Omega-3 Fatty Acids for Major Depressionin Perimenopausal/Menopausal Women
Author: Freeman M, Hibbeln J, Silver M, et al.
Reference: Omega-3 fatty acids for major depressive disorder associated with the menopausal transition: a preliminary open trial. Menopause 2012;18(3):279-284
Design: Open-label study of omega-3 fatty acids for the treatment of major depressive disorder (MDD). After a 1-week single-blind placebo lead-in, participants received 8 weeks of treatment with open-label omega-3 fatty acids. Participants received open-label Lovaza 2 g/day (2 capsules per day). Each capsule of Lovaza contains 840 mg of ethyl esters of omega-3 fatty acids, as a combination of approximately 465 mg of eicosapentaenoic acid (EPA) and approximately 375 mg of docosahexaenoic acid (DHA) per capsule. Each capsule also contains small amounts of docosapentaenoic acid, stearidonic acid, heneicosapentaenoic acid, ecosatetraenoic acid and alpha-linolenic acid totaling the remaining 160 mg.
Participants: Perimenopausal or postmenopausal women, 40 and older who met the criteria for MDD and had a minimum score of 19 on the Montgomery-Asberg Depression Rating Scale (MADRS) at the screening visit. In total, 24 eligible women were enrolled between November 2008 and April 2009.
Primary Outcome: The primary objective was to determine if an 8 week treatment with omega-3 fatty acids would decrease depressive symptoms in perimenopausal and postmenopausal women who had major depressive disorder. The secondary outcome was a change in hot flashes using a hot flash diary and the Hot Flash Related Daily Interference Scale (HFRDIS)
Key findings: Of the 20 women who completed the study, pretreatment MADRS scores were 24.2 and post treatment, 10.7, demonstrating a significant decrease in MDRS scores. Seventy percent of participants had their MADRS score decrease by 50% or more. The remission rate was 45%, i.e. a final MADRS score of 7 or less.
Fifteen of the women had hot flashes at baseline and the number of hot flashes per day improved significantly with a score of 9.0 + 10.3 hot flashes per day pretreatment and 2.5 + 4.0 posttreatment. The average change in score from pretreatment to posttreatment was 5.1
The women whose depression responded to treatment were significantly more likely to have decreased hot flash scores than the nonresponders. This was stronger for nighttime hot flash scores than daytime scores. Women who had a remission of their MDD had a significant decrease in their hot HFRDIS compared with those who did not have remission.
Practice Implications: This study is very clinically meaningful as MDD is experienced by a significant number of perimenopausal and postmenopausal women. While there are many therapeutic options, including hormones, prescription anti-depressants and herbal/vitamin options, not all of these have good data in perimenopausal/menopausal women. This open trial provides good evidence that omega-3 fatty acids can be effective for not only major depression in these women, but hot flashes as well. This study is an echo of a study published by Luca M, et al in 2009, demonstrating that omega-3 fatty acids can be effective to decrease hot flash frequency and improve quality of life. (Lucas M, Asselin G, Merett C, et al. Effects of ethyl-eicosapentaenoic acid omega-3 fatty acid supplementation on hot flashes and quality of life among middle-aged women: a double-blind, placebo-controlled, randomized clinical trial. Menopause 2009;16:357-366.) A future randomized, placebo-controlled trial on omega-3 fatty acids in perimenopausal and postmenopausal women with MDD will be even more convincing but for now, the use of 2 gm/day of high quality of fish oil with the approximate amounts of EPA/DHA used in this study is an appealing therapeutic option either alone or as an adjunct to hormonal and nonhormonal therapies for this population of women.