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MS research update – Could omega-3 help treat depression in MS? – 25 January 2016

Summary

Around half of all people with multiple sclerosis will experience depression at some time. Previous studies in people from the general population with depression have found taking omega-3 fatty acids alongside antidepressant medication has helped to improve depressive symptoms. This study was a pilot trial to see if omega-3 supplementation was an effective add on treatment to antidepressants in people with MS with treatment resistant depression.

39 people with relapsing and progressive forms of MS took part in the study. Participants were randomised to receive either six omega-3 fish oil capsules (omega-3 group) or placebo capsules (control group) every day for three months.

This pilot study found that omega-3 supplements did not have an effect as an add on therapy for treatment resistant depression in people with MS. Although blood levels of omega-3 were significantly increased in those taking the omega-3 supplement, there were no differences in levels of depression or quality of life between the two groups.

Background

Around half of all people with multiple sclerosis will experience depression at some time. There are several treatment approaches available, including medication and talking therapies, however not everyone responds to treatment. For someone with depression that is not responding to treatment (treatment resistant depression) sometimes they might need to change their medication to see if another drug is more effective for them, or try something else in addition. Previous studies in people from the general population with depression have found taking omega-3 fatty acids alongside antidepressant medication has helped to improve depressive symptoms. This study was a pilot trial to see if omega-3 supplementation was an effective add on treatment to antidepressants in people with MS with treatment resistant depression.

How this study was carried out

39 people with relapsing and progressive forms of MS took part in the study. They were all aged between 18 and 85 years old, had been diagnosed with depression and had been on a stable dose of antidepressant medication for at least three months. People could not take part in the study if they had taken fish oil or cod liver oil supplements or ate greater than a one 6 ounce (170g) serving per week of fish or seafood within 30 days of enrolling in the study.

Participants were randomised to receive either six omega-3 fish oil capsules (omega-3 group) or placebo capsules (control group) containing soybean oil that contained 1% fish oil so it tasted and smelled similar to the fish oil capsules. They took three capsules in the morning and three in the afternoon with food, every day for three months.

Blood samples were taken to measure blood levels of omega-3, and participants completed several tests and questionnaires to assess their mood levels and quality of life during the study.

What was found

31 participants completed the study. The researchers found that blood levels of omega-3 were significantly increased in those taking the omega-3 supplement. However there were no differences in levels of depression or quality of life between the two groups.

What does it mean?

This pilot study found that omega-3 supplements did not have an effect as an add on therapy for treatment resistant depression in people with MS. The researchers do highlight the difficulties and importance of selecting appropriate assessments when studying low mood in people with MS as many MS symptoms can mimic depressive symptoms, such as sleep problems and fatigue, making it difficult to completely separate symptoms that are solely MS from those that are solely related to the depression. The researchers conclude that although omega-3 did not have an effect in this study, it could be studied further to see if it had any benefit for other MS symptoms. Although a study covered previously in research update found omega-3 had no effect on other MS symptoms and activity.

Shinto L, Marracci G, Mohr DC, et al.
Omega-3 fatty acids for depression in multiple sclerosis: a randomized pilot study.
PLoS One. 2016 Jan 22;11(1):e0147195. doi: 10.1371/journal.pone.0147195.
Abstract
Read the full text of this paper

More about diet and supplements

Research into diet and multiple sclerosis has been limited and whether it is possible to influence MS through diet and dietary supplements is a controversial topic. Studying diet in any group is a complex and difficult process and there are so many variables to take into account. Changing one nutrient in a diet always causes parallel changes in other nutrient levels and that could affect results and intake may also be complicated by environmental variables too.

You can read more about diet in the A to Z of MS.

You can also read an article by a dietician in the MS Trust newsletter Open Door which discusses aspects of diet including omega-3, which is usually obtained in the diet from oily fish such as salmon and mackerel.

More about MS and mood

Living with MS can be challenging and long lasting changes in mood could be due to managing these challenges or directly as a result of MS and its effect on the central nervous system. People with MS can experience depression, anxiety, stress and other emotional changes, such as an inappropriate or excessive emotional response to an event (pseudobulbar affect).

However many people can find it difficult to talk about mood changes and to seek appropriate support. If you are concerned about changes in your mood, it is important that you speak to your MS specialist team or GP. They should be able to refer you to specialist support or may be able to prescribe treatment directly.

Treatment usually works well and there are various options available, you can try different approaches to find the best one or combination that works for you. You could try medication, talking therapies such as Cognitive behavioural therapy (CBT) or self-management techniques such as exercise, relaxation and mindfulness.

You can read more about anxiety, stress and depression in the A to Z of MS including information on the different therapies available and what you can do to help yourself.

If you have been recently diagnosed with MS, the MS and your feelings information sheet explores how your feelings may be affected and how you can adjust after diagnosis. You can read it online or you can download or order a printed copy.

Research by topic areas...

Assessment tools

Sacco R, Santangelo G, Stamenova S, et al.
Psychometric properties and validity of Beck Depression Inventory II in multiple sclerosis.
Eur J Neurol. 2016 Jan 19. [Epub ahead of print]
Abstract

Causes of MS

Mohammadbeigi A, Kazemitabaee M, Etemadifar M.
Risk factors of early onset of MS in women in reproductive age period: survival analysis approach.
Arch Womens Ment Health. 2016 Jan 20. [Epub ahead of print]
Abstract

Co-existing conditions

Tettey P, Siejka D, Simpson S Jr, et al.
Frequency of comorbidities and their association with clinical disability and relapse in multiple sclerosis.
Neuroepidemiology. 2016 Jan 20;46(2):106-113. [Epub ahead of print]
Abstract

Palavra F, Almeida L, Ambrósio AF, et al.
Obesity and brain inflammation: a focus on multiple sclerosis.
Obes Rev. 2016 Jan 18. [Epub ahead of print]
Abstract

Sorgun MH, Aksun Z, Atalay YB, et al.
Restless legs syndrome in multiple sclerosis.
Turk J Med Sci. 2015;45(6):1268-73.
Abstract

Egeberg A, Mallbris L, Gislason GH, et al.
Risk of multiple sclerosis in patients with psoriasis: a danish nationwide cohort study.
J Invest Dermatol. 2016 Jan;136(1):93-8.
Abstract
Read the full text of this paper

Diagnosis

Messina MJ, Dalla Costa G, Rodegher M, et al.
The communication of multiple sclerosis diagnosis: the patients' perspective.
Mult Scler Int. 2015;2015:353828.
Abstract
Read the full text of this paper

Disease modifying drugs

Fragoso YD, Adoni T, Alves-Leon SV, et al.
Alternatives for reducing relapse rate when switching from natalizumab to fingolimod in multiple sclerosis.
Expert Rev Clin Pharmacol. 2016 Jan 21. [Epub ahead of print]
Abstract

Spelman T, Mekhael L, Burke T, et al.
Risk of early relapse following the switch from injectables to oral agents for multiple sclerosis.
Eur J Neurol. 2016 Jan 19. [Epub ahead of print]
Abstract
Read the full text of this paper

Weinstock-Guttman B, Hagemeier J, Kavak KS, et al.
Randomised natalizumab discontinuation study: taper protocol may prevent disease reactivation.
J Neurol Neurosurg Psychiatry. 2016 Jan 18. [Epub ahead of print]
Abstract

Drugs in development

Sorensen PS, Blinkenberg M.
The potential role for ocrelizumab in the treatment of multiple sclerosis: current evidence and future prospects.
Ther Adv Neurol Disord. 2016 Jan;9(1):44-52.
Abstract
Read the full text of this paper

Epidemiology

Haagsma JA, Maertens de Noordhout C, Polinder S, et al.
Assessing disability weights based on the responses of 30,660 people from four European countries.
Popul Health Metr. 2015;13:10.
Abstract
Read the full text of this paper

Family

Mauseth T, Hjälmhult E.
Adolescents' experiences on coping with parental multiple sclerosis: a grounded theory study.
J Clin Nurs. 2016 Jan 14. [Epub ahead of print]
Abstract

Other

Riccio P, Rossano R, Larocca M, et al.
Anti-inflammatory nutritional intervention in patients with relapsing-remitting and primary-progressive multiple sclerosis: a pilot study.
Exp Biol Med (Maywood). 2016 Jan 18. [Epub ahead of print]
Abstract

Other treatments

Zettl UK, Rommer P, Hipp P, et al.
Evidence for the efficacy and effectiveness of THC-CBD oromucosal spray in symptom management of patients with spasticity due to multiple sclerosis.
Ther Adv Neurol Disord. 2016 Jan;9(1):9-30.
Abstract
Read the full text of this paper

Russo M, Naro A, Leo A, et al.
Evaluating Sativex® in neuropathic pain management: a clinical and neurophysiological assessment in multiple sclerosis.
Pain Med. 2016 Jan 13. [Epub ahead of print]
Abstract
Read the full text of this paper

Zörner B, Filli L, Reuter K, et al.
Prolonged-release fampridine in multiple sclerosis: Improved ambulation effected by changes in walking pattern.
Mult Scler. 2016 Jan 13. [Epub ahead of print]
Abstract

Paediatric MS

Krysko KM, O'Connor P.
Quality of life, cognition and mood in adults with pediatric multiple sclerosis.
Can J Neurol Sci. 2016 Jan 22:1-7. [Epub ahead of print]
Abstract

Graves JS, Barcellos LF, Shao X, et al.
Genetic predictors of relapse rate in pediatric MS.
Mult Scler. 2016 Jan 14. [Epub ahead of print]
Abstract

Physical activity

Klaren RE, Sandroff BM, Fernhall B, et al.
Comprehensive profile of cardiopulmonary exercise testing in ambulatory persons with multiple sclerosis.
Sports Med. 2016 Jan 22. [Epub ahead of print]
Abstract

Sandroff BM, Motl RW, Davis SL.
Effects of vigorous walking exercise on core body temperature and inhibitory control in thermosensitive persons with multiple sclerosis.
Neurodegener Dis Manag. 2016 Feb;6(1):13-21.
Abstract

Pregnancy and childbirth

Herbstritt S, Langer-Gould A, Rockhoff M, et al.
Glatiramer acetate during early pregnancy: a prospective cohort study.
Mult Scler. 2016 Jan 11. [Epub ahead of print]
Abstract

Psychological aspects

Simpson S Jr, Tan H, Otahal P, et al.
Anxiety, depression and fatigue at 5-year review following CNS demyelination.
Acta Neurol Scand. 2016 Jan 12. [Epub ahead of print]
Abstract

Quality of life

Mikula P, Nagyova I, Krokavcova M, et al.
Self-esteem, social participation, and quality of life in patients with multiple sclerosis.
J Health Psychol. 2016 Jan 12. [Epub ahead of print]
Abstract

Relapses

Roberts M, Lush T, Pohorely J.
Improving reporting of multiple sclerosis relapse.
Nurs Times. 2015 Nov 25-Dec 1;111(48):12-4.
Abstract

Stem cells

Bakhuraysah MM, Siatskas C, Petratos S.
Hematopoietic stem cell transplantation for multiple sclerosis: is it a clinical reality?
Stem Cell Res Ther. 2016 Jan 16;7(1):12.
Abstract
Read the full text of this paper

Symptoms and symptom management

Nsamenang SA, Hirsch JK, Topciu R, et al.
The interrelations between spiritual well-being, pain interference and depressive symptoms in patients with multiple sclerosis.
J Behav Med. 2016 Jan 22. [Epub ahead of print]
Abstract

Miller E, Kostka J, Włodarczyk T, et al.
Whole-body cryostimulation (cryotherapy) provides benefits for fatigue and functional status in multiple sclerosis patients. A case-control study.
Acta Neurol Scand. 2016 Jan 18. [Epub ahead of print]
Abstract

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