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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 19 of 19. This is the beginning of the thread.
Posted by brynb on September 19, 2012, at 22:14:09
I am taking Nordic Naturals Omega 3. The directions call for 2 capsules a day, but I was wondering if I should be taking more (or what the right therapeutic dose is) for mood stabilization/improvement.
Thanks in advance.
Posted by Hugh on September 20, 2012, at 12:19:29
In reply to Fish Oil, posted by brynb on September 19, 2012, at 22:14:09
This is from http://www.fattyacidtrip.com/stoll-interview-post/
Dr. Stoll: Our omega-3-fatty-acids-in-bipolar study was the first controlled study in psychiatry. We really had no way of knowing what the minimum effective dosage as, so we decided to use a moderately high dosage that had been successfully used in omega-3 studies of rheumatoid arthritis and other medical disorders. This dosage was about 10 grams per day (6.5 grams of EPA and 3.5 grams of DHA daily). Most of the newer omega-3 studies in major depression used a very low dosage of pure EPA added to partially effective or noneffective antidepressants. For example, in one small study, Dr. Malcolm Peet and colleagues from England compared one gram a day of EPA to two grams a day of EPA, and up to four grams of EPA per day. One gram of EPA did the best by far. The most recent depression study, done by a group from Taiwan, was another unipolar study where they added omega-3 to an antidepressant regimen that was not working. They used the same exact formulation that we didnearly 10 grams of EPA plus DHA in about a 3:2 ratiowith good results.
So, the question of optimal dosage remains unanswered. Practically, I start patients on one gram of EPA per day, and go up on the dosage gradually until an effect is seen on a persons mood. I usually do not have to exceed six grams of EPA per day. The amount of omega-3 in a supplement may be calculated from the side of the bottle.
It is important to know that the amount of active ingredients in supplements is listed on the label by serving size, not necessarily by how much of an ingredient or compound is in one capsule. Companies can make the serving size one, two, three, or a hundred capsulesas big or small as they want.
To determine omega-3 content, simply take the amount of EPA or EPA plus DHA per serving, as listed on the label, and divide it by the serving size to determine how much omega-3 is in each capsule. Thats not understood well by many people. It is important that people read labels carefully. They get fooled.
The FDA requires that supplement manufacturers list the ingredients or nutrients by serving size. But the company can put in any serving size they want, so it may look like there is a lot of EPA, for example, in a product, but the serving size may be 10 capsules. Consumers should be sure to divide whatever value is in the column for the amount of EPA by the number of capsules in a serving, and read labels carefully.
Post: What dose of omega-3 do you recommend and find most effective?
Dr. Stoll: I will distinguish the doses. I usually start everyone on one gram of EPA per day. I prefer to have a little bit of DHA in the formula. They should be at least in a 3:2 or 2:1 EPA to DHA ratio. If one gram doesnt help after one to two weeks, I will raise the dosage to two grams a day of EPA. I definitely use lower doses than I used to, based on the depression data. Occasionally, someone will call or e-mail me with an anecdote that they didnt respond until they were taking 10 grams a daythe original dose in our study. Hopefully, we will resolve that issue in the next few years.
Posted by brynb on September 21, 2012, at 10:52:30
In reply to Re: Fish Oil, posted by Hugh on September 20, 2012, at 12:19:29
Thanks, Hugh, good info. I'll discuss w/ my pdoc when I see him next.
Posted by phillipa on September 21, 2012, at 12:32:03
In reply to Re: Fish Oil » Hugh, posted by brynb on September 21, 2012, at 10:52:30
I also have Nordic Naturals "Ultimate Omega -d 3" Label reads purified fish ol with vitamin D3 For immune function and bone health. Side total omega 3's 1280mg, Epa 650mg, Dha 450mg other omega 3's 180mg Per serving to gel caps. So how does this compute? Was recommended by a compounding pharmacist who takes 2 a day himself? Phillipa
Posted by Christ_empowered on September 29, 2012, at 12:20:54
In reply to Re: Fish Oil » brynb, posted by phillipa on September 21, 2012, at 12:32:03
Clearly, I'm not your doctor. However, I was thinking that instead of ramping up the fish oil to rather high doses, why not throw in some additional mood stabilizing supplements at lower doses? Kinda like a natural cocktail for your mood.
Taurine has been studied (4 grams/day) in conjunction with atypicals as an anti-manic. Works well, also protects the brain from the neuroleptic (prevents TD!). I take a lower dose (2 grams minimum) daily, plus 3 grams niacinamide, plus b-100, plus 10 grams time release C (2 equal 5 gram doses, AM+PM).
I'm a die hard Orthomolecular fan, simply because it worked so well for me. I have either Bipolar I w/Psychotic Features *or* Schizoaffective, manic type. I'm sensitive to neuroleptics (even the atypicals trigger EPS and dysphoria), prone to mixed states and lingering agitation, and naturally anxious.
I'm on just 2 meds--30mgs/day Abilify and 900mgs/day Neurontin. In my dream world, it'd be 10-20 Abilify but, hey--you don't always get what you want, right? At least its Abilify, and the 30mgs/day dose has continued to work, at least with a second medication on board to "smooth things over" when I hit agitated and/or low states. Good stuff.
Again, I'm just sharing this with you because its worked so well for me. I used to be on cocktails and in therapy and lots of my hair fell out (too many pills, especially benzos and amphetamines) and I looked old, etc. etc. Now, thanks to the psych meds+nutrients+ a couple of cheap, Indian generic pharmaceuticals (Propecia/finasteride for hair and Retin-A/tretinoin for skin), I'm looking and feeling pretty darn good. No EPS, no TD, no cognitive impairments, no drug-induced dysphoria. According to my friends, I even look a little bit younger than my 28 years (I guess that for guys--around here at least--that's when you start to see wear and tear).
If you're interested at all in OM (I hope you are--again, simply because it literally saved my life), there's a website I'd recommend:
www.doctoryourself.com
Pretty good stuff. He also links over to and references other experts and sites, so you can find all sorts of additional info just by hunting around on his site.
Good luck!
Posted by brynb on September 29, 2012, at 14:11:55
In reply to Re: Fish Oil, posted by Christ_empowered on September 29, 2012, at 12:20:54
> Clearly, I'm not your doctor. However, I was thinking that instead of ramping up the fish oil to rather high doses, why not throw in some additional mood stabilizing supplements at lower doses? Kinda like a natural cocktail for your mood.
>
> Taurine has been studied (4 grams/day) in conjunction with atypicals as an anti-manic. Works well, also protects the brain from the neuroleptic (prevents TD!). I take a lower dose (2 grams minimum) daily, plus 3 grams niacinamide, plus b-100, plus 10 grams time release C (2 equal 5 gram doses, AM+PM).
>
> I'm a die hard Orthomolecular fan, simply because it worked so well for me. I have either Bipolar I w/Psychotic Features *or* Schizoaffective, manic type. I'm sensitive to neuroleptics (even the atypicals trigger EPS and dysphoria), prone to mixed states and lingering agitation, and naturally anxious.
>
> I'm on just 2 meds--30mgs/day Abilify and 900mgs/day Neurontin. In my dream world, it'd be 10-20 Abilify but, hey--you don't always get what you want, right? At least its Abilify, and the 30mgs/day dose has continued to work, at least with a second medication on board to "smooth things over" when I hit agitated and/or low states. Good stuff.
>
> Again, I'm just sharing this with you because its worked so well for me. I used to be on cocktails and in therapy and lots of my hair fell out (too many pills, especially benzos and amphetamines) and I looked old, etc. etc. Now, thanks to the psych meds+nutrients+ a couple of cheap, Indian generic pharmaceuticals (Propecia/finasteride for hair and Retin-A/tretinoin for skin), I'm looking and feeling pretty darn good. No EPS, no TD, no cognitive impairments, no drug-induced dysphoria. According to my friends, I even look a little bit younger than my 28 years (I guess that for guys--around here at least--that's when you start to see wear and tear).
>
> If you're interested at all in OM (I hope you are--again, simply because it literally saved my life), there's a website I'd recommend:
>
> www.doctoryourself.com
>
> Pretty good stuff. He also links over to and references other experts and sites, so you can find all sorts of additional info just by hunting around on his site.
>
> Good luck!
>Hi CE,
Thanks so much for the info--great stuff!! I am into OM, and will definitely check out that link. Thanks again.
Posted by Hyena on December 1, 2012, at 7:31:51
In reply to Fish Oil, posted by brynb on September 19, 2012, at 22:14:09
Higher doses of EPA than DHA is the best. I take 1500mg EPA daily. Make sure you take vitamin e mixed natural tocopherols with it. These will make the effect stronger for you.
I have found that some supplements when combined with fish oil make me depressed. Test it out yourself and see.
Posted by Prefect on December 1, 2012, at 10:28:52
In reply to Re: Fish Oil, posted by Hyena on December 1, 2012, at 7:31:51
I take 4.5 grams of fish oil containing 2.3 g of fatty acids a day (1.5 g EPA, 0.5 g DHA). Started 3 months ago.
Has done absolutely nothing for my anxiety, but wow has had an amazing effect on recovery from sports injuries and bruises, as well as exercise tolerance. My bruises literally disappear in 2 days, and maybe I'm imagining things, but I can do many more reps and higher weights during strength training. Coincidence? Who knows.
Posted by Hyena on December 8, 2012, at 6:31:27
In reply to Re: Fish Oil, posted by Prefect on December 1, 2012, at 10:28:52
> I take 4.5 grams of fish oil containing 2.3 g of fatty acids a day (1.5 g EPA, 0.5 g DHA). Started 3 months ago.
>
> Has done absolutely nothing for my anxiety, but wow has had an amazing effect on recovery from sports injuries and bruises, as well as exercise tolerance. My bruises literally disappear in 2 days, and maybe I'm imagining things, but I can do many more reps and higher weights during strength training. Coincidence? Who knows.
do you take it all together or separate the doses? i find taking too much in one go actually lowers the effect. so i take 1g epa in morning then 500mg in afternoon with about 800iu vitamin e. if i took 1500mg together i would feel very little effect.
Posted by brynb on December 8, 2012, at 10:26:04
In reply to Re: Fish Oil, posted by Hyena on December 8, 2012, at 6:31:27
I actually stopped taking it all together. All of my other supplements too.
My blood tests showed all my vitamins to be normal, and after speaking to my doc about it, it just seemed unnecessary (an overkill, really) in my particular case.
Posted by Prefect on December 9, 2012, at 20:26:51
In reply to Re: Fish Oil, posted by brynb on December 8, 2012, at 10:26:04
No I break it down. I take a pill 4 times a day (as per bottle instructions) with some type of food. Look for quality product with fish oil. Some are made of larger fish which contain higher amount of toxins. Ascenta is a good product. Every bottle comes with a number you can use on their website to check the results of quality control tests they did on that very bottle, and they're quality certified.
Posted by hyena on December 11, 2012, at 3:35:30
In reply to Re: Fish Oil, posted by Prefect on December 9, 2012, at 20:26:51
> No I break it down. I take a pill 4 times a day (as per bottle instructions) with some type of food. Look for quality product with fish oil. Some are made of larger fish which contain higher amount of toxins. Ascenta is a good product. Every bottle comes with a number you can use on their website to check the results of quality control tests they did on that very bottle, and they're quality certified.
do you take any vitamin e with it? it makes it work much better for me. you might get a better result taking 2 pills at a time also. or you could try 1 pill on an empty stomach. some brands worked like this for me.
also some other nutrients like too much b vitamins can actually weaken the effect or cause a negative effect.
all I can say is that Epa has destroyed my depression and anxiety for more than 2 years now. its given me my life back.
Posted by Prefect on December 11, 2012, at 19:39:10
In reply to Re: Fish Oil » Prefect, posted by hyena on December 11, 2012, at 3:35:30
I don't get depressed. But am going through anxiety, panic and agoraphobia last 4 months after a 7 year remission.
Been taking EFAs for 3 months, absolutely no effect on my anxiety. Might be because my condition may be too severe for it to effect.
But exercise tolerance and injury healing has been almost shocking since I've been taking these things.
Posted by ihatedrugs on January 12, 2013, at 19:13:46
In reply to Re: Fish Oil » Prefect, posted by hyena on December 11, 2012, at 3:35:30
> > No I break it down. I take a pill 4 times a day (as per bottle instructions) with some type of food. Look for quality product with fish oil. Some are made of larger fish which contain higher amount of toxins. Ascenta is a good product. Every bottle comes with a number you can use on their website to check the results of quality control tests they did on that very bottle, and they're quality certified.
>
> do you take any vitamin e with it? it makes it work much better for me. you might get a better result taking 2 pills at a time also. or you could try 1 pill on an empty stomach. some brands worked like this for me.
> also some other nutrients like too much b vitamins can actually weaken the effect or cause a negative effect.
> all I can say is that Epa has destroyed my depression and anxiety for more than 2 years now. its given me my life back.Hi Hyena,
I wanted to know if you still take Morepa or do you take another brand. I did a little bit of research on Morepa and they are all pretty positive.
thanks
ihatedrugs
Posted by Hyena on January 24, 2013, at 15:12:12
In reply to Re: Fish Oil » hyena, posted by ihatedrugs on January 12, 2013, at 19:13:46
hi, yes i still take morepa daily. it's the best brand ive found but if you cant get your hands on it i can also recommend dr tolonen's e epa which worked quite well for me. Source Naturals, ArcticPure EPA is another brand i saw on iherb that looks pretty good. basically any that have ~500 mg epa per pill and as low dha as possible should be good. also remember what i said about vitamin e helping boost the effect and some other substances that can cause a negative reaction when taken with epa.
if you have any other questions let me know.>
> Hi Hyena,
>
> I wanted to know if you still take Morepa or do you take another brand. I did a little bit of research on Morepa and they are all pretty positive.
>
> thanks
> ihatedrugs
>
Posted by AlexCanada on February 23, 2013, at 5:49:22
In reply to Re: Fish Oil, posted by Hyena on December 1, 2012, at 7:31:51
> Higher doses of EPA than DHA is the best. I take 1500mg EPA daily. Make sure you take vitamin e mixed natural tocopherols with it. These will make the effect stronger for you.
> I have found that some supplements when combined with fish oil make me depressed. Test it out yourself and see.Which supps combined w fishoil made you depressed? I usually notice a positive benefit from Omega 3 epa 500 dha 70 (2000-4000mg a day). I began to feel worse past 3 days and it was directly correlated to me stopping omega 3.
But sometimes I have felt that at certain times it may have made me worse and I could not understand why.
Other meds/sups I take are:
Valium 2.25mg
ritalin 5mg
Magnesium Citrate 4000-6000mg (might be raising due to strong positive benefit)
Resveratrol 500-1000mg a day
L-Tyrosine 500-1000mg a day (might be dropping)
B6 200-300mg a day
ginkgo 120mg a day
Licorice root 900mg a day (this one is a bit odd. can increase my ability to feel emotions, especially kindness and genuine empathy but a bit inconsistent. likely the pro-estrogen effect)
Posted by AlexCanada on February 23, 2013, at 5:55:52
In reply to Re: Fish Oil » Prefect, posted by hyena on December 11, 2012, at 3:35:30
> > No I break it down. I take a pill 4 times a day (as per bottle instructions) with some type of food. Look for quality product with fish oil. Some are made of larger fish which contain higher amount of toxins. Ascenta is a good product. Every bottle comes with a number you can use on their website to check the results of quality control tests they did on that very bottle, and they're quality certified.
>
> do you take any vitamin e with it? it makes it work much better for me. you might get a better result taking 2 pills at a time also. or you could try 1 pill on an empty stomach. some brands worked like this for me.
> also some other nutrients like too much b vitamins can actually weaken the effect or cause a negative effect.
> all I can say is that Epa has destroyed my depression and anxiety for more than 2 years now. its given me my life back.Hi. I will try Vitamin E but I'm wondering how exactly it effects omega 3? just increases effect?
Also you mention B vitamins. I currently take B6 200-300mg a day. Would this cause negative effects for omega? If so how? Because I notice sometimes omega gives me more of a benefit while other times it seems to do little.
Should I skip on the B6 for now?
I also take other substances such as anti-oxidant Resveratrol. Would this or anything else I take be a bad mix?
List of my meds/sups:
Valium 2.25mg (spread though day)(trying withdrawal)
ritalin 5mg (spread through day)
Magnesium Citrate 4000-6000mg (might be raising due to strong positive benefit)
Resveratrol 500-1000mg a day
L-Tyrosine 500-1000mg a day (might be dropping)
B6 200-300mg a day
ginkgo 120mg a day
Licorice root 900mg a day (this one is a bit odd. can increase my ability to feel emotions, especially kindness and genuine empathy but a bit inconsistent. likely the pro-estrogen effect)
Posted by Hyena on March 13, 2013, at 14:18:03
In reply to Vitamin B and E benefits/detriments » hyena, posted by AlexCanada on February 23, 2013, at 5:55:52
> > > No I break it down. I take a pill 4 times a day (as per bottle instructions) with some type of food. Look for quality product with fish oil. Some are made of larger fish which contain higher amount of toxins. Ascenta is a good product. Every bottle comes with a number you can use on their website to check the results of quality control tests they did on that very bottle, and they're quality certified.
> >
> > do you take any vitamin e with it? it makes it work much better for me. you might get a better result taking 2 pills at a time also. or you could try 1 pill on an empty stomach. some brands worked like this for me.
> > also some other nutrients like too much b vitamins can actually weaken the effect or cause a negative effect.
> > all I can say is that Epa has destroyed my depression and anxiety for more than 2 years now. its given me my life back.
>
> Hi. I will try Vitamin E but I'm wondering how exactly it effects omega 3? just increases effect?
>
> Also you mention B vitamins. I currently take B6 200-300mg a day. Would this cause negative effects for omega? If so how? Because I notice sometimes omega gives me more of a benefit while other times it seems to do little.
>
> Should I skip on the B6 for now?
>
> I also take other substances such as anti-oxidant Resveratrol. Would this or anything else I take be a bad mix?
>
> List of my meds/sups:
> Valium 2.25mg (spread though day)(trying withdrawal)
> ritalin 5mg (spread through day)
> Magnesium Citrate 4000-6000mg (might be raising due to strong positive benefit)
> Resveratrol 500-1000mg a day
> L-Tyrosine 500-1000mg a day (might be dropping)
> B6 200-300mg a day
> ginkgo 120mg a day
> Licorice root 900mg a day (this one is a bit odd. can increase my ability to feel emotions, especially kindness and genuine empathy but a bit inconsistent. likely the pro-estrogen effect)hi,
for me vitamin e boosts the effect of fish oil. i think it works by preventing the oil becoming rancid in my body.
b vits for me react badly with fish oil. i get more depressed when i mix them. i dont know why. i just avoid them.
thats a very high dose of b6 you're taking. does it benefit you in any way?
resveratrol didnt react badly with FO for me at all. other things did though including: magnesium, selenium and rhodiola.
the best way to find out what helps or hinders is to keep a daily journal of what you take, the foods you eat and exercise you do etc, and how your mood is after. you will quickly see patterns emerge and find out what makes you feel better/worse. this approach helped me hugely to make progress against anxiety/depression.
Posted by alexcanada on March 14, 2013, at 0:50:11
In reply to Re: Vitamin B and E benefits/detriments » AlexCanada, posted by Hyena on March 13, 2013, at 14:18:03
What kind of negative reaction did you have when you mixed Resveratrol + Magnesium or + Rhodiola? Magnesium w Res in the picture has been very inconsistent for me. It sometimes would make me feel a bit better, some small happiness and emotion but often sedation and ironically emotional numbing. Sometimes the benefit would come few hours later while initially I'd feel like crap.
Yeah sometimes when I took Omega 3 with B6 within an hour of one another I'd feel worse and in a darker mood pretty shortly. I suppose it should only be one or the other? Not worth the risk if they are even 12 hours of one another?
The B6 tended to make me a bit more awake and alert but aside from that I wasn't sure if it was helping much. It may have added Anx possibly.
I no longer take B6, Omega 3, Magnesium (accidentally posted 10x my actual dose earlier btw), Tyrosine, or Licorice Root. All of those out of the picture and I feel a little bit better. No longer does it feel like the world is crashing down around me. I do still take Resveratrol about 600+ mg a day and also around 240mg ginkgo biloba. This is with my ritalin, valium, and 100mg gabapentin/neurotin.
Both anti-oxidants. I wonder if any adverse effect.
Would D3 be any issue with my meds and supplements?
Licorice root had some absolute positive effect for my poor interest, and also allowed me to have more emotion but whether it was the Licorice or something interacting I... began to feel quite a bit of general anxiety. The kind which would emerge for no reason. Extremely troubling and uncomfortable. Eventually I stopped it due to bleeding side effect and for some reason my skin was becoming extremely dry. This was at 900mg Licorice Root.
I do keep journals but sometimes can be very difficult to pin point exactly what is doing what. I've tried to simplify things lately though by dropping most supplements I been taking. Some progress but even w journals it can be difficult to wrap my head around things. I may be young but my memory is often very poor.
> for me vitamin e boosts the effect of fish oil. i think it works by preventing the oil becoming rancid in my body.
> b vits for me react badly with fish oil. i get more depressed when i mix them. i dont know why. i just avoid them.
> thats a very high dose of b6 you're taking. does it benefit you in any way?
> resveratrol didnt react badly with FO for me at all. other things did though including: magnesium, selenium and rhodiola.
> the best way to find out what helps or hinders is to keep a daily journal of what you take, the foods you eat and exercise you do etc, and how your mood is after. you will quickly see patterns emerge and find out what makes you feel better/worse. this approach helped me hugely to make progress against anxiety/depression.
>
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