深海魚油的抗發炎的成分可以對抗炎症相關的憂鬱症 Fish oil is an effective treatment and prevention for depression in the context of inflammation

深海魚油的抗發炎的成分可以對抗炎症相關的憂鬱症

蘇冠賓

中國醫藥大學 醫學院副院長

精神醫學及神經科學教授

身心介面實驗室主持人

Personalize medicine with omega-3 fatty acids for depression in pregnant women and children, and depression associated with inflammation. (Su KP*. Journal of Clinical Psychiatry 2015; 76(11): e1476-77)

http://www.psychiatrist.com/JCP/article/Pages/2015/v76n11/v76n1112.aspx

干擾素IFN-α是C型肝炎標準療法，但大約有三成的患者會在治療前三個月內出現重度憂鬱症，這不僅造成C型肝炎病患對這項有效的干擾素治療之恐懼，更導致病患中途放棄治療，影響療效。在精神醫學上，干擾素療法誘發重度憂鬱症現象，卻是憂鬱症的發炎假說最強有力的証據。過去的臨床研究發現，用來治療憂鬱症的抗憂鬱藥物，也可以有效預防IFN-α誘發的憂鬱症發作，然而，由於會讓更多不會誘發憂鬱症者暴露在不需的用藥之下，所以藥物預防並不適合。

由於深海魚油omega-3 polyusnaturated fatty acids (PUFAs) 是安全的保健食品，也是良好神經保護及抗發炎物質，我們先前的研究發現，干擾素誘發憂鬱症和omega-3 PUFAs的濃度太低和發炎及脂質代謝基因變異有關，因此，我們最近利用雙盲、對照的安慰劑 (placebo) 對照實驗設計，來探討omega-3 PUFAs預防干擾素誘發憂鬱症的效果，我們發現EPA可以有效減低干擾素誘發憂鬱症的發生，而EPA和DHA都可延緩憂鬱症發作的時間。

我們這項研究發表在2014年的 Biological Psychiatry，這個結果不但支持了omega-3 PUFAs在預防干擾素誘發憂鬱症的效果，更佐證了深海魚油的抗發炎的成分可以對抗炎症相關的憂鬱症的假說。最近，美國友人David Mischoulon和Mark Rapaport 發表在Mol Psychiatry的研究，更進一步驗證了這個假說。他們把憂鬱症病人依發炎程度來做分型，發現EPA對憂鬱症的功效，只有在發炎程度高的病患才能顯示出來，因此，以發炎相關的憂鬱症患者，可望利用安全的深海魚油來做為第一線治療。

It's important to identify depressed patients who will respond better to omega-3 fatty acids, the so-called personalized medicine. There are several theories about how omega-3 fatty acids may work in depression, and the most relevant one is the anti-inflammatory effects. Recently, my friends David Mischoulon and Mark Rapaport from USA stratified MDD patients with inflammatory markers, and they successfully increased the treatment effect sizes by using omega-3 fatty acids in MDD patients only with high inflammation status (Rapaport et al, Mol Psychiatry, In Press). Their hypothesis here is based on omega-3's reversing effects on inflammation. Interestingly, their findings perfectly support our previous study of personalizing omega-3 fatty acids in prevention of inflammation-related depression.

One advantage of nutritional medicine is its application in early intervention that can avoid unnecessary exposure to medication. In 2014, we published a paper to show that supplementation with omega-3 fatty acids is beneficial in at-risk subjects for interferon-induced depression (Su et al, Biol Psychiatry 2014). The study team confirms the notion that anti-inflammatory strategies are effective antidepressants in the context of depression associated with inflammation.

1. Su KP*. Personalize medicine with omega-3 fatty acids for depression in pregnant women and children, and depression associated with inflammation. Journal of Clinical Psychiatry 2015; 76(11): e1476-77.
2. Su KP, Lai HC, Yang HT, Su WP, Peng CY, Chang JPC, Huang CL, Chang HC, Pariante CM. Omega-3 fatty acids in the prevention of interferon-alpha-induced depression Results from a randomized, controlled trial. Biological Psychiatry 2014 Oct 1; 76(7): 559-66.
3. Rapaport MH, Nierenberg AA, Schettler PJ, Kinkead B, Cardoos A, Walker R, Mischoulon D.Inflammation as a predictive biomarker for response to omega-3 fatty acids in major depressive disorder: a proof-of-concept study. Mol Psychiatry 2015 Mar 24. doi: 10.1038/mp.2015.22. [Epub ahead of print]