Add-on fish oil for depressed patients with heart disease requires further study
Augmenting sertraline with an omega-3 fatty acid for 10 weeks did not result in greater improvement in depressive symptoms compared with sertraline and corn oil placebo in patients with major depressive disorder and coronary heart disease, according to a study published in Journal of Clinical Psychiatry.
“There is considerable interest in whether treating depression improved cardiac event-free survival in [coronary heart disease],” Robert M. Carney, PhD, professor of psychiatry at Washington University School of Medicine in St. Louis, and colleagues wrote. “Unfortunately, few randomized clinical trials have addressed this question, and the interventions tested in these have had relatively small effects on depression.”
Researchers examined whether adding eicosapentaenoic acid (EPA), one of the omega-3 fatty acids found in fish oils, can improve the response to sertraline in 144 patients with major depressive disorder who have or were at high-risk for coronary heart disease (CHD) between May 2014 and June 2018.
Patients were randomized to receive either 50 mg each day of sertraline plus 2 g each day of EPA or 50 mg each day of sertraline and corn oil placebo capsules for 10 weeks. Carney and colleagues measured change on the Beck Depression Inventory II (BDI-II; primary outcome) as well as on the Hamilton Depression Rating Scale (HDRS-17), response, remission and anxiety levels.
The results revealed no differences at posttreatment in the adjusted average BDI-II scores between the placebo and EPA arms (10.3 vs. 12.1; P = .22) after 10 weeks of treatment.
In addition, the investigators found no difference between the placebo and EPA arms on the 17-item Hamilton Depression Rating Scale (7.2 vs. 8; P = .4), the remission rate (50.6% vs. 46.7%; OR = 0.85; 95% CI, 0.43-1.68), treatment response rate (80.5% vs. 73.1%; OR = 0.64; 95% CI, 0.28-1.47) or anxiety levels (between group difference = 1.11; 95% CI, –1.07 to 3.3).
“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,” Carney and colleagues wrote. “Research on variations in the genes involved in the metabolism, synthesis, uptake and utilization of omega-3 may also help to identify patients who will respond to omeda-3 supplements as monotherapy or as augmentation of standard antidepressants.” – by Savannah Demko
Disclosure: Carney or a family member reports holding stock in Pfizer Inc. Please see the study for all other authors’ relevant financial disclosures.