Study: Omega 3s may help with anxiety

By R. Ryan S Patel DO, FAPA OSU-CCS Psychiatrist

A previous blog post discussed probiotics and anxiety (1), a recent review article examined whether omega-3 fatty acid treatment is associated with an improvement in anxiety (2).

What are omega 3 fatty acids?
• Omega-3 polyunsaturated are dietary fatty acids (PUFAs) that include alpha linoleic acid (ALA) which then converted to eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) (3).
• They are nutrients that cannot be made by the human body so we must get them through foods or supplements (3).

What was the study?
The study authors (2) reviewed 19 clinical trials including 2240 participants from 11 countries.

What were the results?

• The authors (2) found an association of improved anxiety symptoms with omega-3 treatment compared with controls groups in both placebo-controlled and non–placebo-controlled trials.
• They also found stronger anti-anxiety effect of omega-3’s when anxiety symptoms were more severe (clinical) than less severe (subclinical) populations (2).

How much omega 3s were used in the studies?

In the review of 19 clinical trials (2), anti-anxiety benefits occurred when using atleast 2grams per day of omega 3s, DHA and EPA combined.

The results did not differ whether the amount of epa was more than or less than 60% of total omega 3s.

What are some caveats?
• The populations studied were broad which makes it difficult to generalize to specific populations like college students.
• Some of the studies had a small sample size.
• There were a broad range of benefits in different studies.
• Omega 3s can interact with medications and supplements.

• Talk to your health provider before considering omega 3’s.

Based on the research findings, not everyone will have the same benefits from omega 3’s.

What are some sources of omega 3s?
According to the National Institute of Health(3), sources of omega 3’s include:
• Fish and other seafood (especially cold-water fatty fish, such as salmon, mackerel, tuna, herring, and sardines)
• Nuts and seeds (such as flaxseed, chia seeds, and walnuts)
• Plant oils (such as flaxseed oil, soybean oil, and canola oil)
• Fortified foods (such as certain brands of eggs, yogurt, juices, milk, soy beverages, and infant formulas)
• Omega-3 dietary supplements include fish oil, krill oil, cod liver oil, and algal oil (a vegetarian source that comes from algae). They come in a wide range of doses and forms.

How much omega 3s do I need per day?
The U.S. Food and Drug Administration recommends consuming no more than 3 g/day of EPA and DHA combined, including up to 2 g/day from dietary supplements (3).

Where can I learn more about omega 3s?

https://ods.od.nih.gov/factsheets/Omega3FattyAcids-Consumer/

What are some resources to improve nutrition?
• Nutrition coaching with The OSU Student Wellness Center
• Nutritionist at The OSU Wilce Wilce Student Health center
• Nutritionist at The OSU Wexner medical center
• Nutrition books
• Take a nutrition class
• Take a look at the Dietary Guidelines for Americans.
Harvard’s page on nutritional psychiatry.

Disclaimer: This article is intended to be informative only. It is advised that you check with your own physician/mental health provider before implementing any changes. With this article, the author is not rendering medical advice, nor diagnosing, prescribing, or treating any condition, or injury; and therefore claims no responsibility to any person or entity for any liability, loss, or injury caused directly or indirectly as a result of the use, application, or interpretation of the material presented.

References:
1. http://u.osu.edu/emotionalfitness/2016/02/05/study-can-adjusting-gu-bacteria-impact-emotions/
2. Su KP, Tseng PT, Lin PY, et al. Association of Use of Omega-3 Polyunsaturated Fatty Acids With Changes in Severity of Anxiety Symptoms: A Systematic Review and Meta-analysis. JAMA 0Netw Open. 2018;1(5):e182327. Published 2018 Sep 14. doi:10.1001/jamanetworkopen.2018.2327
3. https://ods.od.nih.gov/factsheets/Omega3FattyAcids-Consumer/

Leisure, academics, and mental health

By R. Ryan S Patel DO, FAPA OSU-CCS Psychiatrist

In a national survey of over 31 thousand college students, about 31% of college students report stress impacting their academics, followed by anxiety (25%), and depression (16%). (1).

Excessive stress can also lead to depression and anxiety (2).

Leisure activities can play a role in stress management which can help with academics and with mental health.

What is leisure?

One definition of leisure activity is pleasurable activities that individuals engage in voluntarily when they are free from the demands of work or other responsibilities (3).

Are there studies on leisure activities and wellbeing?

A study by Trainor and colleagues looked at leisure activities and psychological well being (4).

Who was studied?

947 students were asked about social, non-social and unstructured leisure activities as well as measures of personality.

What were the results?
spare-time use may be related to well-being only insofar as individuals who are psychologically healthy tend to be involved in structured, supervised, goal oriented, leisure activities, such as sports with others and playing music with healthy peers (4).

What are some caveats?

This is a small cross sectional study which can tell us about association but not cause and effect.

The study was published in 2012, and newer leisure activities have become common, which may or may not be healthy (social media, online-gaming, active video gaming, interactive phone apps, etc).

What are some examples of healthy leisure activities (5)?

  • Spending quiet time alone
  • Visiting others
  • Eating with others
  • Doing fun things with others
  • Clubs/fellowship, and religious group participation
  • Vacationing
  • Communing with nature
  • Playing or watching sports
  • Hobbies

Also consider:

  • Working out or taking exercise classes
  • Meditating
  • Volunteering
  • Participating in an activities based student organization
  • Journaling
  • Drawing/coloring/painting

Anything else that can help?

In addition to leisure activities, the following activities can also help with physical and emotional health:

  • Healthy lifestyle habits(healthy eating habits, healthy exercise, relaxation skills, healthy

sleep habits, etc.) (5)

  • Avoiding harmful habits(smoking, drug use, excessive alcohol, etc) (5)
  • This balance might vary from person to person.

Different people might benefit from different types of play during leisure time. What type of play is best for you?

Are there any campus resources on play?

Any other useful resources on campus?

Learn more about play:

https://u.osu.edu/emotionalfitness/2017/09/22/mental-health-benefits-of-leisure-activities/

https://u.osu.edu/emotionalfitness/2016/09/28/study-play-and-leisures-impact-on-mood-stress-and-wellbeing/

By R. Ryan S Patel DO, FAPA OSU-CCS Psychiatrist

Disclaimer: This article is intended to be informative only. It is advised that you check with your own physician/mental health provider before implementing any changes. With this article, the author is not rendering medical advice, nor diagnosing, prescribing, or treating any condition, or injury; and therefore claims no responsibility to any person or entity for any liability, loss, or injury caused directly or indirectly as a result of the use, application, or interpretation of the material presented.

References:

  1. American College Health Association. American College Health Association-National College Health Assessment II: Reference Group Executive Summary Fall 2017. Hanover, MD: American College Health Association; 2018.
  2. Khan S, Khan RA (2017) Chronic Stress Leads to Anxiety and Depression. Ann Psychiatry Ment Health 5(1): 1091.
  3. Zhang J, Zheng Y.  How do academic stress and leisure activities influence college students’ emotional well-being? A daily diary investigation. J Adolesc. 2017 Oct;60:114-118. doi: 10.1016/j.adolescence.2017.08.003. Epub 2017 Aug 23.
  4. Trainor, P. Delfabbro, S. Anderson, A. Winefield. Leisure activities and adolescent psychological well-being. Journal of Adolescence, 33 (1) (2010), pp. 173-186.
  5. Pressman, S. D, et. al. Association of Enjoyable Leisure Activities With Psychological and Physical Well-Being. Psychosomatic Medicine: September 2009 – Volume 71 – Issue 7 – pp 725-732 doi: 10.1097/PSY.0b013e3181ad7978Top of Form

 

Smartphone Apps for Mental Health

By R. Ryan S Patel DO, FAPA OSU-CCS Psychiatrist

Most people today are familiar with apps for smartphones.  There are apps for many different purposes including mental health. In fact in 2015, mental health apps made up almost a third of disease specific apps in app marketplaces (1).

Some but not all apps are evidence based, researched, and known to work and some other apps are based on evidence based skills.

A 2017 meta review of studies looked at 190 individual papers researching 147 unique digital health tools and found that there may be some benefit of using apps for depression and anxiety but unclear benefit for other disorders at the time of publication. They also found research and method limitations for many studies (2).

A recent study looked at an app called “Virtual hope box” (VHB) (3).

Who was studied? (3)

  • 118 U.S. service veterans receiving mental health treatment and had a recent history of suicidal ideation.
  • They were divided into two groups.
  • One group received mental health treatment as usual supplemented with the VHB app and another group received treatment as usual supplemented with printed materials about coping with suicidality over a 12-week period.

What was measured? (3)

Using validated scales, the study authors measured coping, suicidal ideation, reasons for living, perceived stress and interpersonal needs at various points of the study.

What were the results? (3)

  • Participants using virtual hope box app showed improvements in their ability to cope with unpleasant emotions and thoughts over time.
  • Users found the app helpful for relaxation and distraction or inspiration when feeling distressed, when emotions were overwhelming, or when they felt like hurting themselves.
  • Participants found it easy to use, helpful in dealing with stress and emotional difficulties, likely to use in the future, and would recommended to others.

What are some caveats?

  • This is a small study and may not be applicable to everyone.
  • There are many apps for mental health but research in this area is limited.
  • Newer apps are being introduced frequently.
  • This is a new field of research, and as we learn more, study designs and outcome measures are being improved upon.
  • Not all the apps are free.
  • Mental health apps do not take place of professional treatment.
  • Your mental health professional may be helpful in considering the right app mental health for you.
  • There are many apps that use evidence based techniques such as apps for cognitive behavior therapy, relaxation skills, prolonged exposure, dialectical behavior therapy, mindfulness based apps, etc.
    • One such example is the OSUCCS app, which can be obtained from the app store.

How much time are you spending on your phone? How are apps in general impacting your mental health? Which app is helping you and which is not?

Disclaimer: This article is intended to be informative only. It is advised that you check with your own physician/mental health provider before implementing any changes. With this article, the author is not rendering medical advice, nor diagnosing, prescribing, or treating any condition, or injury; and therefore claims no responsibility to any person or entity for any liability, loss, or injury caused directly or indirectly as a result of the use, application, or interpretation of the material presented.

References:

  1. IMS Institute for Healthcare Informatics. (2015). Patient adoption of mHealth: Use, evidence and remaining barriers to mainstream acceptance. Parsippany, NJ: IMS Institute for Healthcare Informatics.
  2. Hollis, C., Falconer, C. J., Martin, J. L., Whittington, C., Stockton, S., Glazebrook, C. and Davies, E. B. (2017), Annual Research Review: Digital health interventions for children and young people with mental health problems – a systematic and meta-review. J Child Psychol Psychiatr, 58: 474–503. doi:10.1111/jcpp.12663
  3. Nigel E. Bush, Ph.D., Derek J. Smolenski, Ph.D., Lauren M. Denneson, Ph.D., Holly B. Williams, B.A., Elissa K. Thomas, L.P.N., C.C.R.C., Steven K. Dobscha, M.D. A Virtual Hope Box: Randomized Controlled Trial of a Smartphone App for Emotional Regulation and Coping With Distress.  Psychiatric Services 2017; 68:330–336; doi: 10.1176/appi.ps.201600283.