by Kirti Salunkhe, MD
Omega-3 polyunsaturated fatty acids (PUFA) are essential nutrients that must be obtained through diet or supplementation. For cardiac health, dietary intake of omega-3 PUFAs is a recommendation widely recognized by many patients and healthcare providers alike.1 However, as a recent publication in the Journal of the American Medical Association (JAMA), showed, there are indications that omega-3 PUFAs are beneficial in other systems as well. Researchers in Taiwan, from a multi-center collaboration, released their results of a systematic review and meta-analysis that indicated an association was observed between omega-3 PUFA use and a decrease in symptoms of clinical anxiety.2
Anxiety is one of the most common neurological disorders but is also one of the most difficult to fully comprehend and manage. According to the Anxiety and Depression Association of America (ADAA), anxiety affects approximately 40 million adults, or 18.1% of the population, nationwide.3 Furthermore, little more than a third of those affected (36%) receive treatment. The cause of anxiety disorders is rooted in a complex set of risk factors involving genetics, brain chemistry, personality and life events. People who suffer from anxiety also utilize considerable healthcare resources; in fact, they are three to five times as likely to go their healthcare provider (HCP) and are six times more likely to be hospitalized for their disorder.4 According to the National Institutes of Mental Health (NIMH), people with generalized anxiety disorder (GAD) are diagnosed as those who display excessive anxiety or worry, most days a week for at least six months. They worry about things such as personal health, social interactions and daily routine circumstances. Common symptoms of anxiety include:3
- Feeling restless, wound-up, or on-edge
- Being easily fatigued
- Difficulty concentrating; mind going blank
- Being irritable
- Muscle tension
- Difficulty controlling feelings of worry
- Sleep problems, such as difficulty falling or staying asleep, restlessness, or unsatisfying sleep
Omega-3 PUFAs are made of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). Neurologically, EPA is functional and DHA is structural, meaning that EPA has a greater effect on inflammation and neurotransmitter communication whereas DHA is important for brain development and structure, particularly in the developing newborn.5
Earlier research has shown people with anxiety disorders have reduced levels of omega-3 PUFA and data indicate that intake of omega-3 PUFA helps reduce symptoms of anxiety in situations of stress.6-8 However, individually most of the prior studies have been hindered by their small sample size and sometimes conflicting results. To ameliorate this and to better understand potential anxiolytic efficacy that omega-3 PUFAs may have, lead author, Dr. Kuan-Pin Su, from the Department of Psychiatry at China Medical University Hospital in Taiwan, along with his colleagues chose to undertake a systematic review and meta-analysis of this topic.2 The primary objective was changes in severity of anxiety symptoms after treatment with omega-3 PUFAs.2
The meta-analysis involved 19 studies with a total of 2,240 participants.2 They were divided into the following groups:2
- 1,203 participants who received omega-3s
- Mean age 43.7 years; 55% female, mean omega-3 PUFA dose: 1605.7 mg/day
- 1,037 participants who did not receive omega-3s
- Mean age 40.6 years; 55% female
- Numerous validated scales and tools were used in these studies to evaluate anxiety and its symptoms
- The types and subtypes of anxiety disorders were also numerous and included:
- Anxiety post major cardiac events
- Mild to severe depression
- Obsessive-compulsive disorder
- Anxiety incurred by disaster trauma
- Anxiety due to substance abuse
- Premenstrual syndrome
- Anxiety related to Alzheimer and Parkinson diseases
- Generally healthy undergraduate college students but with test anxiety
The results of this analysis showed:2
- Modest anxiolytic effects of omega-3 PUFAs in individuals with various neuropsychiatric or major physical illnesses
- The anxiolytic effects of omega-3 PUFA intake was significantly improved when administered in higher doses (at least 2000mg/day) as compared to those who received omega-3 PUFAs in
doses < 2000 mg/day
- Additional, large scale clinical studies would help confirm these early results
Why is this Clinically Relevant?
- Anxiety is a common and debilitating health issue affecting a significant portion of the population
- Healthcare utilization and associated costs of anxiety are greater than for other clinical conditions
- Prior studies have shown omega-3 PUFAs to be of clinical benefit in numerous health conditions and data show levels of this essential nutrient are lower in patients with anxiety
- Individual studies on anxiety and omega-3 PUFAs are limited by small sample sizes
- This systematic review and meta-analysis is the first of its kind to assess many clinical studies on various types of anxiety disorders utilizing numerous validated tools and scales
- HCPs should recognize and identify patients with anxiety disorders by careful clinical assessment and history
- Initiation of high quality, certified sources of omega-3 PUFA supplementation in doses of 2,000 g/day in patients with anxiety disorder should be considered as part of management plan
- Regular follow up with patients on this supplementation to assess compliance/adherence is critical for improved outcomes in this patient population
- American Heart Association. https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/fats/fish-and-omega-3-fatty-acids. Accessed September 04, 2018.
- Su K, Tseng P, Lin P, et al. Association of Use of Omega-3 Polyunsaturated Fatty Acids With Changes in Severity of Anxiety Symptoms A Systematic Review and Meta-analysis. JAMA Network Open. 2018;1(5):e182327.
- Anxiety Depression Association of America. https://adaa.org/about-adaa/press-room/facts-statistics. Accessed September 04, 2018.
- National Institute of Mental Health. https://www.nimh.nih.gov/health/topics/anxiety-disorders/index.shtml. Accessed September 04, 2018.
- Parker G, Gibson NA, Brotchie H, et al. Omega-3 fatty acids and mood disorders. Am J Psychiatry. 2006;163(6):969-978.
- Song C, Li X, Leonard BE, Horrobin DF. Effects of dietary omega-3 or n-6 fatty acids on interleukin-1beta-induced anxiety, stress, and inflammatory responses in rats. J Lipid Res. 2003;44(10):1984-1991.
- Ross BM. Omega-3 polyunsaturated fatty acids and anxiety disorders. Prostaglandins Leukot Essent Fatty Acids. 2009;81(5-6):309-312.
- Green P, Hermesh H, Monselise A, et al. Red cell membrane omega-3 fatty acids are decreased in nondepressed patients with social anxiety disorder. Eur Neuropsychopharmacol. 2006;16(2):107-113.