Study: Essential fatty acids block the depressive effects of interferon therapy

SU KP, Lai HC, Yang Ht, et al. Omega-3 fatty acids to prevent interferon alpha-induced depression: results of a randomized, controlled study. biopsychiatry . 2014; 76 (7): 559-566.â

A single institution (Liver Center of China Medical University Hospital, Taichung, Taiwan), double-blind, placebo-controlled study

A total of 162 subjects, all of whom were treated for hepatitis-C infection, were randomized for the study. Serious depressive episodes were excluded at the time of evaluation, alcohol or drug use within a year as well as unstable or chronic diseases (e.g. cardiovascular, renal, endocrine) diseases

The study compared the nutritional supplement with eicosapentaenic acid (EPA), Docosahexaenoic acid (DHA) or placebo to prevent depression caused by interferon alpha (ifn α). Two weeks before the beginning of the pegintereron-α-2b therapy, patients received daily treatment with 5 identical capsules EPA (3.5 g/day), DHA (1.75 g/day) or placebo (oil with high oil or acid content, 3.5 g/day). . One hundred-lasting patients were evaluated throughout the entire 24 weeks of Int-α therapy

using the structured mini-international neuropsychiatric interview were assessed at the beginning of the study (before supplementation or placebo intervention); Shortly before INF-α treatment; In weeks 2, 4, 6, 8, 12, 16 and 20; And at the end of treatment with Inf-α (week 24). The primary end point was the occurrence of an episode of major depression at any time during treatment. The fatty acid composition of the erythrocyte membranes and the content of individual fatty acids were measured by chromatography

The frequency of depression was significantly lower in patients treated with EPA, but not with patients treated with DHA ( p =. 037). The appearance of depression in the placebo group was 30 %, in the EPA group 10 %and 28 %in the DHA group. Both the EPA and DHA supplementation significantly delayed the beginning of the IFN-α-induced depression, with the week of the beginning 12 or week 11.7, compared to week 5.3 for placebo ( p =. 002). Both EPA and DHA were well tolerated by this population. With regard to the laboratory findings, EPA treatment increased both the EPA and DHA erythrocyte levels, but DHA only increased the DHA erythrocyte levels. There was no difference in the parts of high hepatitis-C virus (HCV) virus loads between the groups before or after treatment

interferons belong to the protein class of cytokines and are glycoproteins that are known for their ability to "disturb" viral replication in order to control hepatitis-C infection. As proof of the importance of the cytokine cascade in depressive diseases, there is a high rate of IFN-α-induced depression.

This simple intervention of 2 weeks Eicosapentaenic acid could reduce the need to prescribe antidepressants that can have harmful side effects

The role of inflammation and the direct participation of cytokines as the causal factor in depression gains in acceptance. 2.3 Essential fatty acids are natural candidates for therapeutic application due to their low toxicity and known inflammatory effects. In fact, the use of fish oil was validated in depressive symptoms in clinical studies.

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This study is interesting in that the cause of the depression in this population is better defined than usual. Pegintereron causes a quick and dramatic increase in pro -inflammatory cytokines. This offers a clearly defined framework for assessing the short -term application of EPA and DHA. It also has a basis in animal experiments that have shown the benefits of essential fatty acids to relieve cytokin-induced disease behavior and other changes in behavior. ^{6 All of this can indicate advantageous effects that can help compensate for frequent cytokin changes that lead to depressive symptoms and behaviors}

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Note that EPA seems to have a greater advantage over DHA in this study, a result that is also supported by previous research.

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This simple intervention of 2 weeks EPA could reduce the need to prescribe antidepressants that can have harmful side effects. For example, it is known that serotonin reuptake inhibitors increase the risk of gastrointestinal bleeding.

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There are a few reservations about the current study. The study population was ethnically homogeneous, with all Taiwanese participants. Taiwan is also a country with a high fish consumption, so that this may have influenced the basic values ​​of the participants in fatty acids and fatty acid metabolism. Another restriction is that the placebo contained 15 % linoleic acid together with 75 % oleic acid. While the authors believe that this small amount is not sufficient to have inflammatory effects, this disruptive factor may be eliminated in future studies.

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From a clinical point of view, this study suggests that naturopaths have a safe, effective and easy-to-use option to offer HCV patients to prepare for the start of interferon therapy. The use of EPA can help reduce the occurrence of depression, and can rule out the need for the need for more of more toxic drugs to control depressive side effects

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