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Meta-analysis of the effects of eicosapentaenoic acid (EPA) in clinical trials in depression.
Sublette, M Elizabeth; Ellis, Steven P; Geant, Amy L; Mann, J John.
Afiliación
  • Sublette ME; New York State Psychiatric Institute, New York, NY 10032, USA. es2316@columbia.edu
J Clin Psychiatry ; 72(12): 1577-84, 2011 Dec.
Article en En | MEDLINE | ID: mdl-21939614
ABSTRACT

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.
Asunto(s)

Texto completo: 1 Bases de datos: MEDLINE Asunto principal: Ensayos Clínicos Controlados Aleatorios como Asunto / Ácido Eicosapentaenoico / Trastorno Depresivo Mayor Tipo de estudio: Clinical_trials / Guideline / Prognostic_studies / Systematic_reviews Idioma: En Revista: J Clin Psychiatry Año: 2011 Tipo del documento: Article País de afiliación: Estados Unidos

Texto completo: 1 Bases de datos: MEDLINE Asunto principal: Ensayos Clínicos Controlados Aleatorios como Asunto / Ácido Eicosapentaenoico / Trastorno Depresivo Mayor Tipo de estudio: Clinical_trials / Guideline / Prognostic_studies / Systematic_reviews Idioma: En Revista: J Clin Psychiatry Año: 2011 Tipo del documento: Article País de afiliación: Estados Unidos