Department of Psychiatry, The First Affiliated Hospital, Jinan University, Guangzhou, 510630, China.
Department of Psychiatry, Affiliated Hospital of Guangdong Medical University, Zhanjiang, 524001, China.
BMC Psychiatry. 2020 May 20;20(1):248. doi: 10.1186/s12888-020-02656-3.
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.
Randomized 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.
A 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.
High-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.
近年来，n-3 多不饱和脂肪酸（n-3 PUFAs）补充剂在重度抑郁症（MDD）中的应用备受关注，但疗效和应用仍存在争议。本网络荟萃分析旨在比较不同剂量 n-3 PUFAs 对治疗早期 MDD 患者的疗效。
从 Pubmed、Embase 和 Cochrane 图书馆数据库中检索探讨 n-3 PUFA 补充剂治疗 MDD 患者疗效的随机对照试验（RCT）。纳入的 RCT 比较了 n-3 PUFA 对无合并症的成年（≥18 岁）MDD 患者的疗效。提取治疗早期（≤9 周）抑郁症状评分。对所有纳入 RCT 的评分进行标准化均数差（SMD）的合并，在频率论框架中进行配对荟萃分析，在贝叶斯框架中进行随机效应网络荟萃分析，以评估 n-3 PUFAs 的总体和亚组（高剂量和低剂量）疗效。
共纳入 10 项试验的 910 名 MDD 患者，采用 3 种辅助治疗策略（高剂量 n-3 PUFAs、低剂量 n-3 PUFAs 和安慰剂）。配对荟萃分析结果显示，n-3 PUFAs 优于安慰剂（SMD：1.243±0.596；95%CI：0.0602.414）。网络荟萃分析结果显示，高剂量（SMD：0.908±0.331；95%CI：0.2621.581）和低剂量（SMD：0.601±0.286；95%CI：0.034~1.18）n-3 PUFAs 均优于安慰剂，高剂量 n-3 PUFAs 的疗效优于低剂量。
在治疗早期，高剂量 n-3 PUFAs 补充剂可能优于低剂量 n-3 PUFAs。需要开展更多的头对头临床试验，以提供更直接的比较，并增强 n-3 PUFAs 治疗 MDD 的疗效证据。
