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Omega-3s Recommended as Adjunctive Therapy for Major Depression

Megan Brooks

depression

Omega-3 polyunsaturated fatty acids (PUFAs) recommended for treatment of major depressive disorder (MDD), says International Society for Nutritional Psychiatry Research (ISNPR).

FAB RESEARCH COMMENT:

It is now almost 20 years since the first case report, followed quickly by the first controlled clinical trials, showed that symptoms of depression could be reduced by dietary supplementation with the long-chain omega-3 fatty acids found in fish oils - and particularly EPA.

Many clinical trials since then have confirmed that in patients with clinical-level depression (i.e. those who meet full criteria for Major Depressive Disorder), adjunctive treatment with omega-3 LC-PUFA can be beneficial, although findings indicate that the dosage provided needs to include at least 1g/day of EPA.

This new study from the International Society for Nutrition in Psychiatry Research (ISNPR) provides detailed guidelines for clinicians, as well as a comprehensive summary of research to date, compiled and reviewed via consensus by the world's leading researchers and clinicians in this area. For details - and free full text, which is available online via open access - please see:


And for many more news articles and research studies in this important area, see also the following links, which are regularly updated:

A clinical practice guideline from the International Society for Nutritional Psychiatry Research (ISNPR) recommends omega-3 polyunsaturated fatty acids (PUFAs) as adjunctive therapy for major depressive disorder (MDD).

The value of omega-3 PUFAs in depression is "overlooked," even though accumulating evidence supports it. This therapy "needs to be on the radar" of physicians, Kuan-Pin Su, MD, PhD, chief of the Department of General Psychiatry, China Medical University, Taichung, Taiwan, told Medscape Medical News.

Su, a founding member of the ISNPR and a strong proponent of "nutritional psychiatry," organized a subcommittee of the ISNPR and invited the top 10 most-cited authors in the use of omega-3 PUFAs for depression to review the literature and develop the practice guideline on appropriate prescribing of omega-3 fatty acids for MDD.

The consensus guideline was published online September 3 in Psychotherapy and Psychosomatics.

Prophylaxis, Maintenance

The guideline emphasizes the importance of accurate clinical diagnosis and measurement-based psychopathologic assessments in the therapeutic setting when recommending omega-3 PUFAs for depression.

The guideline notes that there is a growing body of evidence demonstrating the efficacy of n-3 PUFAs as an adjunctive treatment for MDD. The guideline authors also note that omega-3s are safe and effective for accelerating the effect of antidepressants at treatment initiation and for augmenting existing antidepressant therapy when efficacy is inadequate.

With respect to formulation and dosage, the guideline recommends pure eicosapentaenoic acid (EPA) or a combination of EPA and docosahexaenoic acid, with net EPA starting from at least 1 g/day up to 2 g/day for at least 8 weeks as adjunctive treatment. Importantly, the authors note that the quality of n-3 PUFAs may affect therapeutic activity.

Potential side effects, such as gastrointestinal and dermatologic conditions, should be monitored, and comprehensive metabolic panels should be obtained during treatment, the guideline authors note.

They call for further research into personalizing the clinical application of n-3 PUFAs in subgroups of patients with MDD whose omega-3 index is low or who have high levels of inflammatory markers.

The panel acknowledges in the guideline that there is ongoing debate on the benefits of omega-3 PUFAs for MDD. Meta-analyses have shown "only small but statistically significant effects," the authors write.

They note that in three meta-analyses, the estimated effect sizes (standardized mean differences between n-3 PUFAs and placebo) ranged from 0.23 to 0.56, with wide confidence intervals (CIs).