From the Guidelines
1-2 g/day of total EPA from pure EPA or an EPA/DHA (>2:1) combination is recommended for tapering off Lexapro (escitalopram) as an adjunctive treatment for major depressive disorder (MDD) 1.
Key Considerations
- The dose can be increased in 2 weeks for non- or partial responders and titrated up to the maximum dose in 4-6 weeks if tolerable.
- It is essential to monitor adverse effects systematically, including gastrointestinal and dermatological conditions, and obtain a comprehensive metabolic panel in patients receiving higher doses of n–3 PUFAs.
- Clinicians should evaluate the quality of n–3 PUFA supplementary products for nonresponders.
Important Details
- Both pure EPA and EPA/DHA (ratio >2:1) combinations are effective as a potential treatment of MDD.
- n–3 PUFAs are considered effective as an adjunctive treatment for acute major depressive episodes, but more evidence is needed for recurrent major depressive episodes 1.
Clinical Application
- Clinicians should use n–3 PUFAs as an adjunctive treatment rather than monotherapy for adult MDD.
- n–3 PUFAs can be used for acceleration (adding n–3 at the beginning of treatment concurrently with another antidepressant) or augmentation (adding n–3 when a prior antidepressant’s effect is inadequate).
From the Research
Omega-3 Fatty Acids and Lexapro (Escitalopram) Tapering
- There is no direct evidence to support a specific dose of omega-3 fatty acids for tapering off Lexapro (escitalopram) 2, 3, 4, 5, 6.
- However, studies have investigated the use of omega-3 fatty acids in combination with antidepressants, including escitalopram, for the treatment of depression:
- A study found that combination therapy with citalopram (a related SSRI) and omega-3 fatty acids (1g/day) was effective in reducing depression symptoms in post-menopausal women 2.
- Another study found that omega-3 fatty acid levels were not correlated with early responsiveness to escitalopram, but neuroticism was a predictor of improvement 3.
- A randomized controlled trial found that combination therapy with citalopram and omega-3 fatty acids (2g/day) was more effective than monotherapy with citalopram in reducing depression symptoms 4.
- The pharmacokinetics of escitalopram have been studied, but there is no specific guidance on tapering off the medication using omega-3 fatty acids 5.
- Omega-3 fatty acids have been studied for their effects on hypertriglyceridemia, and the optimal dose for this condition is still debated 6.