***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE Docosahexaenoic acid ( DHA ) might help prevent or attenuate posttraumatic stress disorder ( PTSD ) symptoms . We examined the efficacy and safety of DHA for preventing PTSD ( DSM-IV ) after severe accidental injury . METHOD From December 2008 to August 2013 , we conducted a r and omized , double-blind , placebo-controlled trial of 110 accident-injured patients consecutively admitted to an intensive care unit of the National Disaster Medical Center in Tokyo , Japan . All patients were taught about their psychological reactions to accidental injury for 20 minutes and were r and omly assigned to receive 1,470 mg/d of DHA plus 147 mg/d of eicosapentaenoic acid ( EPA ; n = 53 ) or placebo ( n = 57 ) for 12 weeks . The primary outcome was total score on the Clinician-Administered PTSD Scale ( CAPS ) at 3-month follow-up . Secondary outcomes included PTSD diagnosis ( full-blown or partial PTSD ) . Adherence to the interventions was assessed by erythrocyte fatty acid composition . RESULTS At 3 months , the CAPS total score revealed no differences between the 2 groups ( 10.78 in the DHA group vs 9.22 in the placebo group ; n = 100 ; P = .572 ) . We found that 11.1 % of the DHA group and 5.5 % of the placebo group developed PTSD . The erythrocyte level of DHA and EPA in the DHA group was significantly elevated compared to the placebo group ( P < .01 ) . CONCLUSIONS Docosahexaenoic acid supplementation was not superior to placebo for the secondary prevention of PTSD symptoms at 3 months after severe accidental injury . The efficacy of a different ratio of DHA and EPA and higher doses of omega-3 fatty acids as secondary prevention of PTSD remains to be determined . TRIAL REGISTRATION Clinical Trials.gov Identifier : NCT00671099 BACKGROUND Polyunsaturated fatty acids ( PUFAs ) are intrinsic cell membrane components and closely involved in neurotransmission and receptor function . Lower omega-3 levels are associated with increased risk of coronary artery disease ( CAD ) , increases in cardiac events in CAD patients , and depression . We sought to examine relationships between depression and serum levels of omega-3 and omega-6 PUFAs in patients recovering from acute coronary syndromes ( ACS ) . METHODS We carried out a case-control study of serum  PUFA levels and current major depression in 54 age- and sex-matched pairs approximately 2 months following ACS .  RESULTS Depressed patients had significantly lower concentrations of total omega-3 and docosahexaenoic acid ( DHA ) , and higher ratios of arachidonic acid ( AA ) to DHA , AA to eicosapentaenoic acid ( EPA ) , and n-3 to n-6 than controls . There were no baseline differences in any potential risk or protective factors for depression . CONCLUSIONS Results are consistent with previous reports in depressed patients without CAD , and with literature concerning omega-3 levels and risk of CAD events . Dietary , genetic , and hormonal factors may all play a role in both depression and CAD . Both prospect i ve studies and r and omized trials are needed to help clarify the interrelationships Objectives : Somatic symptoms are common in depressive disorder and are similar to sickness behaviors due to inflammatory activation after cytokine administration . Omega-3 polyunsaturated fatty acids ( PUFAs ) are natural anti-inflammatory agents and may reduce inflammation-induced behavioral changes . The aim of this study was to investigate the role of PUFAs on the development of somatic symptoms and depression in patients of hepatitis C virus infection ( HCV ) receiving interferon-alpha therapy ( IFN-α )  in a prospect i ve manner . Methods : In this 24-week , prospect i ve cohort study , 43 patients with chronic HCV ongoing IFN-α therapy  were assessed with the mini-international neuropsychiatric interview for major depressive episodes and neurotoxicity rating scale ( NRS ) for somatic symptoms . Results : One-third later developed IFN-α-induced depression ( depression ( DEP ) group ) . As compared to subjects without depression , DEP group had higher NRS scores ( P < 0.001 ) , lower eicosapentaenoic acid ( EPA ) levels ( P = 0.038 ) at week 2 . Somatic symptoms , regardless of painful/non-painful characteristics , had positive association with arachidonic acid ( P < 0.05 ) , and negative association with EPA ( P < 0.05 ) . Conclusion : This study implies that early intervention with omega-3 PUFAs might be a promising strategy to prevent depression and somatic symptoms in patients receiving cytokine therapy BACKGROUND It is suggested that a low intake of fish and /or n-3 PUFA is associated with depressed mood . However , results from epidemiologic studies are mixed , and r and omized trials have mainly been performed in depressed patients , yielding conflicting results . OBJECTIVE We investigated the effect of eicosapentaenoic acid ( EPA ) and docosahexaenoic acid ( DHA ) on mental well-being in a double-blind , placebo-controlled trial . DESIGN Independently living individuals ( n = 302 ) aged > or = 65 y were r and omly assigned to consume 1800 mg/d EPA+DHA , 400 mg/d EPA+DHA , or placebo capsules for 26 wk . Changes in mental well-being were assessed as the primary outcome with the Center for Epidemiologic Studies Depression Scale ( CES-D ) , Montgomery-Asberg Rating Scale ( MADRS ) , Geriatric Depression Scale ( GDS-15 ) , and Hospital Anxiety and Depression Scale ( HADS-A ) . RESULTS Plasma concentrations of EPA+DHA  increased by 238 % in the high-dose and 51 % in the low-dose fish-oil group compared with the placebo group , reflecting excellent compliance . Baseline CES-D scores ranged from 5.9 to 6.8 in the 3 groups and were not significantly different between groups . Mean changes in CES-D scores after 26 wk were -0.2 , 0.2 , and -0.4 ( P = 0.87 ) in the high-dose fish oil , low-dose fish oil , and placebo groups , respectively . Treatment with neither 1800 mg nor 400 mg EPA+DHA differentially affected any of the measures of mental well-being after 13 or 26 wk of intervention compared with placebo . CONCLUSIONS In this r and omized , double-blind , placebo-controlled trial we observed no effect of EPA+DHA supplementation for 26 wk on mental well-being in the general older population studied . This trial was registered at clinical trials.gov as NCT00124852 The efficacy of omega-3 fatty acids for maintaining a better mental state has not been examined among working population s. We aim ed to explore the effectiveness of omega-3 fatty acids for hospital nurses . In a multi-center r and omized trial , 80 junior nurses were r and omly allocated to either omega-3 fatty acids ( 1200 mg/day of eicosapentaenoic acid and 600 mg/day of docosahexaenoic acid ) or identical placebo pills for 13 weeks . The primary outcome was the total score of the Hospital Anxiety and Depression Scale ( HADS ) , determined by a blinded rater at week 26 from the study enrolment . Secondary outcomes included the total score of the HADS at 13 and 52 weeks ; incidence of a major depressive episode ; severity of depression , anxiety , insomnia , burnout , and presenteeism ; utility scores ; and adverse events at 13 , 26 and 52 weeks . The mean HADS score at baseline was 7.2 . At 26 weeks , adjusted mean scores on the HADS were 6.32 ( 95 % CIs of st and ard errors : 5.13 , 7.52 ) in the intervention and 6.81 ( 5.57 , 8.05 ) in the placebo groups , respectively . The coefficient of the group by time interaction was not statistically significant at 0.58 ( -1.35 , 2.50 ; P = 0.557 ) . Although the intervention group showed significant superiority on the HADS score at 52 weeks , depression severity at 52 weeks , insomnia severity at 13 weeks , and absolute presenteeism at 26 weeks , no significant superiority or inferiority was observed on the other outcomes . The additive value of omega-3 fatty acids was not confirmed regarding mental state and self-evaluated work efficiency Psychiatric disorders in general , and major depression and anxiety disorders in particular , account for a large burden of disability , morbidity and premature mortality worldwide . Omega-3 polyunsaturated fatty acids ( PUFAs ) have a range of neurobiological activities in modulation of neurotransmitters , anti-inflammation , anti-oxidation and neuroplasticity , which could contribute to psychotropic effects . Here we review ed recent research on the benefits of omega-3 PUFA supplements in prevention against  major depression , bipolar disorders , interferon-α-induced depression patients with chronic hepatitis C viral infection , and posttraumatic stress disorder . The biological mechanisms underlying omega-3 PUFAs ’ psychotropic effects are proposed and review ed . Nutrition is a modifiable environmental factor that might be important in prevention medicine , which have been applied for many years in the secondary prevention of heart disease with omega-3 PUFAs . This review extends the notion that nutrition in psychiatry is a modifiable environmental factor and calls for more research es on prospect i ve clinical studies to justify the preventive application of omega-3 PUFAs in daily practice Objective This study examined the dose-dependent effects of eicosapentaenoic acid ( EPA ) and docosahexaenoic acid ( DHA ) supplementation on heart rate variability ( HRV ) at rest and during st and ard laboratory stress tasks . We also investigated whether EPA + DHA supplementation was associated with changes in mood state . Methods This placebo-controlled , double-blind , r and omized , three-period crossover trial ( 8-week treatment , 6-week washout ) compared two doses of EPA + DHA supplementation ( 0.85 and 3.4 g/d ) in 26 adults with elevated triglycerides . After each treatment period , HRV was assessed during an acute stress protocol that included a resting baseline , st and ard laboratory stress tasks ( speech task and cold pressor ) , and recovery periods . In addition , mood state was assessed . Results Root mean square of successive differences in interbeat interval and total power increased 9.9 % and 20.6 % , respectively , after the high dose relative to placebo ( Tukey p = .016 and .012 , respectively ) . The low dose was not significantly different from the high dose or placebo dose . There was a trend for a treatment effect on high-frequency HRV ( p = .058 ) , with 21.0 % greater power observed after the high dose compared with placebo ( Tukey p = .052 ) . Mood did not differ between treatments , and there was no association between mood state and HRV . Conclusions In healthy adults with elevated triglycerides , supplementation of 3.4 g/d EPA + DHA result ed in greater HRV , whereas 0.85 g/d EPA + DHA had no effect . These results indicate that EPA + DHA supplementation may improve autonomic tone in adults at increased risk for cardiovascular disease within 8 weeks . Trial Registration NCT00504309 ( Clinical Trials.gov ) OBJECTIVE To determine whether supplementation with the long-chain omega-3 polyunsaturated fatty acids eicosapentaenoic ( EPA ) and docosahexaenoic acid ( DHA ) affects behavioral symptoms and cognitive impairments in children 6 - 12 years of age diagnosed with attention-deficit/hyperactivity disorder ( ADHD ) . STUDY DESIGN The r and omized , double-blind placebo-controlled 16 weeks trial was conducted with 95 children diagnosed with ADHD according to DSM-IV criteria . Behavior was assessed by parents , teachers and investigators using st and ardized rating scales and question naires . Further outcome variables were working memory , speed of information processing and various measures of attention . For a subgroup of 81 participants , erythrocyte membrane fatty acid composition was analyzed before and after the intervention . RESULTS Supplementation with the omega-3 fatty acid mix increased EPA and DHA concentrations in erythrocyte membranes and improved working memory function , but had no effect on other cognitive measures and parent- and teacher-rated behavior in the study population . Improved working memory correlated significantly with increased EPA , DHA and decreased AA ( arachidonic acid ) Observational studies have linked lower omega-3 ( n-3 ) polyunsaturated fatty acids ( PUFAs ) and higher omega-6 ( n-6 ) PUFAs with inflammation and depression , but r and omized controlled trial ( RCT ) data have been mixed . To determine whether n-3 decreases proinflammatory cytokine production and depressive and anxiety symptoms in healthy young adults , this parallel group , placebo-controlled , double-blind  
    Output:
    
Subgroup analysis showed that the association of treatment with reduced anxiety symptoms was significantly greater in subgroups with specific clinical diagnoses than in subgroups without clinical conditions .
The anxiolytic effect of omega-3 PUFAs was significantly better than that of controls only in subgroups with a higher dosage ( at least 2000 mg/d ) and not in subgroups with a lower dosage ( < 2000 mg/d ) .
Conclusions and Relevance This review indicates that omega-3 PUFAs might help to reduce the symptoms of clinical anxiety .