Elsevier

Biological Psychiatry

Volume 68, Issue 2, 15 July 2010, Pages 140-147
Biological Psychiatry

Archival Report
A Meta-Analytic Review of Polyunsaturated Fatty Acid Compositions in Patients with Depression

https://doi.org/10.1016/j.biopsych.2010.03.018Get rights and content

Background

On the basis of evidence from studies showing the antidepressant effects of omega-3 polyunsaturated fatty acids and the inverse relation between fish consumption and the prevalence of depression, the phospholipid hypothesis seems promising in ascertaining the etiology and treatment of depression. Although several studies have shown lower levels of omega-3 (n-3) polyunsaturated fatty acids in depressive patients, the results of individual polyunsaturated fatty acids, including docosahexaenoic acid (DHA), eicosapentaenoic acid (EPA), and the omega-6 (n-6) polyunsaturated fatty acid arachidonic acid (AA), were inconsistent.

Methods

We conducted the meta-analyses of 14 studies comparing the levels of polyunsaturated fatty acids between depressive patients and control subjects. The effect size of each study was synthesized by using a random effects model.

Results

Compared with control subjects, the levels of EPA, DHA, and total n-3 polyunsaturated fatty acids were significantly lower in depressive patients. There was no significant change in AA or total n-6 polyunsaturated fatty acids.

Conclusions

The results showed lower levels of EPA, DHA, and total n-3 polyunsaturated fatty acids in patients with depression, thus implying that n-3 polyunsaturated fatty acids play a role in the pathogenesis of depression. Our findings provide further support to the phospholipid hypothesis of depression and a rationale for using n-3 polyunsaturated fatty acids as an alternative treatment for depression. With these results, future studies examining specific roles of DHA and EPA in different clusters of depressive symptoms are warranted.

Section snippets

Literature Search

To identify eligible studies for this meta-analysis, a computerized search was performed for all publications available up to August 2009 through PubMed at the National Library of Medicine using the following key words: (depression OR depressive disorder) AND (omega-3 OR EPA or DHA OR polyunsaturated fatty acid), limited to literature in English and human studies. Reference lists from identified articles and relevant reviews were scrutinized for studies not indexed in the electronic databases.

Inclusion Criteria of Studies in the Meta-Analysis

Results

On the basis of the aforementioned search strategy, our initial search identified 1007 studies, of which only 14 were included in current meta-analysis according to the inclusion criteria (29, 30, 32, 33, 34, 35, 36, 38, 40, 41, 42, 43, 44, 45) (Figure S1 in Supplement 1), which included 3318 subjects (648 depressive and 2670 control subjects). The characteristics of these articles are described in Table 1.

The primary outcomes were comparisons of PUFA levels between depressive (defined

Discussion

The main finding of this meta-analysis confirms that depression is associated with lower levels of total n-3 PUFAs and both types of n-3 PUFAs, EPA and DHA. Previous observational studies have indicated that clinical depression can be accompanied by low levels of n-3 PUFAs in RBC, plasma and, as more found recently, brain tissue (50). Our findings extend the results from several studies, but not all, that n-3 PUFAs play an important role in depression. It has been reported that the deficit of

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