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Battling the blues.

Several years ago, Dr. Andrew Stoll, director of the Psychopharmacology Research Laboratory at Harvard Medical School-McLean Hospital, conducted a landmark study on the role of omega-3 fatty acids in bipolar disorder and came up with some surprising results. The researcher discovered that when patients with bipolar disorder consumed omega-3 from fish oil, they experienced a marked reduction in episodes of mania and depression. Extensive research continues to demonstrate that omega-3 fatty acids--specifically EPA (eicosapentaenoic acid) and DPA (docosahexanaenoic acid)--form the foundation of a solid, healthy diet, while also reducing the risk of cardiovascular disease and arthritis, among other conditions.

To update readers about Dr. Stoll's ongoing research into the role of omega-3 fatty acids in depression, we spoke with the Harvard researcher and author.

MU: Do your patients, who were part of the original study, continue to take omega-3 and experience relief from their symptoms?

Dr. Stoll: I still see some of these people. All continue to take omega-3 supplements. In my practice, I am in favor of it, so I advise people to take it--if not for the psychiatric benefits, then for the general health benefits.

MU: Is there a downside to supplementing with omega-3?

Dr. Stoll: There isn't. Some people may experience GI distress if they take a large amount of a low-quality supplement. But the highest good-quality fish oil is not rancid and has little or no taste and has no side effects. Another issue that people worry about is bleeding, because EPA inhibits platelet aggregation. But we scoured the scientific literature, and there has never been a documented case of bleeding due to omega-3 fatty acids.

MU: What dosage do you recommend for patients with bipolar or depression?

Dr. Stoll: I start patients on one gram of EPA per day, and go up on the dosage gradually until an effect is seen on a person's mood. I usually do not have to exceed six grams of EPA per day.

The amount of omega-3 in a supplement may be calculated from the side of the bottle. It is important to know that the amount of active ingredients in supplements is listed on the label by serving size, not necessarily by how much of an ingredient or compound is in one capsule. To determine omega-3 content, simply take the amount of EPA or EPA plus DHA per serving, as listed on the label, and divide it by the serving size to determine how much omega-3 is in each capsule.

I definitely use lower doses than I used to, based on recent data. Occasionally, someone will call or e-mail me with an anecdote that they didn't respond until they were taking 10 grams a day--the original dose in our study. Hopefully, we will resolve that issue in the next few years.

MU: Today, people are advised to eat more fish, but at the same time, they are warned about the mercury content of certain fish. What should the consumer do?

Dr. Stoll: It is a real problem. Small fish, like mackerel, sardines, and anchovies that do not live a long time and are nonpredatory, contain few or no toxic contaminants. Large predatory fish, like tuna, tend to be the most contaminated.

Fish oil never has mercury or PCBs because the mercury stays with the solids and does not go into the oil. On the other hand, PCBs and pesticides, which are organic carcinogens from human pollution, will go into the oil. That is why I like the high-concentration fish-oil supplements--50 to 90 percent omega-3 in the formulation. Fish oil supplements are distilled, which lifts the oil away from the contaminants. There are multiple distillation steps in order to arrive at formulations of 90 percent omega-3 concentration, which produces very pure oil.

There is a useful Web site called, where you can actually find the best brands. Companies voluntarily submit their products to Consumer Labs for analysis. They seem to be pretty honest. They give failing marks to companies, even though the supplement makers pay to review products. I trust them 95 percent. They reviewed whole classes of supplements, including omega-3s. You can see that they measured for organic carcinogens, mercury, cadmium, lead, and other contaminants, which is comforting.
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Publication:Medical Update
Geographic Code:1USA
Date:May 1, 2005
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