March 2010

Treating Persistent Insomnia: Therapy, Meds, or Both?
While cognitive behavioral therapy is probably best for long-term treatment of chronic insomnia, hypnotics can add benefits acutely.

Diet and Depression
Overall dietary pattern may be more important than individual components (such as omega-3 fatty acids) in lowering the risk of depression.

In Brief
Another Negative Trial of Ginkgo biloba for Cognitive Decline; Physical Activity during Pregnancy Has Mixed Results on Postpartum Depression

Carotidynia Associated with SSRIs
Carotidynia may be a rare side effect of selective serotonin reuptake inhibitors and might be more common in migraine sufferers.

Clozapine Hypersalivation: A Negative Study with Ipratropium
In a small, double-blind trial, ipratropium (Atrovent and others) was not effective in decreasing sialorrhea associated with clozapine (Clozaril and others) treatment.

Diet and Depression

March 2010

Comorbid depression in patients with coronary heart disease (CHD) increases the risk of morbidity and mortality. Some evidence suggests that increased consumption of the omega-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA)—either through diet or dietary supplements—may benefit such patients by reducing the chance of sudden cardiac death, improving depression, and enhancing the efficacy of antidepressants.1 With a grant from the National Institutes of Health, Carney and coworkers assessed whether omega-3 augmentation improved the efficacy of sertraline (Zoloft and others) for comorbid major depression in patients with CHD.1

In this randomized controlled trial of 122 patients with major depression and CHD, all patients were given sertraline, 50 mg daily, for 10 weeks after a 2-week run-in period. In double-blind fashion, subjects were randomly assigned also to receive 2 g/day of omega-3 acid ethyl esters (930 mg of EPA and 750 mg of DHA) or corn-oil placebo capsules.

The omega-3 augmentation failed to improve depression outcomes compared with placebo. The authors note conflicting results from other studies about the effects of omega-3 supplements on sudden cardiac death and speculate that different cardiac patients may be either benefited or harmed by these supplements.

In an independent study funded by the Spanish government, Sánchez-Villegas and others assessed the effects of a Mediterranean diet on more than 10,000 healthy Spanish participants.2 The Mediterranean diet appeared to protect against the likelihood of developing depression. Perhaps the overall dietary pattern is more important than the effect of single components, such as omega-3 fatty acids, the authors speculate.

This is an interesting and evolving story. People have long wondered about the contributions of diet to general and mental health. Because of biological heterogeneity, different individuals may be differentially responsive to interventions, including dietary factors, in treating or preventing depression. And dietary ingredients might act together to contribute to health maintenance, including brain health. More research is needed.

1Carney RM, Freedland KE, Rubin EH, Rich MW, Steinmeyer C, Harris WS: Omega-3 augmentation of sertraline in treatment of depression in patients with coronary heart disease: A randomized controlled trial. JAMA 2009;302:1651-1657.

2Sánchez-Villegas A, Delgado-Rodriguez M, Alonso A, Schlatter J, Lahortiga F, Majem LS, Martínez-González MA: Association of the Mediterranean dietary pattern with the incidence of depression: The Seguimiento Universidad de Navarra/University of Navarra follow-up (SUN) cohort. Arch Gen Psychiatry 2009;66:1090-1098.