Ethyl-eicosapentaenoic acid for the treatment of psychological distress and depressive symptoms in middle-aged women: a double-blind, placebo-controlled, randomized clinical trial. Influence of life stress on depression: moderation by a polymorphism in the 5-HTT gene. Depression and cardiovascular mortality: a role for n-3 fatty acids? Plasma fatty acid composition and depression are associated in the elderly: the Rotterdam Study. Adherence to healthy dietary guidelines and future depressive symptoms: evidence for sex differentials in the Whitehall II study1234 Exercise and Pharmacotherapy in the Treatment of Major Depressive Disorder Omega-3 fatty acids in major depressive disorder: A preliminary double-blind, placebo-controlled trial Antidepressants on trial: how valid is the evidence? Omega-3 fatty acid supplementation in patients with recurrent self-harm. Single-centre double-blind randomised controlled trial. Omega-3 treatment of childhood depression: a controlled, double-blind pilot study. Considerations regarding neuropsychiatric nutritional requirements for intakes of omega-3 highly unsaturated fatty acids. Lack of seasonal mood change in the Icelandic population: results of a cross-sectional study. Separation anxiety disorder in childhood as a risk factor for future mental illness. Genetic influences on life events in childhood. Fish and long-chain n-3 polyunsaturated fatty acid intakes during pregnancy and risk of postpartum depression: a prospective study based on a large national birth cohort. Addition of omega-3 fatty acid to maintenance medication treatment for recurrent unipolar depressive disorder. A double-blind, placebo-controlled study of the omega-3 fatty acid docosahexaenoic acid in the treatment of major depression. Fish consumption and depression: the Northern Finland 1966 birth cohort study. Efficacy of ethyl-eicosapentaenoic acid in bipolar depression: randomised double-blind placebo-controlled study. Treatment of minor depression in older adults: A pilot study comparing sertraline and exercise Dimensions of adolescent alcohol involvement as predictors of young-adult major depression. Double-Blind, Randomized, Placebo-Controlled Trials of Ethyl-Eicosapentanoate in the Treatment of Bipolar Depression and Rapid Cycling Bipolar Disorder Randomised double-blind placebo-controlled trial of fish oil in the treatment of depression. A dose-ranging study of the effects of ethyl-eicosapentaenoate in patients with ongoing depression despite apparently adequate treatment with standard drugs. Parental maltreatment and proximal risk factors using the Childhood Experience of Care & Abuse (CECA) instrument: a life-course study of adult chronic depression - 5. Socioeconomic status and risk of psychological distress and depression in the Stockholm Public Health Cohort: a population-based study.
BACKGROUND Psychological distress ( PD ) and depressive symptoms are commonly observed during menopausal transition . Studies suggest that omega-3 ( n-3 ) fatty acids may help alleviate depression . OBJECTIVE The objective was to compare enriched ethyl-eicosapentaenoic acid ( E-EPA ) supplementation with placebo for the treatment of PD and depressive symptoms in middle-aged women . DESIGN Women with moderate-to-severe PD ( n = 120 ) were r and omly assigned to receive 1.05 g E-EPA/d plus 0.15 g ethyl-docosahexaenoic acid/d ( n = 59 ) or placebo ( n = 61 ) for 8 wk . The main outcomes were 8-wk changes in PD scores [ Psychological General Well-Being Schedule ( PGWB ) ] and depressive scales [ 20-item Hopkins Symptom Checklist Depression Scale ( HSCL-D-20 ) and the 21-item Hamilton Depression Rating Scale ( HAM-D-21 ) ] . RESULTS At baseline , women with PD were mildly to moderately depressed , and 24 % met the major depressive episode ( MDE ) criteria of the Diagnostic and Statistical Manual of Mental Disorders , 4th edition . After 8 wk , outcomes improved in both groups , but no significant differences were noted between them . Stratification analyses for MDE diagnosis at baseline indicated that differences in adjusted 8-wk changes between the E-EPA group without MDE ( n = 46 ) and the placebo group ( n = 45 ) were 8.0 ( 95 % CI : 0.6 , 15.3 ; P = 0.034 ) for the PGWB , -0.2 ( 95 % CI : -0.01 , -0.4 ; P = 0.040 ) for the HSCL-D-20 , and -2.7 ( 95 % CI : -0.3 , -5.1 ; P = 0.030 ) for the HAM-D-21 . Differences in adjusted 8-wk changes between the E-EPA group with MDE ( n = 13 ) and the placebo group ( n = 16 ) were not significant . CONCLUSIONS To our knowledge , this is the first trial of n-3 supplementation in the treatment of PD and depressive symptoms in middle-aged women . In women with PD without MDE at baseline , the 8-wk changes in PD and depressive scales improved significantly more with E-EPA than with placebo . This trial was registered at http://www.controlled-trials.com as IS RCT N69617477 In a prospect ive-longitudinal study of a representative birth cohort , we tested why stressful experiences lead to  depression  in some people but not in others . A functional polymorphism in the promoter region of the serotonin transporter ( 5-HT T ) gene was found to moderate the influence of stressful life events on depression . Individuals with one or two copies of the short allele of the 5-HT T promoter polymorphism exhibited more depressive symptoms , diagnosable depression , and suicidality in relation to stressful life events than individuals homozygous for the long allele . This epidemiological study thus provides evidence of a gene-by-environment interaction , in which an individual 's response to environmental insults is moderated by his or her genetic makeup BACKGROUND Recent studies indicate that depression plays an important role in the occurrence of cardiovascular diseases ( CVDs ) . The underlying mechanisms are not well understood . OBJECTIVE We investigated whether dietary intake of the n-3 fatty acids ( FAs ) eicosapentaenic acid and docosahexaenoic acid could explain the relation between depressive symptoms and cardiovascular mortality . DESIGN The Zutphen Elderly Study is a prospect i ve cohort study conducted in the Netherl and s. Depressive symptoms were measured in 1990 with the Zung Self-rating Depression Scale in 332 men aged 70 - 90 y and free from CVD and diabetes .  Dietary factors  were assessed with a cross-check dietary history method in 1990 . Mortality data were collected between 1990 and 2000 . Logistic and Cox regression analyses were performed , with adjustment for demographics and CVD risk factors . RESULTS Compared with a low intake ( x : 21 mg/d ) , a high intake ( x : 407 mg/d ) of n-3 FAs was associated with fewer depressive symptoms [ odds ratio : 0.46 ; 95 % CI : 0.22 , 0.95 ; P for trend = 0.04 ] at baseline and no significant reduced risk of 10-y CVD mortality [ hazard ratio ( HR ) : 0.88 ; 95 % CI : 0.51 , 1.50 ] . The adjusted HR for an increase in depressive symptoms with 1 SD for CVD mortality was 1.28 ( 95 % CI : 1.03 , 1.57 ) and did not change after additional adjustment for the intake of n-3 FAs . CONCLUSION An average intake of approximately 400 mg n-3 FA/d may reduce the risk of depression . Our results , however , do not support the hypothesis that the intake of n-3 FAs explains the relation between depression and CVD BACKGROUND It has been hypothesized that n-3 polyunsaturated fatty acids ( PUFAs ) are involved in mood regulation , but epidemiologic evidence for such a link in the general population is lacking . OBJECTIVE This study examined whether community-dwelling elderly persons with depression have a fatty acid composition that is different from that of nondepressed persons . DESIGN We screened 3884 adults aged > or = 60 y for depressive symptoms as part of the Rotterdam Study . Subjects who screened positive had a psychiatric interview to diagnose depressive disorders . All eligible subjects had their blood drawn for measurement of plasma phospholipid concentrations . We compared percentages of n-3 and n-6 PUFAs and their ratios between 264 subjects with depressive symptoms , including 106 subjects with depressive disorders , and 461 r and omly selected reference subjects . We also investigated whether atherosclerosis or the inflammatory response as measured by C-reactive protein underlies the relation between fatty acid composition and depression . RESULTS Subjects with depressive disorders had a higher ratio of n-6 to n-3 PUFAs , but differences in individual PUFAs were mostly small . However , depressed subjects with normal CRP concentrations ( < 1.5 mg/L ) had a substantially altered fatty acid composition ; percentages of n-3 PUFAs and ratios of n-6 to n-3 PUFAs were significantly lower and higher , respectively , in subjects with depressive disorders than in control subjects [ 5.2 % compared with 5.9 % ( P = 0.02 ) and 7.2 compared with 6.6 ( P = 0.01 ) , respectively ] . This relation was not due to atherosclerosis . CONCLUSIONS In community-dwelling persons , fatty acid composition is related to depression . Because this relation was not secondary to inflammation , atherosclerosis , or possible confounders , it suggests a direct effect of fatty acid composition on mood Background : It has been suggested that dietary patterns are associated with future risk of depressive symptoms . However , there is a paucity of prospect i ve data that have examined the temporality of this relation . Objective : We examined whether adherence to a healthy diet , as defined by using the Alternative Healthy Eating Index ( AHEI ) , was prospect ively associated with depressive symptoms assessed over a 5-y period . Design : Analyses were based on 4215 participants in the Whitehall II Study .  AHEI scores were computed in 1991–1993 and 2003–2004 . Recurrent depressive symptoms were defined as having a Center for Epidemiologic Studies Depression Scale score ≥16 or self-reported use of antidepressants in 2003–2004 and 2008–2009 . Results : After adjustment for potential confounders , the AHEI score was inversely associated with recurrent depressive symptoms in a dose-response fashion in women ( P-trend < 0.001 ; for 1 SD in AHEI score ; OR : 0.59 ; 95 % CI : 0.47 , 0.75 ) but not in men . Women who maintained high AHEI scores or improved their scores during the 10-y measurement period had 65 % ( OR : 0.35 % ; 95 % CI : 0.19 % , 0.64 % ) and 68 % ( OR : 0.32 % ; 95 % CI : 0.13 % , 0.78 % ) lower odds of subsequent recurrent depressive symptoms than did women who maintained low AHEI scores . Among AHEI components , vegetable , fruit , trans fat , and the ratio of polyunsaturated fat to saturated fat components were associated with recurrent depressive symptoms in women . Conclusion : In the current study , there was a suggestion that poor diet is a risk factor for future depression in women Objective : To assess whether patients receiving aerobic exercise training  performed either at home or in a supervised group setting achieve reductions in depression comparable to st and ard antidepressant medication ( sertraline ) and greater reductions in depression compared to placebo controls . Methods : Between October 2000 and November 2005 , we performed a prospect i ve , r and omized controlled trial ( SMILE study ) with allocation concealment and blinded outcome assessment in a tertiary care teaching hospital . A total of 202 adults ( 153 women ; 49 men ) diagnosed with major depression were assigned r and omly to one of four conditions : supervised exercise in a group setting ; home-based exercise ; antidepressant medication ( sertraline , 50–200 mg daily ) ; or placebo pill for 16 weeks . Patients underwent the structured clinical interview for depression and completed the Hamilton Depression Rating Scale ( HAM-D ) . Results : After 4 months of treatment , 41 % of the participants achieved remission , defined as no longer meeting the criteria for major depressive disorder ( MDD ) and a HAM-D score of < 8 . Patients receiving active treatments tended to have higher remission rates than the placebo controls : supervised exercise = 45 % ; home-based exercise = 40 % ; medication = 47 % ; placebo = 31 % ( p = .057 ) . All treatment groups had lower HAM-D scores after treatment ; scores for the active treatment groups were not significantly different from the placebo group ( p = .23 ) . Conclusions : The efficacy of exercise in patients seems generally comparable with patients receiving antidepressant medication and both tend to be better than the placebo in patients with MDD . Placebo response rates were high , suggesting that a considerable portion of the therapeutic response is determined by patient expectations , ongoing symptom monitoring , attention , and other nonspecific factors . BDI = Beck Depression Inventory ; CI = confidence interval ; HAM-D = Hamilton Depression Rating Scale ; ITT = intention-to-treat ; MDD = major depressive disorder ; SD = st and ard deviation ; SSRIs = selective serotonin reuptake inhibitors ; TSH = thyroid stimulating hormone Patients with depression have been extensively reported to be associated with the abnormality of omega-3 polyunsaturated fatty acids ( PUFAs ) , including significantly low eicosapentaenoic acid and docosahexaenoic acid in cell tissue contents ( red blood cell membrane , plasma , etc . ) and dietary intake . However , more evidence is needed to support its relation . In this study , we conducted an 8-week , double-blind , placebo-controlled trial , comparing omega-3 PUFAs ( 6.6 g/day ) [ corrected ] with placebo , on the top of the usual treatment , in 28 patients with major depressive disorder . Patients in the omega-3 PUFA group had a significantly decreased score on the 21-item Hamilton Rating Scale for Depression than those in the placebo group ( P < 0.001 ) . From the preliminary findings in this study , omega-3 PUFAs could improve the short-term course of illness and were well tolerated in patients with major depressive disorder A recent meta- analysis concluded that newer antidepressant drugs are equivalent to or no better than placebos , a conclusion at some variance with their commonly judged clinical effectiveness . The ' disconnect ' between r and omised controlled trials and clinical practice would benefit from dissection of contributing factors , and redressing limitations to current trial procedures BACKGROUND Trials have demonstrated benefits of long-chain omega-3 essential fatty acid ( n-3 EFA ) supplementation in a variety of psychiatric disorders . AIMS To assess the efficacy of n-3 EFAs in improving psychological well-being in patients with recurrent self-harm . METHOD Patients ( n=49 ) presenting after an act of repeated self-harm were r and omised to receive 1.2 g eicosapentaenoic acid plus 0.9 g decosahexaenoic acid ( n=22 ) or placebo ( n=27 ) for 12 weeks in addition to st and ard psychiatric care . Six psychological domains were measured at baseline and end point . RESULTS At 12 weeks , the n-3 EFA group had significantly greater improvements in scores for depression , suicidality and daily stresses . Scores for impulsivity , aggression and hostility did not differ . CONCLUSIONS Supplementation achieved substantial reductions in surrogate markers of suicidal behaviour and improvements in well-being . Larger studies are warranted to determine if insufficient dietary intake of n-3 EFAs is a reversible risk factor for self-harm OBJECTIVE Major depressive disorder in children may be more common than previously thought , and its therapeutics are unclear . Because of success in a previous study on omega-3 fatty acids in adult major depressive disorder , the authors planned a pilot study of omega-3 fatty acids in childhood major depression . METHOD Children who entered the study were between the ages of 6 and 12 . Ratings were performed at baseline and at 2 , 4 , 8 , 12 , and 16 weeks using Children 's Depression Rating Scale ( CDRS ) , Children 's Depression Inventory ( CDI ) , and Clinical Global Impression ( CGI ) .  Children were r and omized to  omega-3 fatty acids or placebo as pharmacologic monotherapy . Twenty-eight patients were r and omized , and 20 completed at least 1 month 's ratings . RESULTS Analysis of variance showed highly significant effects of omega-3 on symptoms using the CDRS , CDI , and CGI . CONCLUSIONS Omega-3 fatty acids may have therapeutic benefits in childhood depression BACKGROUND Adverse neurodevelopmental and neuropsychiatric outcomes have been established as signs of nutrient deficiencies and may be applicable to insufficient dietary intakes of omega-3 highly unsaturated fatty acids ( n-3 HUFAs ) . OBJECTIVE Consider if statistical definitions for Daily Reference Intakes can be applied to n-3 HUFAs intakes during pregnancy for maternal and neurodevelopmental deficiencies . DESIGN Data were prospect ively collected from women during pregnancy and children up to age 8 years participating in the Avon Longitudinal Study of Parents and Children ( ALSPAC ) . Statistical analyses took social and lifestyle factors into account . RESULTS During pregnancy , n-3 HUFA  intakes from seafood that putatively meet statistical definitions of an estimated average requirement ranged from 0.05 to 0.06 en% ( 111 - 139 mg/d/2000 Cal ) for suboptimal fine motor control at 42 m and 0.065 - 0.08 en% ( 114 - 181 mg/d/2000 Cal ) for suboptimal verbal IQ at age 8 years and 0.18 - 0.22 en% ( 389 - 486 mg/d/2000 Cal ) for maternal depression at 32 weeks . Intakes of n-3 ranging from 0.2 to 0.41 en% ( 445 - 917 mg/d/2000 Cal ) prevented both increased risk of maternal depression and adverse neurodevelopmental outcomes for children among 97.5 % of the population . No upper limit for safety was found . CONCLUSION During pregnancy , a n-3 HUFA intake of 0.40 en% ( 900 mg/d/2000 Cal ) from seafood is likely to meet the nutritional requirements for 97.5 % of the mothers and children of this population . These considerations do not constitute DRI 's for docosahexaenoic acid and n-3 HUFAs , but may contribute to their formulation OBJECTIVE The prevalence of seasonal affective disorder-as measured by the Seasonal Pattern Assessment Question naire-has been found to be unexpectedly low among Icel and ers . The aim of this cross-sectional study was to measure seasonal variations in the prevalence of anxiety and depression among Icel and ers assessed with the Hospital Anxiety and Depression Question naire . METHOD Four 1 , 000-person cohorts , age 20 - 70 years , selected at r and om from the Icel and ic National Register , were sent the Hospital Anxiety and Depression Scale by mail in either January , April , July , or October . Only responses from the 4-week period after each mailing were considered in the subsequent analysis . RESULTS The mean anxiety and depression scores in winter were not higher than those in summer for either sex . There was no significant difference between winter and summer in rates of actual or borderline cases of anxiety or depression or for the two categories combined . CONCLUSIONS This lack of seasonality in anxiety and depression is in sharp contrast to findings from similar cross-sectional studies and may reflect the low propensity for seasonal affective disorder that has been described in the Icel and ic population OBJECTIVE To ascertain the extent to which childhood separation anxiety disorder ( SAD ) confers risk for the development of psychopathology during young adulthood ( ages 19 - 30 ) . METHOD A subset of the participants of the Oregon Adolescent Depression Project ( n = 816 ) was used . Subjects provided retrospective reports of lifetime mental illness ( including SAD ) and concurrent reports of current mental illness at age 16 and were then followed prospect ively until age 30 . Diagnostic assessment s were conducted twice during adolescence and again at ages 24 and 30 . Based on diagnosis during childhood/adolescence , the subjects were partitioned into four orthogonal groups : SAD ( n = 42 ) , other anxiety disorders ( n = 88 ) , a  heterogeneous psychiatric disorders control group ( n = 389 ) , and a  not mentally ill control group ( n = 297 ) . Adjusting for demographic variables that were significantly associated with group status and for comorbid disorders prior to age 19 , the results were analyzed with hierarchical multiple logistic regression . RESULTS SAD was a strong ( 78.6 % ) risk factor for the development of mental disorders during young adulthood . The major vulnerabilities were for panic disorder and depression . CONCLUSIONS Because SAD creates a major vulnerability for mental disorders during young adulthood , clinicians should be sensitive to the presence of SAD , and children and adolescents with SAD should be treated . Future research should evaluate whether successful treatment of SAD and /or the provision of a preventive intervention during childhood/adolescence reduce the risk for future psychopathology Until recently , life events were considered as chance occurrences . However , there is now increasing evidence that reported life events , at least in adult life are not r and om . Life events not only tend to cluster in families but also appear to be influenced by genetic factors . The aim of this study was to investigate whether genetic factors also influence reported life events in childhood using a systematic ally ascertained sample of 376 twin pairs aged 8 to 17 . Overall , reported life events in this younger population were found to be heritable . However , the degree of genetic and environmental influence appeared to vary across the sexes , at least for parent-rated life events and according to whether life events were rated by the parents or the children themselves . Genetic influences appeared to be more important for self reports , suggesting that individual differences in cognition play a role in reporting life events BACKGROUND Mothers may be reluctant to receive medical treatment of  postpartum depression ( PPD ) , despite the detrimental consequences the disorder can impose on mother and child . Research on alternative methods of prevention and treatment of PPD is warranted . Previous studies have suggested that long-chain n-3 polyunsaturated fatty acids ( PUFAs ) might have a beneficial effect on depression . OBJECTIVE The objective was to explore the association between intake of fish and n-3 PUFAs during pregnancy and PPD in the Danish National Birth Cohort ( DNBC ) . DESIGN Exposure information from the DNBC was linked to the Danish patient and prescription registries for data on clinical ly identified cases of depression up to 1 y postpartum . Intake of fish and n-3 PUFAs was assessed in midpregnancy with a food-frequency question naire . Admission to the hospital for PPD ( PPD-admission ) and prescription of antidepressants ( PPD-prescription ) were treated as separate outcomes . A total of 54,202 women were included in the present study sample . RESULTS Rates of depression were 0.3 % ( PPD-admission ) and 1.6 % ( PPD-prescription ) . No association was observed between fish intake and risk of PPD-admission [ crude odds ratio of 1.01 ( 95 % CI : 0.52 , 1.97 ) and adjusted odds ratio of 0.82 ( 95 % CI : 0.42 , 1.64 ) ] , whereas a higher risk of PPD-prescription was found for the lowest compared with the highest fish intake group [ crude odds ratio of 1.61 ( 95 % CI : 1.26 , 2.06 ) and adjusted odds ratio of 1.46 ( 95 % CI : 1.12 , 1.90 ) ] . No association was observed with respect to n-3 PUFA intake . CONCLUSION Overall , our data from a large prospect i ve cohort linked with high- quality registers showed little evidence to support an association between intake of fish or n-3 PUFAs and PPD OBJECTIVE Studies have reported that countries with high rates of fish oil consumption have low rates of depressive disorder . The authors studied a specific omega-3 fatty acid , the ethyl ester of eicosapentaenoic acid ( E-EPA ) , as an adjunct to treatment for depressive episodes occurring in patients with recurrent unipolar depressive disorder who were receiving maintenance antidepressant therapy . METHOD Twenty patients with a current diagnosis of major depressive disorder participated in a 4-week , parallel-group , double-blind addition of either placebo or E-EPA to ongoing antidepressant therapy .  Seventeen of the patients were women , and three were men . RESULTS Highly significant benefits of the addition of the omega-3 fatty acid compared with placebo were found by week 3 of treatment . CONCLUSIONS It is not possible to distinguish whether E-EPA augments antidepressant action in the manner of lithium or has independent antidepressant properties of its own OBJECTIVE This study was an evaluation of the omega-3 fatty acid docosahexaenoic acid ( DHA ) for the treatment of major depression . METHOD Thirty-six depressed patients were r and omly assigned to receive DHA , 2 g/day , or placebo for 6 weeks . Response was defined a priori as a > or = 50 % reduction in the score on the Montgomery-Asberg Depression Rating Scale .  Thirty-five participants were evaluable ; 18 received DHA , and 17 received placebo . RESULTS Response rates were 27.8 % in the DHA group and 23.5 % in the placebo group . The difference in response rates between groups did not reach statistical significance . CONCLUSIONS This trial failed to show a significant effect of DHA monotherapy in subjects with major depression BACKGROUND Since low fish consumption and omega-3 fatty acids have recently been linked with depression , we investigated by means of a large , general population data base , whether a low fish consumption is associated with increased risk of developing depression . METHODS The Northern Finl and 1966 Birth Cohort was followed up prospect ively from pregnancy up to the age of 31 years . The data on  HSCL-25 depression subscale , doctor-diagnosed life-time depression and fish consumption  ( during the previous 6 months ) of cohort members were obtained by postal question naires at the age of 31 . The final number of cohort members , whose completed variable information was available in multivariate logistic analyses , was 2721 males and 2968 females . RESULTS After adjusting for body mass index , serum total cholesterol level and socioeconomic situation , logistic regression analyses showed that among females the risk of developing depression increased up to 2.6-fold ( 95%CI 1.4 - 5.1 ) among rare fish eaters when compared with regular eaters . In males , there were no significant differences between rare and regular fish eaters for any of the estimates of depression . LIMITATIONS The data on life-time fish consumption of cohort members were not available . CONCLUSIONS A low frequency of fish consumption was statistically significantly associated with  depression in women , but not in men . Possible background -theories behind the gender difference are discussed BACKGROUND Epidemiological and clinical studies suggest that increased intake of eicosapentaenoic acid ( EPA ) alleviates unipolar depression . AIMS To examine the efficacy of EPA in treating depression in bipolar disorder . METHOD In a12-week , double-blind study individuals with bipolar depression were r and omly assigned to adjunctive treatment with placebo ( n=26 ) or with 1 g/day ( n=24 ) or 2 g/day ( n=25 ) of ethyl-EPA . Primary efficacy was assessed by the Hamilton Rating Scale for Depression ( HRSD ) , with changes in the Young Mania Rating Scale and Clinical Global Impression Scale ( CGI ) as secondary outcome measures . RESULTS There was no apparent benefit of 2 g over 1 g ethyl-EPA daily . Significant improvement was noted with ethyl-EPA treatment compared with placebo in the HRSD ( P=0.04 ) and the CGI ( P=0.004 ) scores . Both doses were well tolerated . CONCLUSIONS Adjunctive ethyl-EPA is an effective and well-tolerated intervention in bipolar depression The purpose of this study was to conduct a pilot clinical trial to test the feasibility and efficacy of an exercise program and anti-depressant treatment compared with usual care in improving the emotional and physical functioning of older adults with minor depression . Participants were 37 older adults with minor depression who were r and omized to exercise , sertraline , or usual care ; 32 participants completed the 16-week study . Outcomes included measures of both emotional ( clinician and self-report ) and physical ( observed and self-report ) functioning . There were trends for the superiority of the exercise and sertraline conditions over usual care in improving SF-36 mental health scores and clinician-rated depression scores . Individuals in the exercise condition showed greater improvements in physical functioning than individuals in the usual care condition . Both sertraline and exercise show promise as treatments for late-life minor depression . However , exercise has the added benefit of improving physical functioning as well OBJECTIVE  Adolescent alcohol involvement may increase risk for young-adult depression ;  however , findings are mixed and important questions remain unanswered . Because alcohol involvement among teens is multidimensional , this study examined the extent to which four different adolescent alcohol dimensions ( i.e. , frequency of alcohol use , quantity of consumption , frequency of heavy episodic drinking , and frequency of problem use ) were predictive of young-adult  major depressive disorder ( MDD ) . METHOD Participants in this prospect i ve longitudinal study , which extended from age 11 to age 22 , were 429 rural teens ( including 222 girls ) and their families .  Self-reports of each dimension of adolescent alcohol involvement were obtained at ages 16 and 18 . Depression diagnoses were obtained at age 22 , using a structured interview . Analyses included adolescent depressed mood , measured via self-report at ages 16 and 18 . Data were analyzed using confirmatory factor analysis and structural equation modeling . RESULTS The multidimensional nature of adolescent alcohol involvement was best represented by a first-order problem-use factor and a second-order alcohol-intake factor comprised of quantity , frequency , and heavy drinking . After controlling for gender and depressed mood , adolescent problem use , but not alcohol intake , was a significant positive predictor of young-adult MDD . CONCLUSIONS Findings help clarify the link between alcohol involvement and depression and suggest that harm-reduction strategies may help prevent later mood disorders BACKGROUND The results of pilot trials suggest that omega-3 fatty acids may have efficacy in the treatment of mood symptoms in bipolar disorder . METHODS We conducted a 4-month , r and omized , placebo-controlled , adjunctive trial of ethyl-eicosapentanoate ( EPA ) 6 g/day in the treatment of bipolar depression and rapid cycling bipolar disorder . Subjects were receiving mood-stabilizing medications at therapeutic doses or plasma concentrations . The measures of efficacy were early study discontinuation , changes from baseline in depressive symptoms ( Inventory for Depressive Symptomology total score ) and in manic symptoms ( Young Mania Rating Scale total score ) , and manic exacerbations ( " switches " ) . We also measured side effects and bleeding time , a biomarker of drug action . RESULTS Overall , there were no significant differences on any outcome measure between the EPA and placebo groups . CONCLUSIONS This study did not find overall evidence of efficacy for adjunctive treatment with EPA 6 g/day in out patients with bipolar depression or rapid cycling bipolar disorder Converging evidence suggests that omega-3 polyunsaturated fatty acids have aetiological importance in depression . To determine the effect of adding fish oil to existing therapy in participants who were being treated for depression in a community setting , 77 participants were r and omly assigned to receive 8 g of either fish or olive oil per day in addition to their existing therapy . Fifty-nine ( 77 % ) participants completed 12 weeks of treatment . Dietary , biochemical and lifestyle factors were measured throughout the study . Mood was assessed using the Short Form Hamilton Depression Rating Scale ( HDRS-SF ) and the Beck Depression Inventory II . Sample size calculations were based on the HDRS-SF . Intention-to-treat and per protocol analyses were carried out using residual maximum likelihood . There was no evidence that fish oil improved mood when compared to the placebo oil , despite an increase in circulating omega-3 polyunsaturated fatty acids . However , mood improved significantly in both groups within the first 2 weeks of the study ( P<0.001 ) and this improvement was sustained throughout . In conclusion , fish oil was no more effective than the control as an add-on therapy for depression in this setting BACKGROUND In depressed patients , low blood levels of eicosapentaenoic acid are seen . We tested the antidepressive effect of ethyl-eicosapentaenoate in these patients . METHODS We included 70 patients with persistant depression despite ongoing treatment with an adequate dose of a st and ard antidepressant .  Patients were r and omized on a double-blind basis to placebo or ethyl-eicosapentaenoate at dosages of 1 , 2 , or 4 g/d for 12 weeks in addition to unchanged background medication . Patients underwent assessment using the 17-item Hamilton Depression Rating Scale , the Montgomery-Asberg Depression Rating Scale , and the Beck Depression Inventory . RESULTS Forty-six ( 88 % ) of 52 patients receiving ethyl-eicosapentaenoate and 14 ( 78 % ) of 18 patients receiving placebo completed the 12-week study with no serious adverse events . The 1-g/d group showed a significantly better outcome than the placebo group on all 3 rating scales . In the intention-to-treat group , 5 ( 29 % ) of 17 patients receiving placebo and 9 ( 53 % ) of 17 patients receiving 1 g/d of ethyl-eicosapentaenoate achieved a 50 % reduction on the Hamilton Depression Rating Scale score . In the per- protocol group , the corresponding figures were 3 ( 25 % ) of 12 patients for placebo and 9 ( 69 % ) of 13 patients for the 1-g/d group . The 2-g/d group showed little evidence of efficacy , whereas the 4-g/d group showed nonsignificant trends toward improvement . All of the individual items on all 3 rating scales improved with the 1-g/d dosage of ethyl-eicosapentaenoate vs placebo , with strong beneficial effects on items rating depression , anxiety , sleep , lassitude , libido , and suicidality . CONCLUSION Treatment with ethyl-eicosapentaenoate at a dosage of 1 g/d was effective in treating  depression in patients who remained depressed despite adequate st and ard therapy BACKGROUND This is the final paper of a series concerning  parental maltreatment and chronic depression in women . It extends the scope of the analysis to take account of proximal risk factors , present within at most six months of an onset . It deals with the contribution of factors influencing onset of a depressive episode as well as those related to whether this takes a chronic course . Once a two-stage model dealing with both sets of risk factors has been developed we explore how far distal factors ( more than at least one year earlier ) influence each stage . METHODS Three studies are employed . All take account of parental maltreatment .  Two prospect i ve studies deal with proximal risk factors , and a retrospective one with distal and proximal factors . RESULTS For the first stage of the model concerning onset the influence of parental maltreatment and its correlated risk factors ( e.g. conduct problems ) are almost entirely mediated by proximal factors ( e.g. quality of core relationships ) . However , for the second stage concerning course parental maltreatment makes a direct contribution that is independent of all other risk factors . LIMITATIONS The retrospective nature of some of the data may introduce bias ( But see the second paper in the present series [ Brown , G.W. , Craig , T.K.J. , Harris , T.O. , H and ley , R.V. , Harvey , A.L. , 2007b . Validity of retrospective measures of early maltreatment and depressive episodes using the Childhood Experience of Care & Abuse ( CECA ) instrument - a life-course study of adult chronic depression - 2 . J. Affect . Dis . , 103 , 217 - 224 ] ) . Only females have been considered . CONCLUSIONS The influence of parental maltreatment on the onset of adult depression is largely indirect and the mechanisms involved are reasonably clear . However , the mechanisms involved in the substantial direct contribution of maltreatment to course are as yet unclear . Some interplay of maltreatment and early brain development is one of a number of interesting possibilities BACKGROUND There is limited evidence whether the association between low socioeconomic status and risk of common mental disorders varies with symptom severity , type of socioeconomic indicator or gender . METHODS A population -based survey was conducted among a r and om sample of Stockholm County residents aged 18 - 84 years in 2002 . Respondents were reassessed via a follow-up question naire in 2007 . Participants in both surveys ( n = 23794 ) were categorized according to socioeconomic status at baseline and followed up for onset of psychological distress ( according to the twelve-item general health question naire ) and depression ( according to health data registers ) . Logistic regression was used to calculate odds ratios ( ORs ) and 95 % confidence intervals ( CIs ) . RESULTS Occupational class was not associated with risk of psychological distress , regardless of severity or gender . Occupational class was strongly associated with onset of depression in men ( OR 3.0 [ 95 % CI 1.5 - 5.9 ] , comparing unskilled manual workers with higher non-manual workers ) but not women . Income was associated with risk of onset of all outcomes , and risks increased with symptom severity . Belonging to the highest household income category was particularly protective of depression in women . Education was unrelated to either outcome in men and women overall . LIMITATIONS Retention rate at follow-up was 76 % and depression was ascertained via health service use . CONCLUSION Low socioeconomic position is associated with onset of depression but not mild distress . Attributes of occupational class and household income may be respectively more relevant for the development of depression in men and women
ABSTRACT Depression is a common , recurrent , and debilitating illness that has become more prevalent over the past 100 years .
This report review s the etiology and pathophysiology of depression , and explores the role of omega 3 polyunsaturated fatty acids ( n-3 PUFA ) as a possible treatment .
In seeking to underst and depression , genetic factors and environmental influences have been extensively investigated .
Research has led to several hypotheses for the pathophysiological basis of depression but a definitive pathogenic mechanism , or group thereof , has hitherto remained equivocal .
To date , treatment has been based on the monoamine hypothesis and hence , selective serotonin reuptake inhibitors have been the most widely used class of medication .
In the last decade , there has been considerable interest in n-3 PUFAs and their role in depression .
These fatty acids are critical for development and function of the central nervous system .
Increasing evidence from epidemiological , laboratory , and r and omized placebo-controlled trials suggests deficiency of dietary n-3 PUFAs may contribute to development of mood disorders , and supplementation with n-3 PUFAs may provide a new treatment option .