November 16, 2014

expert reaction to talk at conference on omega-3 supplements to delay psychosis

A talk presented at the International Early Psychosis Conference in Tokyo has reported that omega-3 supplements may delay the onset of psychosis.

Prof Jeremy Hall, Professor of Psychiatry and Neuroscience, Cardiff University, said:

“This is an interesting follow up on a high profile paper from a reputable group. Omega-3 clearly does have a role in the brain so the findings are not totally implausible; however, this is only one smallish study so it’s not exactly proof yet. This is an interesting follow up on a high profile paper from a reputable group, but because it uses the same subjects as the original study replication is needed by another group before we can be at all confident about the results. Still, it is an interesting area.”

Prof Eddie Kane, Director of Centre for Health and Justice, Institute of Mental Health, University of Nottingham, said:

“This is interesting but it needs to be peer-reviewed and replicated before we can say much. There is a 2009 paper that relates diet to psychosis (really it relates it to a connection with diabetes) and another that looks at positive behavioural changes in young prisoners with mental health issues, but there is little else in this area.”

Dr Mrigendra Das, Consultant Foprensic Psychiatrist, Broadmoor Hospital, West London Mental Health Trust, said:

“This work is from a group who have a good track record of working with at risk individuals/adolescents for schizophrenia (it includes McGorry and others from Australia), particularly in looking at preventive strategies for those who are at high risk of developing schizophrenia. Studies looking at omega-3 fatty acids have shown that it leads to a modest improvement when added on to antipsychotics in schizophrenia, however the evidence is weak. A recent meta-analysis reported that there is no evidence it helps in established schizophrenia (see http://www.ncbi.nlm.nih.gov/pubmed/22367656)

“It would be very interesting if indeed the findings are robust and show that omega-3 can delay or prevent schizophrenia but methodological issues matter; the power of the study, cofounding variables etc. It is rather difficult to carry out such studies. We need to wait and see if this gets into a good peer-reviewed journal after scrutiny before reading too much into it. However, it may add to the emerging body of literature that using a range of agents that may help those developing schizophrenia and improve outcomes.”

Prof Peter Jones, Head of Psychiatry, University of Cambridge, said:

“This is a longer term follow-up of a randomised controlled trial (RCT) of 12 weeks of fish-oil treatment in a group at high risk for psychosis that was properly reported a few years ago (Amminger et al., 2010, Arch Gen Psychiatry mentioned in the abstract). There is a biologically plausible web of theory involving inflammation and lower levels of poly-unsaturated fatty acids, with a recent completely independent report of inflammatory markers in childhood being associated with later depression and psychotic experiences (similar to the ultra-high risk (UHR) group in the trial), lower levels of polyunsaturated fatty acids (PUFAs) in first episode psychosis, and much other supportive evidence for this kind of systemic approach that puts the brain back in the body.

“However, there are general caveats that we really need to consider. For example, we haven’t yet seen any details of the follow-up, and this is NOT an independent replication in a larger, independent RCT of omega-3 supplement in high risk or early psychosis – it’s the same subjects as the original pilot trial. A more definitive trial is ongoing, and that will be a clincher one way or the other.

“Nevertheless, the fact that the early and rather dramatic effect in the small, initial trial was maintained is certainly of interest. Let’s hope this will be one occasion when the effect of a pilot trial doesn’t melt away when the larger, independent trial comes out. Those results may be reported in the same meeting in 2016.”

The talk titled: ‘Longer-term follow-up in the Vienna omega-3 psychosis prevention trial’ was presented at the International Early Psychosis Conference in Tokyo.

Declared interests

None declared