Ethyl-Eicosapentaenoic Acid Useful Add-on Therapy in Schizophrenia

Laurie Barclay, MD

September 06, 2002

Sept. 9, 2002 — Ethyl-eicosapentaenoic acid (EPA) may be a useful add-on therapy for schizophrenia, according to results of a randomized, placebo-controlled trial published in the September issue of the American Journal of Psychiatry. Patients who were still symptomatic after six months of standard therapy had a significant reduction in both positive and negative symptoms after 12 weeks of treatment.

"Extrapyramidal symptoms and limited efficacy are serious limitations of conventional antipsychotics, while high acquisition costs have put the novel antipsychotics beyond the reach of patients in lower-income countries," write Robin Emsley, MD, from the University of Stellenbosch, Cape Town, South Africa, and colleagues. "Omega-3 polyunsaturated fatty acids may offer an affordable treatment alternative."

In this parallel-group, fixed-dose, add-on study conducted over 12 weeks, 40 patients with persistent symptoms of chronic, severe schizophrenia after at least six months of stable antipsychotic treatment received EPA or placebo in addition to their existing treatment.

After 12 weeks of treatment, the EPA group had significantly greater reduction of Positive and Negative Syndrome Scale total scores and of dyskinesia scores than the placebo group. The difference between groups reached significance after three weeks of treatment, suggesting an early onset of action.

"We regard these results as remarkable, considering the refractory nature of schizophrenia in the subjects," the authors write.

Study limitations acknowledged by the authors include small sample size, inability to determine if EPA is an effective antipsychotic on its own, and analysis of covariance suggesting that reduction in positive and negative symptoms may be at least partly related to reduction in dyskinesia scores.

"EPA may be an effective, safe, and well-tolerated add-on treatment in chronic schizophrenia," the authors write. "If efficacy in psychosis and tardive dyskinesia is confirmed, it is likely to lead to revision of our understanding of the pathophysiology and treatment of these disorders."

Am J Psychiatry. 2002;286(6):159(9):1596-1598

Reviewed by Gary D. Vogin, MD

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