Treating Depression in Coronary Artery Disease With Omega-3 Fatty Acids
Condition: Coronary Artery Disease; Depression
MeSH terms: Coronary Artery Disease; Myocardial Ischemia; Coronary Disease; Depression; Depressive Disorder
Study type: Interventional
Phase: Phase 3

Summary: 
      Depressive disorders are common in patients with Coronary Artery Disease (CAD), occurring in
      up to 47% of patients. Left untreated, these symptoms not only have a strong negative impact
      on quality-of-life, but also increase risk of future cardiac events and death. Unfortunately,
      about 64% of CAD patients do not respond to current antidepressant treatments.
      Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) are two omega-3 (ω-3) fatty acids
      found in fatty fish that are important for brain function. Recent evidence showed that
      depressed CAD patients have lower levels of EPA and DHA than non-depressed CAD patients. This
      information, taken together with the known roles of ω-3 fatty acids in brain function,
      suggests that deficiencies may contribute to depression. However, it is unknown if increasing
      consumption of ω-3 fatty acids would alleviate depression and improve quality of life. While
      intake of adequate levels of ω-3 fatty acids is difficult to obtain through diet,
      concentrated supplements containing EPA and DHA that are safe, readily available, and
      inexpensive are now obtainable in Canada. CAROTID (CAD Randomized Omega-3 Trial In
      Depression) will randomize patients with CAD, with and without depressive symptoms, after 6
      months of cardiac rehabilitation and usual care to receive either ω-3 fatty acid supplements
      or placebo daily during their final 6 months of cardiac rehabilitation. The investigators
      hypothesize that CAD patients randomized to receive ω-3 fatty acid supplements will show
      greater improvement in depressive symptoms and quality-of-life over time. The investigators
      will also evaluate possible improvements in other important determinants of quality of life:
      memory and other cognitive abilities.
    

Detailed description: 
      Coronary artery disease (CAD) poses a serious risk to the health and well-being of the
      elderly. Depression is common among CAD patients and has a major negative impact on treatment
      outcomes and life expectancy. Late-life depression is also associated with symptoms of
      cognitive impairment and subsequent nonresponse to medications. Coronary artery disease and
      depression together can detrimentally affect autonomous seniors, resulting in increased
      caregiver dependence and health care resource use.

      Forty-seven percent of patients with CAD have depressive disorders. About 64% of these do not
      respond to antidepressant treatments. Recent evidence shows that depressed CAD patients have
      lower levels of omega-3 fatty acids than do non-depressed CAD patients. Along with the known
      role of omega-3 fatty acids in brain health, this suggests that deficiencies may affect
      depression.

      Our study, CAROTID (CAD Randomized Omega-3 Trial In Depression), is a randomized,
      double-blind, placebo-controlled parallel group trial in persons with CAD who are attending a
      cardiac rehabilitation program. Patients will receive either omega-3 fatty acids supplements
      or placebo daily during three months of cardiac rehab. We hypothesize that patients who
      receive omega-3 fatty acids will show greater improvements in depressive symptoms and quality
      of life. This research will determine whether there is an antidepressant effect of omega-3
      fatty acids in CAD patients undergoing cardiac rehabilitation. If successful, then CAROTID
      will provide evidence to guide health care providers in the recommendation and use of these
      supplements.
    

Intervention name(s): Omega-3 Fatty Acid Supplement; Placebo
Intervention type(s): Dietary Supplement; Other
Intervention description(s): 3 capsules (3x1g) fish oil-derived concentrated ethyl esters, providing 1.9 g omega-3 fatty acids (1.2 g EPA and 0.6 g DHA, with 0.1 g other omega-3 fatty acids); 3 capsules (3x1g) of 50/50 soybean/corn oil blend containing less than 0.12 g of omega-3 fatty acids with negligible EPA and DHA
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Fatty Acids, Omega-3