Major depressive disorder (MDD) is associated with low levels of omega-3
polyunsaturated fatty acids (PUFAs), holding promise for new perspectives on disease
etiology and treatment targets. As aggressive and impulsive behaviors are associated with
low omega-3 PUFA levels in some clinical contexts, we investigated plasma PUFA
relationships with trait aggression and impulsivity in patients with MDD. Medication-free
MDD patients (n=48) and healthy volunteers (HV, n=35) were assessed with
the Brown-Goodwin Aggression Inventory. A subset (MDD, n=39; HV, n=33)
completed the Barratt Impulsiveness Scale. Plasma PUFAs eicosapentaenoic acid (EPA,
20:5n-3), docosahexaenoic acid (DHA, 22:6n-3), and arachidonic acid (AA, 20:4n-6) were
quantified and ln-transformed to mitigate distributional skew. Ln-transformed PUFA
(lnPUFA) levels were predictors in regression models, with aggression or impulsivity
scores as outcomes, and cofactors of sex and diagnostic status (MDD with or without a
history of substance use disorder [SUD], or HV). Interactions were tested
between relevant PUFAs and diagnostic status. Additional analyses explored possible
confounds of depression severity, self-reported childhood abuse history, and, in MDD
patients, suicide attempt history. Among PUFA, lnEPA but not lnDHA predicted aggression
(F1,76=12.493, p=0.001),
and impulsivity (F1,65=5.598,
p=0.021), with interactions between lnEPA and history of SUD for
both aggression (F1,76=7.941,
p=0.001) and impulsivity
(F1,65=3.485, p=0.037).
Results remained significant when adjusted for childhood abuse, depression severity, or
history of suicide attempt. In conclusion, low EPA levels were associated with aggression
and impulsivity only in patients with MDD and comorbid SUD, even though in most cases SUD
was in full sustained remission.