And further research , rather than just testing of omega-3s , could try to figure out what is the biological component of omega-3s . It might be that they work for certain groups of people and not for others . The varieties of mental health conditions are so massive even within a specific diagnosis . We probably need to get a more fine grain understanding of the conditions and for the individuals for which these nutrients can be effective before really rolling them out on a massive scale , and to do further research just to prove their efficacy . We don ' t really know all these things yet , despite there being such a big body of research on the potential efficacy already indicated .
Adrian : I think that ' s where the work ’ s being done . I do clinical trials myself on people with depression , but we do know that that label , depression , varies , and that there are great variations among individuals . Some people sleep too much and some people don ' t sleep enough , and some people ' s appetite is higher and others are lower , and some people present with inflammation and some people don ' t . So , yes , I agree . I think the next thing is for us to really identify who it works for and how it works . And we still need a lot more research into that . So , with the omega-3s , do you know , is it people who are low on omega-3s ? Does supplementation help , or are we not even at that point yet ?
Joseph : There ' s been some recent evidence to indicate inflammation could make a difference . And some trials showing that anti-inflammatory medications have higher anti-depressant effects on people with high levels of inflammation . So , you could imagine that being not an easy way to classify people , but a first step . But then also you have some mental health patients who present with high inflammation and some who don ' t . And then even within that group , you have some people where high inflammation seems related to the symptoms , and then some cases where it doesn ' t . So , it ' s confusing .
Adrian : Yes . Absolutely .
Joseph : And so hard to pin down . But I guess the benefit of things like nutrient supplements and omega-3s , is that it ' s not like testing drugs . They are generally perceived to be pretty safe , and widely available , and relatively cheap . So , people who want to just try omega-3s and / or other supplements in conjunction with their current medications can do so – though obviously with their doctor ' s advice , to negate the risk of interaction . It ' s quite easy for people to personalise their treatment and see what works and what doesn ' t work in a simple way , without as much risk as certain medications can present .
But yes , it can be confusing to try and figure out what are the effective conditions - or even the ingredients of omega-3s . We have seen in the literature that the ones with the highest levels of EPA , rather than DHA - the two main components of omega-3 fatty acids - seem to have greater beneficial effects on depressive symptoms as well , with greater reductions . And so that could be another consideration : the actual constitutions and quality of the omega-3 being used .
Adrian : So higher EPA , and dosage wise , given the safety profile with omega-3s , higher EPA , is there a dose that generally has greatest efficacy ?
Joseph : I think it might be 2000 milligrams per day of the high EPA formulas there were where we saw the best effects . But I ' ll double-check that with the thesis . It might even be a little bit higher than that .
Some people have gastrointestinal side effects from very high dose EPAs . So , I guess with any dosage strategy , before moving to the upper limit dose , you ' re better off trialling a very small amount first . Even in the trials , I think they start with a titrated dose methodology . So , start people on around 500 milligrams a day . Just check that the patient is getting on okay before moving up to those higher dosages .
Adrian : And I think people need to be aware too , that if you ' re going to use omega-3s , it ' s not going to work quickly . Your research has indicated that as an adjunct treatment , omega-3s have efficacy . But it ’ s unrealistic to expect dramatic improvements in mood over the short term - that ' s not going to happen .
Joseph : Yes . And there are other nutrients emerging as well . So , I guess different people could benefit from different types of nutrients , it ’ s not all about omega-3s . There ' s Methylfolate , which is the really high dose B vitamin stuff , which seems to have positive effects under some conditions , especially in people with low levels of folate - vitamin B9 . N-acetyl cysteine and the other antioxidants are also showing some efficacy . Again , in different conditions the positive effects are sometimes greater . And researchers are just beginning to try and figure out why they work in some cases and not in others . So , it ' ll be interesting to see how the field develops and actually get finer grain understanding of how different nutrients can influence different mental health conditions in different people .
Adrian : All right . So then , we ' ve got lifestyle psychiatry , dietary interventions , exercise , and we know that there ' s a strong link between smoking and mental health , so smoking cessation could be a really important component of any lifestyle intervention in mental health .
Also , you ' ve mentioned sleep . I know that your work has mainly been in nutraceuticals . My work has mainly been in the herbal side of things , and there are some different herbal options that people could look at as components of lifestyle psychiatry too . Have you done much research on screen time , for example ? Is that in your area - the effect of social media and that type of stuff on mental health ?
Joseph : Yes . We ' ve done some research on that , and particularly on screen time in the context of sedentary behaviour in young people and how that might affect mental health : there ' s a whole
212 | vol29 | no4 | JATMS