In our last blog, we focused on the fact that nutrient supplementation has not only been accepted in the realm of physical health in the past, but it has actually been endorsed by reputable sources such as the Journal of the American Medical Association editors who published the Fairfield and Fletcher articles 11 years ago recommending that all adults take a multivitamin to reduce their risk of cardiovascular disease, cancer, and osteoporosis (note that this is completely inconsistent with very recent studies reported in the Annals of Internal Medicine — but that’s just the way science works, using different nutrients and different methodologies, coming up with discrepant findings, until facts finally emerge).
But readers of this blog are well-aware by now that the brain is the most metabolically important organ of the body, using up vast amounts of nutrients compared to other organs. So why don’t we have mental health journals telling us that the key to prevention of mental disorders is nutrient supplementation?
The simple answer is that mental health research lags behind — we still don’t have enough information on nutrition’s role for prevention. A more complicated answer involves the enormous time lag between scientific findings and translation into clinical practice, something called Knowledge Translation or KT. Beginning with this blog, we are going to review some studies which we think should be influencing clinical practice, but . . . KT is still lagging behind.
Paul Amminger was a familiar name to those following the research on nutrition and mental health long before the ‘blockbuster’ randomized controlled trial (RCT) described below. Working both in Australia (Melbourne) and Austria, Amminger and his colleagues (e.g., Patrick McGorry) had demonstrated that omega-3 fatty acids showed some benefit in psychosis, and appeared to do so in part by increasing availability of glutathione (the master antioxidant that we all want to have more of).
In a 2010 issue of Archives of General Psychiatry, Amminger and his colleagues published an important RCT in which participants aged 13 – 25 were selected because they were at high risk of psychosis, based on a conventional set of criteria that include family history and early symptoms. Eighty-one of these young people were randomized to receive either a) 1.2 g/day of omega-3 fatty acids, or b) placebo. Treatment for all 81 youth lasted only 12 weeks. The researchers then waited for 12 months to determine who developed a clinically confirmed episode of psychosis. The results were very powerful: 4.9% of those who had 12 weeks exposure to fish oil and 27.5% of those who received placebo for 12 weeks advanced to psychosis. This five-fold difference was examined in various ways, and it was shown that the omega-3 use was associated with decreases in both positive and negative symptoms, as well as overall improved functioning.
Malfunctions in the metabolic pathways of fatty acids had previously been linked to the etiology of psychosis. But prior clinical applications had all employed treatment after diagnosis. The implications of the 2010 study are stunning for prevention: in this fully blinded study, 3 months of 1.2 g/day cut risk by 80% for a full year after intervention.
So the question is: How many Early Psychosis or First Episode Psychosis Clinics in the world are telling their patients to go buy fish oil? Bonnie has been asking this question in lectures recently, and she has not yet heard of a single one. If any reader knows of one, please write us. And if any reader is affiliated with such a clinic, we hope they will try to influence practice.
By the way, Amminger and colleagues have published many other papers, especially in relationship to mechanisms. Here are 1-2 sentence summaries of a few of the interesting findings:
Using 12 weeks treatment of only EPA (one omega-3 metabolite) in 24 adults who had experienced a first episode psychosis, 3 T proton magnetic resonance spectroscopy showed increased glutathione in both hemispheres, and increased left hemisphere glutamate (Berger et al., 2008).
In the 81 young people who participated in the Amminger et al. 2010 study, outcome data were examined to determine at which time point the omega-3s began to have therapeutic benefit. It is interesting to those of us studying mostly vitamins and minerals (which act very quickly) that the omega-3s took several weeks, a delayed onset that the authors said seemed “comparable to that of antipsychotics and antidepressants” (Mossaheb et al., 2013).
Again, in those same 81 people who were in the treatment RCT, it was found that the omega-3 treatment affected the enzymes that regulate phospholipid metabolism at an intracellular level (Smesny et al., 2013).
Finally, and perhaps of most interest to some of our readers, an RCT was recently reported that compared 3 different treatments in 115 people at ultra-high risk for the development of psychosis. The 3 treatments, all of which lasted 12 months were: cognitive therapy + risperidone, cognitive therapy + placebo, and supportive therapy + placebo. When transition to a full-blown psychosis was employed as the outcome measure, there was no difference across groups, and to quote the authors: the “essentially equivalent transition rates in all 3 groups fail to provide support for the first-line use of antipsychotic medications in patients at ultra-high risk of psychosis, and an initial approach with supportive therapy is likely to be effective and carries fewer risks (italics added).”
So what is the KT message from this small group of studies? As stated above, if anyone reading this is affiliated with an early psychosis clinic, recommend that everyone at risk begin taking at least a gram of omega-3s per day and consider implementing cognitive and supportive therapy prior to the initiation of medications.
Amminger GP, et al., Long-chain omega-3 fatty acids for indicated prevention of psychotic disorders: A randomized, placebo-controlled trial. Arch Gen Psychiatry, 2010;67(2):146-154.
Berger GE, et al. Ethyl-eicosapentaenoic acid in first-episode psychosis. A 1H-MRS study. Neuropsychopharmacolgy, 2008;33(10);2467-73.
McGorry PD, et al., Randomized controlled trial of interventions for young people at ultra-high risk of psychosis: Twelve-month outcome. J Clin Psychiatry, 2013;74(4):349-356.
Mossaheb N., et al., Effect of omega-3 fatty acids for indicated prevention of young patients at risk for psychosis: When do they begin to be effective? Schizophr Res, 2013;148:163-7.
Smesny S, et al., Omega-3 fatty acid supplementation changes intracellular phospholipase A2 activity and membrane fatty acid profiles I individuals at ultra-high risk for psychosis. Mol Psychiatry, 2013, 7.
If a drug were found to be that effective it would be front-page news, but nobody seems willing to promote nutrition. Very sad!
Dr. Kaplan and Dr. Rucklidge,
I cannot begin to express my gratitude for your work, and for your being part of the dialogue on MIA.
” For every drug that benefits a patient, there is a natural substance that can achieve the same effect.” – Carl Pfeiffer, MD
Changing my diet has had not only a great effect on my body weight (currenly 27 kg down from my highest, BMI 22.7, right in middle of the normal range, though I think as a male I still have slightly too much fat around my waist instead of muscled for that BMI). I also think that the diet had a great effect on my mind, though it wasn’t the only factor. For myself, eating real food and getting the macronutrients right was most important – in my case, going low carb and eating vegetables and meat, etc instead of other stuff I was poisoning my body with.
I also take some omega-3 supplements and try to eat fish regularly. But, I guess for many people it’s more urgent to get rid of “toxic” food and get to eat some better food. Taking omega-3 supplements often won’t get rid of the bad things you do to your body with the other food.
Hi! I hear voices & have been on neuroleptic meds 4 17 years. Around seven years ago I heard of an Irish GP(I live there) who did vitamin therapy for mh service users’. I take fish oil(i have concerns re ecological devastation & future availability & quality), zinc, B vits esp. B3 (supposed to be a natural antipsychotic’), L-methionine, multivitamin, vit c. These have helped mitigate the effects of 600mg solian per day, so much so that shrinks think I am a star performer! Still, they don’t seem to ever really listen to you.
Love to America
Congrats on your success.
And love to Ireland!
Ditto on Duanes comments. Thanks. I’m 66, 4 40 years I heard voices from the age of 16 to 56 , my spiritual emergency was called illusions of grandeur,schizophrenia,manic depression,bipolar depression, which meant most everything was forced on me ; hospitalizations, thorazine , cogentin , stelazine , haldol , ect and sodium penathol . Also, experimentation that would make water boarding seem like a picnic. I must say some of the social workers I saw were worse than nurse Rachit. The shrinks never allowed me more than a sentence and except for one were like Gestapo in white smocks or plain clothes. Escaping whenever possible from their clutches and non compliance saved me .Somehow I knew my parents loved me even though they signed me up for a lot of bullshit. Like so many others and myself at one time they had a strong faith in medical doctors and their titles. Its hard to make a bigger mistake in life. Through many years I prayed to G-d for help. It was slow in coming and I am astounded to still be alive. Traditional Naturopathy (Far beyond the knowledge of nutritionists on diet and mental health) See HERB DOC.COM Richard Schultze ND .Google Paracelsus Klinic in Switzerland read deeply you will be astounded. See MercuryJustice.org read deeply you will be astounded. Homeopathy has been a great help for me. The most amazing cutting edge healing system I’ve ever seen or practiced Yuen Method which combines the teaching of acupuncture,Qui Zhong,Tai Chi, with Quantum Physics ,Biology, and Psycology. As for supplements I believe omega 3 helps.Vitamin B5 taken at the same time with a B complex that also has B5 in it helps for sleep. Also Valerio Aminos helps for sleep and relaxation. 32 oz. per day of freshly made organic green vegetable juice 50% filtered or spring water always helps a person feel better mentally and emotionally.See Robert Youngs book ” Sick and Tired ” truly an eye opener. For me and others the most amazing of all was Advanced Dentistry following Hal Huggins protocols, proper removal of 15 mercury fillings ,replacement with non metal fillings, removal of root canals, examined for cavitations. All voices stopped( AFTER 40 YEARS for me of unwanted voices and Chronic Insomnia Vanished) I swear to you on my life. As for the relationship of diet and supplements. Diet is the tree ,vitamins are the ornaments and neither will work optimally without exercise. Organic food supply ,a stress free lifestyle……what am I dreaming. I finally weaned off of 2 mgs. of haloperidol at the age 56 and have been a drug free psych survivor for 10 years and in many ways still feel like a Rip Van Winkle thats woken up into a night mare of oppression for so many people on the planet by a bunch of interlinked cartels that move forward with impunity preying upon a confused confined population.Have I come full circle? And I can’t say I know what to do.
Although I’d have preferred that the title of this post be more broad: “fish oil and mental illness” I concur that omega 3 fats, preferably in the form of fish oil, have a strong effect on a wide array of psychiatric conditions.
In my practice, I have seen the effect of fish oil be especially dramatic in bipolar disease, such that relatives of the patient could tell when she had skipped her dosage (the same day!)
I recommend my patients take TWO grams of Omega-3s (that means you add up the amount of EPA and DHA listed on the label). In the U.S., the easily available Nature’s Bounty brand (ordinarily I wouldn’t list a brand, but this one is inexpensive and widely available, in U.S. Costco has it) has an enteric-coated fish oil in which 2 caps per day gets you to 1.8 grams per day, which is close enough.
Daniel Heller N.D.
Marin County, California