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

Psychotherapy and Psychosomatics - Tập 88 Số 5 - Trang 263-273 - 2019
Ta‐Wei Guu1,2, David Mischoulon3, Jerome Sarris4,5, Joseph R. Hibbeln6, Robert K. McNamara7, Kei Hamazaki8, Marlene P. Freeman9, Michaël Maes10, Yutaka Matsuoka11, Robert H. Belmaker12, Felice N. Jacka13, Carmine M. Pariante14, Michael Berk15, Wolfgang Marx13, Kuan‐Pin Su16,1
1Departments of Psychiatry and Mind-Body Interface Laboratory (MBI-Lab), China Medical University Hospital, Taichung, Taiwan
2Division of Psychiatry, Departments of Internal Medicine, China Medical University Beigang Hospital, Yunlin, Taiwan
3Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
4Department of Psychiatry, The Melbourne Clinic, Professorial Unit, Melbourne University, Melbourne, VIC, Australia
5NICM Health Research Institute, Western Sydney University, Westmead, NSW, Australia
6Section on Nutritional Neuroscience, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, USA
7Department of Psychiatry, University of Cincinnati College of Medicine, Cincinnati, OH, USA
8Department of Public Health, Faculty of Medicine, University of Toyama, Toyama, Japan
9Clinical Trials Network and Institute, Massachusetts General Hospital, Boston, MA, USA
10Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
11Division of Health Care Research, Center for Public Health Sciences, National Cancer Center Japan, Tokyo, Japan
12Ben Gurion University of the Negev, Beersheba, Israel
13IMPACT SRC, Food and Mood Centre, School of Medicine, Faculty of Health, Deakin University, Sydney, NSW, Australia
14Stress, Psychiatry and Immunology Laboratory, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
15Department of Psychiatry, The University of Melbourne, Melbourne, Vic., Australia
16College of Medicine, China Medical University, Taichung, Taiwan

Tóm tắt

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.

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