Moody kids years later: Long-term outcomes of youth from the Omega-3 and therapy (OATS) studies

Omega-3 fatty acid supplementation for depression in children and adolescents

BACKGROUND

Mental health disorders including major depressive disorder (MDD) are well recognized as major contributors to the global burden of disease among adolescents. The prevalence of adolescent depression is estimated to have increased by at least 25% during the COVID-19 pandemic, compounding the already challenging problem of insufficient mental health service and service accessibility that existed prepandemic. Omega-3 polyunsaturated fatty acid (PUFA) supplementation is currently recommended as a preventive treatment for depression in high-risk adults as well as a second-line monotherapy for adults with mild to moderate MDD, and adjunctive to antidepressants for adults with moderate to severe MDD. The benefits of omega-3 PUFA intake on depressive illness have been hypothesized to occur as a result of their effect on neurotransmission, maintenance of membrane fluidity, and anti-inflammatory action. A comprehensive synthesis and quantification of the existing evidence on omega-3 PUFA's efficacy in treating depression among children and adolescents is essential for clinicians to provide informed guidance to young people and their families, especially considering the absence of current guidelines for this age group.

OBJECTIVES

Primary objective To determine the impact of omega-3 PUFA supplementation versus a comparator (e.g. placebo, wait list controls, no treatment/supplementation, or standard care) on clinician-diagnosed depression or self-reported depression symptoms in children and adolescents. Secondary objectives To estimate the size of the effect of omega-3 PUFAs on depression symptoms. To estimate the effect of each type of omega-3 PUFA (EPA or DHA), compared with placebo, on depression. To determine if the effect is modified by dosage, format (capsule or liquid), sex, or age. To determine compliance and attrition for omega-3 PUFAs as an intervention for depression in children and adolescents. To determine the safety of omega-3 PUFAs as an intervention for depression in children and adolescents.

SEARCH METHODS

We searched CENTRAL, MEDLINE, Embase, three other databases, reference lists of included studies, grey literature, and relevant reviews. The latest search date was 18 May 2023.

SELECTION CRITERIA

We included randomized controlled trials (RCTs) involving males and females aged 19 years or younger with diagnosed depression comparing omega-3 PUFA supplementation to placebo, wait list control, no treatment/supplementation, or standard care.

DATA COLLECTION AND ANALYSIS

We used standard Cochrane methods. Our primary outcomes were self-reported depression symptoms and clinically diagnosed resolution of depression. Our secondary outcomes were attrition, adverse effects, and compliance with the intervention. We used GRADE to assess the certainty of evidence for key outcomes.

MAIN RESULTS

We included five trials with 228 participants in our meta-analysis. All trials used a placebo comparator; intervention duration ranged from 10 to 16 weeks (median: 12 weeks). Omega-3 PUFA supplementation compared to placebo may reduce self-reported depression symptoms, but the evidence is very uncertain (standardized mean difference [SMD] -0.34, 95% confidence interval [CI] -0.85 to 0.17; lower SMD means greater improvement in depression due to omega-3 PUFA; 5 trials, 185 participants; very low-certainty evidence). Omega-3 PUFA supplementation may have little to no effect on remission of depression symptoms compared to placebo, but the evidence is very uncertain (omega-3 PUFA versus placebo: 50% versus 48%; odds ratio [OR] 1.11, 95% CI 0.45 to 2.75; 4 trials, 127 participants; very low-certainty evidence). Omega-3 PUFA supplementation may result in little to no difference in attrition (dropouts) compared to placebo (omega-3 PUFA versus placebo: 18% versus 19%; OR 0.94, 95% CI 0.46 to 1.90; 5 trials, 228 participants; low-certainty evidence). Omega-3 PUFA supplementation may result in little to no difference in adverse effects, with one study reporting more muscle cramps in the fish oil group (13/27 participants) compared to the placebo group (6/29 participants); one study reported more frequent defecation in the omega-3 group (1/29 participants) and one study identified mild skin rash and unusual/manic behavior in the placebo group (2/27 participants). None of the included studies reported serious adverse effects.

AUTHORS' CONCLUSIONS

Based on five small studies, omega-3 PUFA supplementation may reduce self-reported depression symptoms, but the evidence is very uncertain. Omega-3 PUFA supplementation may have little to no effect on depression remission compared to placebo, but the evidence is very uncertain. Omega-3 PUFA supplementation may result in little to no difference in attrition or adverse effects. The studies observed no serious adverse effects. This review highlights early-stage research on omega-3 PUFA and depression in young people. The evidence on the effects of omega-3 PUFA supplementation in improving self-reported depression symptoms or achieving depression remission in children and adolescents is very uncertain. While no harms are evident, more data are needed to confirm potential risks. Addressing current limitations in the evidence base through the design and conduct of methodologically rigorous studies - larger sample sizes, varied dosages, eicosapentaenoic acid/docosahexaenoic acid ratios, treatment durations, and safety profiles - is crucial to advance our understanding of the role of omega-3 PUFA supplementation for depression in children and adolescents.

Nutraceuticals in Psychiatric Disorders: A Systematic Review

Correct nutrition and diet are directly correlated with mental health, functions of the immune system, and gut microbiota composition. Diets with a high content of some nutrients, such as fibers, phytochemicals, and short-chain fatty acids (omega-3 fatty acids), seem to have an anti-inflammatory and protective action on the nervous system. Among nutraceuticals, supplementation of probiotics and omega-3 fatty acids plays a role in improving symptoms of several mental disorders. In this review, we collect data on the efficacy of nutraceuticals in patients with schizophrenia, autism spectrum disorders, major depression, bipolar disorder, and personality disorders. This narrative review aims to provide an overview of recent evidence obtained on this topic, pointing out the direction for future research.

Need for Multidimensional and Multidisciplinary Management of Depressed Preadolescents and Adolescents: A Review of Randomized Controlled Trials on Oral Supplementations (Omega-3, Fish Oil, Vitamin D3)

(1) Background: Depression is a serious health problem with a high cost for public administration. Epidemiological studies report that one in five children have a mental disorder and about 50% of mental health problems exacerbate in childhood and adolescence. Moreover, the antidepressant efficacy in children and adolescents is poorly demonstrated and can cause severe behavioral adverse events such as suicidal ideation. (2) Methods: This systematic literature review examined oral supplementations (Omega-3, fish oil, Vitamin D₃) to treat depressed children, preadolescents, and adolescents. MEDLINE, Scopus, Embase, and PsycInfo were searched for articles published in the last five years. Six studies met the eligibility criteria. The inclusion criteria encompassed children, preadolescents, and adolescents, a diagnosis of depression, and an intervention of oral supplementations such as Omega-3, fish oil, and Vitamin D₃. (3) Results: Most of the studies demonstrated that dietary intervention provides positive outcomes in terms of depression symptoms. (4) Conclusions: Overall, the results demonstrate a positive effect for oral supplementation suggesting an increase intake of Omega-3, fish oil, and Vitamin D₃. However, only a few studies assess the effectiveness of diet recommendations, as a monotherapy or combined treatment, for the management of depression at developmental ages. Thus, there is still a need to further investigate these aspects and to look more specifically at adolescents and preadolescents.

Omega-3 supplements in the prevention and treatment of youth depression and anxiety symptoms: A scoping review

INTRODUCTION

Omega-3 supplements may be efficacious in reducing symptoms of depression and anxiety in adults, particularly as an adjunct to antidepressant medication. However, research in young people is limited. Thus, this scoping review aimed to summarise existing evidence on the efficacy of omega-3 supplementation in treating depression and anxiety symptoms in young people aged 14-24. A secondary aim was to determine whether grey literature intended for the general public accurately reflects the evidence.

METHOD

Four databases (Cochrane CENTRAL, EmBASE, PsycINFO, PubMed) were searched from inception to 4th August 2021. Eligible peer-reviewed studies were empirical studies which examined the efficacy of omega-3 supplements in preventing/treating anxiety and/or depression symptoms in young people aged 14-24. Risk of bias was assessed for randomised studies using the Cochrane Risk of Bias Tool. Selected grey literature databases were also searched, with eligible sources assessed for quality. A stakeholder group including young people with lived experience of anxiety/depression, parents/carers and mental health professionals informed the research questions and data interpretation. Findings were summarised using narrative synthesis.

RESULTS

17 empirical studies (N = 1240 participants) meeting inclusion criteria were identified. Studies varied in treatment and participant characteristics. In general, the data did not support the view that omega-3 supplements were efficacious in improving symptoms of anxiety or depression in young people aged 14-24. In contrast, most grey literature sources recommended the use of omega-3 supplements in young people.

DISCUSSION

Evidence for efficacy of omega-3 supplementation in reducing symptoms of depression and anxiety in young people was inconclusive. More research is needed to identify potential mechanisms and moderators of the effect of omega-3 supplements on depression and anxiety symptoms in young people.

Effects of Fish-Oil Consumption on Psychological Function Outcomes in Psychosis: A Systematic Review and Dose-Response Meta-Analysis of Randomized Controlled Trials

Research on the effects of fish oil on clinical symptoms and psychosocial functioning in people with psychosis has been inconsistent. We conducted this systematic review and meta-analysis to summarize the available data on the effects of oral intake of fish oil on psychological functioning in patients with psychosis. Three online databases including PubMed, Scopus, and Web of Science were searched to identify relevant studies published by April 2021. The exposure was oral fish-oil supplementation. The Positive and Negative Syndrome Scale (PANSS), the Brief Psychiatric Rating Scale (BPRS), and the Global Assessment of Functioning (GAF) were our outcome measures. Seventeen randomized clinical trials involving 1390 patients were included. No change in PANSS was observed following oral fish-oil intake [weighted mean difference (WMD): -0.87; 95% CI: -16.99, 15.26; P = 0.92]. In a nonlinear dose-response analysis, a significant inverse association was observed between <10 wk of fish-oil supplementation and PANSS (WMD: -10; P-nonlinearity = 0.02). Although analysis of 4 studies showed a nonsignificant reduction in BPRS after fish-oil intake (WMD: -2.990; 95% CI: -6.42, 0.44; P = 0.08), a nonlinear dose-response analysis revealed significant inverse associations between dose (>2200 mg/d) and duration of fish-oil supplementation (<15 wk) with BPRS score (WMD: -8; P-nonlinearity = 0.04). Combined effect sizes from 6 randomized clinical trials showed significant increases in GAF after oral administration of fish oil (WMD: 6.66; 95% CI: 3.39, 9.93; P < 0.001). In conclusion, we did not find any significant changes in PANSS and BPRS scores following fish-oil supplementation. Nevertheless, oral fish-oil intake significantly contributed to improvement in GAF scores. This is the first meta-analysis to examine the effects of fish oil on the psychological functioning scores of PANSS, BPRS, and GAF simultaneously.

Psychosocial Treatments for Bipolar Disorder in Children and Adolescents

Evidence suggests that adjunctive psychosocial intervention for the treatment of pediatric bipolar spectrum disorders (BPSDs) is effective, feasible, and highly accepted as both an acute and maintenance treatment for youth with BPSD diagnoses as well as a preventive treatment for high-risk youth who are either asymptomatic or exhibit subsyndromal mood symptoms. Here, we provide a comprehensive review of all known evidence-based interventions, including detailed descriptions of treatment targets and core components, results of clinical trials, and updated research on mediators and moderators of treatment efficacy. Treatments are presented systematically according to level of empirical support (i.e., well established, probably efficacious, possibly efficacious, experimental, or questionable); upcoming and ongoing trials are included when possible. In line with a staging approach, preventive interventions are presented separately. Recommendations for best practices based on age, stage, and additional evidence-based child and family factors shown to affect treatment outcomes are provided. Expected final online publication date for the Annual Review of Clinical Psychology, Volume 18 is May 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

Exploring the therapeutic potential of omega-3 fatty acids in depression

Omega-3 fatty acids have been acknowledged for their number of holdings on an individual's health. Not only in physical valuation but also in managing psychiatric disorders, omega-3 fatty acids have been found to be a powerful formula. It is proclaimed that depressive patients suffer anomaly with the levels of omega-3 polyunsaturated fatty acids in the body, coupled with insignificant EPA and DHA. Enhancement in brain functioning, neuronal functions, and paying attention in interacting with the brain cells are some of the additional tasks, being performed by the supplementation of omega-3 fatty acids. The leading and primary source via dietary supplementation involves the involvement of fish and fish products. These are hypothesized to be the best and dominant source for omega-3 fatty acids. Consumption of omega-3 fatty acid is well safe, that physician highly favors intake of these supplements, remarkably in the case of pregnant women. However, treating this serious life-threatening mental disorder leads to many adverse effects when treated with antidepressants. The dose range includes 1g/d to 10g/d, which is to be incorporated by the patient. It is also tested that the combination of EPA and DHA is found to be more efficacious for a person in treating and preventing depressive symptoms. Some studies verify the supplementation of omega-3 fatty acids in diet was coequally productive and successful with minimal side effects when analyzed with antidepressants. Despite these facts, much research is still needed and presently in process for long-term safety and studying the role of omega-3 fatty acids in human health.

Mental Health in Childhood and Adolescence: The Role of Polyunsaturated Fatty Acids

There is increasing awareness of the importance of polyunsaturated fatty acids (PUFAs) for optimal brain development and function. In recent decades, researchers have confirmed the central role of PUFAs in a variety of patho-physiological processes. These agents modulate the mechanisms of brain cell signalling including the dopaminergic and serotonergic pathways. Therefore, nutritional insufficiencies of PUFAs may have adverse effects on brain development and developmental outcomes. The role of n-3 PUFAs has been studied in several psychiatric disorders in adulthood: schizophrenia, major depression, bipolar disorder, anxiety disorders, obsessive-compulsive disorder, post-traumatic stress disorder, attention deficit hyperactivity disorder (ADHD), autism spectrum disorders, eating disorders, substance use disorder, and borderline personality disorder. In contrast to the great number of studies conducted in adults, there are only limited data on the effects of n-3 PUFA supplementation in children and adolescents who suffer from mental disorders or show a high risk of developing psychiatric disorders. The aim of this review is to provide a complete and updated account of the available evidence of the impact of polyunsaturated fatty acids on developmental psychopathology in children and adolescents and the effect of fatty acid supplementation during developmental milestones, particularly in high-risk populations of children with minimal but detectable signs or symptoms of mental disorders.

Psychoeducational and Skill-building Interventions for Emotion Dysregulation

Family psychoeducation plus skill building is a class of interventions considered to be well-established for youth with mood disorders or emotion dysregulation. Psychoeducational psychotherapy (PEP) is an example of this class of interventions. PEP provides psychoeducation for parents and children, skill building to help children better regulate emotions and behaviors, and strategies for parents to better facilitate school-based interventions, develop specific symptom management techniques, and generate coping strategies for the entire family. Evidence is summarized supporting the efficacy of PEP for reducing rage, overall mood symptom severity, disruptive behavior, and executive functioning deficits in youth. Long-term benefits of PEP are discussed.