June 28, 2013 ? Ongoing studies suggest that using a mix of omega-3 fatty acid supplements and psychotherapy may be helpful for children with depression and a variation of bipolar disorder.
"These are two very promising treatments for children with mood disorders. Previous research has shown both have positive impacts and few side effects, which is an issue with many medications currently available for kids," said Dr. Mary Fristad, a clinical child psychologist at The Ohio State University Wexner Medical Center who is the first to examine the combined effects of psychotherapy and omega-3 in this patient population. "We think the approach will yield a reduction in irritability, improvements in self-esteem and concentration, and better eating and sleeping habits."
Fristad has been working on the approach for nearly twenty years. During that time, she saw great progress made in understanding how medications, psychotherapy and diet impacted biological brain disorders, but relatively little about how these interventions worked in children.
"We were treating kids with effective medications, but their families did not have the coping strategies needed to deal with the child's mood disorder symptoms," recalled Fristad. "Without a supportive environment, you can't expect any pharmacologic or dietary interventions to succeed."
The disconnect prompted Fristad to embark on a series of studies to develop and validate a therapeutic model targeted at families of children with mood disorders. Called psycho-educational psychotherapy, or PEP, the method teaches parents and their children how to manage symptoms and regulate emotions. Families also are taught how to navigate the mental health system for support and learn communication skills to help cope with the disorder. PEP can be done in either a group or individual therapy setting.
Fristad, who is also a professor of psychiatry in Ohio State's College of Medicine, was awarded funding from both the Ohio Department of Mental Health and National Institute of Mental Health to further develop and test PEP.
In 2009, pilot funding from the Ohio State University Center for Clinical and Translational Science (CCTS) was given to Fristad to train the PEP method to dozens of therapists around the state. In 2011, Heather MacPherson, MA, a doctoral student supervised by Fristad, also received a T1 Research Training Fellowship from the CCTS, which allowed MacPherson to examine treatment fidelity and outcomes in the community based implementation of PEP.
Armed with evidence that PEP worked, Fristad partnered with child psychiatrists L. Eugene Arnold, MD, MEd (Ohio State) and Barbara Gracious, MD of Nationwide Children's Hospital (NCH). The team obtained funding from the National Institute of Mental Health and resource support from the CCTS to conduct studies combining PEP with omega-3 supplementation in kids with depression or bipolar-NOS (not otherwise specified).
"There are several different types of dietary omega polyunsaturated fatty acids including omega-3, 6, and 9, but the importance of their relative ratios has had very limited testing in these patient populations," said Gracious. "While all are essential to human health, there is evidence that omega-3 fatty acids in particular play a role in brain cell function and signaling."
Gracious says that epidemiological studies show that people who have a diet rich in omega-3s -- found in seafood and flaxseed -- appear to have fewer psychiatric disorders, and that over time, US intake of omega-3 has substantially decreased.
"Cultures with diets high in omega-3 versus other fatty acid types appear to have a lower incidence of depression and mood disorders," said Gracious. "At the turn of the century, the population in this country was consuming more equal amounts of omega-6 and omega-3 fatty acids. Today, that ratio is completely different, with people consuming ten to twenty times more omega-6 than omega-3."
Gracious notes that in addition to having very few side effects, omega-3 fatty acids may have other health benefits, including helping to prevent cardiovascular, inflammatory, and autoimmune diseases. During the current studies, the research team will be analyzing participants' blood to examine the relationship between inflammatory biomarkers and mood changes.
Both studies are randomized and placebo-controlled, and researchers also intend to compare results from both studies to help provide additional perspectives on the intervention types. Although improvement is expected with both interventions, researchers predict the group receiving both psychotherapy and supplementation will fare the best.
Gracious and Fristad suggest that starting children in psychotherapy at a young age may give them the coping strategies they need as an adult. According to Fristad, early therapy may also help prevent or delay kids from "converting" over to having more serious forms of mood disorders.
Both studies are still enrolling children ages 7-14. Half of the children receive therapy and all receive capsules, either omega-3 or placebo, free of charge, along with careful monitoring and the support needed to continue their treatment.
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