Abstract
BackgroundThe application of n-3 Polyunsaturated Fatty Acids (n-3 PUFAs) supplementation for major depressive disorder (MDD) has been widely discussed in recent years, but its efficacy and application are still controversial. This network meta-analysis was conducted to compare the efficacy of different dosages of n-3 PUFAs on MDD patients in the early period of treatment.MethodsRandomized controlled trials (RCTs) exploring the efficacy of n-3 PUFA supplementation for patients with MDD were retrieved from the databases of Pubmed, Embase and the Cochrane Library. RCTs comparing the efficacy of n-3 PUFA for adult (≥18 years) MDD patients without comorbidity were eligible for our study. The score of depressive symptoms in early therapy period of the treatment (≤9 weeks) was extracted. Standardized mean deviations (SMDs) of all the sores from the eligible RCTs were synthesized in a pairwise meta-analysis in frequentist framework and a random-effects network meta-analysis in Bayesian framework for the overall and subgroups (high- and low-dose) efficacy of n-3 PUFAs.ResultsA total of 910 MDD patients in 10 trials with 3 adjuvant therapy strategies (high-dose n-3 PUFAs, low-dose n-3 PUFAs and placebo) were included. Results of pairwise meta-analysis showed that n-3 PUFAs were superior to placebo (SMD: 1.243 ± 0.596; 95% CI: 0.060 ~ 2.414). Results of the network meta-analysis showed that both the high (SMD: 0.908 ± 0.331; 95% CI: 0.262 ~ 1.581) and the low-dose (SMD: 0.601 ± 0.286; 95% CI: 0.034 ~ 1.18) n-3 PUFAs were superior to placebo, and the efficacy of high-dose n-3 PUFAs is superior to that of low-dose.ConclusionsHigh-dose n-3 PUFAs supplementation might be more superior than low-dose in the early therapy period for MDD. More head-to-head clinical trials need to be carried out to provide more direct comparison and enhance the evidence of the efficacy of n-3PUFAs for MDD.
Highlights
The application of n-3 Polyunsaturated Fatty Acids (n-3 PUFAs) supplementation for major depressive disorder (MDD) has been widely discussed in recent years, but its efficacy and application are still controversial
It has been found that patients among various types of depression [1,2,3,4] with a lower level of docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), so it is considered to be used as an adjuvant treatment of the major depressive disorder (MDD) theoretically
Before effective doses of n-3 PUFA were recommended based on the results of head-to-head trials for MDD patients, comparative effectiveness research is necessary to identify the efficacy of different doses of n-3 PUFA supplementation
Summary
The application of n-3 Polyunsaturated Fatty Acids (n-3 PUFAs) supplementation for major depressive disorder (MDD) has been widely discussed in recent years, but its efficacy and application are still controversial This network meta-analysis was conducted to compare the efficacy of different dosages of n-3 PUFAs on MDD patients in the early period of treatment. Long chain n-3 PUFAs, mainly including eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), play an important role in transport of multiple ions across the cell membrane where there is a need for stable permeability and fluidity These characteristics can be maintained in an optimal state by the n-3 PUFAs. In recent years, it has been found that patients among various types of depression [1,2,3,4] with a lower level of DHA and (or) EPA, so it is considered to be used as an adjuvant treatment of the major depressive disorder (MDD) theoretically. We have noticed there were still several issues to be solved: (1) The effective dose of n-3 PUFAs for MDD is not yet clear, EPA dose in different clinical trials varies greatly (from 45 to 4400 mg/day), whether the efficacy of high-dose n-3 PUFAs is more superior than that of low-dose are not yet identified, and the effect of dose variation on therapeutic efficacy needs to be explored. (2) Whether the efficacy of n-3 PUFAs for MDD was affected by the quantity of DHA needs to be explored. (3) Heterogeneity of included trials needs to be further explored, as the eligible participants, antidepressants usage, dosage and duration of n-3 PUFAs administration, and research duration may be correlated with the estimated results
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