One fish, two fish...

September 19, 2003 6:02 PM

Are Omega-3 oils an effective treatment for Clinical Depression and Bipolar Disorder?This doctor thinks so and the data seems to support his theory. Several studies are going at this time. So why isn't it used more widely in treatment for mood disorders? Do doctors see it as junk science? Or is there another reason?
posted by echolalia67 (26 comments total)

The whole reason I stumbled across this is because a friend was told that she should go on a mood stablizing medication (Lithium, Tegretol, Depakote) in addition to taking antidepressants. I was trying to find out which one had the least side-effects and, lo and behold, stumbled across all this.
posted by echolalia67 at 6:09 PM on September 19, 2003

Lithium is old enough to have an expired patent. So I'm not sure why drug companies would have an interest in pushing it on people.
posted by transona5 at 6:20 PM on September 19, 2003

First off, its very hard to treat bipolar disorder and doctors usually go through more than a few medications before finding the proper, or at least effective, drugs. Its also a very serious illness with a high rate of suicide, so its best to err on the side of caution.

Secondly, bipolar has a history of quack/odd treatments: electric shock therapy, homopathics, etc.

Thirdly, biopsychiatry has a strong point of view/bias, just read thier main page. I'm not discrediting them as a whole, but they do have an agenda.

Lastly, all psychiatric treatments have alternatives. Don't like Paxil? There's always 5-HTP, St. Johns Wort, etc. In the end, a patient should consider herself a medical consumer and be aware of alternatives. Generally, alternatives rarely do better than established treatments and herbs and the such have a much, much lower quality control than pharamaceuticals. So many doctors are a bit hesitant to shift over to "fly-by-night-herbalists-against-the-AMA-corp"'s herb pills.

I don't like this assumption that there's this big bad psychiatric establishment in cahoots with the drug companies. Yes, there's plenty of interplay, but generally a better drug will win out. Prozac is more or less non-existant because of better SSRIs that have come out since. MAO inhibitors are rarely given out, etc.

Kudos to all the people who might find alternative treatments to their benefits, like the archtypical SSRI patient switching to St Johns Wort, but its a risky path in many ways. Quality of drug, self-medicating without professional oversight, etc.

Personally, I'm *very* curious about how many suicides have herbs and homopathic stuff in their medicine cabinets. The press is quick to point out that a suicide was on some big pharm drug, but the sword seems to be one-sided.

Of course Omega-3 could be a good supplement to treatment. A harvard doc comments on it here at LifeExtention.com

Q: Do many psychiatrists and psychologists recognize omega-3 as an adjunct in therapy?

A: They are beginning to. The omega-3 story appeals to both sides. It appeals to very conventional doctors because they read about the biochemistry and see the study data. And omega-3s also appeal to the alternative medicine crowd, because they are natural and safe. Once educated, doctors are responsive. If omega-3 oils were harmful, it would be one thing. But there is actually a benefit, so most doctors do not object to using it.

Now there are other questions like what dosage, what's a pure form, who makes it, etc. Also note many of these studies have people on meds anyway, so as a complete replacement for traditional bipolar meds seems a bit far out there. Not to mention common sense would dictate that if fish-oil was only what it took to "cure" bipolar disease then bipolarism would have been linked to diet a long time ago.
posted by skallas at 6:46 PM on September 19, 2003

They've reformulated lithium into two formulas called Eskalith and Lithobid, so there's some vested interest in lithium for the pharma companies. That being said, if it weren't for the medications produced by the pharma companies, my quality of life would be far below what it currently is. I also know, unfortunately, that conventional treatments for Bipolar disorder have some nasty side-effects, like severe acne, major weight gain, thyroid and liver problems, etc.

I don't necessarily think that psychiatrists are conspiring with drug companies to suppress this information. I just think a lot of docs are generally distainful of alternative therapies (for good reasons, most of the time) and find the opportunity to prescribe the newest thing on the market to be far more sexy.

I just think that, given the initial data, this could be a major godsend to a lot of folks out there who find the side effects of standard treatments to be harsh or simply wish to minimize the amount of medication they have to take on a daily basis. It's readily available, doesn't have side effects, and it's inexpensive.

The prevailing opinion (of what I read today) seems to be that it should be taken as an adjunct, not a replacement, to conventional medications. If using Omega-3s as a supplement allows someone to lower the doses of the conventional medications enough to avoid the unpleasant side effects, then I think doctors need to at least mention it to their patients. Can't hurt, might help.
posted by echolalia67 at 7:09 PM on September 19, 2003

Or is there another reason?

Appealing to a conspiracy between psychiatrists and Big Pharm to keep people on lithium instead of Omega-III is just silly.

Lithium is a fucking rock, for God's sake, mined all over the place, and pharmaceutical grade lithium salts are cheap as dirt, though the controlled-release stuff costs more. Eskalith and Lithobid are just time-release lithium.

And I find it hard to believe that a bunch of physicians who agree that eating rocks is good for bipolar disorder would turn up their noses at fish oil.

The probable answer to why it hasn't become instantly common is, I'd wager, that the evidence isn't so strong that it's a clear home run. So it's not part of the standard of care for bipolar disorder yet. So if you prescribe / suggest fish oils and no/reduced lithium (or whatever), and your patient goes nuts and whacks him or herself or someone else, you're looking at a whopping malpractice suit.

All that said, lithium is nasty shit. Anything with a therapeutic dose that close to a toxic dose is, well, nasty.
posted by ROU_Xenophobe at 7:20 PM on September 19, 2003

echol:If using Omega-3s as a supplement allows someone to lower the doses of the conventional medications enough to avoid the unpleasant side effects

Well, that sounds like a pretty big assumption. Lets say a patient takes a non-effective dose of lithium why should fish oil make up the difference? The laws of diminishing returns may kick in really hard for all we know. It may be the case that dosage would remain the same, but certain desirable effects would be more prominent. Also, there's the case where lowering dosage just a bit and adding fish oil may still equal the same side-effects. Here's to hoping for the best, but I wouldn't be assuming that just yet.

Also, one source lists an overabundance of Omega-3 may negatively affect the immune system, fish oils can make people naseus, and it has a high fat content. Just because its not a med, doesn't mean "natural drugs" can't have unwanted side-effects.
posted by skallas at 7:26 PM on September 19, 2003

Dunno about the rest of you, but omega-3 capsules have some singularly unpleasant intestinal side-effects, for me anyway.
posted by aramaic at 7:27 PM on September 19, 2003

>So why isn't it used more widely in treatment for mood disorders?

Maybe for the same reasons we don't use magnets to treat such (any) problems?

Just guessing here...

Now, it isn't because of some sort of conspiracy theory, because I can give you one of those for Omega-3. Notice how certain "organic" egg growers are claiming how much omega-3 their eggs contain. The egg industry has a lot more government under its belt than the pharmaceutical industry.
posted by shepd at 7:27 PM on September 19, 2003

maybe it's not used because they're still studying it. i know i read somewhere that several studies are going on at this time...
posted by andrew cooke at 7:35 PM on September 19, 2003

Or is there another reason?

Appealing to a conspiracy between psychiatrists and Big Pharm to keep people on lithium instead of Omega-III is just silly.

I was actually getting at something closer to doctors being easily seduced by the possibilities of prescribing the newest, bang-up gee wiz, cutting-edge medication when a less popular, lesser known drug/compound/supplement would do the trick.

That being said, I think that what E. Fuller Torrey said in that article is true - there is a serious conflict of interest going on if pharm companies are bestowing gifts and perks on doctors in an effort to woo them into prescribing their product. And Torrey is no lunatic fringe peddler of junk science.
posted by echolalia67 at 7:49 PM on September 19, 2003

Skallas: "homopathics" All jokes aside, I think you meant Homeopathics. :)
posted by Keyser Soze at 7:52 PM on September 19, 2003

shepd:Maybe for the same reasons we don't use magnets to treat such (any) problems?

Umm, did you actually read any of the information, or are you just being snarky for the hell of it?

Baylor, Harvard, UCLA, UCSD, (information easily found had you read the articles) among others, are doing studies on this. The intial data shows statistically signifigant improvement in stablizing mood fluctuation. I've been hearing about the potential benefits of Omega-3s for depression for years - something about it promoting better mylenization along neural pathways, yadda,yadda - but I was not aware that this much research and data had been gathered. I would have liked to have had the information - if nothing else, I'd like to be able to weigh the pros and cons with my doctor.
posted by echolalia67 at 8:06 PM on September 19, 2003

If you're interested in how fatty acids may affect brain function a good book is The Madness of Adam and Eve: How Schizophrenia Shaped Humanity - a very interesting read.
posted by cbrody at 8:44 PM on September 19, 2003

I was actually getting at something closer to doctors being easily seduced by the possibilities of prescribing the newest, bang-up gee wiz, cutting-edge medication when a less popular, lesser known drug/compound/supplement would do the trick.

I might buy that as a problem with SSRI-and-beyond antidepressants, or the application of anti-seizure medications to bipolar disorder. Which is, to be sure, part of what you're talking about.

But lithium is not new, bang-up gee whiz, or cutting edge. It's a chemical element. And even I can see the benefit of shifting from plain salts to a time-release formula.
posted by ROU_Xenophobe at 8:51 PM on September 19, 2003

Unfortunately, the first 20 patients to try a similar strategy in my practice showed no clear benefit at all. Most viewed the regimen as an expensive hassle (many, many pills or a fishy emulsion) at best. However, we may have been using too high a dose (shooting for the 5 grams/day recommended by Dr. Stoll; see below about using 1 or 2 grams only). And we almost surely did not go long enough, particularly in light of the woman's experience reported in BNN above, which indicates that it may take months to see benefits, which would be manifest as a decrease in the frequency of episodes of depression, primarily.

Ahh, the old "I started taking the medication and months later, I stopped being depressed" routine. Since these people are bipolar, aren't those kinds of cycles natural - I mean, a couple months manic, a couple months depressive, etc?
posted by Veritron at 9:17 PM on September 19, 2003

I started taking fish oil (1g only) a couple of months ago, and I've seen a marked improvement in the stability of my mood; before I started, I was looking at getting my 150mg dose of Venlafaxine increased again -- now I'm looking at getting it decreased.

Not quite a scientific assessment, especially since it's coincided with other things which have improved my mood, but I think it's definately worth a look.
posted by Freaky at 6:26 AM on September 20, 2003

I'm bipolar, on medication-and my doctor has recommended the fish oil capsules as a supplement. A lot of people I know thru internet forums also use it that way. So far I have experienced absolutely no trouble with them.

There's a whole crapload of meds out there for this condition -unfortunately none of them work for everyone. And only three-lithium, depakote and recently lamictal-have been approved specifically for treatment of bipolar disorder. Many of the drugs prescribed for bipolar are anticonvulsants-epilepsy meds-prescribed off label (actually depakote and lamictal are also antiseizure meds).

Even if a med has a good track record for treatment most companies would rather not submit it for clinical trials specifically for bipolar as it would cost millions of dollars-and if it is already being prescribed off label they don't see the point. The problem with that is that some really don't work all that well. Neurontin is one-and evidently there is evidence that Topamax really doesn't work too well either. Pharmaceutical company marketing is indeed a factor-but again, when you are dealing with a no-one-size-fits-all disorder, it is a good thing to have a lot of drugs to choose from.
posted by konolia at 6:40 AM on September 20, 2003

This should be a moot point:

Everyone should take a daily dose of Omega 3 and 6 fatty acids. B-complex too. And antioxidants, and blah blah blah......

For that matter, studies have shown that regular, daily exercise is at least as effective as Prozac.

Meditation is good too.

And - while you're at it, cut out the fast food, sugar, white flour, fried foods, coffee, excessive alcohol (except your daily glass of red wine), smoking, TV watching............

And - if you have the access - a daily walk in the woods is very good indeed.
posted by troutfishing at 6:43 AM on September 20, 2003

Not to mention regular human contact. This is the best therapy of all, for many.

Also - learning, and travel (as well as socialization), promote the release of neural growth factors which have a powerfull antidepressant effect.

Petting zoos are good also.
posted by troutfishing at 6:47 AM on September 20, 2003

Troutfishing, I just joined a health club three weeks ago, and am exercising up to two hours a day four times a week. (Doc also recommends exercise.) I have to say it really helps. If /when my insurance runs out I am sorely tempted to just rely on the fish oil and exercise. But I do have to point out that with bipolar depression, these things really do only work to a point. I don't think exercise helps with paranoia, for instance-that can be one of the things we deal with. Bipolar is a little more than just a "mood" disorder.

That having been said, all the things you mentioned are definitely things that help when one lives with this disease.
posted by konolia at 7:02 AM on September 20, 2003

Veritron:Ahh, the old "I started taking the medication and months later, I stopped being depressed" routine. Since these people are bipolar, aren't those kinds of cycles natural - I mean, a couple months manic, a couple months depressive, etc?

Actually, for a lot of medications it takes a few months for them to work properly. The older meds were not expected to show their full effects for about four months. If you look at Stoll's orginal research you'll notice that compared to the control group (who were receiving a placebo) the test group showed less fluctuation of mood over a few months.

And there as many types of manic/depressed/normal cycles as there are people. Some people cycle every couple of years, some every few months, some weekly, some daily.
posted by echolalia67 at 11:59 AM on September 20, 2003

Exercise is as effective as Prozac? For what? Prozac is used to treat a lot of things, including obsessive-compulsive disorder. Do you have a link to this?
posted by transona5 at 3:54 PM on September 20, 2003

All "new" treatments or possible treatments take time to make it into the mainstream practice of medicine and prescribing. Even with pharmco marketing to docs, docs are slow to move off of the tried and true meds they are used to prescribing (as well as their side effect profiles that they are most familiar with) then to something they know little about.
posted by docjohn at 7:15 PM on September 20, 2003

A 1999 study at Duke found that exercise is equally as effective as major antidepressant medications (the studied example being Zoloft), confirming research showing a general link going back a century. (The main problem with it, therapeutically, is that exercising regularly requires a level of motivation that few heavily depressed individuals have.) There's also a longstanding rule of thumb that approximately one-third of patients achieve a full remission, one-third experience a response and one-third are nonresponders, regardless of what treatment they receive. Indeed, many patients get "better" with no treatment whatsoever. There is proof, however, that medical intervention reduces suicide rates, which is why it's important not to be a total Laingian.
posted by dhartung at 9:04 PM on September 20, 2003

My shrink recommended Omega-3 supplements to complement my Wellbutrin dosages, as well as encouraging me to exercise, pointing me the way of other doctors to solve problems caused by or related to my depression. She's fairly conservative, but smart, so I think that she's a good example of the up-to-date urban shrink. Nobody's actively trying to gyp anybody, it's just ignorance I would think.
posted by jengod at 6:15 PM on September 21, 2003

dhartung - Arrrr, there's the rub. ( "exercising regularly requires a level of motivation that few heavily depressed individuals have" )

konolia - yes, some of us may have a genetic underlay which drives depression, bipolar disorder, etc.
posted by troutfishing at 3:47 AM on September 26, 2003