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Effects of Omega-3 Fatty Acids on Mental Health

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Effects of Omega-3 Fatty Acids on Mental Health Evidence Report/Technology Assessment Number 116 Effects of Omega-3 Fatty Acids on Mental Health Prepared for: Agency for Healthcare Research and Quality U.S. Department of Health and Human Services 540 Gaither Road Rockville, MD 20850 www.ahrq.gov Contract No. 290-02-0021 Prepared by: University of Ottawa Evidence-based Practice Center at The University of Ottawa, Ottawa, Canada Investigators Howard M Schachter, PhD Kader Kourad, MD, PhD Zul Merali, PhD Andrew Lumb, BA Khai Tran, PhD Maia Miguelez, PhD Gabriela Lewin, MD Margaret Sampson, MLIS Nick Barrowman, PhD Hope Senechal, BSc Candice McGahern, HRA Li Zhang, BSc Andra Morrison, BSc Jakov Shlik MD, PhD Yi Pan, MSc Elizabeth C Lowcock, BScH Isabelle Gaboury, MSc Jacques Bradwejn, MD Anne Duffy, MD AHRQ Publication No. 05-E022-2 July 2005 This report is based on research conducted by the University of Ottawa Evidence-based Practice Center (EPC), under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-02-0021). The findings and conclusions in this document are those of the authors, who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services. The information in this report is intended to help health care decisionmakers, patients and clinicians, health system leaders, and policymakers make well-informed decisions and thereby improve the quality of health care services. This report is not intended to be a substitute for the application of clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report as they would any medical reference and in conjunction with all other pertinent information, i.e., in the context of available resources and circumstances presented by individual patients. This report may be used, in whole or in part, as the basis for development of clinical practice guidelines and other quality enhancement tools, or as a basis for reimbursement and coverage policies. Neither AHRQ’s nor the U.S. Department of Health and Human Services’ endorsement of such derivative products may be stated or implied. This document is in the public domain and may be used and reprinted without permission except those copyrighted materials noted for which further reproduction is prohibited without the specific permission of copyright holders. Suggested Citation: Schachter H, Kourad K, Merali Z, Lumb A, Tran K, Miguelez M, et al. Effects of Omega-3 Fatty Acids on Mental Health. Evidence Report/Technology Assessment No. 116. (Prepared by the University of Ottawa Evidence-based Practice Center, Under Contract No. 290-02-0021.) AHRQ Publication No. 05-E022-2. Rockville, MD: Agency for Healthcare Research and Quality. July 2005. ii Preface The Agency for Healthcare Research and Quality (AHRQ), through its Evidence-Based Practice Centers (EPCs), sponsors the development of evidence reports and technology assessments to assist public- and private-sector organizations in their efforts to improve the quality of health care in the United States. This report was requested and funded by the Office of Dietary Supplements, National Institutes of Health. The reports and assessments provide organizations with comprehensive, science-based information on common, costly medical conditions and new health care technologies. The EPCs systematically review the relevant scientific literature on topics assigned to them by AHRQ and conduct additional analyses when appropriate prior to developing their reports and assessments. To bring the broadest range of experts into the development of evidence reports and health technology assessments, AHRQ encourages the EPCs to form partnerships and enter into collaborations with other medical and research organizations. The EPCs work with these partner organizations to ensure that the evidence reports and technology assessments they produce will become building blocks for health care quality improvement projects throughout the Nation. The reports undergo peer review prior to their release. AHRQ expects that the EPC evidence reports and technology assessments will inform individual health plans, providers, and purchasers as well as the health care system as a whole by providing important information to help improve health care quality. We welcome comments on this evidence report. They may be sent by mail to the Task Order Officer named below at: Agency for Healthcare Research and Quality, 540 Gaither Road, Rockville, MD 20850, or by email to [email protected]. Carolyn M. Clancy, M.D. Jean Slutsky, P.A., M.S.P.H. Director Director Agency for Healthcare Research and Quality Center for Outcomes and Evidence Agency for Healthcare Research and Quality Paul M. Coates, Ph.D. Director Kenneth S. Fink, M.D., M.G.A., M.P.H. Office of Dietary Supplements Director, EPC Program National Institutes of Health Agency for Healthcare Research and Quality Beth A. Collins Sharp, R.N., Ph.D. EPC Program Task Order Officer Agency for Healthcare Research and Quality iii Acknowledgments The authors would like to thank numerous individuals for their support of the present project: Isabella Steffensen and Christine Murray for their ability to clarify the meaning of our words, figures and tables; Pieter Oosthuizen and Robin Emsley for responding affirmatively to our request for data; Malcolm Peet for trying to facilitate the sharing of data he collected yet which are now held by one of his studies’ funding sources; Bill Hodge for arranging timely help with assessors of study quality; Samantha Fulton for helping check some of our work; Vladimir Fox for arranging the expert and timely translation of non-English language articles; Herb Woolf for responding with substance to our request of industry for evidence; Peter O’Blenis for assuring that the Internet-based software we used for all aspects of the review process was adapted to our needs; our collaborators at SC-RAND and Tufts-NEMC EPCs; Beth Collins-Sharp, Rosaly Correa-de-Araujo and Jacqueline Besteman who, as our Task Order Officers, provided steady support and guidance on behalf of AHRQ; and, Anne Thurn of the Office of Dietary Supplements for her thoughtful direction on behalf of the Federal Partners. Sections of Chapter 1 were developed in collaboration with Tufts-NEMC EPC, and with contributions from SC- RAND EPC. iv Structured Abstract Context: One popular view holds that psychiatric problems reflect disorders of brain functioning. Fifty percent to 60% of the adult brain is composed of lipids (dry weight), of which 35% are phospholipids comprised of unsaturated fatty acids. Of these, the polyunsaturated fatty acids docosahexaenoic acid (an omega-3 fatty acid) and arachidonic acid (an omega-6 fatty acid) are found in the highest concentrations. Thus, it has been proposed that omega-3 fatty acids could play an important role in mental health. Objectives: The purpose of this study was to conduct a systematic review of the scientific- medical literature to identify, appraise and synthesize the evidence for the effects of omega-3 fatty acids in mental health. Evidence was sought to permit the investigation of three basic questions: the efficacy and safety of omega-3 fatty acids as (primary or supplemental) treatment of psychiatric disorders or conditions (e.g., symptoms alone); the association between intake of omega-3 fatty acids and the onset, continuation or recurrence of psychiatric disorders or conditions; and, the association between the fatty acid content of biomarkers and the onset, continuation or recurrence of psychiatric disorders or conditions. The latter two questions examined the protective value of omega-3 fatty acid content in the diet and/or blood lipid biomarkers. The impact of effect modifiers was examined as well. The results will be used largely to inform a research agenda. Data Sources: A comprehensive search for citations was conducted using five databases (Medline, Embase, Cochrane Central Register of Controlled Trials, PsycInfo, and CAB Health). Searches were not restricted by language of publication, publication type, or study design, except with respect to the MeSH term “dietary fats,” which was limited by study design to increase its specificity. Search elements included: scientific terms, with acronyms, as well as generic and trade names relating to the exposure and its sources (e.g., eicosapentaenoic acid [EPA]; fish oil); and, relevant population terms (e.g., mental disorders). Additional published or unpublished literature was sought through manual searches of references lists of included studies and key review articles, and from the files of content experts. Study Selection: Studies were considered relevant if they described live human populations of any age, investigated the use of any foods or supplements known to contain omega-3 fatty acids, and utilized mental health outcomes. Studies examining the questions concerning treatment efficacy or the fatty acid content of biomarkers had to employ a controlled research design, whereas any type of design other than a case series or case study was permitted to address the possible association of the intake of omega-3 fatty acids and clinical outcomes. Three levels of screening for relevance, and two reviewers per level, were employed. Disagreements were resolved by forced consensus and, if necessary, third party intervention. Data Extraction: All data were abstracted
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