Major depression:epidemiology

247 healthy adults (146 males, 101 females) from the island of Crete were examined, with complete data on 139. Mildly depressed subjects had significantly lower (-34.6%) adipose tissue docosahexaenoic acid (DHA) levels than non-depressed subjects. The observed negative relation between adipose tissue DHA and depression appears to indicate higher long-term dietary DHA intakes with lower depression. Prostaglandins Leukot Essent Fatty Acids  2002 Nov;67(5):311-8   Depression and adipose essential polyunsaturated fatty acids.  Mamalakis G, Tornaritis M, Kafatos A.

The unsaturated fatty acid components of phospholipids are abnormal in depression, with deficits of eicosapentaenoic acid and other omega-3 fatty acids and excesses of the omega-6 fatty acid arachidonic acid. Correction of this abnormality by treatment with eicosapentaenoic acid improves depression. The fatty acid abnormalities provide a rational explanation for the associations of depression with cardiovascular disease, immunological activation, cancer, diabetic complications and osteoporosis. Hum Psychopharmacol  2001 Jan;16(1):45-52   Phospholipid metabolism and depression: the possible roles of phospholipase A2 and coenzyme A-independent transacylase.  Horrobin DF.

Depression is associated with elevated rates of cardiovascular morbidity and mortality. This elevation seems to be due to a significantly increased risk of coronary artery disease and myocardial infarction and, once the ischemic heart disease is established, sudden cardiac death. Recent data suggest that the increased rates of cardiovascular disease in patients with depression may be the result of one or more still-unrecognized underlying physiological factors that predispose a patient to both depression and cardiovascular disease. Two possibly related factors that may have a causal relation with both depressive disorders and cardiovascular disease are an omega-3 fatty acid deficiency and elevated homocysteine levels. We present the available data connecting cardiovascular disease, depression, omega-3 fatty acids, and homocysteine. In addition, we suggest research strategies and some preliminary treatment recommendations that may reduce the increased risk of cardiovascular mortality in patients with major depressive disorder.  Harv Rev Psychiatry  2001 Nov-Dec;9(6):280-93   Omega-3 fatty acids, homocysteine, and the increased risk of cardiovascular mortality in major depressive disorder.  Severus WE, Littman AB, Stoll AL.  J Affect Disord  2002 May;69(1-3):15-29   Seafood consumption, the DHA content of mothers’ milk and prevalence rates of postpartum depression: a cross-national, ecological analysis.  Hibbeln JR.

Mothers selectively transfer docosahexaenoic acid (DHA) to their fetuses to support optimal neurological development during pregnancy. Without sufficient dietary intake, mothers become depleted of DHA and may increase their risk of suffering major depressive symptoms in the postpartum period. We postulated that the DHA content of mothers’ milk and seafood consumption would both predict prevalence rates of postpartum depression across countries. METHODS: Published prevalence data for postpartum depression were included that used the Edinburgh Postpartum Depression Scale (n=14532 subjects in 41 studies). These data were compared to the DHA, eicosapentaenoic acid (EPA) and arachidonic acid (AA) content in mothers’ milk and to seafood consumption rates in published reports from 23 countries. RESULTS: Higher concentrations of DHA in mothers’ milk (r=-0.84, p<0.0001, n=16 countries) and greater seafood consumption (r=-0.81, p<0.0001, n=22 countries) both predicted lower prevalence rates of postpartum depression in simple and logarithmic models, respectively. The AA and EPA content of mothers’ milk were unrelated to postpartum depression prevalence. LIMITATIONS: These findings do not prove that higher omega-3 status cause lower prevalence rates of postpartum depression. Data on potentially confounding factors were not uniformly available for all countries. CONCLUSIONS: Both lower DHA content in mothers’ milk and lower seafood consumption were associated with higher rates of postpartum depression. These results do not appear to be an artifact of cross-national differences in well-established risk factors for postpartum depression. Interventional studies are needed to determine if omega-3 fatty acids can reduce major postpartum depressive symptoms.  Arch Gen Psychiatry  2001 May;58(5):512-3   Comment on:  Arch Gen Psychiatry. 1999 May;56(5):407-12.  Arch Gen Psychiatry. 1999 May;56(5):413-4; discussion 415-6.  Fish consumption, depression, and suicidality in a general population.  Tanskanen A, Hibbeln JR, Hintikka J, Haatainen K, Honkalampi K, Viinamaki H. Psychiatr Serv  2001 Apr;52(4):529-31   Fish consumption and depressive symptoms in the general population in Finland.  Tanskanen A, Hibbeln JR, Tuomilehto J, Uutela A, Haukkala A, Viinamaki H, Lehtonen J, Vartiainen E.  Department of Psychiatry, University of Kuopio, Finland. antti.tanskanen@kuh.

Fish contains high concentrations of omega-3 polyunsaturated fatty acids. Several studies have reported depletions of omega-3 fats among depressed patients, and a cross-national comparison has revealed a significant inverse correlation between annual prevalence of major depression and fish consumption. In a sample of 3,204 Finnish adults, depressive symptoms were estimated with the Beck Depression Inventory. A frequency question was used to measure fish consumption. Multiple logistic regression analysis was conducted to assess the association between depression and fish consumption. After the analysis adjusted for potential confounders, the likelihood of having depressive symptoms was significantly higher among infrequent fish consumers than among frequent consumers.  Arch Gen Psychiatry  2000 Jul;57(7):716-7   Comment on:  Arch Gen Psychiatry. 1999 May;56(5):407-12.  Are omega3 fatty acids beneficial in depression but not mania?  Su KP, Shen WW, Huang SY.

Major depression was associated with: higher MUFA and C22:5omega3 proportions and higher C20:4omega6/C20:5omega3 and C22:5omega6/C22:6omega3 ratios; lower C22:4omega6, C20:5omega3 and C22:5omega3 fractions in phospholipids; lower C18:3omega3, C20:5omega3 and total (sigma)omega3 FAs, and higher C20:4omega6/C20:5omega3 and sumomega6/sumomega3 ratios in cholesteryl esters; lower serum concentrations of phospholipids and cholesteryl esters; and a lower OPI. In depression, there were significant and positive correlations between serum Zn and C20:5omega3 and C22:6omega3 fractions in phospholipids; and significant inverse correlations between serum Zn and the sigmaomega6/sigmaomega3, C20:4omega6/C20:5omega3, and C22:5omega6/C22:6omega3 ratios in phospholipids. There was no significant effect of antidepressive treatment on any of the FAs.  Psychiatry Res  1999 Mar 22;85(3):275-91   Lowered omega3 polyunsaturated fatty acids in serum phospholipids and cholesteryl esters of depressed patients.  Maes M, Christophe A, Delanghe J, Altamura C, Neels H, Meltzer HY.