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Nutritional Supplements May Boost Effects of Antidepressants

International evidence review gives thumbs up to omega-3s.

An international evidence review has found that certain nutritional supplements can increase the effectiveness of antidepressants for people with clinical depression.

Omega 3 fish oils, S-adenosylmethionine (SAMe)*, methylfolate (bioactive form of folate) and Vitamin D, were all found to boost the effects of medication.

University of Melbourne and Harvard researchers examined 40 clinical trials worldwide, alongside a systematic review of the evidence for using nutrient supplements (known as nutraceuticals) to treat clinical depression in tandem with antidepressants such as SSRIs, SNRIs and tricyclics.

Head of the ARCADIA Mental Health Research Group at the University of Melbourne, Dr Jerome Sarris, led the meta-analysis, published today in the American Journal of Psychiatry.

“The strongest finding from our review was that Omega 3 fish oil – in combination with antidepressants – had a statistically significant effect over a placebo,” Dr Sarris said.

“Many studies have shown Omega 3s are very good for general brain health and improving mood, but this is the first analysis of studies that looks at using them in combination with antidepressant medication.

“The difference for patients taking both antidepressants and Omega 3, compared to a placebo, was highly significant. This is an exciting finding because here we have a safe, evidence-based approach that could be considered a mainstream treatment.”

The University of Melbourne research team also found good evidence for methylfolate, Vitamin D, and SAMe as a mood enhancing therapy when taken with antidepressants. They reported mixed results for zinc, vitamin C and tryptophan (an amino acid). Folic acid didn’t work particularly well, nor did inositol.

“A large proportion of people who have depression do not reach remission after one or two courses of antidepressant medication,” Dr Sarris said.

“Millions of people in Australia and hundreds of millions worldwide currently take antidepressants. There’s real potential here to improve the mental health of people who have an inadequate response to them.”

Dr Sarris said medical professionals may be hesitant to prescribe nutraceuticals alongside pharmaceuticals, simply because there has been a lack of scientific evidence around their efficacy.

“Medical practitioners are aware of the benefits of omega 3 fatty acids, but are probably unaware that one can combine them with antidepressant medication for a potentially better outcome,” he said.

This image suppliment pills.

The University of Melbourne research team also found good evidence for methylfolate, Vitamin D, and SAMe as a mood enhancing therapy when taken with antidepressants. They reported mixed results for zinc, vitamin C and tryptophan (an amino acid). Folic acid didn’t work particularly well, nor did inositol. Image is for illustrative purposes only.

The researchers found no major safety concerns in combining the two therapies, but stressed that people on antidepressants should always consult with their health professional before taking nutraceuticals and should be aware these supplements can differ in quality.

“We’re not telling people to rush out and buy buckets of supplements. Always speak to your medical professional before changing or initiating a treatment,” Dr Sarris said.

The researchers are currently conducting a National Health and Medical Research Council study using a combination of these nutraceuticals for depression.

About this psychology research

Funding: Funding provided by National Health and Medical Research Council.

Source: Jane Gardner – University of Melbourne
Image Source: The image is in the public domain.
Original Research: Abstract for “Adjunctive Nutraceuticals for Depression: A Systematic Review and Meta-Analyses” by Jerome Sarris, Ph.D., M.H.Sc., Jenifer Murphy, Ph.D., David Mischoulon, M.D., Ph.D., George I. Papakostas, M.D., Maurizio Fava, M.D., Michael Berk, M.D., Ph.D., and Chee H. Ng, M.D. in American Journal of Psychiatry. Published online April 26 2016 doi:10.1176/appi.ajp.2016.15091228


Abstract

Adjunctive Nutraceuticals for Depression: A Systematic Review and Meta-Analyses

Objective:
There is burgeoning interest in augmentation strategies for improving inadequate response to antidepressants. The adjunctive use of standardized pharmaceutical-grade nutrients, known as nutraceuticals, has the potential to modulate several neurochemical pathways implicated in depression. While many studies have been conducted in this area, to date no specialized systematic review (or meta-analysis) has been conducted.

Method:

A systematic search of PubMed, CINAHL, Cochrane Library, and Web of Science was conducted up to December 2015 for clinical trials using adjunctive nutrients for depression. Where sufficient data were available, a random-effects model analyzed the standard mean difference between treatment and placebo in the change from baseline to endpoint, combining the effect size data. Funnel plot and heterogeneity analyses were also performed.

Results:
Primarily positive results were found for replicated studies testing S-adenosylmethionine (SAMe), methylfolate, omega-3 (primarily EPA or ethyl-EPA), and vitamin D, with positive isolated studies for creatine, folinic acid, and an amino acid combination. Mixed results were found for zinc, folic acid, vitamin C, and tryptophan, with nonsignificant results for inositol. No major adverse effects were noted in the studies (aside from minor digestive disturbance). A meta-analysis of adjunctive omega-3 versus placebo revealed a significant and moderate to strong effect in favor of omega-3. Conversely, a meta-analysis of folic acid revealed a nonsignificant difference from placebo. Marked study heterogeneity was found in a Higgins test for both omega-3 and folic acid studies; funnel plots also revealed asymmetry (reflecting potential study bias).

Conclusions:
Current evidence supports adjunctive use of SAMe, methylfolate, omega-3, and vitamin D with antidepressants to reduce depressive symptoms.

“Adjunctive Nutraceuticals for Depression: A Systematic Review and Meta-Analyses” by Jerome Sarris, Ph.D., M.H.Sc., Jenifer Murphy, Ph.D., David Mischoulon, M.D., Ph.D., George I. Papakostas, M.D., Maurizio Fava, M.D., Michael Berk, M.D., Ph.D., and Chee H. Ng, M.D. in American Journal of Psychiatry. Published online April 26 2016 doi:10.1176/appi.ajp.2016.15091228

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