Positive Health Online

Abstract

GUU and COLLEAGUES,  1 Departments of Psychiatry and Mind-Body Interface Laboratory (MBI-Lab), China Medical University Hospital, Taichung, Taiwan; 2 Division of Psychiatry, Departments of Internal Medicine, China Medical University Beigang Hospital, Yunlin, Taiwan; 3 Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA; 4 NICM, Health Research Institute, Western Sydney University, Westmead, New South Wales, Australia; 5 Department of Psychiatry, The Melbourne Clinic, Professorial Unit, Melbourne University, Melbourne, Victoria, Australia; 6 Section on Nutritional Neuroscience, National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland, USA; 7 Department of Psychiatry, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA; 8 Department of Public Health, Faculty of Medicine, University of Toyama, Toyama, Japan; 9 Clinical Trials Network and Institute, Massachusetts General Hospital, Boston, Massachusetts, USA; 10 Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; 11 Division of Health Care Research, Center for Public Health Sciences, National Cancer Center Japan, Tokyo, Japan; 12 Ben Gurion University of the Negev, Beersheba, Israel; 13 IMPACT SRC, Food and Mood Centre, School of Medicine, Faculty of Health, Deakin University, Sydney, New South Wales, Australia; 14 Stress, Psychiatry and Immunology Laboratory, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; 15 Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia; 16 Departments of Psychiatry and Mind-Body Interface Laboratory (MBI-Lab), China Medical University Hospital, Taichung, Taiwan, cobolsu@gmail.com ; 17 College of Medicine, China Medical University, Taichung, Taiwan, cobolsu@gmail.com reviewed the published literature and developed a consensus-based practice guideline  regarding research practice guidelines for the use of  Omega-3 Fatty Acids in the treatment of major depressive Disorder (MDD).

 

Background

Major depressive disorder (MDD) is a complex mental illness with unmet therapeutic needs. The antidepressant effects of ω-3 polyunsaturated fatty acids (n-3 PUFAs) have been widely reported.

Methodology

The subcommittee of the International Society for Nutritional Psychiatry Research organized an expert panel and conducted a literature review and a Delphi process to develop a consensus-based practice guideline for clinical use of n-3 PUFAs in MDD. The guideline focuses on 5 thematic areas: general concepts, acute treatment strategy, depression recurrence monitoring and prevention, use in special populations, and potential safety issues.

Results

The key practice guidelines contend that: (1) clinicians and other practitioners are advised to conduct a clinical interview to validate clinical diagnoses, physical conditions, and measurement-based psychopathological assessments in the therapeutic settings when recommending n-3 PUFAs in depression treatment; (2) with respect to formulation and dosage, both pure eicosapentaenoic acid (EPA) or an EPA/docosahexaenoic acid (DHA) combination of a ratio higher than 2 (EPA/DHA >2) are considered effective, and the recommended dosages should be 1-2 g of net EPA daily, from either pure EPA or an EPA/DHA (>2:1) formula; (3) the quality of n-3 PUFAs may affect therapeutic activity; and (4) potential adverse effects, such as gastrointestinal and dermatological conditions, should be monitored, as well as obtaining comprehensive metabolic panels.

Conclusion

The expert consensus panel has agreed on using n-3 PUFAs in MDD treatment for pregnant women, children, and the elderly, and prevention in high-risk populations. Personalizing the clinical application of n-3 PUFAs in subgroups of MDD with a low Omega-3 Index or high levels of inflammatory markers might be regarded as areas that deserve future research. Comment in Response to "International Society for Nutritional Psychiatry Research Practice Guidelines for Omega-3 Fatty Acids in the Treatment of Major Depressive Disorder" by Guu et al. (2019).  Thesing CS, Lamers F, Bot M, Penninx BWJH, Milaneschi Y. Psychother Psychosom. 89(1):48. 2020. doi: 10.1159/000504100. Epub 2019 Oct 25; Reply to the Letter to the Editor: Response to "International Society for Nutritional Psychiatry Research Practice Guidelines for Omega-3 Fatty Acids in the Treatment of Major Depressive Disorder" by Guu et al. (2019). Guu TW, Su KP. Psychother Psychosom. 89(1):49.  2020. doi: 10.1159/000504232. Epub Nov 19 2019 . Ta-Wei Guu  1   2 , David Mischoulon  3 , Jerome Sarris  4   5 , Joseph Hibbeln  6 , Robert K McNamara  7 , Kei Hamazaki  8 , Marlene P Freeman  9 , Michael Maes  10 , Yutaka J Matsuoka  11 , R H Belmaker  12 , Felice Jacka  13 , Carmine Pariante  14 , Michael Berk  15 , Wolfgang Marx  13 , Kuan-Pin Su  16   17. International Society for Nutritional Psychiatry Research Practice Guidelines for Omega-3 Fatty Acids in the Treatment of Major Depressive Disorder.

References

Psychother Psychosom. 88(5):263-273. 2019. doi: 10.1159/000502652. Epub Sep 3 2019.

Comment

In the above published research, the international expert consensus panel agreed to use n-3 PUFAs for the treatment of major depressive Disorder (MDD) for pregnant women, children, and the elderly, and prevention in high-risk.