Omega-3 fatty acids as treatments for mental illness: which disorder and which fatty acid?

Brian M Ross, Jennifer Seguin, Lee E Sieswerda, Brian M Ross, Jennifer Seguin, Lee E Sieswerda

Abstract

Background: A growing number of observational and epidemiological studies have suggested that mental illness, in particular mood disorders, is associated with reduced dietary intake and/or cellular abundance of omega-3 polyunsaturated fatty acids (PUFA). This has prompted researchers to test the efficacy of omega-3 PUFA in a range of different psychiatric disorders. We have critically reviewed the double blind placebo controlled clinical trials published prior to April 2007 to determine whether omega-3 PUFA are likely to be efficacious in these disorders.

Results: Most trials involved a small number of participants but were largely well designed. Omega-3 PUFA were well tolerated by both children and adults with mild gastrointestinal effects being the only consistently reported adverse event. For schizophrenia and borderline personality disorder we found little evidence of a robust clinically relevant effect. In the case of attention deficit hyperactivity disorder and related disorders, most trials showed at most small benefits over placebo. A limited meta-analysis of these trials suggested that benefits of omega-3 PUFA supplementation may be greater in a classroom setting than at home. Some evidence indicates that omega-3 PUFA may reduce symptoms of anxiety although the data is preliminary and inconclusive. The most convincing evidence for beneficial effects of omega-3 PUFA is to be found in mood disorders. A meta-analysis of trials involving patients with major depressive disorder and bipolar disorder provided evidence that omega-3 PUFA supplementation reduces symptoms of depression. Furthermore, meta-regression analysis suggests that supplementation with eicosapentaenoic acid may be more beneficial in mood disorders than with docosahexaenoic acid, although several confounding factors prevented a definitive conclusion being made regarding which species of omega-3 PUFA is most beneficial. The mechanisms underlying the apparent efficacy of omega-3 PUFA in mood disorders compared to schizophrenia are discussed as is a rational for the possibly greater efficacy of EPA compared to DHA.

Conclusion: While it is not currently possible to recommend omega-3 PUFA as either a mono- or adjunctive-therapy in any mental illness, the available evidence is strong enough to justify continued study, especially with regard to attentional, anxiety and mood disorders.

Figures

Figure 1
Figure 1
Standardized mean differences in ADHD-related symptoms in omega-3 PUFA-treated compared to placebo-treated subjects. SMD are the standardized mean differences (scaled to standard deviations) in the change-from-baseline scores in the placebo and treatment groups, along with 95% confidence intervals. A summary of each study's characteristics can be found in Table 1. Because of the incomparability of the instruments used in several of the studies, we were only able to include three studies in this summary. We have shown separate estimates for hyperactivity and inattention subscales, as well as distinguished parent and teacher ratings. There are not yet sufficient sufficiently comparable data to justify calculating an overall summary. We have, however, provided preliminary inverse-variance-weighted averages of the two studies in each subsection.
Figure 2
Figure 2
Standardized mean differences in depressive symptoms in omega-3 PUFA-treated compared to placebo-treated subjects with major depressive disorder or bipolar disorder. SMD are the standardized mean differences (scaled to standard deviations) in the change-from-baseline scores in the placebo and treatment groups, along with 95% confidence intervals. A summary of each study's characteristics can be found in Table 4. All studies rated patients using the HDRS, except that conducted by Llorente and colleagues [73], which was therefore excluded from the analysis. I-squared is the proportion of variance attributable to the heterogeneity between studies, and the p-value is for Cohen's Q, a test of the statistical significance of that heterogeneity. The overall estimate is the inverse-variance-weighted average of the studies based on a random effects model.

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Source: PubMed

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