Omega-3 fatty acids for depression in adults

Appleton, Katherine; Voyias, Philip; Sallis, Hannah M; Dawson, Sarah; Ness, Andy R; Churchill, Rachel; Perry, Rachel

doi:10.1002/14651858.cd004692.pub5

Cited by 45 publications

(51 citation statements)

References 187 publications

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“…The molecular mechanisms of sickness behaviors are complex but may involve IL6, IL1-beta, INF-alpha, and other cytokines as well as modulation of arachidonic acid cytochrome P450 metabolites and phosphatidylinositol derivatives by eicosapentaenoic acid (EPA) and effects on cannabinoid CB2 receptors [ 135 , 136 , 137 , 138 ]. EPA may have some benefits for treating anxiety [ 139 ] and PTSD [ 140 , 141 ] but has small non-clinical effects compared to placebo in depression [ 142 ]. This provides the rationale for testing in ME/CFS [ 143 ] and GWI.…”

Section: Dysfunction In Me/cfs and Gwimentioning

confidence: 99%

Review of the Midbrain Ascending Arousal Network Nuclei and Implications for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS), Gulf War Illness (GWI) and Postexertional Malaise (PEM)

Baraniuk

2022

Brain Sciences

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Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS and Gulf War Illness (GWI) share features of post-exertional malaise (PEM), exertional exhaustion, or postexertional symptom exacerbation. In a two-day model of PEM, submaximal exercise induced significant changes in activation of the dorsal midbrain during a high cognitive load working memory task (Washington 2020) (Baraniuk this issue). Controls had no net change. However, ME/CFS had increased activity after exercise, while GWI had significantly reduced activity indicating differential responses to exercise and pathological mechanisms. These data plus findings of the midbrain and brainstem atrophy in GWI inspired a review of the anatomy and physiology of the dorsal midbrain and isthmus nuclei in order to infer dysfunctional mechanisms that may contribute to disease pathogenesis and postexertional malaise. The nuclei of the ascending arousal network were addressed. Midbrain and isthmus nuclei participate in threat assessment, awareness, attention, mood, cognition, pain, tenderness, sleep, thermoregulation, light and sound sensitivity, orthostatic symptoms, and autonomic dysfunction and are likely to contribute to the symptoms of postexertional malaise in ME/CFS and GWI.

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Section: Dysfunction In Me/cfs and Gwimentioning

confidence: 99%

Review of the Midbrain Ascending Arousal Network Nuclei and Implications for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS), Gulf War Illness (GWI) and Postexertional Malaise (PEM)

Baraniuk

2022

Brain Sciences

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“…21,37,43,46,47,[49][50][51][52][53][54]56,[58][59][60][61][62][63][64]66,68,69 Nine systematic reviews with a total of 102 dietary intervention studies in individuals with depression or anxiety were included. 36,[72][73][74][75][76][77][78][79] The reviews were published between 2007 and 2020, with five of the reviews 36,76-79 published within the last 5 years (i.e. since 2016).…”

Section: Resultsmentioning

confidence: 99%

“…79 Four reviews included studies with male and female participants, 36,72,77,78 three included studies with females only, 74,76,79 and in two reviews this was unclear. 73,75 Five of the reviews included studies of individuals with depression, 36,[72][73][74]78 while the other four reviews included studies of individuals with depression and/or other disorders including anxiety, bipolar disorder, and post-traumatic stress disorder. [75][76][77]79 In eight of the reviews the included dietary interventions within studies were supplementation interventions, including six reviews with omega-3 supplementation interventions, [72][73][74][75][76]79 one review with pre-and probiotic supplementation interventions, 77 and one review with any dietary supplementation intervention (with most studies including folic acid, omega-3 or tryptophan supplementation).…”

Section: Resultsmentioning

confidence: 99%

“…78 All nine reviews reported mental health outcomes for one or more included study, while none reported dietary outcomes. Six of the reviews conducted meta-analyses, 36,72,73,75,78,79 and four of these reported significant results in favour of the analysed dietary interventions for depression treatment, 36,72,75,78 however with small effect sizes and noted limitations (e.g. low quality evidence, evidence of publication bias).…”

Section: Resultsmentioning

confidence: 99%

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Effectiveness of dietary interventions in mental health treatment: A rapid review of reviews

Burrows

Teasdale

Rocks

et al. 2022

Nutrition & Dietetics

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Aim This rapid review of reviews aimed to determine the extent of research undertaken on the effectiveness of dietary interventions for individuals with a mental disorder. Methods Three databases (MEDLINE, Embase, Cochrane Reviews and Cochrane Trials) were searched to February 2021 for systematic reviews including experimental studies assessing the effectiveness of dietary interventions with physical or mental health related outcomes in adults or children with one or more of: severe mental illness, depression or anxiety, eating disorders, or substance use disorder. Results are presented descriptively. Results The number of included reviews was 46 (67% in severe mental illness, 20% in depression and anxiety, 7% in eating disorders, and 7% in substance use disorders). Most reviews were published since 2016 (59%), and included studies conducted in adults (63%). Interventions in the eating disorders and severe mental illness reviews were predominantly education and behaviour change, whereas interventions in the substance use disorders, and depression and anxiety reviews were predominantly supplementation (e.g. omega‐3). Twenty‐eight and twelve of the reviews respectively reported mental health and dietary outcomes for one or more included studies. Most reviews in severe mental illness, and depression and anxiety reported conclusions supporting the positive effects of dietary intervention, including positive effects on weight‐related or mental health outcomes, and on mental health outcomes, respectively. Conclusions A larger number of systematic reviews were identified which evaluated dietary interventions in individuals with severe mental illness, and depression and anxiety, compared with substance use disorders, and eating disorders. Dietary intervention is an important component of the treatment that should be available to individuals living with mental disorders, to support their physical and mental health.

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“…While observational studies suggest inverse associations between omega-3 fatty acids and depression, 1, 2 trials supplementing omega-3 fatty acids have yielded mixed results. [3][4][5][6][7] Long-chain omega-3 fatty acids, such as eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), are widely regarded as important for brain health. 8 As a major source of long-chain omega 3 fatty acids is sh consumption, observational associations between circulating omega-3 fatty acids and depression are heavily confounded, and reverse causality from poor dietary intake in depressed individuals is likely.…”

Section: Introductionmentioning

confidence: 99%

Omega- 3 Fatty Acids and Major Depression: A Mendelian Randomization Study

Carnegie

Jones

Borges³

et al. 2022

Preprint

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Objective: Omega-3 fatty acids have been implicated in the aetiology of depressive disorders, though trials supplementing omega 3 to prevent depression have so far been unsuccessful. Whether this association is causal remains unclear. Methods: We used two sample Mendelian Randomization (MR) to help inform causal inference. Genetic variants associated with circulating omega-3 and omega-6 fatty acids in UK Biobank (UKBB, n=115,078) were selected as exposures. The Psychiatric Genomics Consortium (PGC) Major Depressive Disorder (MDD, n=430,775; cases=116,209; controls=314,566) and recurrent Major Depression (rMDD, n=80,933; cases=17,451; controls=62,482) genome wide association studies (GWAS) were used as outcomes. Multivariable (MVMR) models were used to account for biologically correlated lipids, such as high- and low-density cholesterol and triglycerides, and to explore the relative importance of longer chain omega 3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) using data from the Cohorts for Heart and Aging (CHARGE, n=8,866). Genetic colocalization analyses were used to approiximate the probability of a shared underlying causal variant between traits. Results: Genetically predicted total omega-3 fatty acids reduced the odds of MDD (ORIVW 0.96 per standard deviation (SD, i.e. 0.22mmol/l) (95% CIs 0.93-0.98, p=0.003). The largest point estimates were observed for eicosapentaenoic acid (EPA), a long chain omega-3 fatty acid (OREPA 0.92; 95% CI 0.88 to 0.96; p=0.0002). The effect of omega-3 fatty acids was robust to MVMR models accounting for biologically correlated lipids. ‘Leave-one-out’ analyses highlighted the FADS gene cluster as a key driver of the effect. Colocalization analyses suggested a shared causal variant using the primary outcome sample, but inconclusive, meaning genomic confounding could not be fully excluded. Conclusions: This study supports a role for omega-3 fatty acids, particularly EPA, in the aetiology of depression, although pleiotropic mechanisms cannot be ruled out. The findings support guidelines highlighting the importance of EPA dose and ratio for MDD, and the importance of adequate power to detect modest effect sizes.

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Omega-3 fatty acids for depression in adults

Abstract: To assess the effects of n3 polyunsaturated fatty acids (n3PUFAs) (also known as omega-3 fatty acids) compared with comparator (e.g. placebo, anti-depressant treatment, standard care, no treatment, wait-list control) for major depressive disorder in adults.

Cited by 45 publications

References 187 publications

Review of the Midbrain Ascending Arousal Network Nuclei and Implications for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS), Gulf War Illness (GWI) and Postexertional Malaise (PEM)

Review of the Midbrain Ascending Arousal Network Nuclei and Implications for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS), Gulf War Illness (GWI) and Postexertional Malaise (PEM)

Effectiveness of dietary interventions in mental health treatment: A rapid review of reviews

Omega- 3 Fatty Acids and Major Depression: A Mendelian Randomization Study

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