Monday, September 30, 2019
New Practice Guidelines for Omega-3 Fatty Acids in the Treatment of Major Depressive Disorder
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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