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David Baxter

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Essential fatty acids boost antipsychotic treatment response
By Liam Davenport
15 January 2008
J Clin Psychiatry 2007; 68: 1867-1875

Augmentation of antipsychotic medication with the essential fatty acid ethyl-eicosapentaenoic acid (E-EPA) accelerates treatment response and improves tolerability, but does not lead to a sustained symptomatic benefit in early psychosis, international study findings suggest.

Reduced levels of essential fatty acids have been detected in the peripheral and central membrane tissue of schizophrenia patients, regardless of their treatment. Although trials have indicated that essential fatty acid therapy with E-EPA may be beneficial, some of the results have been conflicting, explain Gregor Berger, from University Hospital Basel in Switzerland, and colleagues.

The researchers conducted a 12-week, randomized, double-blind, placebo controlled trial in which 80 patients aged 15-29 years with first-episode psychosis were administered E-EPA 2 g or placebo alongside a flexible dose of atypical antipsychotic medication.

Complete data were available for 69 patients, and a post hoc analysis was performed on a subgroup of 53 nonaffective first-episode psychosis patients, all of whom were treated between 2000 and 2003.

There were no significant differences in symptom change scores at week 12 between patients treated with E-EPA and those given placebo on an analysis of covariance that controlled for baseline symptoms.

However, there was a significant treatment by diagnosis interaction for the time to first response on Cox regression analysis that favored E-EPA patients with nonaffective psychosis, the team reports in the Journal of Clinical Psychiatry.

Cumulative response rates on post hoc analysis also revealed a significantly higher response rate for E-EPA versus placebo at week 6, at 42.9% versus 17.6% across all participants and 54.2% versus 17.2% in nonaffective psychosis patients. The difference was no longer significant at week 12, however.

Between weeks 4 and 6, patients given E-EPA needed 20% less antipsychotic medication than those given placebo, and had significantly less extrapyramidal side effects during the first 9 weeks. E-EPA patients also reported less constipation and fewer sexual side effects than those given placebo.

The team writes: "We were unable to demonstrate a sustained benefit of 2-g E-EPA augmentation compared with atypical antipsychotic medication alone. However, the present study also suggests that E-EPA may accelerate treatment response, reduce the amount of antipsychotic medication prescribed, and improve the tolerability of atypical antipsychotic medication.

"Our study suggests that mainly nonaffective early psychosis patients benefit from E-EPA augmentation, in particular those with a long duration of untreated psychosis."

Abstract
 

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