Here we present brief descriptions of 8 of the top 25 articles we have chosen for their relevance to clinical psychiatric practice, and their clinical applicability. The order in which the articles appear is arbitrary.
⟶ This study supports the indication that fluoxetine is more likely to be effective than other antidepressants in treating MDD in children younger than 18 years.
The study used network meta-analysis of 34 randomized controlled trials, which included 5260 participants, to compare the efficacy of 14 different antidepressants for acute MDD in children younger than 18 years. SSRIs, SNRIs, TCAs, and other medications were compared. A network meta-analysis allows for comparisons between different medications: although many have not been compared directly with each other, all have been compared with placebo.
Only fluoxetine was statistically superior to placebo in producing improvement. Fluoxetine was associated with fewer dropouts because of adverse effects than several SSRIs, TCAs, and SNRIs. Venlafaxine was statistically most likely to produce suicidal thoughts or behaviors. More patients were exposed to fluoxetine than to any of the other medications; thus, power may be a potential bias in that disparate numbers of patients have been exposed to the different medications.
Cipriani A, Zhou X, Del Giovane C, et al. Comparative efficacy and tolerability of antidepressants for major depressive disorder in children and adolescents: a network meta-analysis. Lancet. 2016;388:881-890.
⟶ This article adds to the positive support for omega-3 fatty acid preparations, especially those that are primarily eicosapentaenoic acid (EPA) or ethyl-EPA formulations. In this case, adding omega-3 fatty acids to antidepressant therapies for MDD enhanced the therapeutic effects.
This review of nutraceuticals as adjunctive therapy for depression finds several with repeated positive effects on depression. The nutraceuticals with enough trials to enable meta-analyses were examined. Findings for S-adenosylmethionine (SAMe), methylfolate, omega-3, and vitamin D as adjuncts to SSRI therapy for MDD were more positive than negative.
Creatine and an amino acid combination were studied less often but still showed occasional efficacy. Those that did not show much promise were zinc, vitamin C, tryptophan, and inositol.
Meta-analyses supported omega-3 fatty acids from fish oil as very likely to be effective as adjuncts to antidepressant medications. There was mixed support for folic acid and folate-related compounds, but their effects were not comparable to those of omega-3.
It is not yet clear what the optimal dose is, whether it is the same for all antidepressants, and what the optimal duration of adjunctive treatment would be. While safety remains to be determined, omega-3 fatty acid adjunctive treatment does not appear to increase the adverse effects of antidepressants and offers a relatively safe option compared with supplementation with antipsychotic medications or other nutraceuticals.
Sarris J, Murphy J, Mischoulon D, et al. Adjunctive nutraceuticals for depression: a systematic review and meta-analysis. Am J Psychiatry. 2016;173:575-587.
Dr. Saeed is Professor and Chairman of the Department of Psychiatry and Behavioral Medicine at the Brody School of Medicine at East Carolina University, Director of the ECU Center for Telepsychiatry and e-Behavioral Health as well as of the North Carolina Statewide Telepsychiatry Program (NC-STeP), and Chief of Psychiatry at Vidant Health in Greenville, NC. Dr. Bloch is Professor and Director of Research in the Department of Psychiatry and Behavioral Medicine at Brody School of Medicine at East Carolina University.