Study Also Shows that EPAX 5500 TG Concentrated Fish Oil Supplement Provided Relief of Self-Harming Behaviours Including Depression, Suicidality and Daily Stress
AALESUND, Norway (Feb. 27, 2007) -- Results from a clinical study in patients with self-harming psychiatric disorders was published in the February issue of British Journal of Psychiatry by consultant psychiatrist Malcolm R. Garland, M.D., MRCPsych. The study (1) demonstrated that lower plasma levels of essential fatty acids (EFAs) combined with low cholesterol concentrations were associated with self-harm, a high-risk pathological behaviour, as well as impulsivity and affect.
These findings mirror the mounting epidemiological, basic science and clinical intervention data that indicate low levels of circulation lipids, omega-3 EFAs and cholesterol are risk factors for impulsive and depressive behaviour.
The association between low cholesterol and a recent act of self-harm have been frequently demonstrated (2). The omega-3 EFAs are selectively concentrated in the brain but are obtained exclusively from the diet, mainly from fish and seafood. Countries with greater per capita rates of seafood consumption have lower rates of major depression, bipolar depression, post-partum depression and mortality from homicide (3). Patients who self-harm, exhibit a convergence of many constructs related to serotonergic dysfunction (e.g. depression, impulsivity and violence) (4). Low concentrations of serotonin and metabolites in the cerebral spine of those who attempt suicide is a well-replicated finding and frequently linked to impulsive and self- destructive disorders (5).
The study was conducted to determine whether self-harming people also have low levels of EFA and to examine the association between lipids/ EFAs and two common psychopathological constructs in self-harm:
impulsivity and depression. Depression, impulsivity and suicidal intent were measured in 40 patients who self-harm and matched (in diet, age and sex) controls together with plasma levels and EFAs.
Platelet serotonergic studies were carried out in a subgroup of 27 patients. The patients were recruited over an 18-month period and tested within 24 hours of admission.
The study concluded that patients who self-harm had significantly more pathology on all psychometric measures, lower total cholesterol levels and lower total EFA levels than controls. Total omega-3 and
omega-6 levels were also significantly lower. Impulsivity and depression were significantly inversely correlated with both omega-3 and omega-6 EFAs. Platelet serotonergic measures did not differ between groups and were not related to psychobiological measures.
In an accompanying study to assess the efficacy of omega-3 EFAs in improving psychological well-being in patients with recurrent self- harm, (6), 49 patients, recruited after an act of repeated self-harm, were tested and randomised to receive daily 1.2 grams of EPA and 0.9 grams of DHA (patients were given EPAX 5500TG capsules with 305 milligrams of EPA and 227 milligrams of DHA) or placebo. At 12 weeks, the omega-3 EFA group had significantly greater improvements in scores for depression, suicidality and daily stress; the surrogate markers of suicidal behaviour achieved substantial reductions and improvements in well-being were observed. Scores for impulsivity, aggression and hostility did not differ.
“We were very pleased with the outcome of this study. Although we were financially constrained in terms of the number of subjects we could recruit, we achieved acceptable levels of statistical significance,” said Garland. “At the end of the study, when we were decoding those patients on placebo and on supplementation, our ‘wish’
for those patients we knew were doing well, was for them to be in the supplementation group, and it was almost always fulfilled. We think it is now crucial to proceed to much larger studies looking at the effects of omega-3 EFAs on suicide prevention.”
This trial was the first of omega-3 supplementation in patients with self-harm.
Trials have also demonstrated benefits of long-chain omega-3 EFAs supplementation in a variety of psychiatric disorders. An accompanying single-centred, 12-week randomized active placebo- controlled study suggested that supplementation of omega-3 EFA achieved substantial reduction in surrogate markers for suicidal behaviour and improvements in well-being.
Therapeutic trials of the omega-3 essential fatty acids (EFAs) eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) have yielded promising data for a broad spectrum of psychiatric disorders (3). Rapid advances in the basic science have confirmed the central role of omega-3 EFAs in variety of pathophysiological processes, particularly those involving monoaminergic neurotransmission (7).
Patients with recurrent, non-fatal self-harming behaviour exhibit affective disturbances and impulsive and violent behaviours that have been repeatedly linked to deficits in momaminergic neurotransmission (4). Self-harm is the major cause of morbidity and presents a major therapeutic challenge.
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1) Garland M, et al. Lipids and essential fatty acids in patients
presenting self-harm. British Journal of Psychiatry. (2007), 190, 112-117. doi: 10.1192/bjp.bp.105.019562
2) Garland et al, 2000; Lester 2002
3) Hallahan & Garland, 2005
4) Mann, 2003
5) Roggenbach et al, 2002
6) Hallahan B et al, Omega-3 Fatty acid supplementation in patients
with recurrent self-harm, British Journal of Psychiatry, (2007), 190, 118-122, doi: 10.1192/bjp.bp.106.022707
7) Sublette et al, 2004
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