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Eating Fish Makes Antidepressants More Effective

New research suggests that increasing your consumption of fatty fish may boost the efficacy of your antidepressant. Most people are aware that there are benefits to be had from increasing consumption of fatty fish. This has lead millions of people to take “fish oil” pills in order to reap various health benefits without eating fish. In any regard, most people consider fish to be a very healthy source of food as long as it is free of contaminants like mercury.

Studies have shown that only 42% of individuals who try antidepressants have a positive response. This means that a whopping 58% of people who try traditional antidepressant medications receive no positive effect. This is significant because it means that less than half of people trying “clinically proven” medications for depression aren’t getting any better.

New Study (2014): Eating Fish May Make Antidepressants More Effective

Instead of bashing antidepressants and realizing that psychotropic medications are highly problematic, researchers decided to focus on determining why some people respond and others don’t. Although I would tell you that responses likely have a lot to do with genetic predisposition, researchers weren’t looking at genetics. Instead, they were looking at other factors such as diet that may have influenced a person’s response to antidepressants.

Roel Mocking (the lead researcher) was quoted saying:

“We were looking for biological alterations that could explain depression and antidepressant non-response, so we combined two apparently unrelated measures: metabolism of fatty acids and stress hormone regulation. Interestingly, we saw that depressed patients had an altered metabolism of fatty acids, and that this changed metabolism was regulated in a different way by stress hormones.”

The study was pretty simple: A group of 70 patients with depression were given a 20 mg dose of an SSRI medication every day for a 6 week period. Those who didn’t respond to the 20 mg SSRI treatment were titrated upwards in dosing to 50 mg per day. Researchers then took measurements of both cortisol and fatty acid levels in 70 participants with depression.  They compared these 70 individuals to a sample of 51 non-depressed, healthy controls.

Antidepressant-Responders vs. Non-Responders: Abnormal Fatty Acid Metabolism

By documenting cortisol and fatty acid levels during the study, researchers noticed that depressed individuals who didn’t respond to antidepressants had abnormal fatty acid metabolism. Due to the fact that fish is full of fatty acids (e.g. omega-3 EPA / DHA), researchers noted the amount of fish consumed by participants.

They discovered that individuals that ate little or no fish typically didn’t respond well to antidepressants. Those who ate a lot of fish in their diets generally had a stronger response to the medication. Researchers of this particular study reported that those who ate fatty fish at least one time per week had a 75% chance of responding positively to antidepressants.

Those who never ate any fatty fish had less than a 25% chance of responding to antidepressants. The differences between the two groups were striking – could fish really have this big of an impact on how well an SSRI works? According to this study, the answer is a resounding yes. The study’s lead researcher said, “The alterations in fatty acid metabolism (and their relationship with stress hormone regulation) were associated with future antidepressant response.”

He continued with:

“Importantly, this association was associated with eating fatty fish, which is an important dietary source of omega-3 fatty acids. These findings suggest that measures of fatty acid metabolism, and their association with stress hormone regulation, might be of use in the clinic as an early indicator of future antidepressant response. Moreover, fatty acid metabolism could be influenced by eating fish, which may be a way to improve antidepressant response rates.”

Fish consumption influences efficacy of antidepressant medications

They eventually concluded that fish consumption can influence the efficacy of antidepressants. Specifically, the more fish a person ate, the more likely they responded to their SSRI antidepressant medication. On the other end of the spectrum, people who ate minimal amounts of fish had the poorest responses to antidepressants. As a result of these findings, the researchers gave a preliminary suggestion: if you aren’t responding to an antidepressant medication, try increasing your fish consumption. As the study reported, the amount of fish that a person consumed influenced the strength of their response to an antidepressant.

Does fish really make antidepressants more effective?

Not necessarily. Even Roel Mocking (lead researcher) said that the association between fatty acids in the blood and antidepressant response is not necessarily causal. In other words, just because there was a correlation between those who ate fish and antidepressant response does not necessarily mean that the fish was directly responsible for increased efficacy of the medication.

It is pretty easy to assume that the fish was boosting the efficacy of antidepressants. However, there may be a number of other reasons why the fish made people feel happier. Eating fish is considered healthy for the brain and societies with higher rates of fish consumption tend to have lower rates of mental illnesses.  Below are some other factors to consider in regards to fish consumption and mood.

1. Fish consumption improves mood

There are a variety of studies that support the idea that fish consumption helps improve mood. Those who eat more fish may be more likely to have a better mood than those who don’t. In the study, fish consumption was associated with efficacy of an antidepressant. The fact that fish consumption is capable of improving mood by itself is something that needs to be taken into consideration. Therefore, individuals who are eating fish may be getting an antidepressant-like response from their intake of the fish.

  • Source: http://www.ncbi.nlm.nih.gov/pubmed/24737638

2. Omega-3 Fatty Acids: EPA / DHA

Omega-3 fatty acids such as EPA and DHA are obtained through fish. The brain consists of a significant amount of fatty tissue, a lot of which is DHA. In order to achieve optimal mental health, many people consume fish and/or fish oil pills which contain these omega-3 fatty acids. Another fatty acid, EPA affects the way cells interact with one another. Both of these fatty acids are thought to help minimize depressive symptoms.

  • Source: http://www.ncbi.nlm.nih.gov/pubmed/19499625

3. Healthier diet improves depression

It is well documented that diets high in processed foods and simple sugars tend to be poor for mental health. On the contrary, diets that consist of vegetables, fruits, whole grains, fish, and lean meats tend to be optimal for mental health. There are countless studies that show balanced diets that are low in processed ingredients and simple sugars tend to be better.

Individuals eating more fish may not be as hungry or crave other foods that are poor for mental health. In other cases, eating fish may fill them up during a time they would normally turn to junk food. The fact that a person is eating fish, which is good for the brain as opposed to candy or simple carbohydrates could be a result in mood improvement.

4. Fish may be a standalone antidepressant

Let’s say that someone who is taking an antidepressant is getting benefit from their drug. They’ve taken it for awhile and their mood has improved significantly. Now let’s say they start making healthy changes to their diet and consuming more fish instead of unhealthy carbohydrates. Not only is the person’s brain improving because they are getting vital nutrients, they are also getting the fatty acids necessary for optimal brain health.

The body and brain are getting a benefit from both the EPA and DHA found in the fish. This is hypothesized to contribute to a standalone antidepressant effect in the individual. The fish may be giving the body and the brain more nutrients to optimally function. The fish and the antidepressant may therefore be contributing to separate antidepressant responses in the individual.

5. Synergistic effect: Fish + SSRI

Finally, it is possible to consider that the fish consumption works synergistically with an antidepressant to achieve a supramaximal antidepressant response. In other words, the antidepressant response as a result of consuming fish while taking an SSRI may be significantly greater than each standalone option. There may be some sort of symbiotic relationship between fish consumption, fatty acid metabolism, and ultimately the efficacy of an antidepressant.

Among certain individuals, it is possible that the cumulative antidepressant effect resulting from the fish and their medication may make them feel better than each option as a standalone treatment. More investigation should be conducted as to whether fish consumption or certain fish oils should be recommended as an antidepressant augmentation strategy.

6. Other classes of antidepressants

Since most antidepressants achieve their effect by inhibiting the reuptake of serotonin, fish may enhance this process. It is unknown whether these findings apply to other classes of antidepressants that may not be as serotonin-oriented. One example would be that of Wellbutrin, an atypical antidepressant that affects norepinephrine and dopamine without any impact on serotonin.

It could be hypothesized that those taking certain tricyclics and MAOIs may differ in their responses to adding fish. In future studies, researchers should take into consideration the specific type of drug that a person takes. It may also be worth comparing different SSRIs to determine whether a particular medication combined with fish consumption results in better responses than others.

7. Fish oil pills vs. Eating fish

Another thing that researchers could consider is conducting a similar study in a depressed population and testing a group given an antidepressant with a particular dosing of fish oil. This would test whether the benefit comes specifically from eating fish or whether it may also be attainable through fish oil supplementation. It may be possible that fish oil pills have the same influence over fatty acid metabolism that is provided from fish consumption.

Further research regarding fish intake and antidepressants is necessary

The next step for this particular team of researchers is to determine whether changes in fatty acid metabolism and cortisol activity are specifically related to depression, or whether they also apply to those with other mental illnesses like schizophrenia and PTSD. The findings from the above study will be presented at the European College of Neuropsychopharmacology (ENCP) congress in Berlin, Germany.

There is a need for larger scale studies with bigger samples over a longer timetable to confirm the findings presented by Mocking et al. It is already fairly well documented that eating fish is healthy for a person’s mental health. If you are taking an antidepressant and want to make sure you are doing everything possible to respond to treatment, consider increasing your intake of fish. Fish is considered healthy and there is substantial evidence supporting its consumption and reduction of mental illness.

  • Source: http://www.europeanneuropsychopharmacology.com/article/S0924-977X(14)70632-7/abstract

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