Omega-6 fatty acids and greater likelihood of suicide risk and major depression in early pregnancy

Adrenic acid: A promising biomarker and therapeutic target (Review)

Adrenic acid is a 22‑carbon unsaturated fatty acid that is widely present in the adrenal gland, liver, brain, kidney and vascular system that plays a regulatory role in various pathophysiological processes, such as inflammatory reactions, lipid metabolism, oxidative stress, vascular function, and cell death. Adrenic acid is a potential biomarker for various ailments, including metabolic, neurodegenerative and cardiovascular diseases and cancer. In addition, adrenic acid is influenced by the pharmacological properties of several natural products, such as astragaloside IV, evodiamine, quercetin, kaempferol, Berberine‑baicalin and prebiotics, so it is a promising new target for clinical treatment and drug development. However, the molecular mechanisms by which adrenic acid exerts are unclear. The present study systematically reviewed the biosynthesis and metabolism of adrenic acid, focusing on intrinsic mechanisms that influence the progression of metabolic, cardiovascular and neurological disease. These mechanisms regulate several key processes, including immuno‑inflammatory response, oxidative stress, vascular function and cell death. In addition, the present study explored the potential clinical translational value of adrenic acid as a biomarker and therapeutic target. To the best of our knowledge, the present study is first systematic summary of the mechanisms of action of adrenic acid across a range of diseases. The present study provides understanding of the wide range of metabolic activities of adrenic acid and a basis for further exploring the pathogenesis and therapeutic targets of various diseases.

Association between polyunsaturated fatty acids and depression in women with infertility: a cross-sectional study based on the National Health and Nutrition Examination Survey

Background

Identifying possible influencing factors is crucial for the depression symptoms of women experiencing infertility. This study aims to explore the association between polyunsaturated fatty acids (PUFAs) and the odds of depression symptoms in women experiencing infertility.

Methods

This is a cross-sectional study based on the National Health and Nutrition Examination Survey (NHANES). PUFA intake was obtained through a 24-h dietary recall interview. Depression symptoms were defined using the Patient Health Questionnaire-9 (PHQ-9) with a score of ≥10 points or as taking antidepressants. The association between PUFA and depression was assessed using a logistic regression model by calculating the odds ratio (OR) with 95% confidence interval (CI). Subgroup analysis was carried out based on menopausal status and female hormone use.

Results

There were 725 participants included for analysis. After adjusting the covariables, lower odds of depression symptoms were found in patients with the intake of omega-3 PUFA (OR = 0.48, 95% CI: 0.24-0.96) and omega-6 PUFA (OR = 0.24, 95% CI: 0.14-0.42) in the second tertile (T2) in comparison to the first tertile (T1). The intake of α-linolenic (ALA) (OR = 0.48, 95% CI: 0.23-0.97) and linoleic acid (OR = 0.24, 95% CI: 0.14-0.41) in T2 was also found to be related to the reduced odds of depression symptoms in comparison to T1.

Conclusions

Our findings suggest a potential association between moderate omega-3 and omega-6 PUFA intake and a reduced risk of depression symptoms in women experiencing infertility. This implies that clinicians might find it useful to consider dietary advice that includes PUFA-rich foods as part of a broader strategy to address mental health in this patient group. However, further research is needed to confirm these preliminary findings and to establish the optimal levels of PUFA intake for mental health benefits.

Sex differences in erythrocyte fatty acid composition of first-diagnosed, drug-naïve patients with major depressive disorders

Background: Since depression, sex hormones, and fatty acid status are interrelated, it is important to understand their relationships. In this study, we aimed to investigate sex differences in erythrocyte membrane fatty acid composition among first-diagnosed, drug-naïve patients with major depressive disorders. Methods: The study included 139 individuals with first-diagnosed, drug-naïve depression (male/female = 48/91) and 55 healthy controls (male/female = 24/31). The levels of erythrocyte membrane fatty acids were analyzed to compare the difference between males and females in both patients with depression and healthy controls, as well as to study their correlation with depressive symptoms. Results: In first-diagnosed, drug-naïve patients with major depressive disorders, sex disparities were observed in the levels of erythrocyte saturated fatty acids (SFAs) and n-6 PUFAs (such as C18:0, C20:4n6 and C22:4n6), where higher levels evident in females compared to in males. We found a noteworthy correlation between fatty acid levels and depressive symptoms, in which there is a significant association between female patients and depression but a weaker association between male patients and depression. Conclusion: Our findings demonstrate higher levels of n-6 PUFAs and SFAs in female patients with depression. The relationship between fatty acid composition and depressive symptoms was more prominent in females than males. These findings highlight the significance of considering sex as a crucial and interconnected factor in future investigations and potential adjunctive treatment for mood disorders by targeting fatty acid metabolism.

Potential Suicide Prophylactic Activity by the Fish Oil Metabolite, 4-Hydroxyhexenal

Low levels of n-3 poly-unsaturated fatty acids (n-3 PUFAs) and high levels of n-6 PUFAs in the blood circulation are associated with an increased risk for suicide. Clinical studies indicate that docosahexaenoic acid (DHA, a n-3 PUFA found in fish-oil) displays protective effects against suicide. It has recently been proposed that the activation of the transcription factor NRF2 might be the pharmacological activity that is common to current anti-suicidal medications. Oxidation products from fish oil, including those from DHA, are electrophiles that reversibly bind to a protein ‘KEAP1’, which acts as the molecular inhibitor of NRF2 and so indirectly promotes NRF2-transcriptional activity. In the majority of publications, the NRF2-stimulant effect of DHA is ascribed to the metabolite 4-hydroxyhexenal (4HHE). It is suggested to investigate whether 4HHE will display a therapeutically useful anti-suicidal efficacy.

Naturally absorbed lithium may prevent suicide attempts and deliberate self-harm while eicosapentaenoic acid may prevent deliberate self-harm and arachidonic acid may be a risk factor for deliberate self-harm: The updated different findings in new analyses

BACKGROUND

Since our previous investigation on the effects of trace lithium, eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), and arachidonic acid (AA) on deliberate self-harm and suicide attempts in 2018, to our knowledge, no replication study has been conducted on this topic.

SUBJECTS AND METHODS

We increased 37 new patients and totally 234 patients were re-analyzed to further investigate the association of suicide-related behaviors with levels of trace lithium, EPA, DHA, and AA in a different way to avoid multicollinearity.

RESULTS

Higher lithium levels were significantly associated with fewer suicide attempts and deliberate self-harm, higher EPA levels were significantly associated with fewer deliberate self-harm, and higher AA levels were significantly associated with more deliberate self-harm.

DISCUSSION

Although the sample size was only slightly larger than the previous study, the present results were clearly different from the previous ones due to the use of different statistical analyses to avoid multicollinearity.

CONCLUSION

The present findings suggest that naturally absorbed lithium may protect against suicide and deliberate self-harm, while naturally absorbed EPA may protect against deliberate self-harm. However, naturally absorbed AA may be a risk factor for deliberate self-harm.

Changes in fatty acid levels (saturated, monounsaturated and polyunsaturated) during pregnancy

BACKGROUND

During pregnancy a high amount of fatty acids (FA) is necessary to meet foetus demands, which vary during gestation. The present study describes the changes in maternal fatty acid concentrations during pregnancy in a sample of pregnant women.

METHODS

This is a longitudinal study of 479 pregnant women who were monitored from the first trimester to third trimester of pregnancy. Data on maternal characteristics were recorded and a serum sample was collected in each trimester. The fatty acid profile (saturated (SFA: total, lauric acid, myristic acid, palmitic acid, stearic acid), monounsaturated (MUFA: total, palmitoleic acid, oleic acid) and polyunsaturated fatty acids (PUFA: total omega-6 (n-6), linoleic acid, dihomo-γ-linolenic acid, arachidonic acid (AA), total omega-3 (n-3), eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA)) was analysed with a gas chromatography-mass spectrometry combination.

RESULTS

From the first trimester to third trimester of pregnancy, a significant increase in total SFA, total MUFA and total n-6 PUFA was found. (p < 0.001). Nevertheless, the serum concentration of arachidonic acid (AA), eicosapentaenoic acid (EPA) and total n-3 PUFA decreased during gestation (p < 0.001). A statistically non-significant result was observed for the docosahexaenoic acid (DHA) serum concentration between the first and third trimesters of pregnancy. Significant correlations were observed between each total fatty acid concentrations of the first and third trimesters.

CONCLUSION

The circulating serum concentration of SFA, MUFA and n-6 PUFA increases during pregnancy, whereas essential fatty acids such as AA and EPA decrease, and DHA remains unchanged. Further research is necessary to understand the role played by FA throughout gestation.

Perinatal suicidality: prevalence and correlates in a South African birth cohort

Suicidal ideation and behaviour (SIB) in the perinatal period is prevalent in low- and middle-income countries (LMICs). Past work has been limited by reliance on self-rated scales, and there are few data on SIB severity in such settings. We collected cross-sectional data on SIB using a clinician-administered scale and explored risk factors associated with the presence of SIB and SIB severity. Data were collected from the Drakenstein Child Health Study cohort antenatally and at 6 months postpartum. SIB was measured using the Mini International Neuropsychiatric Interview, and potential sociodemographic, psychosocial, and psychiatric risk factors were assessed. Multivariable analysis determined cross-sectional risk factors. Multinomial regressions determined predictors of SIB risk categories. Among 748 women, the antenatal SIB prevalence was 19.9% and postpartum 22.6%. SIB was associated with younger age (antepartum), PTSD (postpartum), and depression (ante- and postpartum). Depression and PTSD predicted belonging to the high-risk SIB group. The medium-risk group was more likely to have depression, alcohol use during pregnancy, and substance abuse. Depression, PTSD, food insecurity, recent intimate partner violence (IPV), and childhood trauma were associated with the low-risk group versus the no-risk group. Screening is needed for perinatal SIB. Associations of perinatal SIB with younger age and major depression are consistent with previous work. The association with PTSD is novel, and underscores the importance of assessment of trauma exposure and outcomes in this population. Different risk categories of SIB may have different causal pathways and require different interventions.

Effect of Evening Primrose Oil on Postmenopausal Psychological Symptoms: A Triple-Blind Randomized Clinical Trial

OBJECTIVES

Psychological symptoms of menopause may impose a negative effect on the quality of life of menopausal women. Thus, the management of these symptoms can improve the quality of life and psychological health of such woman. The present study aimed to determine the effect of evening primrose on psychological symptoms in menopausal women.

METHODS

In this triple-blind randomized clinical trial, the effect of the evening primrose oil on postmenopausal psychological symptoms was investigated. The subjects were 100 menopausal women, referred to a healthcare center in Dastena city (Chaharmahal and Bakhtiari Province, Iran), who were randomly assigned to two groups. The intervention group used two 1 g pearls of evening primrose oil daily. The study instruments included a sub-scale of Menopause Rating Scale (MRS). Menopause data were analyzed using an independent t-test and Friedman test by the SPSS software. P values < 0.05 were considered statistically significant.

RESULTS

The two groups were balanced in demographic characteristics and psychological disorder severity before the intervention. The median (interquartile range) MRS score in the intervention group before the intervention and 2 and 4 weeks after the intervention were 11 (10-12), 6 (5-7), and 3 (2-4), respectively, and in the placebo, they were 11 (9-11), 10 (9-11), and 11 (10-12). A significant reduction was observed in the intervention group compared with the placebo group 2 and 4 weeks post-intervention.

CONCLUSION

The use of evening primrose oil can decrease postmenopausal psychological symptoms.

Emerging insights on drug delivery by fatty acid mediated synthesis of lipophilic prodrugs as novel nanomedicines

Many drug molecules that are currently in the market suffer from short half-life, poor absorption, low specificity, rapid degradation, and resistance development. The design and development of lipophilic prodrugs can provide numerous benefits to overcome these challenges. Fatty acids (FAs), which are lipophilic biomolecules constituted of essential components of the living cells, carry out many necessary functions required for the development of efficient prodrugs. Chemical conjugation of FAs to drug molecules may change their pharmacodynamics/pharmacokinetics in vivo and even their toxicity profile. Well-designed FA-based prodrugs can also present other benefits, such as improved oral bioavailability, promoted tumor targeting efficiency, controlled drug release, and enhanced cellular penetration, leading to improved therapeutic efficacy. In this review, we discuss diverse drug molecules conjugated to various unsaturated FAs. Furthermore, various drug-FA conjugates loaded into various nanostructure delivery systems, including liposomes, solid lipid nanoparticles, emulsions, nano-assemblies, micelles, and polymeric nanoparticles, are reviewed. The present review aims to inspire readers to explore new avenues in prodrug design based on the various FAs with or without nanostructured delivery systems.

Effects of Omega 3 Fatty Acids on Main Dimensions of Psychopathology

The usefulness of polyunsaturated fatty acids on inflammatory, cardiovascular, and the nervous system was studied in the last decades, but the mechanisms underlying their benefic properties are still partially unknown. These agents seem to express their action on the membrane phospholipid composition and permeability and modulation of second messenger cascades. In psychiatry, the efficacy and tolerability of omega-3 fatty acids were investigated in several psychiatric disorders, including major depression, bipolar disorder, personality disorders, high-risk conditions to develop psychosis, attention-deficit hyperactivity disorder, and autism spectrum disorders. Initial findings in this field are promising, and some relevant questions need to be addressed. In particular, the effects of these agents on the main symptom dimensions have to be investigated in a trans-diagnostic perspective. The present systematic review is aimed to examine the available data on the efficacy of omega-3 fatty acids on domains of psychotic symptoms, affective symptoms, impulsivity, and aggressiveness, and harmful behaviors, and suicide risk.

Lipidome Profiles Are Related to Depressive Symptoms and Preterm Birth Among African American Women

African American women have the highest rate of preterm birth (PTB; <37 completed weeks' gestation) of any racial and ethnic group in the United States (14.1%). Depressive symptoms (DS) have been linked to PTB risk of African American women. We hypothesized that maternal lipidomic profiles are related to prenatal DS and gestational age at birth among African American women. Women were enrolled at 9-25 weeks' gestation, completed questionnaires, and provided plasma samples. Lipidomic profiles were determined by "shotgun" Orbitrap high-resolution/accurate mass spectrometry. Data were analyzed using SIMCA P+ software. There was a clear separation in the orthogonal projections to latent structures discriminant analysis score plot between women with Center for Epidemiologic Studies Depression Scale (CES-D) scores ≥23 and women with CES-D scores ≤22. Similarly, a clear separation was observed in the model between PTB and full-term birth. Corresponding S-plot, loading plot, and variable importance in projection plot/list were used to identify the lipids responsible for the groupings. Higher levels of specific triglyceride (TG) species and lower levels of specific phosphatidylcholines (PCs) PC(37:1), PC(41:6), and PC(39:3) were associated with PTB. PC PC(37:1) levels were also lower among women with CES-D scores ≥23, pointing toward a possible connection between DS and PTB. Although overweight pregnant women showed higher levels of TGs, the PTB model showed specific TGs unique to PTB. Lipidomic profiles in pregnant African American women are related to DS, and our data suggest a role for specific TGs and PCs in PTB.

Biomarkers of suicidal behaviors: A comprehensive critical review

Suicide is a relevant worldwide public health problem. Many studies have shown that different demographic and clinical factors are potentially associated with suicidal behavior. Other studies have reported data about the role of biomarkers in the onset of suicidal behaviors. Specifically, researchers have found that suicidal risk may be increased by abnormalities in serotonergic system, hypothalamic-pituitary-adrenal axis, lipid metabolism, immune system and neuronal plasticity. The identification of specific biological parameters associated with self-harm may be helpful to implement prevention strategies and also to detect new therapeutic strategies. In this review, we summarize and analyze the results of main studies about neurobiological mechanisms related to suicidal behavior, also exploring the possible interconnection between the different biological systems.

Metabolomic evidence for the therapeutic effect of gentiopicroside in a corticosterone-induced model of depression

BACKGROUND

Depression is a disease that seriously threatens the quality of human life. To explore the effect of gentiopicroside on depression, this study investigated the therapeutic effect of gentiopicroside on corticosterone-induced depressionin vivo and in vitro by using metabolomic methods.

METHODS

A total of 36 rats were randomly assigned to three groups: a normal group, model group (depression), and treatment group (depression + gentiopicroside). Corticosterone was administrated to induce depression-like model rats. Morris water maze test was used to validated the behavior performance. The hippocampus of rats was obtained for metabolomic detection. Metabolites that were differentially expressed between the groups were extracted for Heatmap, Go, and pathway enrichment analyses. Finally, neuronal cells were cultured and examined to validated the effect of gentiopicroside.

RESULTS

Corticosterone injured rats learning capacity, and decreased the levels of 5-HT, and reversed by gentiopicroside delivery. Metabolites obtained from the hippocampus of rats in the three groups were subjected to a principal component analysis (PCA). Go and pathway enrichment analyses revealed the involvement of sphingolipid metabolism et al. Gentiopicroside could inhibit apoptosis caused by corticosterone, and also decrease neuronal cell proliferation and BDNF levels in vitro. Arachidonic acid (ARA) reversed the protective effect of gentiopicroside on neuronal cells.

CONCLUSION

These findings suggest that gentiopicroside reduces apoptosis and increases the proliferation of hippocampus cells in depressed animals by regulating metabolites. Moreover, our study provides a new basis for the clinical treatment of depression and demonstrates the potential efficacy of gentiopicroside in this area of pathology.

Environmental Stressors May Drive Inflammation and Alter Neurocircuitry to Promote Suicidal Behavior

Suicide morbidity and mortality are serious public health problems, accounting for over 40,000 deaths annually and over $10 billion in combined medical and work loss costs. Suicidal behavior is the outcome of a complex causal web of distal and proximal risk processes that includes a range of interacting environmental and biological determinants. We review current understanding of risk and protective factors, including recent findings on inflammatory processes, discuss recent research on environmental risks for suicidal behaviors with a focus on economic stress, and examine potential mechanisms by which external factors and internal processes such as inflammation might contribute to pathways leading to suicidal behavior. We propose a model that links changes in the default network or resting state of brain activity with corresponding changes in brain structure and function, which in turn may be influenced by diverse inflammatory mediators, and suggest a potential framework that highlights multidisciplinary opportunities for further research.

Naturally absorbed polyunsaturated fatty acids, lithium, and suicide-related behaviors: A case-controlled study

OBJECTIVE

Previous studies have investigated the effects of omega-3, omega-6 and lithium on suicide-related behaviors separately. This study was performed to comprehensively investigate the effects of naturally absorbed EPA, DHA, arachidonic acid and lithium in relation to suicide attempt and deliberate self-harm, with adjustment for each other.

METHODS

We analyzed plasma EPA, DHA, arachidonic acid levels and serum lithium levels of 197 patients including 33 patients with suicide attempts, 18 patients with deliberate self-harm, and 146 control patients.

RESULTS

Multivariate logistic regression analysis with adjustment for age, gender, EPA, DHA, arachidonic acid and log-transformed lithium levels revealed that the negative associations with EPA levels (adjusted OR 0.972, 95% CI 0.947-0.997, p = 0.031) and log-transformed lithium levels (adjusted OR 0.156, 95% CI 0.038-0.644, p = 0.01) and the positive association with DHA levels (adjusted OR 1.026, 95% CI 1.010-1.043, p = 0.002) were significant in patients with suicide attempts than in control patients. The analysis also demonstrated that the positive association with arachidonic acid levels (adjusted OR 1.015, 95% CI 1.005-1.025, p = 0.004) was significant in patients with deliberate self-harm than in control patients.

LIMITATIONS

The limitations are relatively small number of patients and the effects of demographics of individual patients could not be adjusted for the analyses.

CONCLUSIONS

The present findings suggest that, as naturally absorbed nutrients, higher EPA and lithium levels may be associated with less suicide attempt, and that higher arachidonic acid levels may be associated with more deliberate self-harm.

How lipids may affect risk for suicidal behavior

Suicide and nonfatal suicidal behaviors are major causes of mortality and morbidity worldwide. Variability in rates of suicide and suicidal behaviors within and between countries has been attributed to population and individual risk factors, including economic status and cultural differences, both of which can have suicide risk effects mediated through a variety of factors, of which perhaps the least understood is the role of diet. We therefore review the scientific literature concerning two major dietary lipid classes, cholesterol and polyunsaturated fatty acids (PUFAs), that have been associated with higher risk of suicide attempts and suicide. We consider potential mechanistic intermediates including serotonin transporters and receptors, toll-like receptors (TLRs), nuclear factor kappa-light-chain-enhancer of activated B cells (NFκB), and peroxisome proliferator activated receptors (PPARs). Based on this review, we describe a theoretical model linking cholesterol and PUFA status to suicide risk, taking into account the effects of cholesterol-lowering interventions on PUFA balance, membrane lipid microdomains (rafts) as a nexus of interaction between cholesterol and omega-3 PUFAs, and downstream effects on serotonergic neurotransmission and specific inflammatory pathways.

A systematic review of the associations between maternal nutritional biomarkers and depression and/or anxiety during pregnancy and postpartum

BACKGROUND

Nutritional requirements need to be met in order to adapt to pre- and postnatal changes. Our aim was to systematically review the evidence of associations between nutritional biomarkers and psychological distress during pregnancy and in the first postnatal year.

METHODS

MEDLINE, EMBASE, PsycINFO, Scielo, LILACS, clinicaltrials.gov, International Clinical Trials Registry, Cochrane Library, Scopus and Web of Science databases were searched for articles from inception to 4/15/2016. Studies of maternal nutritional biomarkers in blood (fatty acids/micronutrients/amino acids) and associations with psychological distress (depression/anxiety/stress) were included. Two independent reviewers extracted data based on study designs, participants, outcomes, exposures, and association measures.

RESULTS

Thirty-eight studies were included. A total of 13 studies showed divergent or no associations between serum/plasma/erythrocyte fatty acid concentrations and depression/anxiety during pregnancy and postpartum. Changes in serum cholesterol levels from pregnancy to postpartum showed a significant inverse correlation with depression in one out of three studies. Five out of seven studies found an inverse association between serum vitamin D levels and pre- and postnatal depression. Plasma tryptophan levels were inversely correlated with postnatal depression scores in three out of four studies. We identified that one out of two studies presented no significant association between vitamin B₁₂/folate/ferritin concentrations and depression in postpartum.

LIMITATIONS

There was higher variability between association measures, time and scales of depression and anxiety assessments.

CONCLUSIONS

The majority of high-quality studies suggest that lower vitamin D levels may be associated with postpartum depression. However, further evidence is needed for guiding clinical practice on nutritional biomarkers.

Omega-3 supplementation from pregnancy to postpartum to prevent depressive symptoms: a randomized placebo-controlled trial

Background

Low n-3 polyunsaturated fatty acids (PUFAs) has been linked to depression, but the preventive effect of n-3PUFAs supplementation on maternal depression needs further investigation. We aimed to evaluate the efficacy of a daily dose of n-3 PUFAs supplementation (fish oil) on the prevention of postpartum depression (PPD).

Methods

A randomized, placebo-controlled, double blind trial was designed and nested into a cohort study conducted in Rio de Janeiro, Brazil. Sixty pregnant women identified as being at risk for PPD were invited and randomly assigned to receive fish oil capsules [1.8 g (1.08 g of Eicosapentaenoic (EPA) and 0.72 g of Docosapentaenoic (DHA) acids)] or placebo (control). The Edinburgh Postnatal Depression Scale (EPDS) was scored at 5–13 (T0, baseline), 22–24 (T1), 30–32 weeks of gestation (T2) and 4–6 weeks’ postpartum (T3). Supplementation started at week 22–24 of gestation (T1) and lasted for 16 weeks. Serum fatty acids were assayed to evaluate compliance. Prevalence of EPDS ≥11 was the primary outcome, and mean and changes in EPDS score, length of gestation, and birth weight the secondary outcomes. Linear mixed-effect (LME) and random-intercept logistic regression models were performed to test the effect of fish oil supplementation on prevalence of EPDS ≥11 and EPDS scores variation.

Results

In intention-to-treat (ITT) analysis, at 30–32 weeks’ gestation women in the fish oil presented higher serum concentration of EPA, DHA and lower n-6/n-3 ratio comparing to the control group. There were no differences between intervention and control groups in the prevalence of EPDS ≥11, EPDS scores over time, or in changes in EPDS scores from pregnancy to postpartum in either the ITT or per-protocol analyses. Women in the fish oil group with previous history of depression presented a higher reduction on the EPDS score from the second to the third trimester in the fish oil comparing to the control group in the ITT analyses [−1.0 (−3.0–0.0) vs. -0.0 (−1.0–3.0), P = 0.038). These results were confirmed on the LME model (β = −3.441; 95%CI: -6.532– -0.350, P = 0.029).

Conclusion

Daily supplementation of 1.8 g of n-3 PUFAs during 16 weeks did not prevent maternal depressive symptoms in a sample of Brazilian women.

Trial registration

ClinicalTrials.gov Identifier: NCT01660165. Retrospectively registered on 24 May 2012.

The Relationship between Fatty Acids and Different Depression-Related Brain Regions, and Their Potential Role as Biomarkers of Response to Antidepressants

Depression is a complex disorder influenced by a variety of biological and environmental factors. Due to significant heterogeneity, there are remarkable differences in how patients respond to treatment. A primary objective of psychiatric research is to identify biological markers that could be used to better predict and enhance responses to antidepressant treatments. Diet impacts various aspects of health, including depression. The fatty acid composition of the Western diet, which has a high ratio of n-6:n-3 polyunsaturated fatty acids, is associated with increased incidence of depression. The brain is rich in lipids, and dietary fatty acids act within specific brain regions to regulate processes that impact emotional behavior. This manuscript reviews existing evidence demonstrating brain region-specific fatty acid profiles, and posits that specific fatty acids may serve as predictive biomarkers of response to antidepressants. Furthermore, increasing blood levels of certain fats, such as n-3s, via dietary intervention may serve as an adjunct to improve the efficacy of antidepressants. Notably, most of the existing research regarding fats and depression-related brain regions has focused on n-3s, as compared to n-6s, monounsaturated, and saturated fats. This review article will help guide future work investigating the relationships between fatty acids, brain regions, and antidepressant efficacy.

Polyunsaturated fatty acids and suicide risk in mood disorders: A systematic review

Deficiency of omega-3 polyunsaturated fatty acids (PUFAs) and an alteration between the ratio of omega-3 and omega-6 PUFAs may contribute to the pathogenesis of bipolar disorder and unipolar depression. Recent epidemiological studies have also demonstrated an association between the depletion of PUFAs and suicide. Our aim was to investigate the relationship between PUFAs and suicide; assess whether the depletion of PUFAs may be considered a risk factor for suicidal behavior; in addition to detailing the potential use of PUFAs in clinical practice. We performed a systematic review on PUFAs and suicide in mood disorders, searching MedLine, Excerpta Medica, PsycLit, PsycInfo, and Index Medicus for relevant epidemiological, post-mortem, and clinical studies from January 1997 to September 2016. A total of 20 articles from peer-reviewed journals were identified and selected for this review. The reviewed studies suggest that subjects with psychiatric conditions have a depletion of omega-3 PUFAs compared to control groups. This fatty acid depletion has also been found to contribute to suicidal thoughts and behavior in some cases. However, large epidemiological studies have generally not supported this finding, as the depletion of omega-3 PUFAs was not statistically different between controls and patients diagnosed with a mental illness and/or who engaged in suicidal behavior. Increasing PUFA intake may be relevant in the treatment of depression, however in respect to the prevention of suicide, the data is currently not supportive of this approach. Changes in levels of PUFAs may however be a risk factor to evaluate when assessing for suicide risk. Clinical studies should be conducted to prospectively assess whether prescriptive long-term use of PUFAs in PUFA-deficient people with depression, may have a preventative role in attenuating suicide.

Vitamin B-6 Status in Unsupplemented Pregnant Women Is Associated Positively with Serum Docosahexaenoic Acid and Inversely with the n-6-to-n-3 Fatty Acid Ratio

BACKGROUND

Vitamin B-6-deficient diets decrease plasma docosahexaenoic acid (DHA), eicosapentaenoic acid (EPA), and arachidonic acid (AA) concentrations in healthy adults. These fatty acids (FAs) are important for fetal neurodevelopment, but the relation between vitamin B-6 status and circulating polyunsaturated FAs (PUFAs) during pregnancy is unknown.

OBJECTIVE

We sought to assess the relation between plasma pyridoxal 5' phosphate (PLP; the active form of vitamin B-6) and serum DHA, EPA, AA, linoleic acid, eicosadienoic, and α-linolenic acid concentrations during pregnancy.

METHODS

A prospective cohort study in 186 healthy pregnant Brazilian women (aged 20-40 y) who were not using supplements was conducted in Rio de Janeiro, Brazil. Participants were enrolled in the first trimester of pregnancy (5-13 gestational weeks) and were followed up twice between 20-26 and 30-36 wk of gestation. Longitudinal linear mixed-effects regression models were used to evaluate the associations between 1) first-trimester PLP and PUFA concentrations across pregnancy and 2) ΔPLP (i.e., difference between third- and first-trimester plasma PLP concentrations) and PUFA concentrations across pregnancy. Models were adjusted for gestational week, first-trimester body mass index, smoking habit, and dietary intakes of vitamin B-6, fish, total fat, and PUFAs.

RESULTS

Plasma PLP concentrations (median, IQR) substantially declined during pregnancy from 35.8 nmol/L (28.6-44.3 nmol/L) in the first trimester to 21.0 nmol/L (15.8-26.3 nmol/L) in the second trimester, and 16.8 nmol/L (12.9-20.3 nmol/L) in the third trimester (both P < 0.0001). Changes in plasma PLP concentrations across trimesters were positively associated with serum DHA concentrations (β = 0.252, P = 0.012) and inversely associated with serum n-6-to-n-3 (ω-6-to-ω-3) FA ratio (β = -0.010; P = 0.015), after adjustments for confounders.

CONCLUSIONS

Maternal vitamin B-6 status during pregnancy was positively associated with the circulating concentration of DHA and inversely associated with n-6:n-3 FAs in Brazilian women who were not taking vitamin supplements. Further study is required to determine the impact of poor vitamin B-6 status on fetal neurodevelopment.

Dietary n-3 PUFA, fish consumption and depression: A systematic review and meta-analysis of observational studies

BACKGROUND

Fish consumption and n-3 polyunsaturated fatty acids (PUFA) have been hypothesized to exert preventive effects toward depressive disorders, but findings are contrasting. We aimed to systematically review and perform meta-analysis of results from observational studies exploring the association between fish, n-3 PUFA dietary intake, and depression.

METHODS

A search on the main bibliographic source of the observational studies up to August 2015 was performed. Random-effects models of the highest versus the lowest (reference) category of exposure and dose-response meta-analysis were performed.

RESULTS

A total of 31 studies including 255,076 individuals and over 20,000 cases of depression, were examined. Analysis of 21 datasets investigating relation between fish consumption and depression resulted in significant reduced risk (RR=0.78, 95% CI: 0.69, 0.89), with a linear dose-response despite with moderate heterogeneity. Pooled risk estimates of depression for extreme categories of both total n-3 PUFA and fish-derived n-3 PUFA [eicosapentaenoic acid (EPA)+docosahexaenoic acid (DHA)] resulted in decreased risk for the highest compared with the lowest intake (RR=0.78, 95% CI: 0.67, 0.92 and RR=0.82, 95% CI: 0.73, 0.92, respectively) and dose-response analysis revealed a J-shaped association with a peak decreased risk for 1.8g/d intake of n-3 PUFA (RR=0.30, 95% CI: 0.09, 0.98).

LIMITATION

Design of the studies included and confounding due to lack adjustment for certain variables may exist.

CONCLUSIONS

The present analysis supports the hypothesis that dietary n-3 PUFA intake are associated with lower risk of depression.

Epidemiology of maternal depression, risk factors, and child outcomes in low-income and middle-income countries

Maternal depression, a non-psychotic depressive episode of mild to major severity, is one of the major contributors of pregnancy-related morbidity and mortality. Maternal depression (antepartum or post partum) has been linked to negative health-related behaviours and adverse outcomes, including psychological and developmental disturbances in infants, children, and adolescents. Despite its enormous burden, maternal depression in low-income and middle-income countries remains under-recognised and undertreated. In this Series paper, we systematically review studies that focus on the epidemiology of perinatal depression (ie, during antepartum and post-partum periods) among women residing in low-income and middle-income countries. We also summarise evidence for the association of perinatal depression with infant and childhood outcomes. This review is intended to summarise findings from the existing literature, identify important knowledge gaps, and set the research agenda for creating new generalisable knowledge pertinent to increasing our understanding of the prevalence, determinants, and infant and childhood health outcomes associated with perinatal depression. This review is also intended to set the stage for subsequent work aimed at reinforcing and accelerating investments toward providing services to manage maternal depression in low-income and middle-income countries.

Suicidal ideation in pregnancy: an epidemiologic review

Suicidal behaviors are the leading causes of injury and death worldwide, and are leading causes of maternal deaths in some countries. One of the strongest risk factors, suicidal ideation, is considered a harbinger and distal predictor of later suicide attempt and completion, and also presents an opportunity for interventions prior to physical self-harm. The purpose of this systematic epidemiologic review is to synthesize available research on antepartum suicidal ideation. Original publications were identified through searches of the electronic databases using the search terms pregnancy, pregnant women, suicidal ideation, and pregnan* and suicid* as root searches. We also reviewed references of published articles. We identified a total of 2626 articles through the electronic database search. After irrelevant and redundant articles were excluded, 57 articles were selected. The selected articles were original articles that focused on pregnancy and suicidal ideation. Of the 57 included articles, 20 reported prevalence, 26 reported risk factors, 21 reported consequences of antepartum suicidal ideation, and 5 reported on screening measures. Available evidence indicates that pregnant women are more likely than the general population to endorse suicidal ideation. Additionally, a number of risk factors for antepartum suicidal ideation were identified including intimate partner violence, <12-year education, and major depressive disorder. There is a need for enhanced screening for antepartum suicidal ideation. The few screening instruments that exist are limited as they were primarily developed to measure antepartum and postpartum depression. Given a substantial proportion of women with suicidal ideation that does not meet clinical thresholds of depression and given the stress-diathesis model that shows susceptibility to suicidal behavior independent of depressive disorders, innovative approaches to improve screening and detection of antepartum suicidal ideation are urgently needed.

Perinatal Major Depression Biomarkers: A systematic review

Postpartum depression, now termed perinatal depression by the DSM-5, is a clinically relevant disorder reaching 15% of incidence. Although it is quite frequent and associated with high social dysfunction, only recently its underpinning biological pathways have been explored, while multiple and concomitant risk factors have been identified (e.g. psychosocial stress). Peripartum depression usually has its onset during the third trimester of pregnancy or in the postpartum, being one of the most common medical complications in new mothers. Purpose of the present review is to summarize the state of art of biological biomarkers involved in the pathogenesis of perinatal depression, in view of the fact that suboptimal prenatal milieu can induce permanent damage in subsequent offspring life and have a negative impact on mother-child relationship. Furthermore, parents' biological changes due to medical/psychiatric disorders or stress exposure could influence offspring life: a concept known as 'intergenerational transmission', acting by variations into gametes and the gestational uterine environment. Given the evidence that perinatal mental disorders involve risks for the mother and offspring, the search for reliable biomarkers in high-risk mothers actually represents a medical priority to prevent perinatal depression.

Suicide during Perinatal Period: Epidemiology, Risk Factors, and Clinical Correlates

Perinatal period may pose a great challenge for the clinical management and treatment of psychiatric disorders in women. In fact, several mental illnesses can arise during pregnancy and/or following childbirth. Suicide has been considered a relatively rare event during the perinatal period. However, in some mental disorders (i.e., postpartum depression, bipolar disorder, postpartum psychosis, etc.) have been reported a higher risk of suicidal ideation, suicide attempt, or suicide. Therefore, a complete screening of mothers' mental health should also take into account thoughts of suicide and thoughts about harming infants as well. Clinicians should carefully monitor and early identify related clinical manifestations, potential risk factors, and alarm symptoms related to suicide. The present paper aims at providing a focused review about epidemiological data, risk factors, and an overview about the main clinical correlates associated with the suicidal behavior during the pregnancy and postpartum period. Practical recommendations have been provided as well.

Targeted alterations in dietary n-3 and n-6 fatty acids improve life functioning and reduce psychological distress among patients with chronic headache: a secondary analysis of a randomized trial

Omega-3 and omega-6 fatty acids are precursors of bioactive lipid mediators posited to modulate both physical pain and psychological distress. In a randomized trial of 67 subjects with severe headaches, we recently demonstrated that targeted dietary manipulation-increasing omega-3 fatty acids with concurrent reduction in omega-6 linoleic acid (the H3-L6 intervention)-produced major reductions in headache compared with an omega-6 lowering (L6) intervention. Because chronic pain is often accompanied by psychological distress and impaired health-related quality of life (HRQOL), we used data from this trial to examine whether the H3-L6 intervention favorably impacted these domains. Additionally, we examined the effect of the interventions on the number of cases with substantial physical or mental impairments as defined by cutoff values in the Brief Symptom Inventory (BSI-18), Medical Outcomes Study Short Forms 12 (SF-12), Headache Impact Test (HIT-6), and the number of headache days per month. In the intention-to-treat analysis, participants in the H3-L6 group experienced statistically significant reductions in psychological distress (BSI-18 mean difference: -6.56; 95% confidence interval [CI]: -11.43 to -1.69) and improvements in SF-12 mental (mean difference: 6.01; 95% CI: 0.57 to 11.45) and physical (mean difference: 6.65; 95% CI: 2.14 to 11.16) health summary scores. At 12 weeks, the proportion of subjects experiencing substantial impairment according to cutoff values in the BSI-18, SF-12 physical, HIT-6, and headache days per month was significantly lower in the H3-L6 group. Dietary manipulation of n-3 and n-6 fatty acids, previously shown to produce major improvements in headache, was found to also reduce psychological distress and improve HRQOL and function.

A review of recent evidence in human studies of n-3 and n-6 PUFA intake on cardiovascular disease, cancer, and depressive disorders: does the ratio really matter?

Polyunsaturated fatty acids (PUFAs) have been considered of great interest for human health due to their potential anti-inflammatory action that may protect from a number of chronic-degenerative diseases with an inflammatory pathogenesis. This review aimed to report the most updated evidence of both n-3 and n-6 PUFAs effect on cardiovascular disease, cancer, and depression in humans. Attention has been also paid to those studies exploring the effects of the ratio intake. Results from pooled analyses of human studies reported a general positive effect of n-3 PUFAs intake on all outcomes considered. In contrast, the role of n-6 PUFAs on human health needs to be better assessed in order to clearly identify which compound exerts beneficial/harmful effects. Only a limited number of clinical studies considered the n-3:n-6 PUFAs ratio, rather reporting contrasting results. A number of limitations when considering the ratio between these two families of PUFAs have risen.

Lower inter-partum interval and unhealthy life-style factors are inversely associated with n-3 essential fatty acids changes during pregnancy: a prospective cohort with Brazilian women

OBJECTIVE

To analyze serum fatty acids concentrations during healthy pregnancy and evaluate whether socioeconomic, demographic, obstetric, nutritional, anthropometric and lifestyle factors are associated with their longitudinal changes.

STUDY DESIGN

A prospective cohort of 225 pregnant women was followed in the 5th-13th, 20th-26th and 30th-36th weeks of gestation. Serum samples were collected in each trimester of pregnancy and analyzed to determine the fatty acids composition using a high-throughput robotic direct methylation method coupled with fast gas-liquid chromatography. The independent variables comprised the subjects' socioeconomic and demographic status, obstetric history, early pregnancy body mass index (BMI), dietary and lifestyle parameters. Analyses were performed using linear mixed-effects models.

RESULTS

The overall absolute concentrations of fatty acids increased from the 1st to the 2nd trimester and slightly increased from the 2nd to the 3rd trimester. Early pregnancy BMI, inter-partum interval and weekly fish intake were the factors associated with changes in eicosapentaenoic + docosahexaenoic acids (EPA+DHA) and total n-3 polyunsaturated fatty acids (PUFAs). Early pregnancy BMI, age and monthly per-capita income were inversely associated with the changes in the n-6/n-3 ratio. Alcohol consumption was positively associated with the n-6/n-3 ratio.

CONCLUSION

Early pregnancy BMI was positively associated with EPA+DHA and total n-3 PUFAs, while presenting a reduced weekly fish intake and a lower inter-partum interval were associated with lower levels of n-3 PUFAs. A lower per-capita family income and a drinking habit were factors that were positively associated with a higher n-6/n-3 ratio.

Dissociable effects of dorsal and ventral hippocampal DHA content on spatial learning and anxiety-like behavior

Chronic deficiency of dietary docosahexaenoic acid (DHA) during critical developmental windows results in severe deficits in spatial learning, anxiety and hippocampal neuroplasticity that parallel a variety of neuropsychiatric disorders. However, little is known regarding the influence of long-term, multigenerational exposure to dietary DHA enrichment on these same traits. To characterize the potential benefits of multigenerational DHA enrichment, mice were fed a purified 10:1 omega-6/omega-3 diet supplemented with either 0.1% preformed DHA/kg feed weight or 1.0% preformed DHA/kg feed weight through three generations. General locomotor activity, spatial learning, and anxiety-like behavior were assessed in adult male offspring of the third generation. Following behavioral assessments, ventral and dorsal hippocampus was collected for DHA and arachidonic acid (AA) analysis. Animals consuming the 0.1% and 1.0% DHA diet did not differ from control animals for locomotor activity or on performance during acquisition learning, but made fewer errors and showed more stable across-day performance during reversal learning on the spatial task and showed less anxiety-like behavior. Consumption of the DHA-enriched diets increased DHA content in the ventral and dorsal hippocampus in a region-specific manner. DHA content in the dorsal hippocampus predicted performance on the reversal training task. DHA content in the ventral hippocampus was correlated with anxiety-like behavior, but AA content in the dorsal hippocampus was a stronger predictor of this behavior. These results suggest that long-term, multigenerational DHA administration improves performance on some aspects of complex spatial learning, decreases anxiety-like behavior, and that modulation of DHA content in sub-regions of the hippocampus predicts which behaviors are likely to be affected.