive disorders and severity, this 6-year longitudinal study could not confirm an uni- or bidirectional association over time. The association between depression and n-3 PUFA plasma levels is unlikely to be causal.
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Takeuchi E, Yamada D, Suzuki S, Saitoh A, Itoh M, Hayashi T, Yamada M, Wada K, Sekiguchi M. Participation of the nucleus accumbens dopaminergic system in the antidepressant-like actions of a diet rich in omega-3 polyunsaturated fatty acids. PLoS One 2020; 15:e0230647. [PMID: 32210469 PMCID: PMC7094879 DOI: 10.1371/journal.pone.0230647] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 03/04/2020] [Indexed: 01/04/2023] Open
Abstract
The beneficial effects of omega (ω)-3 polyunsaturated fatty acid (PUFA) supplementation on major depressive disorder have been actively studied, but the underlying mechanism remains unknown. The present study examined the involvement of the nucleus accumbens (NAc) dopaminergic systems in behavioral changes in mice fed a diet high in ω-3 PUFAs. Mice fed a diet containing about double the amount of ω-3 PUFAs (krill oil (KO) diet) exerted shorter immobility times in the forced swim test (FST) than mice fed a control diet, containing only α-linolenic acid (ALA) as ω-3 PUFAs. The shorter immobility times were observed in both male and female mice. A dopamine metabolite, 3,4-dihydroxyphenylacetic acid, increased in the NAc in male mice fed the KO diet when compared with those fed the control diet. In addition, dopamine, 3-methoxytyramine, and homovanillic acid increased in the NAc in female mice fed the KO diet. Notably, the effects of the KO diet on the immobility time in the FST were abolished by microinjection of sulpiride, an antagonist of D2-like receptors, into the NAc. A similar microinjection of an antagonist selective for D1-like receptors, SKF83566, also abolished the reduction in immobility in the FST. Moreover, we found that tyrosine hydroxylase-positive cells increased in the ventral tegmental area (VTA) in mice fed the KO diet. These results suggest that modulation of the VTA-NAc dopaminergic pathway is one of the mechanisms by which a KO diet rich in ω-3 PUFAs reduces the immobility behavior in the mouse FST.
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Affiliation(s)
- Eri Takeuchi
- Department of Degenerative Neurological Diseases, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Daisuke Yamada
- Department of Degenerative Neurological Diseases, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Satoshi Suzuki
- Department of Neuropsychopharmacology, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Akiyoshi Saitoh
- Department of Neuropsychopharmacology, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Masayuki Itoh
- Department of Biochemistry and Cellular Biology, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Takashi Hayashi
- Department of Biochemistry and Cellular Biology, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Mitsuhiko Yamada
- Department of Neuropsychopharmacology, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Keiji Wada
- Department of Degenerative Neurological Diseases, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Tokyo, Japan
- AMED-CREST, Japan Agency for Medical Research and Development, Tokyo, Japan
| | - Masayuki Sekiguchi
- Department of Degenerative Neurological Diseases, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Tokyo, Japan
- * E-mail: ,
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Wang T, Niu K, Fan A, Bi N, Tao H, Chen XT, Wang HL. Dietary intake of polyunsaturated fatty acids alleviates cognition deficits and depression-like behaviour via cannabinoid system in sleep deprivation rats. Behav Brain Res 2020; 384:112545. [PMID: 32035867 DOI: 10.1016/j.bbr.2020.112545] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 02/02/2020] [Accepted: 02/05/2020] [Indexed: 01/01/2023]
Abstract
Sleep deprivation (SD) is a common feature in modern society. Prolonged sleep deprivation causes cognition deficits and depression-like behavior in the model of animal experiments. Endocannabinoid system are key modulators of synaptic function, which were related to memory and mood. Although the underlying mechanism remains unknown, several studies indicated the benefits of polyunsaturated fatty acids (PUFAs, linolenic acid, 39.7 %; linoleic acid, 28 %; and oleic acid, 22 %) on brain function through the endocannabinoid system. The present study aimed to evaluate the influence of dietary PUFAs on cognition deficits induced by sleep deprivation in Sprague Dawley rats. The rats were sleep deprivation continuously for 7 days and fed with PUFAs at three different dosages (2, 4 and 8 μl/g body weight) at the meantime. The effect of PUFAs on cognition was investigated by object recognition test while depressive-like behavior were detected using sucrose preference test and forced swim test. The mechanism of PUFAs was elucidated by hippocampal synaptic transmission analyses. The resluts revealed that SD led to the disorder of cognition and mood which was improved by the supplement of PUFAs. SD significantly increased the mEPSC frequency, and decreased the protein level of cannabinoid type-1 receptors (CB1R). These changes were restored by supplement of PUFAs, which showed a similar level to the control group. Behaviour tests showed that the positive effects on repairing cognition and anxiety disorders were almost completely abolished when the CB1R receptor antagonist rimonabant was applied to the SD rats. These findings indicated that PUFAs are a factor regulating cognition deficits and depression induced by SD via cannabinoid type-1 receptors.
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Affiliation(s)
- Tiandong Wang
- Engineering Research Center of Bio-process, Ministry of Education, Hefei University of Technology, 193 Tunxi Road, Hefei, Anhui 230009, PR China; School of Food Science and Engineering, Hefei University of Technology, Hefei, Anhui 230009, PR China
| | - Kang Niu
- School of Food Science and Engineering, Hefei University of Technology, Hefei, Anhui 230009, PR China
| | - Anni Fan
- School of Food Science and Engineering, Hefei University of Technology, Hefei, Anhui 230009, PR China
| | - Nanxi Bi
- School of Food Science and Engineering, Hefei University of Technology, Hefei, Anhui 230009, PR China
| | - Han Tao
- School of Food Science and Engineering, Hefei University of Technology, Hefei, Anhui 230009, PR China
| | - Xiang-Tao Chen
- School of Pharmacy, Anhui Medical University, Hefei, Anhui 230031, PR China.
| | - Hui-Li Wang
- Engineering Research Center of Bio-process, Ministry of Education, Hefei University of Technology, 193 Tunxi Road, Hefei, Anhui 230009, PR China; School of Food Science and Engineering, Hefei University of Technology, Hefei, Anhui 230009, PR China.
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Martin K, Périard J, Rattray B, Pyne DB. Physiological Factors Which Influence Cognitive Performance in Military Personnel. HUMAN FACTORS 2020; 62:93-123. [PMID: 31009241 DOI: 10.1177/0018720819841757] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To identify and detail physiological factors that influence cognition in military personnel. BACKGROUND Maintenance of cognitive and task performance is important under several scenarios, none more so than in a military context. Personnel are prepared for and trained to tolerate many of the stressors they encounter; however, consideration of stressors typically extends only as far as the physical, psychological, and environmental requirements of a given task. While considering these factors certainly characterizes the broader picture, several physiological states and traits can influence cognition and thus, should also be considered. METHOD A systematic review of the electronic databases Medline (PubMed), EMBASE (Scopus), PsycINFO, and Web of Science was conducted from inception up to January 2019. Eligibility criteria included current military personnel, an outcome of cognition, and the assessment of a physiological factor. RESULTS The search returned 60,564 records, of which 60 were included in the review. Eleven studies examined the impact of demographic factors on cognition, 16 examined fatigue, 10 investigated nutrition, and 24 the impact of biological factors on cognitive performance. CONCLUSION Factors identified as having a positive impact on cognition include aerobic fitness, nutritional supplementation, and visual acuity. In contrast, factors identified as having a negative impact include fatigue arising from sustained operations, dehydration, undernutrition, and an exaggerated physiological stress response to a cognitive task or a stressor. A further subset of these factors was considered modifiable. APPLICATION The modifiable factors identified provide avenues for training and preparation to enhance cognition in ways previously unconsidered.
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Affiliation(s)
- Kristy Martin
- 2234 University of Canberra, Australian Capital Territory, Australia
| | - Julien Périard
- 2234 University of Canberra, Australian Capital Territory, Australia
| | - Ben Rattray
- 2234 University of Canberra, Australian Capital Territory, Australia
| | - David B Pyne
- 2234 University of Canberra, Australian Capital Territory, Australia
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Chávez-Castillo M, Nava M, Ortega Á, Rojas M, Núñez V, Salazar J, Bermúdez V, Rojas-Quintero J. Depression as an Immunometabolic Disorder: Exploring Shared Pharmacotherapeutics with Cardiovascular Disease. Curr Neuropharmacol 2020; 18:1138-1153. [PMID: 32282306 PMCID: PMC7709154 DOI: 10.2174/1570159x18666200413144401] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 03/04/2020] [Accepted: 04/16/2020] [Indexed: 12/12/2022] Open
Abstract
Modern times have seen depression and cardiovascular disease (CVD) become notorious public health concerns, corresponding to alarming proportions of morbidity, mortality, decreased quality of life, and economic costs. Expanding comprehension of the pathogenesis of depression as an immunometabolic disorder has identified numerous pathophysiologic phenomena in common with CVD, including chronic inflammation, insulin resistance, and oxidative stress. These shared components could be exploited to offer improved alternatives in the joint management of these conditions. Abundant preclinical and clinical data on the impact of established treatments for CVD in the management of depression have allowed for potential candidates to be proposed for the joint management of depression and CVD as immunometabolic disorders. However, a large proportion of the clinical investigation currently available exhibits marked methodological flaws which preclude the formulation of concrete recommendations in many cases. This situation may be a reflection of pervasive problems present in clinical research in psychiatry, especially pertaining to study homogeneity. Therefore, further high-quality research is essential in the future in this regard.
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Affiliation(s)
| | | | | | | | | | - Juan Salazar
- Address correspondence to this author at the Endocrine and Metabolic Diseases Research Center, School of Medicine, University of Zulia, Maracaibo 20th Avenue 4004, Venezuela; Tel/Fax: ++582617597279; E-mail:
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Yang R, Zhang MQ, Xue Y, Yang R, Tang MM. Dietary of n-3 polyunsaturated fatty acids influence neurotransmitter systems of rats exposed to unpredictable chronic mild stress. Behav Brain Res 2019; 376:112172. [DOI: 10.1016/j.bbr.2019.112172] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 08/19/2019] [Accepted: 08/21/2019] [Indexed: 12/21/2022]
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Nasir M, Bloch MH. Trim the fat: the role of omega-3 fatty acids in psychopharmacology. Ther Adv Psychopharmacol 2019; 9:2045125319869791. [PMID: 31489174 PMCID: PMC6713969 DOI: 10.1177/2045125319869791] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 07/22/2019] [Indexed: 12/21/2022] Open
Abstract
The American Psychiatric Association (APA) currently recommends the use of omega-3 fatty acid supplementation for depressive disorders, impulse-control disorders, and psychotic disorders in treatment guidelines. This review examines the evidence for efficacy of omega-3 fatty acids in depressive disorders, bipolar disorder, anxiety disorders, post-traumatic stress disorder (PTSD), and psychosis. Meta-analysis of randomized-controlled trials of omega-3 fatty acids for depression are inconclusive, with strong evidence of publication bias, sizable heterogeneity between included studies, and substantial methodological shortcomings in included trials. The large amount of heterogeneity in findings of RCTs of omega-3 fatty acids for unipolar depression is likely attributable to highly heterogeneous sample populations that are given different omega-3 supplements [which differ widely in eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) content, ratio, and dosage] as either adjunctive or monotherapy of other existing treatments, and then measure several different outcomes of depression symptomatology with likely incomplete blinding. Evidence of efficacy of omega-3 supplementation in treating psychosis, PTSD, anxiety, and bipolar mania is minimal. The current guidelines recommending the use of omega-3 fatty acids in adulthood psychiatric conditions should be revisited, especially given several recent negative studies examining the effects of omega-3 fatty acids for cardiovascular disease. Recommending likely ineffective treatment to patients, no matter how benign the side-effect profile, has opportunity cost (e.g. other more effective medications or therapies not being utilized) and likely affects patient compliance with other evidence-based treatments.
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Affiliation(s)
- Madeeha Nasir
- Child Study Center, Yale University School of Medicine, New Haven, CT, USA
| | - Michael H. Bloch
- Child Study Center, Yale University School of Medicine, 230 S. Frontage Road, New Haven, CT, 06520, USA
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
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Abstract
OBJECTIVES As clinical practice guidelines vary widely in their search strategies and recommendations of complementary and alternative medicine (CAM) for depression, this overview aimed at systematically summarising the level 1 evidence on CAM for patients with a clinical diagnosis of depression. METHODS PubMed, PsycInfo and Central were searched for meta-analyses of randomised controlled clinical trials (RCTs) until 30 June 2018. Outcomes included depression severity, response, remission, relapse and adverse events. The quality of evidence was assessed according to Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) considering the methodological quality of the RCTs and meta-analyses, inconsistency, indirectness, imprecision of the evidence and the potential risk of publication bias. RESULTS The literature search revealed 26 meta-analyses conducted between 2002 and 2018 on 1-49 RCTs in major, minor and seasonal depression. In patients with mild to moderate major depression, moderate quality evidence suggested the efficacy of St. John's wort towards placebo and its comparative effectiveness towards standard antidepressants for the treatment for depression severity and response rates, while St. John's wort caused significant less adverse events. In patients with recurrent major depression, moderate quality evidence showed that mindfulness-based cognitive therapy was superior to standard antidepressant drug treatment for the prevention of depression relapse. Other CAM evidence was considered as having low or very low quality. CONCLUSIONS The effects of all but two CAM treatments found in studies on clinical depressed patients based on low to very low quality of evidence. The evidence has to be downgraded mostly due to avoidable methodological flaws of both the original RCTs and meta-analyses not following the Consolidated Standards of Reporting Trials and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Further research is needed.
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Affiliation(s)
- Heidemarie Haller
- Department of Internal and Integrative Medicine, Evang. Kliniken Essen-Mitte, Faculty of Medicine, Universitat Duisburg-Essen, Essen, Germany
| | - Dennis Anheyer
- Department of Internal and Integrative Medicine, Evang. Kliniken Essen-Mitte, Faculty of Medicine, Universitat Duisburg-Essen, Essen, Germany
| | - Holger Cramer
- Department of Internal and Integrative Medicine, Evang. Kliniken Essen-Mitte, Faculty of Medicine, Universitat Duisburg-Essen, Essen, Germany
| | - Gustav Dobos
- Department of Internal and Integrative Medicine, Evang. Kliniken Essen-Mitte, Faculty of Medicine, Universitat Duisburg-Essen, Essen, Germany
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Tang M, Floyd S, Cai H, Zhang M, Yang R, Dang R. The status of ω-3 PUFAs influence chronic unpredicted mild stress-induced metabolic side effects in rats through INSIG/SREBP pathway. Food Funct 2019; 10:4649-4660. [PMID: 31292598 DOI: 10.1039/c9fo00076c] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Metabolic disturbances, including lipid metabolism, bone metabolism, and glycometabolism, are common in depression. Omega-3 polyunsaturated fatty acids (ω-3 PUFAs), which are reported to possess antidepressant effect, have also been shown to regulate metabolism. To further clarify the potential link between ω-3 PUFAs and stress-induced metabolic disturbances, metabolic-related parameters including body weight, visceral fat, fatty acid composition and serum parameters, such as serum lipids, free fatty acid (FFA), glucose (GLU), calcium and phosphorus in rats were measured. Moreover, hepatic insulin induced gene (INSIG)/sterol regulatory element binding protein (SREBP) pathway was also investigated. After 5 weeks of chronic unpredicted mild stress (CUMS) administration, rats were induced to a depressive-like state and exhibited decreased serum high-density lipoprotein (HDL-c), body weight and visceral fat, accompanied by altered C18:2n6c and ω-3/ω-6 PUFAs. Supplement of ω-3 PUFAs showed robust antidepressant effects and has beneficial effects on lipid profile. On the contrary, ω-3 PUFAs deficiency induced the visceral fat accumulation and decreased the serum calcium and phosphorus in stressed rats. Additionally, CUMS significantly increased hepatic expressions of SREBP-cleavage activating protein (SCAP)/SREBP-1 and decreased the expression of INSIG-1. This disturbance of SREBPs system is aggravated by ω-3 PUFAs deficiency and alleviated by ω-3 PUFAs supplementation. This study discloses the novel findings that ω-3 PUFAs deficiency will exacerbate the metabolic disturbances in stressed rats. Furthermore, supplementation of ω-3 PUFAs on individuals with a high risk of depression might be an effective way to prevent metabolic disorders accompanied by depression with the involvement of INSIG/SREBP pathway.
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Affiliation(s)
- Mimi Tang
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha 410008, China.
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Zhang TT, Xu J, Wang YM, Xue CH. Health benefits of dietary marine DHA/EPA-enriched glycerophospholipids. Prog Lipid Res 2019; 75:100997. [DOI: 10.1016/j.plipres.2019.100997] [Citation(s) in RCA: 99] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Revised: 07/04/2019] [Accepted: 07/04/2019] [Indexed: 02/07/2023]
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Mathur MB, VanderWeele TJ. Finding Common Ground in Meta-Analysis "Wars" on Violent Video Games. PERSPECTIVES ON PSYCHOLOGICAL SCIENCE 2019; 14:705-708. [PMID: 31188714 DOI: 10.1177/1745691619850104] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Independent meta-analyses on the same topic can sometimes yield seemingly conflicting results. For example, prominent meta-analyses assessing the effects of violent video games on aggressive behavior have reached apparently different conclusions, provoking ongoing debate. We suggest that such conflicts are sometimes partly an artifact of reporting practices for meta-analyses that focus only on the pooled point estimate and its statistical significance. Considering statistics that focus on the distributions of effect sizes and that adequately characterize effect heterogeneity can sometimes indicate reasonable consensus between "warring" meta-analyses. Using novel analyses, we show that this seems to be the case in the video-game literature. Despite seemingly conflicting results for the statistical significance of the pooled estimates in different meta-analyses of video-game studies, all of the meta-analyses do in fact point to the conclusion that, in the vast majority of settings, violent video games do increase aggressive behavior but that these effects are almost always quite small.
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Affiliation(s)
- Maya B Mathur
- 1 Department of Epidemiology, Harvard T. H. Chan School of Public Health.,2 Quantitative Sciences Unit, Stanford University
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Carney RM, Freedland KE, Rubin EH, Rich MW, Steinmeyer BC, Harris WS. A Randomized Placebo-Controlled Trial of Omega-3 and Sertraline in Depressed Patients With or at Risk for Coronary Heart Disease. J Clin Psychiatry 2019; 80:19m12742. [PMID: 31163106 PMCID: PMC6550340 DOI: 10.4088/jcp.19m12742] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 02/25/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Studies of depressed psychiatric patients have suggested that antidepressant efficacy can be increased by adding eicosapentaenoic acid (EPA), one of the omega-3 fatty acids found in fish oils. The purpose of this study was to determine whether the addition of EPA improves the response to sertraline in depressed patients with or at high risk for coronary heart disease (CHD). METHODS Between May 2014 and June 2018, 144 patients with DSM-5 major depressive disorder seen at the Washington University School of Medicine with or at high risk for CHD were randomized to receive either 50 mg/d of sertraline and 2 g/d of EPA or 50 mg/d of sertraline and corn oil placebo capsules for 10 weeks. The Beck Depression Inventory II (BDI-II) was the primary outcome measure. RESULTS After 10 weeks of treatment, there were no differences between the arms on the mean baseline-adjusted BDI-II (placebo, 10.3; EPA, 12.1; P = .22), the 17-item Hamilton Depression Rating Scale (placebo, 7.2; EPA, 8.0; P = .40), or the 10-week remission rate (BDI-II score ≤ 8: placebo, 50.6%; EPA, 46.7%; odds ratio = 0.85; 95% CI, 0.43 to 1.68; P = .63). CONCLUSIONS Augmentation of sertraline with 2 g/d of EPA for 10 weeks did not result in greater improvement in depressive symptoms compared to sertraline and corn oil placebo in patients with major depressive disorder and CHD or CHD risk factors. Identifying the characteristics of cardiac patients whose depression may benefit from omega-3 and clarifying the pathways linking omega-3 to improvement in depression symptoms are important directions for future research. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02021669; FDA IND registration number: 121107.
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Affiliation(s)
- Robert M. Carney
- Departments of Psychiatry, Washington University School of Medicine, Saint Louis, MO
| | - Kenneth E. Freedland
- Departments of Psychiatry, Washington University School of Medicine, Saint Louis, MO
| | - Eugene H. Rubin
- Departments of Psychiatry, Washington University School of Medicine, Saint Louis, MO
| | - Michael W. Rich
- Departments of Medicine, Washington University School of Medicine, Saint Louis, MO
| | - Brian C. Steinmeyer
- Departments of Psychiatry, Washington University School of Medicine, Saint Louis, MO
| | - William S. Harris
- Department of Internal Medicine, University of South Dakota and OmegaQuant, LLC, Sioux Falls, SD
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Marriott BP, Turner TH, Hibbeln JR, Pregulman M, Newman J, Johnson KB, Malek AM, Malcolm RJ, Burbelo GA, Wissman JW. Design and methods for the Ranger Resilience and Improved Performance on Phospholipid bound Omega-3's (RRIPP-3 study). Contemp Clin Trials Commun 2019; 15:100359. [PMID: 31080908 PMCID: PMC6503132 DOI: 10.1016/j.conctc.2019.100359] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 03/20/2019] [Accepted: 04/05/2019] [Indexed: 12/13/2022] Open
Abstract
Intake of nutrients fundamental for optimal neuronal function is of increasing interest. The potential importance of omega-3 highly unsaturated fatty acids (HUFAs) for optimizing emotional states, cognitive function, and mental health has been demonstrated in observational studies and randomized controlled trials. Omega-3 (HUFAs), specifically EPA (eicosapentaenoic acid) and docosahexaenoic acid (DHA), are concentrated in neural tissues and are essential for neural function, normative neurodevelopment, neurotransmitter, and neural immune functions. Omega-3 HUFAs must be obtained from the diet, predominantly from marine sources such as fish and other seafood. HUFAs also can be found in a variety of dietary supplements (omega-3 fatty acid esters, fish oil and krill oil). As dietary supplements, omega-3 HUFAs (fatty acid esters, fish and krill oils) differ substantially in their physicochemical properties and nutrient content. Here we present the design and methods for the Ranger Resilience and Improved Performance on Phospholipid bound Omega-3's (RRIPP-3) study. RRIPP-3 was a double blind, randomized, controlled trial among individuals in the United States (US) Army Infantry Basic Officer Leaders Course (IBOLC) and following US Ranger School training (RC) at Fort Benning, GA of omega-3 HUFA on krill oil versus placebo supplementation. The RRIPP-3 study sought to determine if krill oil supplementation with omega-3 HUFAs supports aspects of cognitive functioning critical to battlefield success when measured immediately after an intense combat simulation. Sub-analyses addressed basic improvements in IBOLC performance. We also describe additional outcome measures critical for interpretation of the study results, such as diet and other dietary supplement use.
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Affiliation(s)
- Bernadette P Marriott
- Nutrition Section, Division of Gastroenterology and Hepatology, Department of Medicine, and Military Division, Department of Psychiatry and Behavioral Sciences, College of Medicine, Medical University of South Carolina, 114 Doughty Street, Ste. 630D, MSC774, Charleston, SC, 29425, USA
| | - Travis H Turner
- Department of Neurology, College of Medicine, Medical University of South Carolina, 96 Jonathan Lucas Street, Suite 301 CSB, Charleston, SC, 29425, USA
| | - Joseph R Hibbeln
- Acting Chief, Section on Nutritional Neurosciences, LMBB, NIAAA, NIH, 5625 Fishers Lane, Rm 3N-07, MSC 9410, Bethesda, MD, 20892, USA
| | - Marcie Pregulman
- Nutrition Section, Division of Gastroenterology and Hepatology, Department of Medicine, College of Medicine, Medical University of South Carolina, 114 Doughty Street, Ste. 630D, MSC774, Charleston, SC 29425, USA
| | - Jill Newman
- Nutrition Section, Division of Gastroenterology and Hepatology, Department of Medicine, College of Medicine, Medical University of South Carolina, 114 Doughty Street, Ste. 630D, MSC774, Charleston, SC 29425, USA
| | - Kristen B Johnson
- Nutrition Section, Division of Gastroenterology and Hepatology, Department of Medicine, College of Medicine, Medical University of South Carolina, 114 Doughty Street, Ste. 630D, MSC774, Charleston, SC 29425, USA
| | - Angela M Malek
- Department of Public Health Sciences, Medical University of South Carolina, 135 Cannon Street, Ste. 303C, Charleston, SC, 29425, USA
| | - Robert J Malcolm
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street, Charleston, SC, 29425, USA
| | | | - Jeffrey W Wissman
- Maneuver Center of Excellence, Infantry Basic Officers Leader Course, Fort Benning, GA, 31905, USA
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