A Systematic Review of Effectiveness of Omega-3 Fatty Acid Supplementation on Symptoms, Social Functions, and Neurobiological Variables in Schizophrenia
Hsu M-C and Ouyang W-C (2021) Biol Res Nurs 23(4) 723-737. doi: 10.1177/10998004211020121. Epub 2021 Jul 20.
Abstract:
Background:
Disturbance of lipid, particularly omega-3 polyunsaturated fatty acid (PUFA), metabolism is associated with the etiology and symptoms of schizophrenia. Numerous clinical studies have tried to evaluate whether omega-3 PUFA supplementation can ameliorate the disorder, but the results are inconclusive.
Objectives:
This systematic review integrates and refines the research evidence of the effectiveness of omega-3 PUFA nutritional supplementation on schizophrenia during the different developmental phases of the disease (prodromal, first-episode, and chronic phases) and examines whether different developmental stages modulate the efficacy of omega-3 PUFA supplementation.
Data sources:
Scientific articles from 2000 to 2020 in PubMed/Medline, Allied Health Literature, PsychINFO, and SCOPUS following the Preferred Reporting Items for Systematic Reviews guidelines.
Methods:
A systematic review was performed. We reviewed electronic databases and identified 1,266 clinical studies. Of these, 26 met the inclusion criteria.
Results:
The effectiveness of omega-3 dietary supplementation on symptoms varies among different phases of illness. Omega-3 supplementation significantly improves positive and negative symptoms at the prodromal phase, improves mainly the negative symptoms in patients with the first-episode, and effects symptoms partly in patients with chronic schizophrenia.
Discussion:
The effectiveness of omega-3 PUFA dietary supplementation is modulated by age, duration of untreated psychosis and illness, baseline levels of omega-3 fatty acids, and status of antioxidant capacity of patients. The important implications for psychiatric research and clinical practice developments as well as nursing care are presented and discussed.
Keywords:
chronic schizophrenia; eicosapentaenoic and docosahexaenoic acid supplementation and intervention; first-episode; symptoms; ultra-high risk for psychosis.
FAB RESEARCH COMMENT:
The first reports that dietary supplementation with long-chain omega-3 fatty acids could reduce schizophrenia symptoms were published over 20 years ago, following earlier studies showing lower blood omega-3 in at least a subset of patients with schizophrenia compared with matched controls.Since then, findings from controlled clinical trials of omega-3 for psychosis have been mixed, with some showing benefits, and others not.
These trials have involved a wide variety of populations (including acute or chronic schizophrenia patients, as well as young people showing prodromal symptoms, i.e. 'high risk' groups), as well as different treatment fomulations and dosages, study designs and outcome measures.
Futhermore, as both medication status and baseline blood fatty acids have also emerged as potentially important influences on the efficacy of omega-3, these issues were also considered in this new systematic review of clinical trials.
Findings indicate that benefits of omega-3 supplementation vary with age and duration of untreated psychosis and illness - with better results from earlier intervention.
As might be expected, lower baseline levels of omega-3 fatty acids also appear to be associated with greater benefits, and 'antioxidant capacity' of patients may also be an important factor.
The authors also discuss the implications of the current evidence for both research and clinical practice, including general nursing care.
While pharmaceutical treatments for schizophrenia can reduce core symptoms such as delusions and hallucinations, antipsychotic medications have many negative side-effects - including metabolic effects that significantly increase risks for Type 2 diabetes and obesity.
These medications also show only limited efficiacy for the social and cognitive impairments associated with this condition.
For some patients, omega-3 may therefore be helpful as an adjunctive treatment (or even an alternative option if medications may not be suitable or acceptable)
For more information on this subject, please see:
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