OMEGA-3 FOR DEPRESSION AND OTHER CARDIAC RISK FACTORS

OMEGA-3 针对抑郁症和其他心脏危险因素

• 批准号: 8988288
• 负责人: ROBERT M CARNEY
• 金额: $ 71.06万
• 依托单位: WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-01-01 至 2017-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8988288
• 关键词: Adverse effects; Antidepressive Agents; Blood; C-reactive protein; Cardiac; Cardiovascular system; Citalopram; Clinical Trials; Coagulation Process; Cognitive Therapy; Control Groups; Controlled Clinical Trials; Coronary heart disease; DSM-IV; Dietary intake; Disease-Free Survival; Docosahexaenoic Acids; Double-Blind Method; Eicosapentaenoic Acid; Electrocardiogram; Enrollment; Erythrocytes; Evaluation; Event; Fatty Acids; Fibrinogen; Fluoxetine; Formulation; Future; Hamilton Rating Scale for Depression; Health; Heart; Heart Diseases; Heart Rate; Hour; Inflammation; Intervention; Lead; Major Depressive Disorder; Measures; Mediating; Mental Depression; Mirtazapine; Monitor; Morbidity - disease rate; Omega-3 Fatty Acids; Outcome; Participant; Patients; Pharmaceutical Preparations; Phospholipids; Placebo Control; Placebos; Plasma; Platelet Factor 4; Population; Publishing; Quality of life; Randomized; Reporting; Research; Risk; Risk Factors; Risk Marker; Sertraline; Severities; TNF gene; Testing; Time; acute coronary syndrome; base; capsule; cardiac depression; cardiovascular risk factor; clinical practice; comorbid depression; depressed patient; dosage; effective therapy; efficacy testing; efficacy trial; heart rate variability; improved; interpersonal therapy; meetings; mortality; single episode major depressive disorder; standard care; sudden cardiac death; treatment effect

DESCRIPTION (provided by applicant): Depression increases the risk for cardiac morbidity and mortality 2-4 fold in patients with coronary heart disease (CHD). Recent clinical trials have tested standard treatments for comorbid depression in patients with CHD, and some have evaluated their effects on cardiac morbidity and mortality. Most of these trials have shown that standard treatments have only modest effects on depression and have produced relatively small differences between the intervention and control condition. Consequently, they have been unable to determine whether effective treatment of depression can improve cardiac outcomes. Low dietary intake and low plasma phospholipid or erythrocyte levels of two omega-3 fatty acids, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), are associated with depression and other cardiac risk markers, including ones that may mediate the relationship between depression and cardiac mortality. There is growing evidence from small psychiatric trials that the efficacy of standard antidepressants can be improved by coadministration of an omega-3 FA formulation containing at least 1 gram of EPA with a ratio of between 2 to 4 parts EPA to 1 part DHA (2-4EPA:1DHA). The purpose of the proposed research is to determine whether antidepressant augmentation with this omega-3 FA formulation is superior to antidepressant therapy alone for major depression in patients with CHD, and to investigate its effects on other cardiac risk markers in these patients. The proposed study is a randomized, placebo-controlled, double-blind clinical trial. Patients who meet the DSM-IV-TR criteria for a major depressive episode 2-4 months after an acute coronary syndrome (ACS) will be given 25 mg/day of sertraline plus two placebo capsules for 14 days. The first 170 participants who continue to meet the DSM-IV-TR criteria for major depression, score e15 on the Hamilton Rating Scale for Depression (HAM-D), report no serious side effects, and take both drugs >90% of days, will undergo a baseline evaluation and then be randomly assigned to receive either 50 mg/day of sertraline plus omega-3 FA or 50 mg/day of sertraline plus placebo for 10 weeks. At baseline and after 10 weeks, participants will complete assessments of depression, 24 hour ambulatory ECG monitoring to measure 24 hour heart rate and heart rate variability, and blood draws to measure procoagulant and proinflammatory markers and blood levels of EPA, DHA, other omega-3 FAs, and the omega-6 FAs. If sertraline plus this omega-3 formulation significantly reduces depression compared to sertraline plus placebo, and if it improves or at least does not worsen other cardiovascular risk markers, this study will provide a strong basis for proposing a multicenter clinical trial of sertraline augmented with omega-3 to determine whether treatment of depression can improve survival in patients with post-ACS depression.

描述（由申请人提供）：抑郁症会使冠心病 (CHD) 患者的心脏病发病率和死亡率风险增加 2-4 倍。最近的临床试验测试了先心病患者共病抑郁症的标准治疗方法，有些还评估了它们对心脏病发病率和死亡率的影响。大多数这些试验表明，标准治疗对抑郁症的影响不大，并且干预条件和对照条件之间的差异相对较小。因此，他们无法确定抑郁症的有效治疗是否可以改善心脏结局。膳食摄入量低和两种 omega-3 脂肪酸（二十碳五烯酸 (EPA) 和二十二碳六烯酸 (DHA)）的血浆磷脂或红细胞水平低，与抑郁症和其他心脏风险标志物相关，包括可能介导抑郁症和心脏死亡率之间关系的标志物。小型精神病学试验越来越多的证据表明，通过同时服用含有至少 1 克 EPA 的 omega-3 FA 制剂（其中 EPA 与 1 份 DHA 的比例为 2 至 4 份（2-4EPA:1DHA）），可以提高标准抗抑郁药的疗效。拟议研究的目的是确定使用这种 omega-3 FA 制剂增强抗抑郁治疗对于 CHD 患者的重度抑郁症是否优于单独的抗抑郁治疗，并研究其对这些患者其他心脏风险标志物的影响。拟议的研究是一项随机、安慰剂对照、双盲临床试验。符合 DSM-IV-TR 标准的急性冠脉综合征 (ACS) 后 2-4 个月内重度抑郁发作的患者将接受 25 毫克/天的舍曲林加两粒安慰剂胶囊，为期 14 天。前 170 名继续符合 DSM-IV-TR 重度抑郁症标准、汉密尔顿抑郁量表 (HAM-D) 评分为 e15、报告无严重副作用、且服用两种药物超过 90% 的参与者将接受基线评估，然后被随机分配接受 50 毫克/天的舍曲林加 omega-3 FA 或 50 毫克/天的舍曲林加安慰剂，为期 10 周。在基线和 10 周后，参与者将完成抑郁症评估、24 小时动态心电图监测（以测量 24 小时心率和心率变异性）、抽血以测量促凝血和促炎标记物以及 EPA、DHA、其他 omega-3 FA 和 omega-6 FA 的血液水平。如果与舍曲林加安慰剂相比，舍曲林加这种 omega-3 制剂能显着减少抑郁症，并且如果它改善或至少不会恶化其他心血管风险标志物，那么这项研究将为提议舍曲林加 omega-3 的多中心临床试验提供坚实的基础，以确定抑郁症治疗是否可以提高 ACS 后抑郁症患者的生存率。