Elsevier

Biological Psychiatry

Volume 55, Issue 9, 1 May 2004, Pages 891-896
Biological Psychiatry

Original article
Major depression is associated with lower omega-3 fatty acid levels in patients with recent acute coronary syndromes

https://doi.org/10.1016/j.biopsych.2004.01.021Get rights and content

Abstract

Background

Polyunsaturated fatty acids (PUFAs) are intrinsic cell membrane components and closely involved in neurotransmission and receptor function. Lower omega-3 levels are associated with increased risk of coronary artery disease (CAD), increases in cardiac events in CAD patients, and depression. We sought to examine relationships between depression and serum levels of omega-3 and omega-6 PUFAs in patients recovering from acute coronary syndromes (ACS).

Methods

We carried out a case-control study of serum PUFA levels and current major depression in 54 age- and sex-matched pairs approximately 2 months following ACS.

Results

Depressed patients had significantly lower concentrations of total omega-3 and docosahexaenoic acid (DHA), and higher ratios of arachidonic acid (AA) to DHA, AA to eicosapentaenoic acid (EPA), and n-3 to n-6 than controls. There were no baseline differences in any potential risk or protective factors for depression.

Conclusions

Results are consistent with previous reports in depressed patients without CAD, and with literature concerning omega-3 levels and risk of CAD events. Dietary, genetic, and hormonal factors may all play a role in both depression and CAD. Both prospective studies and randomized trials are needed to help clarify the interrelationships.

Section snippets

Study design and subjects

We carried out a case–control study, nested in the ESCAPE project (Epidemiologic Study of Acute Coronary syndromes and the Pathophysiology of Emotions), a prospective cohort study assessing the prognostic consequences and pathophysiologic mechanisms of depression in ACS patients. The protocol was approved by the Research Ethics Committees of the Montreal Heart Institute, and Hôpital du Sacré Coeur de Montréal. Between August 31, 1999, and August 2, 2001, patients in these hospitals who

Depressed patients

Among the 54 currently depressed cases, there were 20 patients (37.0%) with a previous depression. Four of the currently depressed (7.4%) had atypical depressions, and 11 (20.4%) had melancholic depressions. Some 31.5% had at least one current comorbid DSM-IV Axis I disorder, with the most common being generalized anxiety disorder (n = 11). Duration of the current episode of depression ranged from 2 weeks to 2.8 years (median duration, 2 months). One third were taking antidepressants (all

Discussion

The primary finding of this study is that major depression in acute coronary syndrome patients is associated with significantly lower plasma levels of ω-3 PUFAs, in particular of DHA. Although we did not observe the hypothesized differences in levels of EPA or AA, differences between the depressed and nondepressed went in the predicted direction. However, given the variance of the measures, the sample size was only large enough to detect medium effect sizes for EPA and AA (.30 to .50), and we

Acknowledgements

This research was supported by the Medical Research Council of Canada and an unrestricted grant from GlaxoSmithKline (Grant No. POP-37744 to NF-S, FL), the Charles A. Dana Foundation (NF-S, FL), the Fondation du Center Hospitalier de l'Université de Montréal (NF-S, FL), the Montreal Heart Institute Foundation (NF-S, FL), the Pierre David Fund (FL), and the Cardiovascular Health Network of the Fonds de la recherche en santé du Québec (PJ).

We thank J. Lespérance for angiographic coding, M.-C.

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