Depression is common in patients with heart disease and a risk factor for cardiac-related death. But antidepressants often don’t improve symptoms in depressed heart patients. In a new approach, scientists at Washington University School of Medicine in St. Louis gave these patients antidepressants plus omega-3 fatty acids, which are known both for their heart benefits and for alleviating depression in some people. However, the combination therapy was no better than antidepressants alone, the researchers report in the Oct. 21 issue of the Journal of the American Medical Association.
“A number of studies have shown omega-3 fatty acids in fish oil can reduce the severity of clinical depression in otherwise healthy people,” says principal investigator Robert. M. Carney, Ph.D. “We thought adding omega-3 to an antidepressant drug might enhance the effect of the antidepressant therapy, but it did not.”
In this study, Carney and his colleagues looked at 122 depressed heart patients between 2005 and 2008. All patients received the antidepressant drug sertraline (Zoloft®) for 10 weeks; half also got a capsule of omega-3 (Lovaza®). The rest took an inactive, corn oil-filled capsule.
The researchers expected depression symptoms in patients taking both sertraline and omega-3 to improve more than in those taking only the antidepressant drug. But after 10 weeks, there was no significant difference between the two groups.
“The majority did respond to the depression treatment to some extent, but there was no difference in improvement between those who got omega-3 and the group that received the corn-oil placebo,” says Carney, a professor of psychiatry and director of the Behavioral Medicine Center at Washington University.” This is disappointing in light of the fact that depression is a significant risk factor for cardiac mortality, and we are in need of more effective treatments for depression in these patients.”
Omega-3 fatty acids are found in fish oil and are known to improve risk factors for heart disease, such as blood pressure and cholesterol. The fish oil also has been used to treat depression, joint pain, migraines and autoimmune diseases. Unlike standard omega-3 supplements found in health food stores, this study used a special formula available only by prescription designed to enhance its effects on both depression and cardiovascular disease.
“Omega-3 is an essential fatty acid, which means we have to get it from the diet,” says Carney. “The American Heart Association advises people to eat at least some fish each week, and they actually recommend omega-3 for patients with heart disease because of its cardiovascular benefits.”
Carney says it’s possible the fish oil may be more effective at a different dose, or if it’s taken for more than 10 weeks. But the issue, he says, is that antidepressant drugs just are not very effective for many depressed patients, whether they have heart disease or not.
“They’re better than placebo but not always a lot better,” Carney says. “And they don’t have much of an effect on depression in many of these heart patients. In addition, I don’t see any medications anytime soon that are likely to change that. We always hope for a big breakthrough. We were hoping for one in this study. We didn’t see it, but we may need to do things a little differently and try again.”
Moving forward, Carney and his colleagues are investigating psychotherapy in depressed cardiac patients. Earlier this year, the same researchers reported that non-drug therapies, such as cognitive behavior therapy and supportive stress management, improved depression symptoms in patients recovering from heart bypass surgery.
Now they’re studying cognitive behavior therapy in greater numbers of depressed heart patients and sometimes combining psychotherapy with antidepressant medication.
For more information about ongoing heart disease/depression studies, call (314) 286-1517 or toll free at (877) 717-0757.
Carney RM, Freedland KE, Rubin EH, Rich MW, Steinmeyer BC, Harris WS. Omega-3 augmentation of sertraline in treatment of depression in patients with coronary heart disease: a randomized controlled trial. Journal of the American Medical Association, vol. 302:15, pp. 1651-1657. Oct. 21, 2009
This study was supported by the National Heart, Lung and Blood Institute of the National Institutes of Health. Glaxo-Smith-Kline supplied omega-2 and placebo capsules and Pfizer Inc. supplied sertraline.
Washington University School of Medicine’s 2,100 employed and volunteer faculty physicians also are the medical staff of Barnes-Jewish and St. Louis Children’s hospitals. The School of Medicine is one of the leading medical research, teaching and patient care institutions in the nation, currently ranked third in the nation by U.S. News & World Report. Through its affiliations with Barnes-Jewish and St. Louis Children’s hospitals, the School of Medicine is linked to BJC HealthCare.