Meta-analysis of the effects of Eicosapentaenoic Acid (EPA) in clinical trials in depression

Journal of Clinical Psychiatry

Volumn 72, Issue 12, 2011, Pages 1577-1584

  Sublette, M Elizabeth ^a,b   Ellis, Steven P ^a,b   Geant, Amy L ^a   Mann, J John ^a,b  

^a NEW YORK STATE PSYCHIATRIC INSTITUTE   (United States)

^b Och Spine at New York Presbyterian Hospitals   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

DOCOSAHEXAENOIC ACID; ICOSAPENTAENOIC ACID; PLACEBO;

AGE; ARTICLE; BECK DEPRESSION INVENTORY; BIPOLAR DISORDER; COMORBIDITY; DRUG EFFICACY; HAMILTON SCALE; HUMAN; MAJOR DEPRESSION; META ANALYSIS; MONOTHERAPY; MONTGOMERY ASBERG DEPRESSION RATING SCALE; PRIORITY JOURNAL; SCORING SYSTEM; SYSTEMATIC REVIEW; TREATMENT DURATION;

EID: 84555220604     PISSN: 01606689     EISSN: None     Source Type: Journal    
DOI: 10.4088/JCP.10m06634     Document Type: Article

References (73)

1. Lin PY, Huang SY, Su KPA. A meta-analytic review of polyunsaturated fatty acid compositions in patients with depression. Biol Psychiatry. 2010;68(2):140-147.
2. McNamara RK, Hahn CG, Jandacek R, et al. Selective deficits in the omega-3 fatty acid docosahexaenoic acid in the postmortem orbitofrontal cortex of patients with major depressive disorder. Biol Psychiatry. 2007;62(1):17-24. (Pubitemid 46898224)
3. Sublette ME, Hibbeln JR, Galfalvy H, et al. Omega-3 polyunsaturated essential fatty acid status as a predictor of future suicide risk. Am J Psychiatry. 2006;163(6):1100-1102. (Pubitemid 44464499)
4. Calder PC. n-3 Fatty acids and cardiovascular disease: evidence explained and mechanisms explored. Clin Sci (Lond). 2004;107(1):1-11. (Pubitemid 38932191)
5. Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico. Dietary supplementation with n-3 polyunsaturated fatty acids and vitamin E after myocardial infarction: results of the GISSI-Prevenzione trial. Lancet. 1999;354(9177):447-455.
6. Simopoulos AP. Omega-3 fatty acids in inflammation and autoimmune diseases. J Am Coll Nutr. 2002;21(6):495-505. (Pubitemid 36026261)
7. McNamara RK. Membrane omega-3 fatty acid deficiency as a preventable risk factor for comorbid coronary heart disease in major depressive disorder. Cardiovasc Psychiatry Neurol. 2009;2009:Article ID 362795. Epub September 16, 2009.
8. Parker GB, Heruc GA, Hilton TM, et al. Low levels of docosahexaenoic acid identified in acute coronary syndrome patients with depression. Psychiatry Res. 2006;141(3):279-286.
9. Holt RI, Phillips DI, Jameson KA, et al. Hertfordshire Cohort Study Group. The relationship between depression and diabetes mellitus: findings from the Hertfordshire Cohort Study. Diabet Med. 2009;26(6):641-648.
10. Freeman MP, Hibbeln JR, Wisner KL, et al. Omega-3 fatty acids: evidence basis for treatment and future research in psychiatry. J Clin Psychiatry. 2006;67(12):1954-1967. (Pubitemid 46048194)
11. Ross BM, Seguin J, Sieswerda LE. Omega-3 fatty acids as treatments for mental illness: which disorder and which fatty acid? Lipids Health Dis. 2007;6(1):21.
12. Lin PY, Su KP. A meta-analytic review of double-blind, placebo- controlled trials of antidepressant efficacy of omega-3 fatty acids. J Clin Psychiatry. 2007;68(7):1056-1061. (Pubitemid 47340326)
13. Martins JG. EPA but not DHA appears to be responsible for the efficacy of omega-3 long chain polyunsaturated fatty acid supplementation in depression: evidence from a meta-analysis of randomized controlled trials. J Am Coll Nutr. 2009;28(5):525-542.
14. Appleton KM, Rogers PJ, Ness AR. Updated systematic review and meta-analysis of the effects of n-3 long-chain polyunsaturated fatty acids on depressed mood. Am J Clin Nutr. 2010;91(3):757-770.
15. Carney RM, Freedland KE, Rubin EH, et al. Omega-3 augmentation of sertraline in treatment of depression in patients with coronary heart disease: a randomized controlled trial. JAMA. 2009;302(15):1651-1657.
16. Mischoulon D, Papakostas GI, Dording CM, et al. A double-blind, randomized controlled trial of ethyl-eicosapentaenoate for major depressive disorder. J Clin Psychiatry. 2009;70(12):1636-1644.
17. Grenyer BF, Crowe T, Meyer B, et al. Fish oil supplementation in the treatment of major depression: a randomised double-blind placebo-controlled trial. Prog Neuropsychopharmacol Biol Psychiatry. 2007;31(7):1393-1396. (Pubitemid 47304478)
18. da Silva TM, Munhoz RP, Alvarez C, et al. Depression in Parkinson's disease: a double-blind, randomized, placebo-controlled pilot study of omega-3 fatty-acid supplementation. J Affect Disord. 2008;111(2-3):351-359.
19. Silvers KM, Woolley CC, Hamilton FC, et al. Randomised double-blind placebo-controlled trial of fish oil in the treatment of depression. Prostaglandins Leukot Essent Fatty Acids. 2005;72(3):211-218. (Pubitemid 40139086)
20. Hamilton M. A rating scale for depression. J Neurol Neurosurg Psychiatry. 1960;23(1):56-62.
21. Nemets H, Nemets B, Apter A, et al. Omega-3 treatment of childhood depression: a controlled, double-blind pilot study. Am J Psychiatry. 2006;163(6):1098-1100. (Pubitemid 44464498)
22. Rogers PJ, Appleton KM, Kessler D, et al. No effect of n-3 long-chain polyunsaturated fatty acid (EPA and DHA) supplementation on depressed mood and cognitive function: a randomised controlled trial. Br J Nutr. 2008;99(2):421-431.
23. Beck AT, Ward CH, Mendelson M, et al. An inventory for measuring depression. Arch Gen Psychiatry. 1961;4:561-571.
24. Montgomery SA, Asberg M. A new depression scale designed to be sensitive to change. Br J Psychiatry. 1979;134(4):382-389. (Pubitemid 9136500)
25. Poznanski EO, Cook SC, Carroll BJ. A depression rating scale for children. Pediatrics. 1979;64(4):442-450. (Pubitemid 9247602)
26. Lovibond PF, Lovibond SH. The structure of negative emotional states: comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behav Res Ther. 1995;33(3):335-343.
27. R Development Core Team. R: A Language and Environment for Statistical Computing. Vienna, Austria: R Foundation for Statistical Computing; 2006.
28. Hedges L, Olkin I. Statistical Methods for Meta-Analysis. New York, NY: Academic Press; 1985.
29. Peet M, Horrobin DF. A dose-ranging study of the effects of ethyleicosapentaenoate in patients with ongoing depression despite apparently adequate treatment with standard drugs. Arch Gen Psychiatry. 2002;59(10):913-919.
30. Rosenthal R. Parametric Measures of Effect Size. In: Cooper H, Hedges L, eds. The Handbook of Research Synthesis. New York, NY: Russell Sage Foundation; 1994:231-244.
31. Frangou S, Lewis M, McCrone P. Efficacy of ethyl-eicosapentaenoic acid in bipolar depression: randomised double-blind placebo-controlled study. Br J Psychiatry. 2006;188(1):46-50. (Pubitemid 43021926)
32. Draper N, Smith H. Applied Regression Analysis. New York, NY: Wiley; 1981.
33. Lahiri P. Model Selection. In: Lahiri P, ed. Lecture Notes-Monograph. Beachwood, Ohio: Institute of Mathematical Statistics; 2001.
34. Keck PE Jr, Mintz J, McElroy SL, et al. Double-blind, randomized, placebo-controlled trials of ethyl-eicosapentanoate in the treatment of bipolar depression and rapid cycling bipolar disorder. Biol Psychiatry. 2006;60(9):1020-1022. (Pubitemid 44739928)
35. Freeman MP, Davis M, Sinha P, et al. Omega-3 fatty acids and supportive psychotherapy for perinatal depression: a randomized placebo-controlled study. J Affect Disord. 2008;110(1-2):142-148.
36. Marangell LB, Martinez JM, Zboyan HA, et al. A double-blind, placebocontrolled study of the omega-3 fatty acid docosahexaenoic acid in the treatment of major depression. Am J Psychiatry. 2003;160(5):996-998. (Pubitemid 41079588)
37. Nemets B, Stahl Z, Belmaker RH. Addition of omega-3 fatty acid to maintenance medication treatment for recurrent unipolar depressive disorder. Am J Psychiatry. 2002;159(3):477-479. (Pubitemid 34184747)
38. Su KP, Huang SY, Chiu CC, et al. Omega-3 fatty acids in major depressive disorder: A preliminary double-blind, placebo-controlled trial. Eur Neuropsychopharmacol. 2003;13(4):267-271. (Pubitemid 36904053)
39. Su KP, Huang SY, Chiu TH, et al. Omega-3 fatty acids for major depressive disorder during pregnancy: results from a randomized, double-blind, placebo-controlled trial. J Clin Psychiatry. 2008;69(4):644-651. (Pubitemid 351792341)
40. Rees AM, Austin MP, Parker GB. Omega-3 fatty acids as a treatment for perinatal depression: randomized double-blind placebo-controlled trial. Aust N Z J Psychiatry. 2008;42(3):199-205. (Pubitemid 351234189)
41. Huang MC, Brenna JT, Chao AC, et al. Differential tissue dose responses of (n-3) and (n-6) PUFA in neonatal piglets fed docosahexaenoate and arachidonoate. J Nutr. 2007;137(9):2049-2055. (Pubitemid 47367264)
42. Moriguchi T, Loewke J, Garrison M, et al. Reversal of docosahexaenoic acid deficiency in the rat brain, retina, liver, and serum. J Lipid Res. 2001;42(3):419-427. (Pubitemid 32270066)
43. Umhau JC, Dauphinais KM, Patel SH, et al. The relationship between folate and docosahexaenoic acid in men. Eur J Clin Nutr. 2006;60(3):352-357. (Pubitemid 43354928)
44. Gao F, Kiesewetter D, Chang L, et al. Whole-body synthesis secretion of docosahexaenoic acid from circulating eicosapentaenoic acid in unanesthetized rats. J Lipid Res. 2009;50(12):2463-2470.
45. Conklin SM, Runyan CA, Leonard S, et al. Age-related changes of n-3 and n-6 polyunsaturated fatty acids in the anterior cingulate cortex ofindividuals with major depressive disorder. Prostaglandins Leukot Essent Fatty Acids. 2010;82(2-3):111-119.
46. Boston PF, Bennett A, Horrobin DF, et al. Ethyl-EPA in Alzheimer's disease - a pilot study. Prostaglandins Leukot Essent Fatty Acids. 2004;71(5):341-346. (Pubitemid 39233559)
47. Engström K, Saldeen AS, Yang B, et al. Effect of fish oils containing different amounts of EPA, DHA, and antioxidants on plasma and brain fatty acids and brain nitric oxide synthase activity in rats. Ups J Med Sci. 2009;114(4):206-213.
48. Chen CT, Liu Z, Ouellet M, et al. Rapid beta-oxidation of eicosapentaenoic acid in mouse brain: an in situ study. Prostaglandins Leukot Essent Fatty Acids. 2009;80(2-3):157-163.
49. Kawashima A, Harada T, Kami H, et al. Effects of eicosapentaenoic acid on synaptic plasticity, fatty acid profile and phosphoinositide 3-kinase signaling in rat hippocampus and differentiated PC12 cells. J Nutr Biochem. 2010;21(4):266-277.
50. Smith WL. Cyclooxygenases, peroxide tone and the allure of fish oil. Curr Opin Cell Biol. 2005;17(2):174-182. (Pubitemid 40380941)
51. Miller AH, Maletic V, Raison CL. Inflammation and its discontents: the role of cytokines in the pathophysiology of major depression. Biol Psychiatry. 2009;65(9):732-741.
52. Maes M, Smith RS. Fatty acids, cytokines, and major depression. Biol Psychiatry. 1998;43(5):313-314.
53. Raison CL, Capuron L, Miller AH. Cytokines sing the blues: inflammation and the pathogenesis of depression. Trends Immunol. 2006;27(1):24-31. (Pubitemid 43083561)
54. Calder PC. n-3 Polyunsaturated fatty acids, inflammation, and inflammatory diseases. Am J Clin Nutr. 2006;83(suppl):1505S-1519S. (Pubitemid 44713092)
55. De Vriese SR, Christophe AB, Maes M. Lowered serum n-3 polyunsaturated fatty acid (PUFA) levels predict the occurrence of postpartum depression: further evidence that lowered n-PUFAs are related to major depression. Life Sci. 2003;73(25):3181-3187. (Pubitemid 37242978)
56. Edwards R, Peet M, Shay J, et al. Omega-3 polyunsaturated fatty acid levels in the diet and in red blood cell membranes of depressed patients. J Affect Disord. 1998;48(2-3):149-155. (Pubitemid 28244216)
57. Maes M, Smith R, Christophe A, et al. Fatty acid composition in major depression: decreased ω3 fractions in cholesteryl esters and increased C20:4ω6/C20:5ω3 ratio in cholesteryl esters and phospholipids. J Affect Disord. 1996;38(1):35-46.
58. Mamalakis G, Tornaritis M, Kafatos A. Depression and adipose essential polyunsaturated fatty acids. Prostaglandins Leukot Essent Fatty Acids. 2002;67(5):311-318. (Pubitemid 35397372)
59. Peet M, Murphy B, Shay J, et al. Depletion of omega-3 fatty acid levels in red blood cell membranes of depressive patients. Biol Psychiatry. 1998;43(5):315-319. (Pubitemid 28137622)
60. Lee HJ, Rao JS, Rapoport SI, et al. Antimanic therapies target brain arachidonic acid signaling: lessons learned about the regulation of brain fatty acid metabolism. Prostaglandins Leukot Essent Fatty Acids. 2007;77(5-6):239-246. (Pubitemid 350198854)
61. Rapoport SI, Basselin M, Kim HW, et al. Bipolar disorder and mechanisms of action of mood stabilizers. Brain Res Rev. 2009;61(2):185-209.
62. Sublette ME, Russ MJ, Smith GS. Evidence for a role of the arachidonic acid cascade in affective disorders: a review. Bipolar Disord. 2004;6(2):95-105. (Pubitemid 38443562)
63. Su KP, Huang SY, Peng CY, et al. Phospholipase A2 and cyclooxygenase 2 genes influence the risk of interferon-α-induced depression by regulating polyunsaturated fatty acids levels. Biol Psychiatry. 2010;67(6):550-557.
64. Freemantle E, Vandal M, Tremblay-Mercier J, et al. Omega-3 fatty acids, energy substrates, and brain function during aging. Prostaglandins Leukot Essent Fatty Acids. 2006;75(3):213-220. (Pubitemid 44292526)
65. Berge RK, Madsen L, Vaagenes H, et al. In contrast with docosahexaenoic acid, eicosapentaenoic acid and hypolipidaemic derivatives decrease hepatic synthesis and secretion of triacylglycerol by decreased diacylglycerol acyltransferase activity and stimulation of fatty acid oxidation. Biochem J. 1999;343(pt 1):191-197. (Pubitemid 29473895)
66. Mori TA, Burke V, Puddey IB, et al. Purified eicosapentaenoic and docosahexaenoic acids have differential effects on serum lipids and lipoproteins, LDL particle size, glucose, and insulin in mildly hyperlipidemic men. Am J Clin Nutr. 2000;71(5):1085-1094. (Pubitemid 30230554)
67. Jump DB. n-3 Polyunsaturated fatty acid regulation of hepatic gene transcription. Curr Opin Lipidol. 2008;19(3):242-247. (Pubitemid 351653561)
68. van Raalte DH, Li M, Pritchard PH, et al. Peroxisome proliferator- activated receptor (PPAR)-α: a pharmacological target with a promising future. Pharm Res. 2004;21(9):1531-1538. (Pubitemid 41184380)
69. Frangou S, Lewis M, Wollard J, et al. Preliminary in vivo evidence of increased N-acetyl-aspartate following eicosapentanoic acid treatment in patients with bipolar disorder. J Psychopharmacol. 2007;21(4):435-439. (Pubitemid 47077299)
70. Puri BK, Counsell SJ, Hamilton G, et al. Eicosapentaenoic acid in treatment-resistant depression associated with symptom remission, structural brain changes and reduced neuronal phospholipid turnover. Int J Clin Pract. 2001;55(8):560-563. (Pubitemid 33040558)
71. Maes M, Mihaylova I, Kubera M, et al. Why fish oils may not always be adequate treatments for depression or other inflammatory illnesses: docosahexaenoic acid, an omega-3 polyunsaturated fatty acid, induces a Th-1-like immune response. Neuroendocrinol Lett. 2007;28(6):875-880.
72. Stoll AL, Severus WE, Freeman MP, et al. Omega 3 fatty acids in bipolar disorder: a preliminary double-blind, placebo-controlled trial. Arch Gen Psychiatry. 1999;56(5):407-412. (Pubitemid 29215428)
73. McNamara RK. Evaluation of docosahexaenoic acid deficiency as a preventable risk factor for recurrent affective disorders: current status, future directions, and dietary recommendations. Prostaglandins Leukot Essent Fatty Acids. 2009;81(2-3):223-231.