Guu Ta-Wei, Mischoulon David, Sarris Jerome, Hibbeln Joseph, McNamara Robert K, Hamazaki Kei, Freeman Marlene P, Maes Michael, Matsuoka Yutaka J, Belmaker R H, Marx Wolfgang, Pariante Carmine, Berk Michael, Jacka Felice, Su Kuan-Pin
Departments of Psychiatry and Mind-Body Interface Laboratory (MBI-Lab), China Medical University Hospital, Taichung, TAIWAN; Division of Psychiatry, Departments of Internal Medicine, China Medical University Beigang Hospital, Yunlin, TAIWAN.
Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
J Affect Disord. 2020 Mar 15;265:233-238. doi: 10.1016/j.jad.2020.01.050. Epub 2020 Jan 15.
Omega-3 polyunsaturated fatty acids (n-3 PUFAs) are recommended as an integrative treatment for major depressive disorder (MDD). In 2019, the International Society for Nutritional Psychiatry Research (ISNPR) developed the first practice guidelines for n-3 PUFA treatment of MDD. To strengthen these guidelines and enhance their clinical applicability, we synthesized the evidence and clinical experiences previously obtained through the Delphi methodology.
Nineteen statements covering five major domains in MDD treatment were formulated through internal meetings. Fourteen international experts were invited to participate in the web-based Delphi process that validated the statements. Likert scales were used, and consensus level was set at 7.0/10.0, with the equivocal level set at 5.1-6.9. The items with scores < 5.0 were allocated into a second round Delphi survey with inverse questions.
All panelists completed the survey. Sixteen statements reached consensus, and the statement "n-3 PUFAs are one of the potential adjunctive treatments for adult MDD" reached the highest agreement. "N-3 PUFAs are one of the potential monotherapies for adult MDD" instead scored lowest. Regarding "special populations," many items, reached high consensus despite sub-optimal supportive evidence.
The panelists had a specialized interest in n-3 PUFAs; focus was placed on clinical issues rather than on biological mechanisms.
The Delphi process helps bridge the gap between scientific evidence and clinical practice, supports certain uses of PUFA and identifies insufficiency in current evidence that merit future research.
ω-3多不饱和脂肪酸（n-3 PUFAs）被推荐作为重度抑郁症（MDD）的综合治疗方法。2019年，国际营养精神病学研究协会（ISNPR）制定了首个n-3 PUFAs治疗MDD的实践指南。为强化这些指南并提高其临床适用性，我们综合了先前通过德尔菲法获得的证据和临床经验。
通过内部会议制定了涵盖MDD治疗五个主要领域的19条陈述。邀请了14位国际专家参与基于网络的德尔菲过程，以验证这些陈述。使用李克特量表，共识水平设定为7.0/10.0，模棱两可水平设定为5.1-6.9。得分<5.0的项目被纳入第二轮带有反向问题的德尔菲调查。
所有小组成员均完成了调查。16条陈述达成了共识，“n-3 PUFAs是成人MDD的潜在辅助治疗方法之一”这一陈述达成的共识最高。“n-3 PUFAs是成人MDD的潜在单一疗法之一”得分最低。关于“特殊人群”，尽管支持证据不足，但许多项目仍达成了高度共识。
小组成员对n-3 PUFAs有专门兴趣；重点放在临床问题而非生物学机制上。
德尔菲过程有助于弥合科学证据与临床实践之间的差距，支持PUFA的某些用途，并确定当前证据中的不足之处，值得未来研究。
