DEPRESSION zyxwvut 019%953X/OO $15.00 zy + z .OO DOCOSAHEXANOIC ACID AND OJ-3 zyx FATTY ACIDS IN DEPRESSION David Mischoulon, MD, PhD, and Maurizio Fava, MD Despite the tremendous advances in the treatment of major de- pressive disorder, 30% to 50% of patients treated with antidepressants still may not respond adequately, even after multiple trials of different medication^.'^, l8 Obstacles to effective antidepressant treatment include limited efficacy of some antidepressants in some individuals and adverse effects that may prevent the achievement of a therapeutic dose or may overwhelm the benefits of medications when they work. The develop- ment of a safe, effective antidepressant with minimal or no side effects is a primary goal in the field of psychopharmacology. Natural remedies, although used for centuries worldwide, have become increasingly popular in the United States over the past few years, particularly for the treatment of depressive and anxious symp- toms. Part of their appeal is caused by ease of accessibility because they are available without a prescription; also, they typically have more favorable side-effect profiles than do marketed antidepressants; however, limited research data answer whether these medications are effective, preferable to conventional remedies, or superior to placebo.38, 39 Several natural psychotropics have been studied, including St. John's wort, kava, ginkgo biloba, and s-adenosyl methionine.", 52 Most controlled studies tend to support their use in treating mild to moderate illness rather than severe illness. Their relatively benign side-effect pro- files seem to make them more tolerable to patients, however. No pub- From the Depression Clinical and Research Program, Department of Psychiatry, Massachu- setts General Hospital and Harvard Medical School, Boston, Massachusetts THE PSYCHIATRIC CLINICS OF NORTH AMERICA VOLUME 23 NUMBER zyxwvut 4 DECEMBER 2000 785