School of Life and Health Sciences, University of Roehampton, London, UK.
School of Psychology, University of Roehampton, London, UK.
Prostaglandins Leukot Essent Fatty Acids. 2023 May;192:102572. doi: 10.1016/j.plefa.2023.102572. Epub 2023 Apr 2.
The omega-3 polyunsaturated fatty acids (PUFAs) eicosapentaenoic- (EPA), docosahexaenoic- (DHA) and docosapentaenoic acid (DPAn-3) are promising therapeutic options in reducing the severity of anxious and depressive symptoms. However, meta-analyses of randomised controlled trials (RCTs) yield mixed findings. This systematic review and meta-analysis reviewed the evidence and assessed the efficacy of EPA, DHA and DPAn-3 in reducing the severity of anxiety and depression with specific consideration to methodological complications unique to the field e.g., dose and ratio of omega-3 PUFAs and placebo composition. Random-effects meta-analysis of ten RCTs comprising 1426 participants revealed statistically significant reduction in depression severity with EPA-enriched interventions at proportions ≥ 60% of total EPA + DHA (SMD: -0.36; 95% CI: -0.68, -0.05; p = 0.02) (I = 86%) and EPA doses between ≥ 1 g/day and < 2 g/day (SMD: -0.43; 95% CI: -0.79, -0.07; p = 0.02) (I = 88%); however, EPA doses ≥ 2 g/day were not associated with significant therapeutic effects (SMD: -0.20; 95% CI: -0.48, 0.07; p = 0.14). Only one study reported significant reduction in anxiety severity with 2.1 g/day EPA (85.6% of total EPA + DHA), therefore meta-analysis was not possible. No trials administering DPAn-3 were identified. Visual examination of the funnel plot revealed asymmetry, suggesting publication bias and heterogeneity amongst the trials. These results support the therapeutic potential of EPA in depression at proportions ≥ 60% of total EPA + DHA and doses ≥ 1 g/day and < 2 g/day. The observed publication bias and heterogeneity amongst the trials reflect the need for more high-quality trials in this area with consideration to the unique nature of omega-3 PUFAs research, to more fully elucidate the therapeutic potential of EPA, DHA and DPAn-3.
ω-3 多不饱和脂肪酸（PUFAs）二十碳五烯酸（EPA）、二十二碳六烯酸（DHA）和二十二碳五烯酸（DPAn-3）在减轻焦虑和抑郁症状的严重程度方面是很有前途的治疗选择。然而，随机对照试验（RCTs）的荟萃分析得出的结果喜忧参半。本系统评价和荟萃分析审查了证据，并评估了 EPA、DHA 和 DPAn-3 在降低焦虑和抑郁严重程度方面的疗效，特别考虑了该领域特有的方法学复杂性，例如 ω-3 PUFAs 的剂量和比例以及安慰剂的组成。对包含 1426 名参与者的 10 项 RCT 的随机效应荟萃分析显示，EPA 富集干预在 EPA+DHA 总量的比例≥60%（SMD：-0.36；95%CI：-0.68，-0.05；p=0.02）（I=86%）和 EPA 剂量在≥1g/天和<2g/天时（SMD：-0.43；95%CI：-0.79，-0.07；p=0.02）（I=88%）时，抑郁严重程度有统计学显著降低；然而，EPA 剂量≥2g/天与显著的治疗效果无关（SMD：-0.20；95%CI：-0.48，0.07；p=0.14）。只有一项研究报告了 EPA 每天 2.1g 治疗后焦虑严重程度显著降低（EPA+DHA 总量的 85.6%），因此无法进行荟萃分析。没有发现给予 DPAn-3 的试验。漏斗图的直观检查显示存在不对称性，表明存在发表偏倚和试验之间的异质性。这些结果支持 EPA 在 EPA+DHA 总量的比例≥60%和剂量≥1g/天和<2g/天时对抑郁有治疗潜力。试验之间观察到的发表偏倚和异质性反映了需要在该领域开展更多高质量的试验，同时考虑到 ω-3 PUFAs 研究的独特性质，以更充分地阐明 EPA、DHA 和 DPAn-3 的治疗潜力。
