Do Omega-3s Reduce the Risk for Transition to Psychosis?

Summary and Comment |
December 9, 2016

Do Omega-3s Reduce the Risk for Transition to Psychosis?

  1. Steven Dubovsky, MD

Not according to this multicenter, 1-year study

  1. Steven Dubovsky, MD

Up to 32% of people at ultra-high risk (UHR) develop psychosis — generally, schizophrenia — over 3 years (although the rate has recently declined according to some analyses). In a single-center, randomized, placebo-controlled trial, 3 months of omega-3 polyunsaturated fatty acids (PUFAs) were associated with lower rates of transition to psychosis up to 6 years later (NEJM JW Psychiatry Oct 2015 and Nat Commun 2015; 6:7934). To replicate these results, researchers in an Australian multicenter trial randomized 304 UHR subjects with low or deteriorated functioning in the previous year to 6 months of placebo or PUFAs (1.4 g/day).

All patients also had cognitive-behavioral case management (CBCM; mean, 11 sessions); 62% took antidepressants. Antipsychotic drugs and mood stabilizers were not allowed. Follow-up lasted 6 months, with 26% of participants lost to follow-up.

The primary outcome, transition to psychosis, did not differ between PUFA and placebo (end of treatment: PUFA, 6.7%; placebo, 5.1%; follow-up: PUFA, 11.5%; placebo, 11.2%). Functioning and other symptomatic outcomes also showed no meaningful between-group differences.

Comment

As the authors and editorialists note, a low overall transition rate might have been related to concomitant treatment with a psychotherapy that is known to reduce the risk for transition to psychosis, as well as with antidepressants, which can have a similar effect. However, the effect of CBCM is not so great that it could obscure the benefit of PUFA. A subgroup analysis did not support the hypothesis that higher-risk patients would have had a better response. Higher doses might have been beneficial, but as of now there is insufficient evidence that omega-3s reduce the risk of psychosis in UHR individuals.

Editor Disclosures at Time of Publication

  • Disclosures for Steven Dubovsky, MD at time of publication Grant / Research support Otsuka; Tower Foundation; Oshei Foundation; Patrick Lee Foundation; Wendt Foundation; Takeda; Lilly; Sumitomo; Hoffmann-La Roche; Pfizer, Neurim Pharmaceuticals; Neurocrine Biosciences Editorial boards Mind and Brain; Bulletin of the Menninger Clinic; Current Psychiatry; Journal of Psychosomatic Research

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