Omega-3 fatty acids for the treatment of depression: systematic review and meta-analysis.

Omega-3 fatty acids for the treatment of depression: systematic review and meta-analysis.
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DOI:
10.1038/mp.2011.100
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发表时间:
2012-12
影响因子:
11
通讯作者:
Hannestad, J.
Hannestad, J.
中科院分区:
医学1区
文献类型:
--
作者:
Bloch, M. H.;Hannestad, J.

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我们对omega-3脂肪酸治疗重度抑郁症的随机、安慰剂对照试验进行了荟萃分析,以确定疗效并检查试验间异质性的来源。检索PubMED(1965- 2010年5月)中关于omega-3脂肪酸治疗重度抑郁症的随机、安慰剂对照试验。我们的主要结果测量是标准化的平均差异,在抑郁症严重程度的临床措施。在分层荟萃分析中,我们检查了试验持续时间、试验方法学质量、基线抑郁严重程度、诊断指征、omega-3制剂中二十碳五烯酸(EPA)和二十二碳六烯酸(DHA)的剂量以及omega-3脂肪酸是否作为单药治疗或加强治疗的影响。在13项随机、安慰剂对照试验中,检查了omega-3脂肪酸的疗效,涉及731名受试者,荟萃分析表明,与安慰剂相比,omega-3脂肪酸治疗没有显著获益(SMD=0.11,95% CI:-0.04,0.26)。Meta分析显示了显著的异质性和发表偏倚。在使用修整和填充法调整发表偏倚后,几乎所有关于omega-3有益的证据都被删除(SMD=0.01,95%CI:-0.13,0.15)。次要分析表明,在方法学质量较低的试验中,omega-3脂肪酸的疗效有增加的趋势,持续时间较短的试验,使用完成者而不是意向治疗分析的试验,以及研究参与者基线抑郁严重程度较高的试验,目前发表的试验表明omega-3脂肪酸对重度抑郁症的益处较小,不显著。在已发表文献中观察到的几乎所有治疗有效性均可能归因于发表偏倚。
We conducted a meta-analysis of randomized, placebo-controlled trials of omega-3 fatty acid treatment of major depressive disorder in order to determine efficacy and to examine sources of heterogeneity between trials. PubMED (1965-May 2010) was searched for randomized, placebo-controlled trials of omega-3 fatty acids for major depressive disorder. Our primary outcome measure was standardized mean difference in a clinical measure of depression severity. In stratified meta-analysis we examined the effects of trial duration, trial methodological quality, baseline depression severity, diagnostic indication, dose of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) in omega-3 preparations, and whether omega-3 fatty acid was given as monotherapy or augmentation. In 13 randomized, placebo-controlled trials examining the efficacy of omega-3 fatty acids involving 731 participants, meta-analysis demonstrated no significant benefit of omega-3 fatty acid treatment compared to placebo (SMD=0.11, 95% CI: -0.04, 0.26). Meta-analysis demonstrated significant heterogeneity and publication bias. Nearly all evidence of omega-3 benefit was removed after adjusting for publication bias using the trim-and-fill method (SMD=0.01, 95% CI: -0.13, 0.15). Secondary analyses suggested a trend towards increased efficacy of omega-3 fatty acids in trials of lower methodological quality, trials of shorter duration, trials, which utilized completers rather than intention-to-treat analysis, and trials in which study participants had greater baseline depression severity, Current published trials suggest a small, non-significant benefit of omega-3 fatty acids for major depression. Nearly all of the treatment efficacy observed in the published literature may be attributable to publication bias.
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