Psychoeducational Psychotherapy and Omega-3 Supplementation Improve Co-Occurring Behavioral Problems in Youth with Depression: Results from a Pilot RCT

Abstract

This pilot randomized controlled trial (RCT) investigated benefits of omega-3 fatty acid supplementation and Individual-Family Psychoeducational Psychotherapy (PEP; a family-focused, cognitive-behavioral therapy) for behavior problems among youth with depression. Participants aged 7–14 with DSM-IV-TR depressive disorders (N = 72; 56.9% male) were randomized to 1 of 4 treatment conditions: PEP + omega-3, PEP monotherapy (with pill placebo), omega-3 monotherapy, or placebo (without active intervention). At screen, baseline, and 2, 4, 6, 9, and 12 weeks post-baseline, parents completed the SNAP-IV, which assesses attention-deficit/hyperactivity disorder symptoms, oppositional defiant disorder symptoms, and overall behavior problems. At screen, baseline (randomization), 6 and 12 weeks, parents completed the Eyberg Child Behavior Inventory (ECBI), which includes Intensity and Problem scales for child behavior problems. Youth who had a completed SNAP-IV or ECBI for at least two assessments during treatment (n=48 and 38, respectively) were included in analyses of the respective outcome. ClinicalTrials.gov:NCT01341925. Linear mixed effects models indicated a significant effect of combined PEP + omega-3 on SNAP-IV Total (p = .022, d = 0.80) and Hyperactivity/Impulsivity trajectories (p = .008, d=0.80), such that youth in the combined group saw greater behavioral improvement than those receiving only placebo. Similarly, youth in combined treatment had more favorable ECBI Intensity trajectories than youth who received no active treatment (p = .012, d = 1.07). Results from this pilot RCT suggest that combined PEP + omega-3 is a promising treatment for co-occurring behavior symptoms in youth with depression.

Polyunsaturated Fatty Acids: What is Their Role in Treatment of Psychiatric Disorders?

“…Thirty-six studies were published in order to evaluate the efficacy of EPA and DHA in mild and moderate unipolar depression [56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72,73,74,75,76,77,78,79,80,81,82,83,84,85,86,87,88,89,90,91]. Among these, eight were performed in women with perinatal depression [58,64,66,68,71,81,82,88].…”

“…Among these, eight were performed in women with perinatal depression [58,64,66,68,71,81,82,88]. Three studies were conducted in adolescents [62,86,87] and three trials in elderly depressive patients [72,73,75]. To limit the heterogeneity of this review, we decided to exclude trials on the efficacy of PUFAs in treating MDD in subjects with medical comorbidity and trials in which depressive symptoms were secondary to dementia and other neurological diseases.…”

“…In adolescence, two studies reported the efficacy of combination of EPA and DHA in reducing depressive symptoms [62] and behavioral symptoms, such as hyperactivity, impulsivity and opposition that often occur with depression in youths [86]. On the contrary one RCT [87] concluded that in adolescents with major depression omega-3 fatty acids did not appear superior to the placebo.…”

Effects of Omega 3 Fatty Acids on Main Dimensions of Psychopathology

“…A consistent number of studies investigated the role of PUFAs in the treatment of major depressive disorder (MDD). Although some of them [79][80][81][82][83][84][85][86][87][88][89][90][91][92][93][94][95][96] found no significant data, several trials [97][98][99][100][101][102][103][104][105][106][107][108][109][110][111][112] showed an improvement of depressive symptoms in patients treated with n-3 PUFAs in combination with antidepressants. In particular, a combination of higher dose of EPA with lower dose of DHA (EPA 1.67 g/day + DHA 0.83 g/day), added to existing antidepressant treatment, revealed beneficial effects on mood [102,103].…”

Omega-3 Fatty Acid Plasma Levels Before and After Supplementation: Correlations with Mood and Clinical Outcomes in the Omega-3 and Therapy Studies

“…Both are reliable and valid measures (Young et al 1978;Poznanski et al 1984;Fristad et al 1992Fristad et al , 1995Youngstrom et al 2003). (For a thorough discussion of ''filtered'' versus ''unfiltered'' ratings, see Yee et al 2015).…”