Major Depressive Disorder (MDD) is a serious psychiatric illness that is increasing in prevalence. It is estimated that by 2020 MDD will be a leading cause of disease or injury worldwide. Clinical manifestations, biomarkers and treatment outcomes are widely variable among those affected, making the etiology difficult to explain.
Current medical treatment for depression relies on the “monoamine hypothesis”, suggesting serotonin dysregulation is responsible for the mood disorder. This is apparent through the common prescription of SSRI’s (selective serotonin repuptake inhibitors) and SNRI’s (Serotonin-norepinephrine reuptake inhibitors). However, did you know that Tianepine, which actually enhances serotonin repuptake, is also approved as an antidepressent treatment? Furthermore, other drugs that have nothing to do with serotonin, such as NDRI’s (norepinephrine-dopamine repuptake inhibitors) and second-generation anti-psychotics (CDA), are also prescribed antidepressant agents. The monoamine hypothesis alone can’t explain how each of these drugs can have similar outcomes while acting through completely different mechanisms. Interestingly enough, these antidepressant treatments do share one common mechanism; anti-inflammation.
The role of inflammation in depression has been a hot topic of late in medical research. It is well established that depressed patients have elevated levels of c-reactive protein (CRP), acute phase proteins, and inflammatory cytokines. Additionally, patients with MDD show lower levels of anti-inflammatory Omega 3 fatty acids in blood and brain tissues. A deficit of Omega-3’s is also associated with neurological, cardiovascular, cerebrovascular, autoimmune, and metabolic diseases, as well as bipolar disorder. Societies with high consumption of fish in their diets appear to have lower prevalence of these conditions.
A recent meta-analysis published in Biomedicine looked at numerous studies and found strong evidence to support the adjunctive use of omega-3’s to treat depression. Improvements in depressive symptoms, higher response rates, lower risks of suicide and decreased aggression were among these findings. It has also been determined that high-dose consumption of Omega-3’s is safe, even when concurrently administered with other agents that increase bleeding, such as aspirin and warfarin.
As stated above, the etiology behind depression is varied. While the mono-amine hypothesis certainly applies to some of the mechanisms, it only has modest effects as a one size fits all treatment. Everyone can benefit from marine-based Omega 3’s, specifically EPA/DHA, so there is no reason why this should not be incorporated into conventional treatment of MDD. If you have seen me, we have most likely already screened your inflammatory markers and determined what dose of EPA/DHA is right for you. After you have been taking Omega 3’s for some time, we have a simple take home blood spot test that measures the exact ratio of Omega 3 to Omega 6 in your blood, which will tell us if your current diet and supplement schedule is providing enough of to achieve the clinical anti-inflammatory benefits. Please call the office if you have any symptoms of depression so we can create a nutritional protocol that is right for you.
Yours in health,
Dr. Hall