Trebatická Jana, Hradečná Zuzana, Böhmer František, Vaváková Magdaléna, Waczulíková Iveta, Garaiova Iveta, Luha Ján, Škodáček Igor, Šuba Ján, Ďuračková Zdeňka
Department of Child and Adolescent Psychiatry, Faculty of Medicine, Comenius University and Child University Hospital, Limbová 1, 833 40 Bratislava, Slovakia.
Institute of Medical Chemistry, Biochemistry and Clinical Biochemistry, Faculty of Medicine, Comenius University, Sasinkova 2, 813 72 Bratislava, Slovakia.
Child Adolesc Psychiatry Ment Health. 2017 Jul 5;11:30. doi: 10.1186/s13034-017-0167-2. eCollection 2017.
The prevalence of mood disorders in children is a growing global concern. Omega-3 fatty acids (FA) are emerging as a promising adjuvant therapy for depressive disorder (DD) in paediatric patients. The primary objective of this pilot, single-centre, randomized, double-blind controlled study was to compare the efficacy of an Omega-3 FA fish oil emulsion with a control oil emulsion alongside standard treatment for depressive symptoms in children and adolescents suffering from depressive disorder (DD) and mixed anxiety depressive disorder (MADD).
38 children (12 patients were treated and diagnosed for at least 1 month before enrolment, 26 patients were first-time diagnosed as DD) aged 11-17 years were randomised 1:1 to the intervention (Omega-3 FA, 19 patients) or active comparator (Omega-6 FA, 19 patients) groups. Children's depression inventory (CDI) ratings were performed at baseline, every 2 weeks for a 12-week intervention period and at 4-week post-intervention. 35 patients (17 in Omega-3 and 18 in Omega-6 groups) who completed the whole intervention period were evaluated. Patients from Omega-3 group were stratified according to diagnosis into two subgroups (DD-10/17 and mixed anxiety depressive disorder (MADD)-7/17 patients) and in the Omega-6 group into DD-10/18 and MADD-8/18 patients. Groups were evaluated separately. Differences between-groups were tested with the Student´s test or non-parametric Mann-Whitney U test. Two-way ANOVA with repeated measures and Friedman test were used to analyse the effect for response in CDI score. p < 0.05 was considered significant in all statistical analyses.
Significant reductions in CDI scores in 35 analysed patients who completed 12 weeks intervention were observed after 12 weeks of intervention only in the Omega-3 group (p = 0.034). After stratification to depressive disorder and mixed anxiety depressive disorder subgroups, the DD subgroup receiving the Omega-3 FA fish oil showed statistically greater improvement (score reduction after 8 week treatment of -9.1 CDI, p = 0.0001) when compared to the MADD subgroup (score reduction after 8 week treatment -4.24 CDI, p = 0.271).
CDI scores were reduced in the Omega-3 group and the depression subgroup had greater improvement than the mixed depressive/anxiety group. An Omega-3 fatty acid rich fish oil emulsion may be an effective adjuvant supplement during the treatment of depressive disorders in children. ISRCTN81655012.
儿童情绪障碍的患病率在全球范围内日益受到关注。ω-3脂肪酸正逐渐成为治疗儿科患者抑郁症的一种有前景的辅助疗法。这项单中心、随机、双盲对照试验性研究的主要目的是比较ω-3脂肪酸鱼油乳剂与对照油乳剂在治疗患有抑郁症（DD）和混合性焦虑抑郁障碍（MADD）的儿童及青少年抑郁症状时，联合标准治疗的疗效。
38名年龄在11至17岁的儿童（12名患者在入组前已接受治疗和诊断至少1个月，26名患者首次被诊断为DD）被1:1随机分为干预组（ω-3脂肪酸，19名患者）或活性对照剂组（ω-6脂肪酸，19名患者）。在基线、为期12周的干预期内每2周以及干预后4周进行儿童抑郁量表（CDI）评分。对完成整个干预期的35名患者（ω-3组17名，ω-6组18名）进行评估。ω-3组的患者根据诊断分为两个亚组（DD组10/17名患者和混合性焦虑抑郁障碍（MADD）组7/17名患者），ω-6组分为DD组10/18名患者和MADD组8/18名患者。分别对各亚组进行评估。组间差异采用学生t检验或非参数曼-惠特尼U检验。采用重复测量的双向方差分析和弗里德曼检验分析CDI评分的反应效果。所有统计分析中，p<0.05被认为具有统计学意义。
在完成12周干预的35名分析患者中，仅ω-3组在干预12周后观察到CDI评分显著降低（p=0.034）。分层为抑郁症和混合性焦虑抑郁障碍亚组后，接受ω-3脂肪酸鱼油的DD亚组与MADD亚组相比（8周治疗后CDI评分降低-4.24，p=0.271），在统计学上显示出更大的改善（8周治疗后CDI评分降低-9.1，p=0.0001）。
ω-3组的CDI评分降低，且抑郁症亚组比混合性抑郁/焦虑组有更大改善。富含ω-3脂肪酸的鱼油乳剂可能是治疗儿童抑郁症期间一种有效的辅助补充剂。ISRCTN81655012。
