Ethyl-eicosapentaenoic acid for the treatment of psychological
distress and depressive symptoms in middle-aged women: a double-blind,
placebo-controlled, randomized clinical trial
Michel Lucas1,2,3, Geneviève Asselin1,2,3, Chantal Mérette1,2,3, Marie-
Josée Poulin1,2,3 and Sylvie Dodin1,2,3
1 From the Lucie and André Chagnon Chair for the Teaching of an
Integrated Approach in Prevention, Laval University, Saint-François
d'Assise Hospital (CHUQ), Quebec, Canada (ML, GA, and SD); the
Department of Psychiatry, Robert Giffard Research Centre, Laval
University, Quebec, Canada (CM and M-JP); and the Department of
Obstetrics and Gynaecology, Laval University, Quebec, Canada (SD).

2 Supported by the Lucie and André Chagnon Chair for the Teaching of
an Integrated Approach in Prevention, Laval University. Omega-3
capsules and matching placebo for the study were provided by Isodis
Natura (Brussels, Belgium).

3 Reprints not available. Address correspondence to M Lucas, Lucie and
André Chagnon Chair for the Teaching of an Integrated Approach in
Prevention, Laval University, Saint-François d'Assise Hospital (CHUQ),
45 Leclerc Street, Room D6-701, Quebec, Canada G1L 2G1. E-mail:
michel.lucas@crchul.ulaval.ca.

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 randomly
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 ISRCTN69617477.

Am J Clin Nutr 89: 641-651, 2009.
First published December 30, 2008;
doi:10.3945/ajcn.2008.26749
© 2009 American Society for Clinical Nutrition
----------------------------

Flaxseed oil and fish-oil capsule consumption alters human red blood
cell n-3 fatty acid composition: a multiple-dosing trial comparing 2
sources of n-3 fatty acid.
Am J Clin Nutr. 2008 Sep;88(3):801-9.
Barceló-Coblijn G, Murphy EJ, Othman R, Moghadasian MH, Kashour T,
Friel JK.
Department of Pharmacology, University of North Dakota, Grand Forks,
ND, USA.

BACKGROUND:
An increase in plasma n-3 fatty acid content, particularly
eicosapentaenoic acid (20:5n-3; EPA) and docosahexaenoic acid
(22:6n-3; DHA), is observed after consumption of fish oil-enriched
supplements.
Because alpha-linolenic acid (18:3n-3; ALA) is the direct precursor
of EPA and DHA, ALA-enriched supplements such as flax may have a
similar effect, although this hypothesis has been challenged because
of reported low conversion of ALA into DHA. OBJECTIVE:
To address this question, we designed a clinical trial in which flax
oil, fish-oil, and sunflower oil (placebo group) capsules were given
to firefighters (n = 62), a group traditionally exposed to
cardiovascular disease risk factors.
DESIGN:
Firefighters were randomly divided into 6 experimental groups
receiving 1.2, 2.4, or 3.6 g flax oil/d; 0.6 or 1.2 g fish oil/d; or
1 g sunflower oil/d for 12 wk.
Blood was drawn every 2 wk, and the total phospholipid fatty acid
composition of red blood cells was determined.
RESULTS:
As expected, fish oil produced a rapid increase in erythrocyte DHA
and total n-3 fatty acids.
The consumption of either 2.4 or 3.6 g flax oil/d (in capsules) was
sufficient to significantly increase erythrocyte total phospholipid
ALA, EPA, and docosapentaenoic acid (22:5n-3) fatty acid content.
There were no differences among groups in plasma inflammatory markers
or lipid profile.
CONCLUSIONS:
The consumption of ALA-enriched supplements for 12 wk was sufficient
to elevate erythrocyte EPA and docosapentaenoic acid content, which
shows the effectiveness of ALA conversion and accretion into
erythrocytes.
The amounts of ALA required to obtain these effects are amounts that
are easily achieved in the general population by dietary
modification.

PMID: 18779299

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