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The primary outcome measure was change in CDRS-R total score, and secondary outcomes measures were change in manic symptoms (Young Mania Rating Scale), global symptom and functioning measures (Clinical Global Impression-Severity [CGI-S] \/CGI Improvement [CGI-I], Children's Global Assessment Scale, and Child Behavior Checklist), safety and laboratory measures, and anterior cingulate cortex (ACC) and bilateral ventrolateral prefrontal cortex neurometabolite concentrations using proton magnetic resonance spectroscopy at 4 T.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Fifty-six patients were randomized, and 42 completed the 12-week trial (placebo:\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      \u2009=\u200921; fish oil,\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      \u2009=\u200921). Subjects randomized to fish oil, but not placebo, exhibited a significant baseline to endpoint increase in erythrocyte\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      -3 PUFAs. Reductions in CDRS-R scores did not differ between treatment groups (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u20090.15), and similar remission (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u20090.58) and response (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u20090.77) rates were observed. Fish oil produced a significantly greater decrease in CGI-S (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u20090.0042) and CGI-I (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u20090.036) scores compared with placebo. Baseline to endpoint change in ACC creatine (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u20090.004) and ACC choline (Cho) (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u20090.024) differed significantly between groups. Baseline ACC Cho levels were inversely correlated with baseline and baseline to endpoint change in CDRS-R scores, and baseline to endpoint change in ACC Cho correlated with baseline-endpoint change in CDRS-R scores and\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      -3 PUFA. There were no group differences in safety and tolerability ratings or laboratory measures.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>\n                      Fish oil monotherapy was not superior to placebo for reducing depressive symptoms in high-risk youth as assessed by the CDRS-R, but was safe and well tolerated and superior to placebo on clinician ratings of global symptom improvement. Associations among ACC Cho levels, depression symptom severity, and\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      -3 PUFA warrant additional investigation.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1089\/cap.2019.0124","type":"journal-article","created":{"date-parts":[[2020,3,13]],"date-time":"2020-03-13T12:32:57Z","timestamp":1584102777000},"page":"293-305","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":23,"title":["Effects of Fish Oil Monotherapy on Depression and Prefrontal Neurochemistry in Adolescents at High Risk for Bipolar I Disorder: A 12-Week Placebo-Controlled Proton Magnetic Resonance Spectroscopy Trial"],"prefix":"10.1177","volume":"30","author":[{"given":"Robert K.","family":"McNamara","sequence":"first","affiliation":[{"name":"Division of Bipolar Disorders Research, Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey R.","family":"Strawn","sequence":"additional","affiliation":[{"name":"Division of Bipolar Disorders Research, Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Max J.","family":"Tallman","sequence":"additional","affiliation":[{"name":"Division of Bipolar Disorders Research, Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey A.","family":"Welge","sequence":"additional","affiliation":[{"name":"Division of Bipolar Disorders Research, Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L. 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