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Hi Dr. Quinn:

I just read your response to “Dear Dr. Q.” in the addvance magzine. Over the past several months I have witnessed some dramatic changes in both PMS and Perimenopause along with AD/HD symptoms in some of the women I have been treating.

The protocol is the same as Andy Stoll’s for depression. The best results have come from unadulterated fish oil; I prefer Carlson’s; the initial dose is 1000mg of EPA for two to three weeks. If there is no response the dose is increased to 3000mg of EPA; again if no response in three weeks the dose can be increased with guidance to 6000mg. The fishy taste has nearly been eliminated from Carlson’s Super Fish. A teaspoon contains 800mg of EPA. I have seen Vitamin Shoppe with a similar product screened for heavy metals.

The EPA acts like the second messenger response that we see with all effective antidepressants except without the most troublesome side effects and excessive financial drain of the prescribed medications. Other benefits include healthier looking skin, relief from psoriasis, improvement in anti inflammatory functions etc.

There are about a half dozen studies — mostly from other countries — supporting the effectiveness of eicosapentanoic acid (EPA) for depression, mood swings, even bipolar disorder. My experience with a middle-aged woman with “untreatable” bipolar disorder was extremely dramatic. Antidepressant effects were apparent a week after starting 9000mg of EPA. Her suicidal depression of two years’ duration was gradually relieved over a three week period. She has remained depression free for over one and a half years. She continues to take the same medications that were ineffective alone prior to her EPA supplementation.

I hope this is helpful. I enjoy reading your newsletter — keep it coming. Happy New Year!!!

Robert LoPresti, Ph.D.

Dear Dr. LoPresti:

Omega 3 fatty acids have a host of other benefits with minimum side effects, even for those who do not achieve mood benefits. I, too, have spoken with other clinicians who recommend Omega 3 fatty acid supplementation especially for depression and for its anti-inflammatory effects in heart disease and arthritis. I was so impressed, I recommended it for my sister who was newly diagnosed with Rheumatoid Arthritis. She has coped with AD/HD most of her life, but was only diagnosed and treated with stimulants as an adult.

Readers looking for a reference on this can find “The Omega-3 Connection,” by Andrew Stoll, M.D., 2001, Simon & Schuster, New York. Dr. Andrew Stoll is from McLean Hospital in Boston, MA. It is my understanding that researchers at the McLean Hospital did a small open label study with Omega 3 fatty acids to treat bipolar disorder in children and adolescents, in which the dose was titrated up to a maximum of 2580 mg per day. Although a few improved, the majority did not show significant improvement on mania rating scales during the eight weeks of monitoring.

I think the jury is still out on many of these treatments, some of which are very compelling to consider (though some may be helpful for some individuals; we have no way to predict which ones), and we definitely need more information and studies.

We must be mindful that the stimulants remain the “gold-standard” and are recommended as first-line agents for the treatment of AD/HD in both adults and children.

Pat Quinn, MD

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