title: Adjunctive low-dose docosahexaenoic acid (DHA) for major depression: An open-label pilot trial.
abstract: BACKGROUND
  Whilst the majority of evidence supports the adjunctive use of eicosapentaenoic acid (EPA) in improving mood, to date no study exists using low-dose docosahexaenoic acid (DHA) alone as an adjunctive treatment in patients with mild to moderate major depressive disorder (MDD).
  
  
  METHODS
  A naturalistic 8-week open-label pilot trial of low-dose DHA, (260 mg or 520 mg/day) in 28 patients with MDD who were non-responsive to medication or psychotherapy, with a Hamilton Depression Rating Scale (HAM-D) score of greater than 17, was conducted. Primary outcomes of depression, clinical severity, and daytime sleepiness were measured.
  
  
  RESULTS
  After 8 weeks, 54% of patients had a ≥50% reduction on the HAM-D, and 45% were in remission (HAM-D ≤ 7). The eta-squared statistic (0.59) indicated a large effect size for the reduction of depression (equivalent to Cohen's d of 2.4). However confidence in this effect size is tempered due to the lack of a placebo. The mean score for the Clinical Global Impression Severity Scale was significantly improved by 1.28 points (P < 0.05). Despite a significant reduction in the HAM-D score for middle insomnia (P = 0.02), the reduction in excessive daytime somnolence on the total Epworth Sleepiness Scale (ESS) did not reach significance. No significant adverse reactions to DHA were found.
  
  
  CONCLUSIONS
  Within the major limits of this open-label pilot study, the results suggest that DHA may provide additional adjunctive benefits in patients with mild- to -moderate depression.
authors.affiliation: a Faculty of Medicine, Department of Psychiatry , The University of Melbourne , Australia.
authors.forename: Deidre J
authors.identifier: http://orcid.org/0000-0003-0177-4908
authors.initials: DJ
authors.lastname: Smith
authors.affiliation: a Faculty of Medicine, Department of Psychiatry , The University of Melbourne , Australia.|b Centre for Human Psychopharmacology , Swinburne University of Technology , Australia.
authors.forename: Jerome
authors.initials: J
authors.lastname: Sarris
authors.affiliation: a Faculty of Medicine, Department of Psychiatry , The University of Melbourne , Australia.
authors.forename: Nathan
authors.identifier: http://orcid.org/0000-0001-7908-6043
authors.initials: N
authors.lastname: Dowling
authors.affiliation: a Faculty of Medicine, Department of Psychiatry , The University of Melbourne , Australia.
authors.forename: Manjula
authors.initials: M
authors.lastname: O'Connor
authors.affiliation: a Faculty of Medicine, Department of Psychiatry , The University of Melbourne , Australia.
authors.forename: Chee H
authors.initials: CH
authors.lastname: Ng
mesh_terms: D000328:Adult; D000928:Antidepressive Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D014150:Antipsychotic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D003131:Combined Modality Therapy / Q000009:adverse effects; D003863:Depression / Q000178:diet therapy / Q000188:drug therapy / Q000503:physiopathology / Q000628:therapy; D003865:Major Depressive Disorder / Q000178:diet therapy* / Q000188:drug therapy / Q000503:physiopathology / Q000628:therapy; D061218:Depressive Disorder, Treatment-Resistant / Q000178:diet therapy* / Q000188:drug therapy / Q000503:physiopathology / Q000628:therapy; D039721:Diagnostic and Statistical Manual of Mental Disorders; D019587:Dietary Supplements / Q000009:adverse effects; D004281:Docosahexaenoic Acids / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019964:Mood Disorders / Q000139:chemically induced / Q000209:etiology / Q000517:prevention & control; D010865:Pilot Projects; D011569:Psychiatric Status Rating Scales; D011613:Psychotherapy; D012720:Severity of Illness Index; D020919:Sleep Disorders, Intrinsic / Q000209:etiology / Q000517:prevention & control
chemical_list: D000928:Antidepressive Agents; D014150:Antipsychotic Agents; D004281:Docosahexaenoic Acids
keywords: Adjunctive; DHA; Depression; Docosahexaenoic acid; Omega-3