Omega-3 for Mental health

 In Feature article, Mental Health, Pharmacy Information

There are numerous products in the UK that contain omega-3 fatty acids. Currently there are three preparations listed in the BNF that contain unsaturated fatty acids that belong to the group of omega-3 fatty acids (eicosapentaenoic acid and docosahexaenoic acid). These are Omacor® and Prestylon®, which contain Omega-3-acid, ethyl esters, and Maxepa®, which contains omega-3-marine, triglycerides. These are licensed for adjuvant treatment in secondary prevention of myocardial infarction, and for treatment of hypertriglyceridaemia when dietary measures are not sufficient.

Omega-3 fatty acids are involved in neuronal, vascular and immune functioning. Their effects on neuronal membranes and neuronal activity have increased the use of these preparations to treat different mental health conditions over recent years. But what is the evidence currently available for this use?

Some clinical trials exist for the treatment of depression and schizophrenia with omega-3 fatty acids, although the grade of evidence is limited. In depressed patients that do not respond to conventional therapy, there is some favourable evidence regarding treatment as an adjuvant therapy while using antidepressants.This is not, however, endorsed by current NICE guidance.

NICE has published some advice regarding schizophrenia and omega-3 fatty acid medicines, concluding that the evidence for people with schizophrenia using them is limited. The results regarding their effectiveness are not consistent and their use in this population remains experimental. The full publication may be accessed here:

http://tinyurl.com/pc6svu5

A relatively recent, moderate-sized randomised controlled trial of omega-3 fatty acids has shown the best evidence of any intervention, reducing the rates of transition from ‘high risk’ psychotic states to a sustained psychosis in children and adolescents. Although NICE does not recommend the use of omega-3 fatty acids prophylactically in this group of patients, it does encourage a research programme to test out the likely benefits and costs of using omega-3 fatty acids for children and young people at high risk of developing psychosis. The full NICE guideline “Psychosis and schizophrenia in children and young people: recognition and management” where this is explained in detail is available here:

http://tinyurl.com/ptl5xh8

Omega-3 fatty acids present few side effects (mild GI disturbances is the most common) and they should be given with food. Caution is required in patients at high risk of haemorrhage, or those taking anticoagulants, when they are prescribed to people with non-insulin dependent diabetes or in patients with aspirin-sensitive asthma.

A dose of five Omacor® capsules or ten Maxepa® capsules daily has been suggested in the “Maudsley Prescribing Guidelines in Psychiatry: 12th Edition” to treat residual symptoms of schizophrenia, particularly in patients responding poorly to clozapine treatment.

Note that when omega-3 fatty acids are prescribed for a psychiatric condition in a detained patient under the Mental Health Act, these preparations should be listed in the relevant consent forms to treatment. Also, treatment for mental health conditions using omega-3 fatty acids would be off-licensed use for these indications.

References and further reading:

http://tinyurl.com/q2qv488

The Maudsley Prescribing Guidelines, 12th Edition, D. Taylor, C.Paton S, Kapur.

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