International guidelines strengthened: Omega-3 clinical applicability for MDD

15 January

A new consensus study published in the Journal of Affective Disorders(opens in a new window) has confirmed the clinical use of omega-3 fatty acids as an integrative treatment for the management of major depressive disorder (MDD), strengthening the recently developed International Society for Nutritional Psychiatry Research (ISNPR) Practice Guidelines.

Professor Jerome Sarris from NICM Health Research Institute, co-led the study with a broader group of thirteen international experts from Australasia, Asia, Europe and North America employing a multi-disciplinary Delphi consensus methodology. Following a literature review, nineteen statements were formulated and validated in the study covering five major domains in MDD treatment using omega-3 polyunsaturated fatty acids (n-3 PUFAs): general concepts, acute treatment strategy, recurrence and prevention, special populations, and safety.

In total, 16 of the 19 statements in the study reached consensus and were summarised and incorporated into the guidelines. Results confirmed n-3 PUFAs as an evidence-based potential treatment for adult MDD, being found to be both efficacious and safe. The guidelines stated that n-3 PUFAs are better used as an adjunctive therapy than a monotherapy, and that both pure eicosapentaenoic acid (EPA) and higher EPA/docosahexaenoic acid (EPA/DHA) ratio formulations are preferable. It was also endorsed that clinicians who use n-3 PUFA treatments should do so only after a clinical interview with the patient to confirm the diagnosis, assess mental status and relevant physical conditions.

Further, the identified insufficiencies in current evidence that merit future research efforts include the use of n-3 PUFAs in special populations such as patients who are over-weight, children, the elderly or in pregnancy. In addition, further research is required in treatment for recurrence and prevention of MDD, and biological data on the antidepressant mechanism of n-3 PUFAs.

The clinical guidelines were undertaken to manage gaps existing between evidence and practice, address variations in the existing literature and improve the applicability of the ISNPR Practice Guidelines.

While many clinicians and some consumers may know about n-3 PUFAs having a potential role in the treatment of depression, previously there were no definitive clinical guidelines available,” said Professor Sarris

“Our international collaboration has now addressed this, providing clear guidance in respect to a range of clinical considerations when prescribing n-3 PUFAs in depression.”

Similar with other psychiatric disorders there is a significant unmet need in the treatment of MDD, which affects around seven per cent of the population in a given year, and has been the world’s leading cause of disability.

Whilst standard antidepressants are commonly used, there remains some inadequacies in efficacy and tolerability. The antidepressant effects of n-3 PUFAs are widely reported and they are considered a safe and well-tolerated nutrient with additional promise from further research.

The paper, A multi-national, multi-disciplinary Delphi consensus study on using omega-3 polyunsaturated fatty acids (n-3 PUFAs) for the treatment of major depressive disorder (opens in a new window) was published online on 15 January 2020 in The Journal of Affective Disorders.