Meta-analysis of the effects of eicosapentaenoic acid (EPA) in clinical trials in depression
Sublette ME, Ellis SP, Geant AL, Mann JJ
The Journal of clinical psychiatry · 285 citas
Cómo se estudió
- Diseño
- Metaanálisis (indexado por PubMed)
- Estudiado en
- Personas
- Resultado principal
- Marcadores de salud y funcionamiento
Quién lo pagó
- Financiación
- Financiación independiente
- Gobierno
- National Institute of Mental Health
- Gobierno
- NIMH NIH HHS
- Subvenciones
- National Institute of Mental Health (K-08 MH079033); National Institute of Mental Health (MH040695); National Institute of Mental Health (R01 MH040695)
Según 2 financiadores declarados.
Publicación
- Publicado
- 2011-09-06 · J Clin Psychiatry · vol. 72 · número 12 · págs. 1577–1584
- Editorial
- Physicians Postgraduate Press, Inc.
- Citado
- 417 citas · más que el 97% de estudios similares · 4.8× el promedio de su campo
- Impacto
- Entre el 10 % más citado de su campo
- Referencias
- 79 trabajos
- Acceso
- Acceso abierto (copia en repositorio)
- Áreas de investigación
- Fatty Acid Research and Health · Treatment of Major Depression · Tryptophan and brain disorders
- Palabras clave
- eicosapentaenoic acid, omega-3 polyunsaturated fatty acids, fish oil supplements, depression, major depressive episode, docosahexaenoic acid, EPA/DHA ratio, bipolar depression, depression rating scales, treatment duration, diagnostic heterogeneity, treatment effect heterogeneity
- MeSH
- humans, docosahexaenoic acids, eicosapentaenoic acid, placebos, treatment outcome, randomized controlled trials as topic, major depressive disorder
4 autores
- M. Elizabeth Sublette🇺🇸 · autor de correspondenciaNew York State Psychiatric Institute; Columbia University
- Steven P. Ellis🇺🇸New York State Psychiatric Institute; Columbia University
- Amy L. GeantNew York State Psychiatric Institute
- J. John Mann🇺🇸New York State Psychiatric Institute; Columbia University
Resumen
El texto original del estudio, en el idioma en que se publicó.
Objective
Randomized trials of omega-3 polyunsaturated fatty acid (PUFA) treatment for depression have differed in outcome. Recent meta-analyses ascribe discrepancies to differential effects of eicosapentaenoic acid (EPA) versus docosahexaenoic acid (DHA) and to diagnostic heterogeneity. This meta-analysis tests the hypothesis that EPA is the effective component in PUFA treatment of major depressive episodes.
Data sources
PubMed/MeSH was searched for studies published in English from 1960 through June 2010 using the terms fish oils (MeSH) AND (depressive disorder [MeSH] OR bipolar depression) AND randomized controlled trial (publication type). The search was supplemented by manual bibliography review and examination of relevant review articles.
Study selection
The search yielded 15 trials involving 916 participants. Studies were included if they had a prospective, randomized, double-blinded, placebo-controlled study design; if depressive episode was the primary complaint (with or without comorbid medical conditions); if omega-3 PUFA supplements were administered; and if appropriate outcome measures were used to assess depressed mood.
Data extraction
Extracted data included study design, sample sizes, doses and percentages of EPA and DHA, mean ages, baseline and endpoint depression ratings and standard deviations for PUFA and placebo groups, and P values. The clinical outcome of interest was the standardized mean difference in the change from baseline to endpoint scores on a depression rating scale in subjects taking PUFA supplements versus subjects taking placebo.
Data synthesis
In a mixed-effect model, percentage of EPA in the supplements was the fixed-effect predictor, dichotomized into 2 groups: EPA < 60% or EPA ≥ 60% of the total EPA + DHA. Secondary analyses explored the relevance of treatment duration, age, and EPA dose.
Results
Supplements with EPA ≥ 60% showed benefit on standardized mean depression scores (effect size = 0.532; 95% CI, 0.277-0.733; t = 4.195; P < .001) versus supplements with EPA < 60% (effect size = -0.026; 95% CI, -0.200 to 0.148; t = -0.316; P = .756), with negligible contribution of random effects or heteroscedasticity and with no effects of treatment duration or age. Supplements with EPA < 60% were ineffective. Exploratory analyses supported a nonlinear model, with improvement determined by the dose of EPA in excess of DHA, within the range of 200 to 2,200 mg/d of EPA.
Conclusions
Supplements containing EPA ≥ 60% of total EPA + DHA, in a dose range of 200 to 2,200 mg/d of EPA in excess of DHA, were effective against primary depression. Translational studies are needed to determine the mechanisms of EPA's therapeutic benefit.
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