Sunday, 2 June 2013

Schizophrenia and EPA

Treatment with omega-3

Due to the many of adverse side effects of antipsychotic drugs there is increasing interest in alternative treatments for schizophrenia. I will be addressing one of these treatments; ethyl-eicosaptaenoic acid (E-EPA) which is a fatty acid found in omega-3. Below are some of the studies that I have looked at involving E-EPA, also referred to as just EPA.

1) In a study testing the effects of placebo vs omega-3 supplements it was found that 27.5% experienced further development of psychosis after treatment with placebo and only 4.9% experienced this when treated with omega-3 supplements. I wasn't able to find the numbers of people involved or length of test, length until psychosis developed or amount of EPA dosage, but there are more studies.

2) In this second test, 81 high risk youths (young people who had a family history of schizophrenia), all previously showed early symptoms of schizophrenia - short hallucinations and delusions. Based on research, if not treated roughly half would develop schizophrenia. Half of these youths took 1,500mg (1.5 grams) of fish oil for 3 months, and the other half took a placebo. A year after the study started, 3% that took fish oil developed schizophrenia compared with 28% who took the placebo. Previous studies suggest that antipsychotic drugs would have reduced the rate to 12% though they have severe side-effects.

3) In 8 studies ranging from 6 to 16 weeks in duration and involving 517 people diagnosed with schizophrenia there were minimal improvements when subjects were supplemented with EPA and DHA compared to placebo. These tests overall found that the omega-3 oils gave a small increase in general functioning and mental state but not to a statistically significant degree. This could show that omega-3 fatty acids are not effective or that the trials were too small and short in duration, however, it is difficult to tell as this treatment is in its early stage.

4) 87 patients whose average age was 40, took 3,000 mg of EPA per day. This test showed no improvement in schizophrenic symptoms. However, most of these patients had been ill for 2 decades and the study says that "the patients described as benefiting from EPA in prior studies were younger and had a shorter duration of illness." And that; "[Prior] reports have indicated symptom improvement ranging from 17% to 85% when omega-3 fatty acids were added to patients usual medication."

5) 76 patients in a trial of fish oil tablets vs placebo; 41 patients took fish oil tablets 4 times per day and 25 took placebo over a 3 month period. Of the 41 patients that took the fish oil, 2 developed a psychotic disorder after 1 year while 11 of the placebo group developed a psychotic disorder within the one year period.

6) In a study involving an unknown number of patients taking different dosages of EPA; 1g, 2g, and 4g per day it was found that 2,000mg was most effective in reducing psychotic symptoms. This dosage was found to have increased the amount of red cell EPA without decreasing red cell arachidonic acid. This study showed an inverted U relationship between improvement of symptoms and dosage of EPA. Similar effects were shown in a depression study in which 1,000mg per day was most effective.

7) "Administration of omega-3 in adolescent rats prevents positive, negative and cognitive symptoms in a ketamine animal model of schizophrenia. Whether these findings are a consequence of BDNF increase is unclear. However, this study gives compelling evidence for larger clinical trials to confirm the use of omega-3 to prevent schizophrenia and for studies to reinforce the beneficial role of omega-3 in brain protection." - BDNF (brain derived neurotrophic factor) is involved in the growth of new neurons.

It is possible that EPA is able to treat or prevent the onset of full blown schizophrenia if caught early enough and that the studies which didn't work involved patients who had had schizophrenia for a longer duration. One thing is for sure, though, and this is that EPA has very few side effects, most noticeable is that some people experience occasional nausea, but perhaps at dosages of 2,000mg per day this would be reduced or not felt. With such few side effects it seems that EPA is worth trying for the chance of reducing symptoms.

Omega-3 fatty acids or essential fatty acids (EFAs) are fundamental to normal brain functioning. They are thought to help the brain function in 3 major ways. Firstly, by maintaining the cell membranes of neurons. Secondly, causing beneficial changes in neurotransmission and lastly, by reducing oxidative stress. All 3 of these factors have been investigated in separate studies and shown that they are impaired in cases of schizophrenia. Previous research has also shown omega-3 to be an effective add-on to treatment in reducing both the positive and negative symptoms of schizophrenia, as well as lowering levels of dyskinesia, a movement disorder that is sometimes a side-effect of antipsychotics. Evidence also suggests that male schizophrenics have a deficit of EFAs (omega-3 and omega-6 polyunsaturated fats) in their orbitofrontal cortex. Treatment with antipsychotic medications tends to partially correct this deficit and atypical / second generation medications tend to be more effective at this than typical / first general medications.

Common omega-3 sources: wild salmon, herring, mackerel, anchovies and sardines, flaxseed, kiwi, walnuts and poultry.

There have also been some studies indicating that the prognosis of schizophrenic patients is worse in developed countries than in developing countries, despite the availability of medications in the former. This has led to the idea that diet has a major role to play in schizophrenia as well. The countries that had the worst outcomes for schizophrenics consumed much more saturated fats. Better outcomes were associated with a diet in which fat was obtained from fruit, nuts and fish. Also; "A higher national dietary intake of refined sugar and dairy products predicted a worse 2-year outcome of schizophrenia. A high national prevalence of depression was predicted by a low dietary intake of fish and seafood." - PsychologyToday. One reason for this is that sugar lowers BDNF which could cause the brain shrinkage in schizophrenia.

The consensus is that the sooner someone exhibiting signs of psychosis is treated, the greater their response to treatment, the less likely they are to relapse and an overall better quality of life they will have.

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