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      Supplementation‐induced increase in circulating omega‐3 serum levels is not associated with a reduction in depressive symptoms: Results from the MooDFOOD depression prevention trial

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          Abstract

          Background

          There is ambiguity on how omega‐3 (n‐3) polyunsaturated fatty acids (PUFAs) are associated with depression, and what the temporality of the association might be. The present study aimed to examine whether (intervention‐induced changes in) n‐3 PUFA levels were associated with (changes in) depressive symptoms.

          Methods

          Baseline, 6‐ and 12‐month follow‐up data on 682 overweight and subclinically depressed persons from four European countries that participated in the MooDFOOD depression prevention randomized controlled trial were used. Participants were allocated to four intervention groups: (a) placebos, (b) placebos and food‐related behavioral activation therapy (F‐BA), (c) multinutrient supplements (fish oil and multivitamin), and (d) multinutrient supplements and F‐BA. Depressive symptoms were measured using the inventory of depressive symptomatology. PUFA levels (µmol/L) were measured using gas chromatography. Analyses were adjusted for sociodemographics, lifestyle, and somatic health.

          Results

          Increases in n‐3 PUFA, docosahexaenoic acid, and eicosapentaenoic acid levels over time were significantly larger in the supplement groups than in placebo groups. Change in PUFA levels was not significantly associated with the change in depressive symptoms ( β = .002, SE = 0.003, p = .39; β = .003, SE = 0.005, p = .64; β = .005, SE = 0.005, p = .29; β = −.0002, SE = 0.0004, p = .69). Baseline PUFA levels did not modify the intervention effects on depressive symptoms.

          Conclusions

          In overweight and subclinical depressed persons, multinutrient supplements led to significant increases in n‐3 PUFA levels over time, which were not associated with changes in depressive symptoms. Multinutrient supplements do not seem to be an effective preventive strategy in lowering depressive symptoms over time in these at‐risk groups.

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          Most cited references40

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          The PHQ-9: validity of a brief depression severity measure.

          While considerable attention has focused on improving the detection of depression, assessment of severity is also important in guiding treatment decisions. Therefore, we examined the validity of a brief, new measure of depression severity. The Patient Health Questionnaire (PHQ) is a self-administered version of the PRIME-MD diagnostic instrument for common mental disorders. The PHQ-9 is the depression module, which scores each of the 9 DSM-IV criteria as "0" (not at all) to "3" (nearly every day). The PHQ-9 was completed by 6,000 patients in 8 primary care clinics and 7 obstetrics-gynecology clinics. Construct validity was assessed using the 20-item Short-Form General Health Survey, self-reported sick days and clinic visits, and symptom-related difficulty. Criterion validity was assessed against an independent structured mental health professional (MHP) interview in a sample of 580 patients. As PHQ-9 depression severity increased, there was a substantial decrease in functional status on all 6 SF-20 subscales. Also, symptom-related difficulty, sick days, and health care utilization increased. Using the MHP reinterview as the criterion standard, a PHQ-9 score > or =10 had a sensitivity of 88% and a specificity of 88% for major depression. PHQ-9 scores of 5, 10, 15, and 20 represented mild, moderate, moderately severe, and severe depression, respectively. Results were similar in the primary care and obstetrics-gynecology samples. In addition to making criteria-based diagnoses of depressive disorders, the PHQ-9 is also a reliable and valid measure of depression severity. These characteristics plus its brevity make the PHQ-9 a useful clinical and research tool.
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            The Inventory of Depressive Symptomatology (IDS): psychometric properties.

            The psychometric properties of the 28- and 30-item versions of the Inventory of Depressive Symptomatology, Clinician-Rated (IDS-C) and Self-Report (IDS-SR) are reported in a total of 434 (28-item) and 337 (30-item) adult out-patients with current major depressive disorder and 118 adult euthymic subjects (15 remitted depressed and 103 normal controls). Cronbach's alpha ranged from 0.92 to 0.94 for the total sample and from 0.76 to 0.82 for those with current depression. Item total correlations, as well as several tests of concurrent and discriminant validity are reported. Factor analysis revealed three dimensions (cognitive/mood, anxiety/arousal and vegetative) for each scale. Analysis of sensitivity to change in symptom severity in an open-label trial of fluoxetine (N = 58) showed that the IDS-C and IDS-SR were highly related to the 17-item Hamilton Rating Scale for Depression. Given the more complete item coverage, satisfactory psychometric properties, and high correlations with the above standard ratings, the 30-item IDS-C and IDS-SR can be used to evaluate depressive symptom severity. The availability of similar item content for clinician-rated and self-reported versions allows more direct evaluations of these two perspectives.
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              Essential fatty acids in health and chronic disease.

              Human beings evolved consuming a diet that contained about equal amounts of n-3 and n-6 essential fatty acids. Over the past 100-150 y there has been an enormous increase in the consumption of n-6 fatty acids due to the increased intake of vegetable oils from corn, sunflower seeds, safflower seeds, cottonseed, and soybeans. Today, in Western diets, the ratio of n-6 to n-3 fatty acids ranges from approximately 20-30:1 instead of the traditional range of 1-2:1. Studies indicate that a high intake of n-6 fatty acids shifts the physiologic state to one that is prothrombotic and proaggregatory, characterized by increases in blood viscosity, vasospasm, and vasoconstriction and decreases in bleeding time. n-3 Fatty acids, however, have antiinflammatory, antithrombotic, antiarrhythmic, hypolipidemic, and vasodilatory properties. These beneficial effects of n-3 fatty acids have been shown in the secondary prevention of coronary heart disease, hypertension, type 2 diabetes, and, in some patients with renal disease, rheumatoid arthritis, ulcerative colitis, Crohn disease, and chronic obstructive pulmonary disease. Most of the studies were carried out with fish oils [eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA)]. However, alpha-linolenic acid, found in green leafy vegetables, flaxseed, rapeseed, and walnuts, desaturates and elongates in the human body to EPA and DHA and by itself may have beneficial effects in health and in the control of chronic diseases.
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                Author and article information

                Contributors
                c.thesing@ggzingeest.nl
                Journal
                Depress Anxiety
                Depress Anxiety
                10.1002/(ISSN)1520-6394
                DA
                Depression and Anxiety
                John Wiley and Sons Inc. (Hoboken )
                1091-4269
                1520-6394
                26 August 2020
                November 2020
                : 37
                : 11 , FAMILY, HOMELESSNESS, AND DIETARY RELATIONSHIPS TO MENTAL HEALTH ( doiID: 10.1002/da.v37.11 )
                : 1079-1088
                Affiliations
                [ 1 ] Department of Psychiatry, Amsterdam Public Health Research Institute de Boelelaan, Amsterdam UMC Vrije Universiteit Amsterdam Amsterdam The Netherlands
                [ 2 ] Department of Health Sciences, Faculty of Science and the Amsterdam Public Health research institute Vrije Universiteit Amsterdam Amsterdam the Netherlands
                [ 3 ] Department of Psychology University of Exeter Exeter United Kingdom
                [ 4 ] Department of Psychiatry, Psychosomatics, and Psychotherapy Goethe‐Universität Frankfurt Frankfurt a.M. Germany
                [ 5 ] Institut Universitari d'Investigació en Ciències de la Salut, Idisba, Rediapp University of Balearic Islands Palma de Mallorca Spain
                [ 6 ] Department of Psychiatry and Psychotherapy, Medical Faculty University of Leipzig Leipzig Germany
                Author notes
                [*] [* ] Correspondence Carisha S. Thesing, Department of Psychiatry, VU University Medical Center, Oldenaller 1, 1081 HJ Amsterdam, Netherlands.

                Email: c.thesing@ 123456ggzingeest.nl

                Author information
                http://orcid.org/0000-0002-9153-2576
                http://orcid.org/0000-0001-7407-6540
                Article
                DA23092
                10.1002/da.23092
                7693241
                32845021
                1b4bbd61-6756-4213-b4fc-87d86e35d9ee
                © 2020 The Authors. Depression and Anxiety Published by Wiley Periodicals LLC

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                : 27 November 2019
                : 29 April 2020
                : 29 July 2020
                Page count
                Figures: 1, Tables: 3, Pages: 10, Words: 7266
                Funding
                Funded by: European Union FP7 MooDFOOD project
                Award ID: 613598
                Funded by: National Institute for Health Research (NIHR), through the Primary Care Research Network and the NIHR Exeter Clinical Research Facility , open-funder-registry 10.13039/501100000272;
                Categories
                Research Article
                Research Articles
                Custom metadata
                2.0
                November 2020
                Converter:WILEY_ML3GV2_TO_JATSPMC version:5.9.4 mode:remove_FC converted:27.11.2020

                Clinical Psychology & Psychiatry
                moodfood,omega‐3,prevention,subclinical depression,supplement
                Clinical Psychology & Psychiatry
                moodfood, omega‐3, prevention, subclinical depression, supplement

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