Fish Oil Fails to Help Kids With Severe Depression

Including a daily fish oil supplement along with psychotherapy did not demonstrate any notable advantage compared to a placebo for children ...

Including a daily fish oil supplement along with psychotherapy did not demonstrate any notable advantage compared to a placebo for children and teenagers suffering from moderate-to-severe major depressive disorder, according to a randomized study.

Children's Depression Rating Scale-Revised (CDRS-R) scores showed comparable improvements by week 36 in young individuals receiving structured psychotherapy combined with either an omega-3 fatty acid supplement or a placebo (adjusted mean difference of 0.77 points, 95% CI -1.39 to 2.93,P=0.49), stated Gregor Berger, MD, from the University of Zurich in Switzerland, along with his team.

Depression remission (CDRS-R score ≤28 points) was actually observed more frequently by week 36 in the placebo group compared to the omega-3 supplement group (31.9% versus 41.1%), and the percentage of participants who met the response criteria (a reduction of at least 30% in CDRS-R scores) was also higher by week 12 in the placebo group (31.2% versus 39.1%).

"These results do not endorse the use of 1.5 g of omega-3 fatty acids as an additional treatment for childhood MDD," the authors stated inJAMA Network Open.

"Omega-3 fatty acids have drawn interest as a potential supplementary therapy for clinical depression," they observed, which is backed by some previous findings that have suggestedsmall to moderate improvementsin symptoms among adults experiencing depression, particularly when used alongside antidepressants. Previous research on adolescents and young adults has typically shown inconsistent findings.

Although many people believe that omega-3 fatty acids improve mood, a view backed by several meta-analyses and expert groups, Berger's team highlighted the importance of thoroughly assessing even treatments that appear harmless," they noted. "Encouraging ineffective therapies could delay proper care and potentially lead to worse results for teenagers suffering from depression.

They cautioned, 'Such delays can contribute to the persistence of depressive disorders, which in turn raise the likelihood of future suicide.'

More targeted approaches for childhood depression are required, they emphasized, as suicide remains thesecond leading cause death among U.S. teenagers. In 2020,about 17%15% of U.S. teenagers experienced at least one episode of depression.

Future research could potentially concentrate on evaluating omega-3 supplements within particular groups, such as young individuals experiencing depression associated with inflammation.

In the current trial, Berger's team recruited and randomly assigned 257 young individuals with a DSM-4 diagnosed single or recurring major depressive disorder across five Swiss child and adolescent psychiatric centers from April 2017 to March 2022.

Participants ranged in age from 8 to 18 years (mean age 15.7), with 73.2% being female. Admission was contingent upon CDRS-R scores of 40 or higher at the start of the study.

One half of the participants were given 1.5 grams of omega-3 polyunsaturated fatty acids each day, consisting of 1,000 milligrams of eicosapentaenoic acid (EPA) and 500 milligrams of docosahexaenoic acid (DHA). The remaining participants received a placebo containing the same quantity of medium-chain triglycerides. For children under the age of 13, the dose was halved. The supplements were to be consumed once daily along with a meal.

Pill counts and blood tests indicated a strong level of treatment compliance.

All individuals received care at authorized child and adolescent mental health services, which encompassed both inpatient and outpatient settings, delivered by professionals who follow evidence- and consensus-driven protocols for addressing depression in young people.

Of the 35% of participants who were taking an antidepressant at the start, fluoxetine (46.7%) was the most frequently used, followed by sertraline (33.3%) and escitalopram (Lexapro, 12.2%).

"Significantly, over one-third of participants began guideline-aligned selective serotonin reuptake inhibitor treatment within 6 weeks but experienced only slight improvements, highlighting the limited impact of existing medication approaches for severe pediatric MDD and the critical need to detect treatment-resistant patterns sooner," the authors observed.

In a manner similar to the progression of CDRS-R scores, both trial groups demonstrated meaningful enhancements in quality of life and self-reported depression levels during the study. Additionally, there was no difference between the groups regarding suicidal thoughts.

Severe adverse events were similar across the groups, with 45 cases in the omega-3 group and 31 in the placebo group. This involved 28 instances of suicide attempts. There were no fatalities.

It is possible that the use of antidepressants may have contributed to higher placebo response rates, according to the authors, although more antidepressants were given to participants in the omega-3 group. The study was also constrained by the absence of control over media consumption and dietary habits.

The research was funded through a grant provided by the IICT initiative of the Swiss National Science Foundation (SNSF).

Berger stated there were no conflicts of interest. Additional co-authors disclosed connections with the SNSF, Gertrud Thalmann Fonds, Ebnet Foundation, Takeda Pharmaceutical Company Limited, and Salmon Pharma/MEDICE, along with possessing relevant patents.