International Society for Nutritional Psychiatry Research Practice Guidelines for Omega-3 Fatty Acids in the Treatment of Major Depressive Disorder

Abstract

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. 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. 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. 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.

Fatty Acid Reference Intervals in Red Blood Cells among Pregnant Women in Norway–Cross Sectional Data from the ‘Little in Norway’ Cohort

“…It was mentioned that this index plays a pathophysiologic role in depressive symptoms [ 45 , 49 , 50 ]. The International Society for Nutritional Psychiatry Research Practice Guidelines for ω-3 fatty acids has recently recommended therapeutic dosages of pure EPA or a combination of EPA and DHA (with net EPA starting from at least 1 up to 2 g/day) for at least eight weeks as a potential treatment for major depressive disorders [ 51 ]. We have previously shown that low omega-3 index in pregnancy is a possible risk factor for postpartum depression [ 52 ], with a cut-off at 4%.…”

Supplementation‐induced increase in circulating omega‐3 serum levels is not associated with a reduction in depressive symptoms: Results from the MooDFOOD depression prevention trial

“…This suggests that n‐3 PUFA supplements may be less effective in individuals at risk for depression than in currently depressed patients. Recently, the International Society for Nutritional Psychiatry Research Practice has formulated guidelines for the use of n‐3 PUFA supplementation in the treatment and prevention of MDD (Guu et al, 2019). In response, we argued that there is indeed some evidence from RCTs for the usefulness of n‐3 PUFA supplementation in the treatment of clinically depressed cases, but there is not enough evidence from RCTs on the usefulness of n‐3 PUFA supplementation in the prevention of depression in at‐risk individuals (Thesing, Lamers, Bot, Penninx, & Milaneschi, 2019).…”

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

“…Su et al revealed that a high dose of n-3 PUFAs (4400 mg EPA + 2200 mg DHA per day) had a significantly decreased score on the 21-item Hamilton Depression Rating Scale (HDRS) [7]. However, the effects of a high dose of DHA on depression are still unclear [8][9][10], because most of the evidence supports the theory of EPA superiority [11,12]. Before effective doses of n-3 PUFA were recommended based on the results of head-to-head trials for MDD patients, comparative effectiveness research is necessary to identify the efficacy of different doses of n-3 PUFA supplementation.…”