human
***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: BACKGROUND Psychological distress ( PD ) and depressive symptoms are commonly observed during menopausal transition . Studies suggest that omega-3 ( n-3 ) fatty acids may help alleviate depression . OBJECTIVE The objective was to compare enriched ethyl-eicosapentaenoic acid ( E-EPA ) supplementation with placebo for the treatment of PD and depressive symptoms in middle-aged women . DESIGN Women with moderate-to-severe PD ( n = 120 ) were r and omly assigned to receive 1.05 g E-EPA/d plus 0.15 g ethyl-docosahexaenoic acid/d ( n = 59 ) or placebo ( n = 61 ) for 8 wk . The main outcomes were 8-wk changes in PD scores [ Psychological General Well-Being Schedule ( PGWB ) ] and depressive scales [ 20-item Hopkins Symptom Checklist Depression Scale ( HSCL-D-20 ) and the 21-item Hamilton Depression Rating Scale ( HAM-D-21 ) ] . RESULTS At baseline , women with PD were mildly to moderately depressed , and 24 % met the major depressive episode ( MDE ) criteria of the Diagnostic and Statistical Manual of Mental Disorders , 4th edition . After 8 wk , outcomes improved in both groups , but no significant differences were noted between them . Stratification analyses for MDE diagnosis at baseline indicated that differences in adjusted 8-wk changes between the E-EPA group without MDE ( n = 46 ) and the placebo group ( n = 45 ) were 8.0 ( 95 % CI : 0.6 , 15.3 ; P = 0.034 ) for the PGWB , -0.2 ( 95 % CI : -0.01 , -0.4 ; P = 0.040 ) for the HSCL-D-20 , and -2.7 ( 95 % CI : -0.3 , -5.1 ; P = 0.030 ) for the HAM-D-21 . Differences in adjusted 8-wk changes between the E-EPA group with MDE ( n = 13 ) and the placebo group ( n = 16 ) were not significant . CONCLUSIONS To our knowledge , this is the first trial of n-3 supplementation in the treatment of PD and depressive symptoms in middle-aged women . In women with PD without MDE at baseline , the 8-wk changes in PD and depressive scales improved significantly more with E-EPA than with placebo . This trial was registered at http://www.controlled-trials.com as IS RCT N69617477 In a prospect ive-longitudinal study of a representative birth cohort , we tested why stressful experiences lead to  depression  in some people but not in others . A functional polymorphism in the promoter region of the serotonin transporter ( 5-HT T ) gene was found to moderate the influence of stressful life events on depression . Individuals with one or two copies of the short allele of the 5-HT T promoter polymorphism exhibited more depressive symptoms , diagnosable depression , and suicidality in relation to stressful life events than individuals homozygous for the long allele . This epidemiological study thus provides evidence of a gene-by-environment interaction , in which an individual 's response to environmental insults is moderated by his or her genetic makeup BACKGROUND Recent studies indicate that depression plays an important role in the occurrence of cardiovascular diseases ( CVDs ) . The underlying mechanisms are not well understood . OBJECTIVE We investigated whether dietary intake of the n-3 fatty acids ( FAs ) eicosapentaenic acid and docosahexaenoic acid could explain the relation between depressive symptoms and cardiovascular mortality . DESIGN The Zutphen Elderly Study is a prospect i ve cohort study conducted in the Netherl and s. Depressive symptoms were measured in 1990 with the Zung Self-rating Depression Scale in 332 men aged 70 - 90 y and free from CVD and diabetes .  Dietary factors  were assessed with a cross-check dietary history method in 1990 . Mortality data were collected between 1990 and 2000 . Logistic and Cox regression analyses were performed , with adjustment for demographics and CVD risk factors . RESULTS Compared with a low intake ( x : 21 mg/d ) , a high intake ( x : 407 mg/d ) of n-3 FAs was associated with fewer depressive symptoms [ odds ratio : 0.46 ; 95 % CI : 0.22 , 0.95 ; P for trend = 0.04 ] at baseline and no significant reduced risk of 10-y CVD mortality [ hazard ratio ( HR ) : 0.88 ; 95 % CI : 0.51 , 1.50 ] . The adjusted HR for an increase in depressive symptoms with 1 SD for CVD mortality was 1.28 ( 95 % CI : 1.03 , 1.57 ) and did not change after additional adjustment for the intake of n-3 FAs . CONCLUSION An average intake of approximately 400 mg n-3 FA/d may reduce the risk of depression . Our results , however , do not support the hypothesis that the intake of n-3 FAs explains the relation between depression and CVD BACKGROUND It has been hypothesized that n-3 polyunsaturated fatty acids ( PUFAs ) are involved in mood regulation , but epidemiologic evidence for such a link in the general population is lacking . OBJECTIVE This study examined whether community-dwelling elderly persons with depression have a fatty acid composition that is different from that of nondepressed persons . DESIGN We screened 3884 adults aged > or = 60 y for depressive symptoms as part of the Rotterdam Study . Subjects who screened positive had a psychiatric interview to diagnose depressive disorders . All eligible subjects had their blood drawn for measurement of plasma phospholipid concentrations . We compared percentages of n-3 and n-6 PUFAs and their ratios between 264 subjects with depressive symptoms , including 106 subjects with depressive disorders , and 461 r and omly selected reference subjects . We also investigated whether atherosclerosis or the inflammatory response as measured by C-reactive protein underlies the relation between fatty acid composition and depression . RESULTS Subjects with depressive disorders had a higher ratio of n-6 to n-3 PUFAs , but differences in individual PUFAs were mostly small . However , depressed subjects with normal CRP concentrations ( < 1.5 mg/L ) had a substantially altered fatty acid composition ; percentages of n-3 PUFAs and ratios of n-6 to n-3 PUFAs were significantly lower and higher , respectively , in subjects with depressive disorders than in control subjects [ 5.2 % compared with 5.9 % ( P = 0.02 ) and 7.2 compared with 6.6 ( P = 0.01 ) , respectively ] . This relation was not due to atherosclerosis . CONCLUSIONS In community-dwelling persons , fatty acid composition is related to depression . Because this relation was not secondary to inflammation , atherosclerosis , or possible confounders , it suggests a direct effect of fatty acid composition on mood Background : It has been suggested that dietary patterns are associated with future risk of depressive symptoms . However , there is a paucity of prospect i ve data that have examined the temporality of this relation . Objective : We examined whether adherence to a healthy diet , as defined by using the Alternative Healthy Eating Index ( AHEI ) , was prospect ively associated with depressive symptoms assessed over a 5-y period . Design : Analyses were based on 4215 participants in the Whitehall II Study .  AHEI scores were computed in 1991–1993 and 2003–2004 . Recurrent depressive symptoms were defined as having a Center for Epidemiologic Studies Depression Scale score ≥16 or self-reported use of antidepressants in 2003–2004 and 2008–2009 . Results : After adjustment for potential confounders , the AHEI score was inversely associated with recurrent depressive symptoms in a dose-response fashion in women ( P-trend < 0.001 ; for 1 SD in AHEI score ; OR : 0.59 ; 95 % CI : 0.47 , 0.75 ) but not in men . Women who maintained high AHEI scores or improved their scores during the 10-y measurement period had 65 % ( OR : 0.35 % ; 95 % CI : 0.19 % , 0.64 % ) and 68 % ( OR : 0.32 % ; 95 % CI : 0.13 % , 0.78 % ) lower odds of subsequent recurrent depressive symptoms than did women who maintained low AHEI scores . Among AHEI components , vegetable , fruit , trans fat , and the ratio of polyunsaturated fat to saturated fat components were associated with recurrent depressive symptoms in women . Conclusion : In the current study , there was a suggestion that poor diet is a risk factor for future depression in women Objective : To assess whether patients receiving aerobic exercise training  performed either at home or in a supervised group setting achieve reductions in depression comparable to st and ard antidepressant medication ( sertraline ) and greater reductions in depression compared to placebo controls . Methods : Between October 2000 and November 2005 , we performed a prospect i ve , r and omized controlled trial ( SMILE study ) with allocation concealment and blinded outcome assessment in a tertiary care teaching hospital . A total of 202 adults ( 153 women ; 49 men ) diagnosed with major depression were assigned r and omly to one of four conditions : supervised exercise in a group setting ; home-based exercise ; antidepressant medication ( sertraline , 50–200 mg daily ) ; or placebo pill for 16 weeks . Patients underwent the structured clinical interview for depression and completed the Hamilton Depression Rating Scale ( HAM-D ) . Results : After 4 months of treatment , 41 % of the participants achieved remission , defined as no longer meeting the criteria for major depressive disorder ( MDD ) and a HAM-D score of < 8 . Patients receiving active treatments tended to have higher remission rates than the placebo controls : supervised exercise = 45 % ; home-based exercise = 40 % ; medication = 47 % ; placebo = 31 % ( p = .057 ) . All treatment groups had lower HAM-D scores after treatment ; scores for the active treatment groups were not significantly different from the placebo group ( p = .23 ) . Conclusions : The efficacy of exercise in patients seems generally comparable with patients receiving antidepressant medication and both tend to be better than the placebo in patients with MDD . Placebo response rates were high , suggesting that a considerable portion of the therapeutic response is determined by patient expectations , ongoing symptom monitoring , attention , and other nonspecific factors . BDI = Beck Depression Inventory ; CI = confidence interval ; HAM-D = Hamilton Depression Rating Scale ; ITT = intention-to-treat ; MDD = major depressive disorder ; SD = st and ard deviation ; SSRIs = selective serotonin reuptake inhibitors ; TSH = thyroid stimulating hormone Patients with depression have been extensively reported to be associated with the abnormality of omega-3 polyunsaturated fatty acids ( PUFAs ) , including significantly low eicosapentaenoic acid and docosahexaenoic acid in cell tissue contents ( red blood cell membrane , plasma , etc . ) and dietary intake . However , more evidence is needed to support its relation . In this study , we conducted an 8-week , double-blind , placebo-controlled trial , comparing omega-3 PUFAs ( 6.6 g/day ) [ corrected ] with placebo , on the top of the usual treatment , in 28 patients with major depressive disorder . Patients in the omega-3 PUFA group had a significantly decreased score on the 21-item Hamilton Rating Scale for Depression than those in the placebo group ( P < 0.001 ) . From the preliminary findings in this study , omega-3 PUFAs could improve the short-term course of illness and were well tolerated in patients with major depressive disorder A recent meta- analysis concluded that newer antidepressant drugs are equivalent to or no better than placebos , a conclusion at some variance with their commonly judged clinical effectiveness . The ' disconnect ' between r and omised controlled trials and clinical practice would benefit from dissection of contributing factors , and redressing limitations to current trial procedures BACKGROUND Trials have demonstrated benefits of long-chain omega-3 essential fatty acid ( n-3 EFA ) supplementation in a variety of psychiatric disorders . AIMS To assess the efficacy of n-3 EFAs in improving psychological well-being in patients with recurrent self-harm . METHOD Patients ( n=49 ) presenting after an act of repeated self-harm were r and omised to receive 1.2 g eicosapentaenoic acid plus 0.9 g decosahexaenoic acid ( n=22 ) or placebo ( n=27 ) for 12 weeks in addition to st and ard psychiatric care . Six psychological domains were measured at baseline and end point . RESULTS At 12 weeks , the n-3 EFA group had significantly greater improvements in scores for depression , suicidality and daily stresses . Scores for impulsivity , aggression and hostility did not differ . CONCLUSIONS Supp 
    Output:
    
agent
***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: BACKGROUND Psychological distress ( PD ) and depressive symptoms are commonly observed during menopausal transition . Studies suggest that omega-3 ( n-3 ) fatty acids may help alleviate depression . OBJECTIVE The objective was to compare enriched ethyl-eicosapentaenoic acid ( E-EPA ) supplementation with placebo for the treatment of PD and depressive symptoms in middle-aged women . DESIGN Women with moderate-to-severe PD ( n = 120 ) were r and omly assigned to receive 1.05 g E-EPA/d plus 0.15 g ethyl-docosahexaenoic acid/d ( n = 59 ) or placebo ( n = 61 ) for 8 wk . The main outcomes were 8-wk changes in PD scores [ Psychological General Well-Being Schedule ( PGWB ) ] and depressive scales [ 20-item Hopkins Symptom Checklist Depression Scale ( HSCL-D-20 ) and the 21-item Hamilton Depression Rating Scale ( HAM-D-21 ) ] . RESULTS At baseline , women with PD were mildly to moderately depressed , and 24 % met the major depressive episode ( MDE ) criteria of the Diagnostic and Statistical Manual of Mental Disorders , 4th edition . After 8 wk , outcomes improved in both groups , but no significant differences were noted between them . Stratification analyses for MDE diagnosis at baseline indicated that differences in adjusted 8-wk changes between the E-EPA group without MDE ( n = 46 ) and the placebo group ( n = 45 ) were 8.0 ( 95 % CI : 0.6 , 15.3 ; P = 0.034 ) for the PGWB , -0.2 ( 95 % CI : -0.01 , -0.4 ; P = 0.040 ) for the HSCL-D-20 , and -2.7 ( 95 % CI : -0.3 , -5.1 ; P = 0.030 ) for the HAM-D-21 . Differences in adjusted 8-wk changes between the E-EPA group with MDE ( n = 13 ) and the placebo group ( n = 16 ) were not significant . CONCLUSIONS To our knowledge , this is the first trial of n-3 supplementation in the treatment of PD and depressive symptoms in middle-aged women . In women with PD without MDE at baseline , the 8-wk changes in PD and depressive scales improved significantly more with E-EPA than with placebo . This trial was registered at http://www.controlled-trials.com as IS RCT N69617477 In a prospect ive-longitudinal study of a representative birth cohort , we tested why stressful experiences lead to  depression  in some people but not in others . A functional polymorphism in the promoter region of the serotonin transporter ( 5-HT T ) gene was found to moderate the influence of stressful life events on depression . Individuals with one or two copies of the short allele of the 5-HT T promoter polymorphism exhibited more depressive symptoms , diagnosable depression , and suicidality in relation to stressful life events than individuals homozygous for the long allele . This epidemiological study thus provides evidence of a gene-by-environment interaction , in which an individual 's response to environmental insults is moderated by his or her genetic makeup BACKGROUND Recent studies indicate that depression plays an important role in the occurrence of cardiovascular diseases ( CVDs ) . The underlying mechanisms are not well understood . OBJECTIVE We investigated whether dietary intake of the n-3 fatty acids ( FAs ) eicosapentaenic acid and docosahexaenoic acid could explain the relation between depressive symptoms and cardiovascular mortality . DESIGN The Zutphen Elderly Study is a prospect i ve cohort study conducted in the Netherl and s. Depressive symptoms were measured in 1990 with the Zung Self-rating Depression Scale in 332 men aged 70 - 90 y and free from CVD and diabetes .  Dietary factors  were assessed with a cross-check dietary history method in 1990 . Mortality data were collected between 1990 and 2000 . Logistic and Cox regression analyses were performed , with adjustment for demographics and CVD risk factors . RESULTS Compared with a low intake ( x : 21 mg/d ) , a high intake ( x : 407 mg/d ) of n-3 FAs was associated with fewer depressive symptoms [ odds ratio : 0.46 ; 95 % CI : 0.22 , 0.95 ; P for trend = 0.04 ] at baseline and no significant reduced risk of 10-y CVD mortality [ hazard ratio ( HR ) : 0.88 ; 95 % CI : 0.51 , 1.50 ] . The adjusted HR for an increase in depressive symptoms with 1 SD for CVD mortality was 1.28 ( 95 % CI : 1.03 , 1.57 ) and did not change after additional adjustment for the intake of n-3 FAs . CONCLUSION An average intake of approximately 400 mg n-3 FA/d may reduce the risk of depression . Our results , however , do not support the hypothesis that the intake of n-3 FAs explains the relation between depression and CVD BACKGROUND It has been hypothesized that n-3 polyunsaturated fatty acids ( PUFAs ) are involved in mood regulation , but epidemiologic evidence for such a link in the general population is lacking . OBJECTIVE This study examined whether community-dwelling elderly persons with depression have a fatty acid composition that is different from that of nondepressed persons . DESIGN We screened 3884 adults aged > or = 60 y for depressive symptoms as part of the Rotterdam Study . Subjects who screened positive had a psychiatric interview to diagnose depressive disorders . All eligible subjects had their blood drawn for measurement of plasma phospholipid concentrations . We compared percentages of n-3 and n-6 PUFAs and their ratios between 264 subjects with depressive symptoms , including 106 subjects with depressive disorders , and 461 r and omly selected reference subjects . We also investigated whether atherosclerosis or the inflammatory response as measured by C-reactive protein underlies the relation between fatty acid composition and depression . RESULTS Subjects with depressive disorders had a higher ratio of n-6 to n-3 PUFAs , but differences in individual PUFAs were mostly small . However , depressed subjects with normal CRP concentrations ( < 1.5 mg/L ) had a substantially altered fatty acid composition ; percentages of n-3 PUFAs and ratios of n-6 to n-3 PUFAs were significantly lower and higher , respectively , in subjects with depressive disorders than in control subjects [ 5.2 % compared with 5.9 % ( P = 0.02 ) and 7.2 compared with 6.6 ( P = 0.01 ) , respectively ] . This relation was not due to atherosclerosis . CONCLUSIONS In community-dwelling persons , fatty acid composition is related to depression . Because this relation was not secondary to inflammation , atherosclerosis , or possible confounders , it suggests a direct effect of fatty acid composition on mood Background : It has been suggested that dietary patterns are associated with future risk of depressive symptoms . However , there is a paucity of prospect i ve data that have examined the temporality of this relation . Objective : We examined whether adherence to a healthy diet , as defined by using the Alternative Healthy Eating Index ( AHEI ) , was prospect ively associated with depressive symptoms assessed over a 5-y period . Design : Analyses were based on 4215 participants in the Whitehall II Study .  AHEI scores were computed in 1991–1993 and 2003–2004 . Recurrent depressive symptoms were defined as having a Center for Epidemiologic Studies Depression Scale score ≥16 or self-reported use of antidepressants in 2003–2004 and 2008–2009 . Results : After adjustment for potential confounders , the AHEI score was inversely associated with recurrent depressive symptoms in a dose-response fashion in women ( P-trend < 0.001 ; for 1 SD in AHEI score ; OR : 0.59 ; 95 % CI : 0.47 , 0.75 ) but not in men . Women who maintained high AHEI scores or improved their scores during the 10-y measurement period had 65 % ( OR : 0.35 % ; 95 % CI : 0.19 % , 0.64 % ) and 68 % ( OR : 0.32 % ; 95 % CI : 0.13 % , 0.78 % ) lower odds of subsequent recurrent depressive symptoms than did women who maintained low AHEI scores . Among AHEI components , vegetable , fruit , trans fat , and the ratio of polyunsaturated fat to saturated fat components were associated with recurrent depressive symptoms in women . Conclusion : In the current study , there was a suggestion that poor diet is a risk factor for future depression in women Objective : To assess whether patients receiving aerobic exercise training  performed either at home or in a supervised group setting achieve reductions in depression comparable to st and ard antidepressant medication ( sertraline ) and greater reductions in depression compared to placebo controls . Methods : Between October 2000 and November 2005 , we performed a prospect i ve , r and omized controlled trial ( SMILE study ) with allocation concealment and blinded outcome assessment in a tertiary care teaching hospital . A total of 202 adults ( 153 women ; 49 men ) diagnosed with major depression were assigned r and omly to one of four conditions : supervised exercise in a group setting ; home-based exercise ; antidepressant medication ( sertraline , 50–200 mg daily ) ; or placebo pill for 16 weeks . Patients underwent the structured clinical interview for depression and completed the Hamilton Depression Rating Scale ( HAM-D ) . Results : After 4 months of treatment , 41 % of the participants achieved remission , defined as no longer meeting the criteria for major depressive disorder ( MDD ) and a HAM-D score of < 8 . Patients receiving active treatments tended to have higher remission rates than the placebo controls : supervised exercise = 45 % ; home-based exercise = 40 % ; medication = 47 % ; placebo = 31 % ( p = .057 ) . All treatment groups had lower HAM-D scores after treatment ; scores for the active treatment groups were not significantly different from the placebo group ( p = .23 ) . Conclusions : The efficacy of exercise in patients seems generally comparable with patients receiving antidepressant medication and both tend to be better than the placebo in patients with MDD . Placebo response rates were high , suggesting that a considerable portion of the therapeutic response is determined by patient expectations , ongoing symptom monitoring , attention , and other nonspecific factors . BDI = Beck Depression Inventory ; CI = confidence interval ; HAM-D = Hamilton Depression Rating Scale ; ITT = intention-to-treat ; MDD = major depressive disorder ; SD = st and ard deviation ; SSRIs = selective serotonin reuptake inhibitors ; TSH = thyroid stimulating hormone Patients with depression have been extensively reported to be associated with the abnormality of omega-3 polyunsaturated fatty acids ( PUFAs ) , including significantly low eicosapentaenoic acid and docosahexaenoic acid in cell tissue contents ( red blood cell membrane , plasma , etc . ) and dietary intake . However , more evidence is needed to support its relation . In this study , we conducted an 8-week , double-blind , placebo-controlled trial , comparing omega-3 PUFAs ( 6.6 g/day ) [ corrected ] with placebo , on the top of the usual treatment , in 28 patients with major depressive disorder . Patients in the omega-3 PUFA group had a significantly decreased score on the 21-item Hamilton Rating Scale for Depression than those in the placebo group ( P < 0.001 ) . From the preliminary findings in this study , omega-3 PUFAs could improve the short-term course of illness and were well tolerated in patients with major depressive disorder A recent meta- analysis concluded that newer antidepressant drugs are equivalent to or no better than placebos , a conclusion at some variance with their commonly judged clinical effectiveness . The ' disconnect ' between r and omised controlled trials and clinical practice would benefit from dissection of contributing factors , and redressing limitations to current trial procedures BACKGROUND Trials have demonstrated benefits of long-chain omega-3 essential fatty acid ( n-3 EFA ) supplementation in a variety of psychiatric disorders . AIMS To assess the efficacy of n-3 EFAs in improving psychological well-being in patients with recurrent self-harm . METHOD Patients ( n=49 ) presenting after an act of repeated self-harm were r and omised to receive 1.2 g eicosapentaenoic acid plus 0.9 g decosahexaenoic acid ( n=22 ) or placebo ( n=27 ) for 12 weeks in addition to st and ard psychiatric care . Six psychological domains were measured at baseline and end point . RESULTS At 12 weeks , the n-3 EFA group had significantly greater improvements in scores for depression , suicidality and daily stresses . Scores for impulsivity , aggression and hostility did not differ . CONCLUSIONS Supp 
    Output:
    