Eighty-one putatively prodromal patients (16.4 years, 33.3% male) were included in this 12-month, randomized, double-blind, placebo-controlled trial comparing 1.2 g omega-3 PUFA (700 mg eicosapentaenoic acid [EPA] and 420 mg docosahexaenoic acid [DHEA]h) with placebo over 12 weeks with a follow-up of 40 weeks off medication/placebo. Randomization was stratified with regard to depressive symptoms (cut-off score on the Montgomery-Asberg Depression Rating Scale [MADRS]). Operationally defined conversion rates served as the outcome measure, with psychopathology ratings as secondary measures. Overall, this study had a very high 12-month completion rate (93.8%); adherence rates based on pill count and self-rating were as high as 81% and 75% in the active and placebo groups. The main result was that patients treated for 3 months with omega-3 PUFAs had significantly lower conversion rates to psychosis, at the end of the acute 3-month treatment phase and also after an additional 9 months off omega-3 PUFA (12-month conversion rate: 4.9% vs 27.5%). The number needed to treat (NNT) to prevent 1 additional patient with conversion to psychosis at 1 year was only 5. In addition, positive, negative, and general symptoms measured by the Positive and Negative Syndrome Scale (PANSS) were significantly more reduced in the active treatment group, whereas adverse events did not differ. Finally, the ratio of putatively beneficial omega-3 to omega-6 fatty acids increased significantly, linking the clinical effects to a proposed biological mechanism.
The Year in Psychosis and Bipolar Disorder: Omega-3s and Psychosis Prevention
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