The Hemp Connection:
antidepressant

This is to address some great questions about fish oil that Katie sent in.

Katie asked:
after reading about fish oil and its obvious benefits, I finally bought some Carlson Super Omega-3 Fish Oil Concentrate soft gels yesterday at Whole Foods.

I have several questions I have tried to get answered via this site and the Internet, but can't seem to find clear answers, so I am throwing them out here, in hopes you can help.

1. The bottle says"Each Carlson Super Omega — 3 soft gel contains 1000 mg (1 gram) of a special concentrate of fish body oils from deep, cold-water fish which are especially rich in the important Omega-3's EPA and DHA." However, the Supplemental Facts read EPA 300 mg DHA 200 mg Other Omega-3's 100mg. I believe that adds up to 600mg. Right? There is no mention of the other 400 mg. Where are they? I'm very confused about this. Can you explain this to me? There is also Natural Vitamin E — 10 IU…incase that means something.

2. How many pills/mg am I supposed to take? I read between 1000 mg and 3000 mg. Which makes me confused again because even though the bottle says 1000 mg in each pill I can only find 600 of them! I want to make sure that I am taking enough, but not taking too much! How much do you take? Also, do I work up to that or just dive in?

3. Last question…is there anything else I should be taking with the fish oil? I know that sometimes if you take something you need to supplement with something else. Is that the case here?

Thank you in advance for your advice and information!

My response:
Katie, these are really great questions and something that I am often asked by my clients. Here's the scoop:

1. The dosage on the ingredient list can indeed be very confusing and frankly I believe it is a way in which some supplement companies try to give the impression that you are getting a better product with higher potency, but it can be misleading. When the label states something like…"contains 1000 mg marine oil", you are not getting the complete information.

The critical ingredients and the amounts you need to know about are — how much EPA (eicosapentanoic acid) and DHA (docosahexaenoic acid) are contained in each capsule.

EPA and DHA have been shown to support healthy functioning of the cardiovascular, immune, gastrointestinal, and musculoskeletal systems. EPA is also an excellent anti-inflammatory and helpful in conditions such as insulin resistance, diabetes and auto-immune related inflammation.

DHA is an important factor for those with PCOS as it supports many aspects of health including pregnancy, fetal development, and healthy neurological function.

The other"marine lipids" are simply the total fat of the fish, where the EPA and DHA are the active portions of that fat. It is the"actives" that are providing the therapeutic value. The vitamin E in the capsules is for preservative purposes and helps prevent rancidity of the fat.

2. Regarding the dosage you should take, that is a harder question to answer because it will depend on what you are trying to target. Those with PCOS should be targeting anywhere from 500 — 1000 mg. DHA. So you need to know how much DHA is in each cap, for example if the capsule has only 200mg. of DHA, you'll need to take 3 of them to get approximately 500mg. You can then work up to a higher dose, always start with the lower dose and work your way up. Sometimes it is easier to get a liquid version that is high potency versus taking handfuls of pills to achieve the same dose.

I do not recommend that you take a liquid fish oil that is derived from Cod Liver Oil as the source as it usually has a high amount of Vitamin A and it is possible to get toxic doses of vitamin A. Another thing to note is that in a combination EPA/DHA cap, the dosage EPA will usually be higher than the amount of DHA, that is no problem. The EPA will only be of additional benefit.

Don't hesitate consulting with a registered dietitian knowledgeable both in PCOS and supplements in order to have your supplementation tailored to your specific health needs — remember we are all different, with unique physiology, medical history and requirements.

3. Fish Oil does not have to be taken with anything else to enhance its function. It can be taken all at once, with meals, between meals — it is very flexible this way.

Here are a couple of additional tips:

- if you tend to"burp" back fish oil, make sure to buy a brand that comes in an"enterically coated capsule", they might cost a few cents more, but it's worth it.
- refrigerate your fish oil to protect it and this also can help reduce"burp back".
- contributes to creating beautiful, healthy skin.

One last fun fact about fish oil. Most of it actually comes from the southern hemisphere not as you might think from the deep waters off Norway!

Here's to fish oil!

Carmina McGee, MS, RD, LE
Ventura, California
805.816.2629
info@carminamcgee.com

In a study I did with over 1,000 women with PCOS who visited my website, over 85% described symptoms of anxiety and/or depression, conditions commonly treated with antidepressants. Therefore, any information I find regarding these medications and their effect on pregnancy is crucial to share.

In the study referenced in this post, over a period of almost 10 years, a total of 1,780 women who experienced 1,835 pregnancies over this time while also receiving either paroxetine (Paxil) or a combination of Paxil and at least one other antidepressants, during the first trimester of pregnancy. These women were compared to 9,008 women experiencing 9,134 pregnancies while on other antidepressants and antidepressant combinations that did not include paroxetine, in the first trimester of pregnancy, over the same period of time. The researchers report that there is a modest increased risk of congenital malformation (birth defects) in women who use paroxetine alone or in combination therapy during the first trimester of pregnancy.

Bottom line? Since often times you don't even know you're pregnant during that first trimester, if you are trying to conceive, or even having sex, and you are being treated for depression, it would be prudent to discuss an alternative to paroxetine with your caregiver.

Better safe than sorry!

Cole JA, Ephross SA, Cosmatos IS, Walker AM. Paroxetine in the first trimester and the prevalence of congenital malformations. Pharmacoepidemiol Drug Saf. 2007 Oct;16(10):1075-85. Comment in: Pharmacoepidemiol Drug Saf. 2007 Nov;16(11):1181-3.

Since 80% of the women with PCOS who visit my website also report some kind of mood disorder (mainly anxiety and/or depression, this research abstract caught my eye. For many of you it's challenging enought to get pregnant…once you're there, it's crucial to stay pregnant!

This study reported that in women who have taken a selective serotonin reuptake inhibitor (a popular category of antidepressant), there was a significant increase in miscarriage. The medications specifically mentioned in the abstract were citalopram/Celexa, fluoxetine/Prozac, fluvoxamine/Luvox, paroxetine/Paxil, sertraline/Zoloft.

If you're having trouble getting and staying pregnant, you may wish to discuss this possible influence with your caregiver.

Here is the reference for anyone who wants to share it.

Rahimi R, Nikfar S, Abdollahi M. Pregnancy outcomes following exposure to serotonin reuptake inhibitors: a meta-analysis of clinic trials. Reprod Toxicol 2006 Nov;22(4): 571-5.

Knowing that PCOS often goes unrecognized, and that PCOS research often overlooks some of the most important issues cysters deal with, I'm trying to bring research to this blog you may not find if you're using"PCOS" as your search term but which may be entirely pertinent. In this case, I want to talk about antidepressants, which are very commonly prescribed in PCOS, whether it's officially diagnosed or unrecognized.

This study was conducted because of the number of women who use antidepressants. That increases the possibility that a woman may, intentionally or not, become pregnant while taking antidepressant medications. The researchers wanted to know if fetal exposure to antidepressants may influence brain and nervous system development. This particular study was done with mice, but it was previously determined that mice and humans demonstrate similar mother-fetal transfer with the medications being evaluated.

Fluvoxamine (Luvox) had a lower rate of transfer than did fluoxetine (Prozac). More offspring died in the group using fluoxetine, and most of these deaths were due to heart failure related to cardiac defects. The researchers reported no deaths related to fluvoxamine.

In addition, the part of the brain that distributes serotonin to the rest of the brain, the raphe nucleus, did not function properly in the brains of rat pups whose mothers had been exposed to fluoxetine. Behaviorally, these rats exhibited more anxiety- and depression-related behaviors as adults than rats who had not been exposed.

So it seems that babies of moms who have depression may be set up to have the same problems when they become adults. Some of that may be genetic, but some of it may be perpetuated by the way the mother's biochemistry is treated by her caregivers.

Bottom line, if you're using antidepressants, even if you're NOT trying to become pregnant but you MIGHT become pregnant because you're sexually active, you may want to be sure that you discuss this with your physician and determine which treatment option is most appropriate.

Don't forget diet and fish oil--they can eliminate the need in many cases to even have to make this kind of decision!

Noorlander CW, Ververs FF, Nikkels PG, van Echteld CJ, Visser GH, Smidt MP. Modulation of serotonin transporter function during fetal development causes dilated heart cardiomyopathy and lifelong behavioral abnormalities. PLoS ONE. 2008 Jul 23;3(7):e2782.

I'm passing this along since the coexistence of depression and pregnancy is so very high amongst the readers of this blog. Findings like these are a huge reason I am so adamant about finding ways that nutrition and nonpharmacological treatments can keep both mother and baby healthy all the way through conception and pregnancy.

To see this story with its related links on the guardian.co. uk site, click here

Antidepressants linked to premature birth risk

Tuesday October 6 2009
BMJ Group

Mothers-to-be risk having a premature birth if they take commonly used antidepressants during pregnancy, a new study has found. Antidepressants called SSRIs (the group of drugs that includes Prozac) were also linked to a higher risk of babies needing treatment in intensive care soon after birth.What do we know already?

More than 1 in 10 women become depressed during pregnancy. In cases where doctors recommend drug treatment, the first choice is often a selective serotonin reuptake inhibitor (SSRI).

Doctors are advised that pregnant women should take SSRIs"only if potential benefit outweighs risk". Unfortunately, there's little research on how safe these drugs are during pregnancy. We do know that SSRIs get into the unborn baby's bloodstream, and that some babies get withdrawal symptoms soon after birth. Some research also suggests that babies may be more at risk of heart defects if their mother takes an SSRI called paroxetine in the first three months of pregnancy, although this problem is not common.

A new study has looked at 329 women who were taking SSRIs while pregnant. The health of their babies was compared with the health of babies born to women not taking antidepressants. Some of the women in this latter group had mental health problems, while others did not.What does the new study say?

Women taking an SSRI had twice the risk of a premature birth. On average, women gave birth four or five days sooner if they took an SSRI while pregnant. But the results don't tell us the actual numbers of women in each group who gave birth prematurely, so we can't say what the actual risk is.

About 16 in 100 babies needed treatment in an intensive care unit if their mother had taken an SSRI, compared with 7 in 100 babies whose mothers were healthy, and 9 in 100 babies whose mothers had a mental health problem but who weren't taking an SSRI.

Babies also appeared less healthy overall if their mother had taken an SSRI. This was measured looking at their skin colour, how much they moved about, their pulse rate and breathing, and how much they responded to stimulation.

SSRIs didn't increase the risk of having an underweight baby. The study only looked at what happened around birth, so we don't know whether or not SSRIs have longer-term consequences. How reliable are the findings?

This is a fairly good study. Since it also included a group of women who had mental health problems but who were not taking an SSRI, we can partly rule out the possibility that mental health issues affected the baby's health rather than antidepressants. However, it could still be that women taking SSRIs were more seriously depressed than the women they were compared with, or that they had worse overall health. This factor might have affected the health of the babies, and it makes the study less reliable.Where does the study come from?

The women who took part in the research all had antenatal care at a hospital in Aarhus, Denmark. The study appeared in a journal called Archives of Pediatrics & Adolescent Medicine, published by the American Medical Association. Some of the funding came from the Danish Medical Research Council.What does this mean for me?

The study suggests that, in the short term at least, there could be some negative consequences to taking SSRIs while pregnant. What the research doesn't tell us is how the risks of SSRIs in pregnancy compare with the dangers of untreated depression.

Depression itself can affect how babies grow. It can also cause unpleasant symptoms for the mother. There's a high chance of becoming depressed again when women stop taking antidepressants when they're pregnant. So, we can't simply say that pregnant women should completely avoid SSRIs.What should I do now?

If you're pregnant and taking an antidepressant, don't stop treatment suddenly. You could put yourself at risk of unpleasant withdrawal symptoms, and your depression could come back. Your doctor can help you weigh up the risks and benefits of treatment. If you and your doctor decide it's the right thing to do, you'll need to come off your medicine gradually. You could also ask about other types of treatment, such as talking therapy.

If you're taking antidepressants and you want to get pregnant, talk to your doctor. Depending on how severe your depression is, your doctor might suggest slowly coming off your medicine, or continuing to take it.From:

Lund N, Pedersen LH, Henriksen TB. Selective serotonin reuptake inhibitor exposure in utero and pregnancy outcomes. Archives of Pediatrics & Adolescent Medicine. 2009; 163: 949-954.
BMJ Publishing Group Limited ("BMJ Group") 2009

We focus almost entirely on the women's side of infertility on this blog. Now here's information important to the other half of the equation. The beauty of this is…the very advice we're giving to you women…can help men with depression, too. This article comes from Natural News, links are at the bottom.

SSRI Antidepressants Linked To Male Infertility
by S. L. Baker, features writer

(NaturalNews) The Food and Drug Administration (FDA) issued a warning a few years ago that pregnant women taking the selective serotonin reuptake inhibitor (SSRI) antidepressant paroxetine risk giving birth to infants with major birth defects, including heart abnormalities ( http://www.naturaln ews.com/021225_ P…). Now comes word that the same drug (sold as Paxil, Paxil CR, Seroxat, Pexeva, and generic paroxetine hydrochloride) carries another danger that could keep babies from being born in the first place. A new study just published in the online edition of the journal Fertility and Sterility concludes as many as fifty percent of all men taking the antidepressant could have damaged sperm and compromised fertility.

New York Presbyterian Hospital and Weill Cornell Medical Center researchers followed 35 healthy male volunteers who took paroxetine for five weeks. Then sperm samples from the men were studied using an assay called terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) to evaluate whether there were missing pieces of genetic code in the sperm DNA. This condition, know as DNA fragmentation, is associated with reproductive problems.

The results? The percentage of men with abnormal DNA fragmentation soared from less than 10 percent to 50 percent while taking the antidepressant. This is a crucial finding because DNA fragmentation has long been known to correlate with an increased risk of birth defects, poor fertility and unsuccessful pregnancy outcomes — even when high tech, extraordinarily expensive fertility enhancing techniques such as in vitro fertilization and intracytoplasmic sperm injection are used.

The study, one of the first scientific investigations into the effect of SSRIs on sperm quality, also confirmed that paroxetine impairs sexual function. More than a third of the research subjects reported significant changes in erectile function and about half had difficulty ejaculating.

"It's fairly well known that SSRI antidepressants negatively impact erectile function and ejaculation. This study goes one step further, demonstrating that they can cause a major increase in genetic damage to sperm," Dr. Peter Schlegel, the study's senior author and chairman of the Department of Urology and professor of reproductive medicine at Weill Cornell Medical College, explained in a statement to the media."Although this study doesn't look directly at fertility, we can infer that as many as half of men taking SSRIs have a reduced ability to conceive. These men should talk with their physician about their treatment options, including non-SSRI depression medications."

The scientists could not identify the exact way the SSRI caused the DNA fragmentation, but the evidence strongly suggests the drug slows sperm as it moves through the male reproductive tract from the testis to the ejaculatory ducts. When this happens, the sluggish sperm grows old and its DNA becomes damaged.

"This is a new concept for how drugs can affect fertility and sperm. In most cases, it was previously assumed that a drug damaged sperm production, so the concept that sperm transport could be affected is novel," Dr. Schlegel stated.

The study contains some good news for men currently on Paxil and related drugs who may be concerned about their fertility. All the changes the researchers found appeared to be totally reversible. Specifically, normal levels of sexual function and DNA fragmentation both returned to normal one month after discontinuation of the drug.

For more information:
http://news. med.cornell. edu/wcmc/ wc…
http://www.fda. gov/Drugs/ DrugSafety …
http://www.naturaln ews.com/026483_ SSRI_fertility_ DNA.html