A multi-national, multi-disciplinary Delphi consensus study on using omega-3 polyunsaturated fatty acids (n-3 PUFAs) for the treatment of major depressive disorder

Ta-Wei Guu; David Mischoulon; Jerome Sarris; Joseph Hibbeln; Robert K McNamara; Kei Hamazaki; Marlene P Freeman; Michael Maes; Yutaka J Matsuoka; R H Belmaker; Wolfgang Marx; Carmine Pariante; Michael Berk; Felice Jacka; Kuan-Pin Su

doi:10.1016/j.jad.2020.01.050

A multi-national, multi-disciplinary Delphi consensus study on using omega-3 polyunsaturated fatty acids (n-3 PUFAs) for the treatment of major depressive disorder

J Affect Disord. 2020 Mar 15:265:233-238. doi: 10.1016/j.jad.2020.01.050. Epub 2020 Jan 15.

Authors

Ta-Wei Guu¹, David Mischoulon², Jerome Sarris³, Joseph Hibbeln⁴, Robert K McNamara⁵, Kei Hamazaki⁶, Marlene P Freeman⁷, Michael Maes⁸, Yutaka J Matsuoka⁹, R H Belmaker¹⁰, Wolfgang Marx¹¹, Carmine Pariante¹², Michael Berk¹³, Felice Jacka¹¹, Kuan-Pin Su¹⁴

Affiliations

¹ 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.
² Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
³ NICM, Health Research Institute, Western Sydney University, Westmead, NSW, AUSTRALIA; The Melbourne Clinic, Professorial Unit, Department of Psychiatry, Melbourne University, VIC, AUSTRALIA.
⁴ Section on Nutritional Neuroscience, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, USA.
⁵ Department of Psychiatry, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
⁶ Department of Public Health, Faculty of Medicine, University of Toyama, Toyama, Japan.
⁷ Clinical Trials Network and Institute, Massachusetts General Hospital, Boston, MA, USA.
⁸ Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
⁹ Division of Health Care Research, Center for Public Health Sciences, National Cancer Center Japan, Tokyo, Japan.
¹⁰ Ben Gurion University of the Negev, Beersheba, Israel.
¹¹ Deakin University, Faculty of Health, School of Medicine, IMPACT SRC and the Food & Mood Centre, Australia.
¹² Stress, Psychiatry and Immunology Laboratory, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.
¹³ Deakin University, Faculty of Health, School of Medicine, IMPACT SRC and the Food & Mood Centre, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, Centre for Youth Mental Health, Florey Institute for Neuroscience and Mental Health and the Department of Psychiatry, The University of Melbourne, Melbourne, Australia.
¹⁴ Departments of Psychiatry and Mind-Body Interface Laboratory (MBI-Lab), China Medical University Hospital, Taichung, TAIWAN; Tainan Municipal An-Nan Hospital, China Medical University, Tainan, TAIWAN; College of Medicine, China Medical University, Taichung, TAIWAN. Electronic address: cobolsu@gmail.com.

PMID: 32090746
DOI: 10.1016/j.jad.2020.01.050

Abstract

Introduction: 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.

Methods: 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.

Results: 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.

Limitation: The panelists had a specialized interest in n-3 PUFAs; focus was placed on clinical issues rather than on biological mechanisms.

Conclusions: 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.

Keywords: DHA; Delphi; EPA; guideline; major depressive disorder.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Consensus
Delphi Technique
Depressive Disorder, Major* / drug therapy
Fatty Acids, Omega-3* / therapeutic use
Fatty Acids, Unsaturated
Humans

Substances

Fatty Acids, Omega-3
Fatty Acids, Unsaturated

Abstract

Publication types

MeSH terms

Substances

Grants and funding