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Letter to the Editor   |    
Schizophrenia, Syndrome X, and Omega-3 Fatty Acids
FRANÇOIS POUWER, Ph.D.; RITSAERT LIEVERSE, M.D., M.Sc.; MICHAELA DIAMANT, M.D., Ph.D.; JOHANNA ASSIES, M.D., Ph.D.
Am J Psychiatry 2004;161:1926-1926. doi:10.1176/appi.ajp.161.10.1926

To the Editor: In an interesting study, Martina C.M. Ryan, M.B., M.R.C.Psych., et al. (1) found an increased prevalence of impaired glucose tolerance and insulin resistance in patients with drug-naive, first-episode schizophrenia in relation to healthy comparison subjects. This finding is in line with the results of a recent review showing that features of the metabolic syndrome X are more common in subjects with schizophrenia than in the general population (2). Dr. Ryan and colleagues discussed the influence of diet (1), but we believe that they omitted the possible role of polyunsaturated fatty acids of the omega-3 and omega-6 series, in particular, eicosapentaenoic acid and arachidonic acid. Substantial evidence suggests that impaired polyunsaturated fatty acid metabolism is related to both schizophrenia and the metabolic syndrome X. In recent reviews, low consumption of omega-3 polyunsaturated fatty acid was concluded to be associated with hypertriglyceridemia, cardiovascular disease, and probably also to insulin resistance and type 2 diabetes (35). Of interest, lowered omega-3 polyunsaturated fatty acid levels have also been reported in the erythrocytes of drug-naive psychotic patients (6) and in medicated young schizophrenic patients in comparison with normal comparison subjects (7). Furthermore, placebo-controlled trials have found eicosapentaenoic acid to be effective in schizophrenia, depression, and borderline personality disorder (810).

We believe that randomized, controlled trials are warranted to test whether supplementation with long-chain omega-3 polyunsaturated fatty acid, such as eicosapentaenoic acid, can improve the symptoms of schizophrenia and prevent the development of features of the metabolic syndrome X in subjects with schizophrenia.

Ryan MCM, Collins P, Thakore JH: Impaired fasting glucose tolerance in first-episode, drug-naive patients with schizophrenia. Am J Psychiatry  2003; 160:284–289
[PubMed]
[CrossRef]
 
Ryan MCM, Thakore JH: Physical consequences of schizophrenia and its treatment: the metabolic syndrome. Life Sci  2002; 71:239–257
[PubMed]
[CrossRef]
 
Weber P, Raederstorff D: Triglyceride-lowering effect of omega-3 LC-polyunsaturated fatty acids—a review. Nutr Metab Cardiovasc Dis  2000; 10:28–37
[PubMed]
 
Kris-Etherton PM, Harris WS, Appel LJ: Fish consumption, fish oil, omega-3 fatty acids, and cardiovascular disease. Circulation  2002; 106:2747–2757
[PubMed]
[CrossRef]
 
Hu FB, van Dam RM, Liu S: Diet and risk of type II diabetes: the role of types of fat and carbohydrate. Diabetologia  2001; 44:805–817
[PubMed]
[CrossRef]
 
Khan MM, Evans DR, Gunna V, Scheffer RE, Parikh VV, Mahadik SP: Reduced erythrocyte membrane essential fatty acids and increased lipid peroxides in schizophrenia at the never-medicated first-episode of psychosis and after years of treatment with antipsychotics. Schizophr Res  2002; 58:1–10
[PubMed]
[CrossRef]
 
Assies J, Lieverse R, Vreken P, Wanders RJ, Dingemans PM, Linszen DH: Significantly reduced docosahexaenoic and docosapentaenoic acid concentrations in erythrocyte membranes from schizophrenic patients compared with a carefully matched control group. Biol Psychiatry  2001; 49:510–522
[PubMed]
[CrossRef]
 
Horrobin DF: Omega-3 fatty acid for schizophrenia (letter). Am J Psychiatry  2003; 160:188–189
[PubMed]
[CrossRef]
 
Nemets B, Stahl Z, Belmaker RH: Addition of omega-3 fatty acid to maintenance medication treatment for recurrent unipolar depressive disorder. Am J Psychiatry  2002; 159:477–479
[PubMed]
[CrossRef]
 
Zanarini MC, Frankenburg FR: Omega-3 fatty acid treatment of women with borderline personality disorder: a double-blind, placebo-controlled pilot study. Am J Psychiatry  2003; 160:167–169
[PubMed]
[CrossRef]
 
+

References

Ryan MCM, Collins P, Thakore JH: Impaired fasting glucose tolerance in first-episode, drug-naive patients with schizophrenia. Am J Psychiatry  2003; 160:284–289
[PubMed]
[CrossRef]
 
Ryan MCM, Thakore JH: Physical consequences of schizophrenia and its treatment: the metabolic syndrome. Life Sci  2002; 71:239–257
[PubMed]
[CrossRef]
 
Weber P, Raederstorff D: Triglyceride-lowering effect of omega-3 LC-polyunsaturated fatty acids—a review. Nutr Metab Cardiovasc Dis  2000; 10:28–37
[PubMed]
 
Kris-Etherton PM, Harris WS, Appel LJ: Fish consumption, fish oil, omega-3 fatty acids, and cardiovascular disease. Circulation  2002; 106:2747–2757
[PubMed]
[CrossRef]
 
Hu FB, van Dam RM, Liu S: Diet and risk of type II diabetes: the role of types of fat and carbohydrate. Diabetologia  2001; 44:805–817
[PubMed]
[CrossRef]
 
Khan MM, Evans DR, Gunna V, Scheffer RE, Parikh VV, Mahadik SP: Reduced erythrocyte membrane essential fatty acids and increased lipid peroxides in schizophrenia at the never-medicated first-episode of psychosis and after years of treatment with antipsychotics. Schizophr Res  2002; 58:1–10
[PubMed]
[CrossRef]
 
Assies J, Lieverse R, Vreken P, Wanders RJ, Dingemans PM, Linszen DH: Significantly reduced docosahexaenoic and docosapentaenoic acid concentrations in erythrocyte membranes from schizophrenic patients compared with a carefully matched control group. Biol Psychiatry  2001; 49:510–522
[PubMed]
[CrossRef]
 
Horrobin DF: Omega-3 fatty acid for schizophrenia (letter). Am J Psychiatry  2003; 160:188–189
[PubMed]
[CrossRef]
 
Nemets B, Stahl Z, Belmaker RH: Addition of omega-3 fatty acid to maintenance medication treatment for recurrent unipolar depressive disorder. Am J Psychiatry  2002; 159:477–479
[PubMed]
[CrossRef]
 
Zanarini MC, Frankenburg FR: Omega-3 fatty acid treatment of women with borderline personality disorder: a double-blind, placebo-controlled pilot study. Am J Psychiatry  2003; 160:167–169
[PubMed]
[CrossRef]
 
+
+

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