Can Nutritional Psychiatry Offer New Solutions for Anxiety?

In this episode of Daily Value, we explore the potential of omega-3 fatty acids, particularly EPA and DHA, as an adjunctive therapy for reducing anxiety symptoms. A recent meta-analysis (PMID: 38890670) reviewed 23 randomized controlled trials involving over 2,100 participants, revealing that a certain amount of omega-3s per day can significantly reduce anxiety symptoms, especially when combined with traditional treatments like antidepressants.

Talking points:

• Anxiety disorders: what are they and how many people have them?
• Fish oil benefits for anxiety disorders
• Effective dosage of omega-3 fatty acids for reducing anxiety symptoms.
• Mechanisms of action: Omega-3s may reduce anxiety through 4 proposed mechanisms.

https://pubmed.ncbi.nlm.nih.gov/38890670/

Transcript

Speaker 1: 0:00

Welcome to Daily Value. I'm William Wallace, and today we're going to be exploring a topic of growing interest in both the medical and nutritional sciences, a topic that we can effectively put under the umbrella of one of my favorite general topics, that being nutritional psychiatry. Specifically, we're going to be talking about omega-3 fatty acids and the potential their use in certain doses might have for reducing anxiety symptoms in adults, the topic being stimulated by a recent meta-analysis suggesting that omega-3 fatty acid supplementation could be a promising adjunctive therapy for reducing anxiety symptoms. This episode will dissect the findings, explore the potential mechanisms and discuss how these insights might be applied in clinical practice. As always, please remember that this podcast is for educational purposes only and it does not substitute for professional medical advice. Consult your healthcare provider before making any changes to your treatment plan, especially if you are taking medications or have been diagnosed with a clinical anxiety disorder, or have been diagnosed with a clinical anxiety disorder.

Speaker 1: 1:08

Anxiety disorders are among the most prevalent mental health issues in the world. In fact, some data suggests that over 34% of people worldwide experience an actual anxiety disorder at some point in their lives. Anxiety symptoms can be one of many things and present itself differently across different people. The American Psychiatric Association Dictionary defines anxiety as an emotion characterized by apprehension and somatic symptoms of tension, in which an individual anticipates impending danger, catastrophe or misfortune. To maybe put it in a bit more simple terms, anxiety comes with two different sets of symptoms. Those are emotional symptoms like feeling fear or apprehension, maybe even foreboding, and the other set of symptoms are somatic meaning of the body, and those include things like an increased heart rate, trembling and so on. A shared characteristic across anxiety disorders would be an increase in either set of symptoms. Now, in order to be an anxiety disorder, symptoms have to be present for up to six months and when the symptoms are out of proportion to the actual threat or the perceived threat.

Speaker 1: 2:20

While traditional treatments such as cognitive behavioral therapy and pharmacotherapy are effective, they are not without limitations and or side effects, especially the use of traditional medications when used at high doses and for long periods of time. Such medications include selective serotonin reuptake inhibitors, like paroxetine, or selective serotonin norepinephrine reuptake inhibitors, like venlafaxine. These medications can be effective, but are also associated with side effects, such as dependency, tolerance issues, as well as sexual dysfunction, which can limit their long-term use. The potential side effects limiting the use of the medications for many people has led to interest in nutritional factors that play a role in, or could aid in treating symptoms of something like anxiety.

Speaker 1: 3:11

Omega-3 polyunsaturated fatty acids, or PUFAs, particularly eicosapentaenoic acid, that is EPA, and docosahexaenoic acid, that is DHA, have been shown to regulate things like dopamine and serotonin signaling in the brain, making them potential candidates for reducing anxiety symptoms. The brain needs a sufficient amount of both of these fatty acids to function properly, as they act as both signaling molecules and structural support molecules. The central nervous system actually has the second highest concentration of these fatty acids, next to adipose tissue. There are several mechanisms tied to the prospect of EPA and DHA reducing anxiety symptoms. A systematic review that was published in 2020 suggested four potential mechanisms. Those include reducing the inflammatory response associated with anxiety, increasing brain-derived neurotrophic factor, or BDNF, lowering cortisol and supporting cardiovascular health. Research has demonstrated that an anti-inflammatory response in the form of inflammatory protein release are associated with anxiety. Data in animals and humans shows a decrease in these inflammatory proteins when taking insufficient amounts of omega-3 fatty acids. Likewise, circulating BDNF levels are higher in people with a higher omega-3 index. Higher omega-3 index. Now, whether that's meaningful for the brain or not is up for debate, since peripheral BDNF is primarily platelet-derived, but that's a totally separate discussion. It's those two particular mechanisms which have been tied to omega-3 supplementation, specifically two grams per day of EPA, being useful for reducing depressive symptoms. Now a meta-analysis published in 2018 did find that 2 grams of total omega-3 supplementation did improve anxiety symptoms in adults, but there are also plenty of studies that have found no relation to omega-3 supplementation and reduced anxiety as such.

Speaker 1: 5:09

The optimal dosage and efficacy of omega-3 supplementation in anxiety management has been unclear, prompting the recent publication that brought on this topic. The meta-analysis published by Bafkar et al and published in BMC Psychiatry reviewed 23 randomized controlled trials with a total of 2,189 participants to evaluate the dose-dependent effects of omega-3 supplementation on anxiety symptoms. The results indicated that supplementation with one gram per day of omega-3 fatty acids, that's, dha and EPA, led to a moderate reduction in anxiety symptoms, with the most significant improvement observed at a dosage of two grams per day. Importantly, doses above two grams per day did not confer additional benefits. Now there are two important nuances in the findings to point out. Firstly, there did not seem to be an effect when looking at a subgroup of people who had a very high baseline risk for anxiety or depressive symptoms, people who may need treatment the most. However, for people who were being treated with antidepressants or anxiolytic medications, there was a significant improvement in anxiety symptoms in people using omega-3 in conjunction with their medication, compared to people not using medication or using medication but no additional omega-3s. This suggests that omega-3s may be more effective as an adjunct treatment in combination with medication that people may already be using, prescribed for their anxiety.

Speaker 1: 6:43

Now there is research showing that omega-3s can be effective at enhancing the antidepressive effects of antidepressant medication. The last noteworthy finding of this study was that this study was unable to find a difference in effectiveness of EPA versus DHA, mostly because the studies they looked at were often combining DHA and EPA, like is often the case in real-world supplement settings. As I mentioned previously, there are studies suggesting that EPA-dominant formulas do reduce depressive symptoms more strongly than DHA-dominant formulas do reduce depressive symptoms more strongly than DHA-dominant formulas, but for the purpose of anxiety-related symptoms, the best we can say right now is 2 grams of combined DHA and EPA may provide an effect, even if small, so that's a good starting point. It is worth noting that studies with a high risk of bias in the AMET analyses reported the largest effect sizes compared to the studies, with less risk of bias, meaning that the overall quality of evidence available on this topic right now is quite low. So what do these findings mean for actual real-world practice?

Speaker 1: 7:50

Well, the evidence suggests that omega-3 supplementation, particularly at a dosage of around 2 grams per day, could be an effective adjunctive therapy for individuals with anxiety disorders. This is especially relevant for people who experience side effects from conventional medications or those who are seeking complementary therapies to what they're already doing. For practitioners, it's important to consider the type of omega-3 supplement being used. A balanced supplement containing EPA and DHA with a dosage of approximately 2 grams per day may support intended outcomes, but when it comes to things like depressive symptoms, epa-dominant formulas may fare best. Overall, 2 grams a day of combined EPA and DHA are a suitable suggestion for most people for general health purposes. In conclusion, while omega-3 fatty acids hold promise as a safe and potentially effective intervention for reducing anxiety symptoms, they should be considered as part of a broader, individualized treatment plan. Thank you for tuning in to Daily Value. If you found this episode insightful, please subscribe and share it with others who might benefit from this information. Until next time, stay informed and stay mentally healthy.