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Comparative Study
. 2016 Mar 2;6(3):e010172.
doi: 10.1136/bmjopen-2015-010172.

ω-3 Fatty acids for major depressive disorder in adults: an abridged Cochrane review

Katherine M Appleton  1 , Hannah M Sallis  2 , Rachel Perry  3 , Andrew R Ness  3 , Rachel Churchill  4
Affiliations
Comparative Study

ω-3 Fatty acids for major depressive disorder in adults: an abridged Cochrane review

Katherine M Appleton et al. BMJ Open. .

Erratum in

  • Correction.
    [No authors listed] [No authors listed] BMJ Open. 2017 Jan 16;7(1):e010172corr1. doi: 10.1136/bmjopen-2015-010172corr1. BMJ Open. 2017. PMID: 28093445 Free PMC article. No abstract available.

Abstract

Objective: To assess the effects of n-3 polyunsaturated fatty acids (n-3PUFAs; also known as ω-3 fatty acids) compared with comparator for major depressive disorder (MDD) in adults.

Design: Systematic review and meta-analyses.

Data sources: The Cochrane Depression, Anxiety and Neurosis Review Group's Specialised Registers (CCDANCTR) and International Trial Registries searched to May 2015. CINAHL searched to September 2013.

Inclusion criteria: a randomised controlled trial (RCT); that provided n-3PUFAs as an intervention; used a comparator; measured depressive symptomology as an outcome; and was conducted in adults with MDD.

Outcomes: Primary outcomes were depressive symptomology and adverse events.

Results: 20 trials encompassing 26 relevant studies were found. For n-3PUFAs versus placebo, n-3PUFA supplementation resulted in a small-to-modest benefit for depressive symptomology: SMD=-0.32 (95% CI -0.52 to -0.12; 25 studies, 1373 participants, very low-quality evidence), but this effect is unlikely to be clinically meaningful, is very imprecise and, based on funnel plot inspection, sensitivity analyses and comparison with large well-conducted trials, is likely to be biased. Considerable evidence of heterogeneity between studies was also found, and was not explained by subgroup or sensitivity analyses. Numbers of individuals experiencing adverse events were similar in intervention and placebo groups (OR=1.24, 95% CI 0.95 to 1.62; 19 studies, 1207 participants; very low-quality evidence). For n-3PUFAs versus antidepressants, no differences were found between treatments in depressive symptomology (MD=-0.70 (95% CI -5.88 to 4.48); 1 study, 40 participants, very low-quality evidence).

Conclusions: At present, we do not have sufficient evidence to determine the effects of n-3PUFAs as a treatment for MDD. Further research in the form of adequately powered RCTs is needed.

Keywords: EPIDEMIOLOGY; NUTRITION & DIETETICS; THERAPEUTICS.

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Figures

Figure 1
Figure 1
PRISMA diagram demonstrating the outcomes of the search process, and inclusion of studies in the review and meta-analyses. CCDANCTR, Cochrane Depression, Anxiety and Neurosis Review Group's Specialised Registers; MDD, major depressive disorder; n-3PUFA, n-3 polyunsaturated fatty acid; RCT, randomised controlled trial.
Figure 2
Figure 2
Judgements of risk of bias for each domain and each study in the review.
Figure 3
Figure 3
Forest plot for the outcome depressive symptomology (continuous) for the comparison of n-3PUFAs with placebo. DHA, docosahexaenoic acid; EPA, eicosapentaenoic acid; n-3PUFA, n-3 polyunsaturated fatty acid.
Figure 4
Figure 4
Forest plot for the outcome adverse events for the comparison of n-3PUFAs with placebo. DHA, docosahexaenoic acid; EPA, eicosapentaenoic acid; n-3PUFA, n-3 polyunsaturated fatty acid.
Figure 5
Figure 5
Funnel plot for the outcome depressive symptomology (continuous) for the comparison of n-3 polyunsaturated fatty acids with placebo.
Figure 6
Figure 6
Funnel plot for the outcome adverse events for the comparison of n-3 polyunsaturated fatty acids with placebo.
See this image and copyright information in PMC

References

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