High-dose omega-3 polyunsaturated fatty acid supplementation might be more superior than low-dose for major depressive disorder in early therapy period: a network meta-analysis
Luo X-D, Feng J-S, Yang Z, Huang Q-T, Lin J-D, Yang B, Su K-P, Pan J-Y (2020) BMC Psychiatry 20(1) 248. doi: 10.1186/s12888-020-02656-3.
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Abstract:
Background:
The application of n-3 Polyunsaturated Fatty Acids (n-3 PUFAs) supplementation for major depressive disorder (MDD) has been widely discussed in recent years, but its efficacy and application are still controversial. This network meta-analysis was conducted to compare the efficacy of different dosages of n-3 PUFAs on MDD patients in the early period of treatment.
Methods:
Randomized controlled trials (RCTs) exploring the efficacy of n-3 PUFA supplementation for patients with MDD were retrieved from the databases of Pubmed, Embase and the Cochrane Library.
RCTs comparing the efficacy of n-3 PUFA for adult (≥18 years) MDD patients without comorbidity were eligible for our study.
The score of depressive symptoms in early therapy period of the treatment (≤9 weeks) was extracted. Standardized mean deviations (SMDs) of all the sores from the eligible RCTs were synthesized in a pairwise meta-analysis in frequentist framework and a random-effects network meta-analysis in Bayesian framework for the overall and subgroups (high- and low-dose) efficacy of n-3 PUFAs.
Results:
A total of 910 MDD patients in 10 trials with 3 adjuvant therapy strategies (high-dose n-3 PUFAs, low-dose n-3 PUFAs and placebo) were included. Results of pairwise meta-analysis showed that n-3 PUFAs were superior to placebo (SMD: 1.243 ± 0.596; 95% CI: 0.060 ~ 2.414).
Results of the network meta-analysis showed that both the high (SMD: 0.908 ± 0.331; 95% CI: 0.262 ~ 1.581) and the low-dose (SMD: 0.601 ± 0.286; 95% CI: 0.034 ~ 1.18) n-3 PUFAs were superior to placebo, and the efficacy of high-dose n-3 PUFAs is superior to that of low-dose.
Conclusions:
High-dose n-3 PUFAs supplementation might be more superior than low-dose in the early therapy period for MDD. More head-to-head clinical trials need to be carried out to provide more direct comparison and enhance the evidence of the efficacy of n-3PUFAs for MDD.
FAB RESEARCH COMMENT:
This meta-analysis examined the effects of the dosage of EPA/DHA used in clinical trials of 'omega-3 for depression' in adults - and found that high-dose supplementation was superior to low dosage, although both showed superiority over placebo.Importantly, this study only involved patients with clinical-level depression (Major Depressive Disorder) who did not also have any major comorbid health conditions.
- Previous meta-analyses of controlled clinical trials have shown that benefits from omega-3 supplementation are more likely in patients with clinically diagnosed depression than in populations assessed only via checklist measures of depressive symptoms.
- Similarly, although depression often co-occurs with other health conditions - some of which may also be mitigated by increased omega-3 intake (e.g. physical conditions such as cardiovascular disease, some inflammatory conditions, or migraines; or mental conditions including ADHD or dementia) - co-occurring conditions are a potential complicating factor in evaluting the effects of omega-3 on depression alone.
As the authors note, more clinical trials are still needed in this area to resolve outstanding issues and controversies in this area, particularly in relation to:
1) the specific populations most likely to benefit from adjunctive treatment with omega-3 for reducing depressive symptoms, and
2) the optimal formulations and dosages of omega-3
Meanwhile, clinical treatment guidelines - based on the best available evidence from clinical trials to date - have already been published by leading international experts in both fatty acids (a highly complex and specialist area) and psychiatry (likewise) - including See:
For more information on this topic, please see the following lists of articles, which are regularly updated:
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