Treatment of Depression with Evidence-Based Nutraceuticals

Introduction to Nutraceutical Recommendations

The American Psychiatric Association recommends the use of omega-3 fatty acids (EPA ≥1-2g daily, with an EPA:DHA ratio >2:1) as an adjunctive therapy to conventional antidepressants for the treatment of major depressive disorder, with a strength of evidence classified as Grade A 1, 2, 3
The International Society for Nutritional Psychiatry Research suggests that omega-3 fatty acids have the most robust evidence for the treatment of depression, with a recommended dose of EPA ≥1-2g daily and an EPA:DHA ratio >2:1, and a strength of evidence classified as Grade A 1, 2, 4
The use of omega-3 fatty acids as monotherapy is not recommended for the treatment of major depressive disorder, due to limited evidence and potential risks 1, 2, 3

The American College of Psychiatrists recommends the use of omega-3 fatty acids as an adjunctive therapy to conventional antidepressants, with a strength of evidence classified as Grade A 1, 2, 3
The International Society for Nutritional Psychiatry Research suggests that St. John's Wort (300-1800mg daily of standardized extract) may be considered as an adjunctive therapy, but with caution due to potential interactions with other medications, and a strength of evidence classified as Grade B 5, 6
Acupuncture may be considered as an adjunctive therapy, particularly when combined with conventional antidepressants, with a strength of evidence classified as Grade B 6, 7

The American College of Obstetricians and Gynecologists recommends the use of omega-3 fatty acids as an adjunctive therapy for the treatment of perinatal depression, with a strength of evidence classified as Grade A 1, 8
The American Academy of Pediatrics recommends the use of omega-3 fatty acids (EPA 380-400mg + DHA 180-200mg) for the treatment of childhood depression, with a strength of evidence classified as Grade B 9
The International Society for Nutritional Psychiatry Research suggests that omega-3 fatty acids may be particularly beneficial for individuals with elevated inflammatory markers, with a strength of evidence classified as Grade A 3, 8

The use of omega-3 fatty acids is generally considered safe, with a favorable side effect profile compared to conventional antidepressants, and a strength of evidence classified as Grade A 1, 2
St. John's Wort may interact with other medications, and its use should be carefully monitored, with a strength of evidence classified as Grade B 5
All nutraceuticals should be recommended primarily as adjunctive therapies within a standard medical/professional care model, especially in cases of more severe mental illness, with a strength of evidence classified as Grade A 1, 2

Estudos em jovens com transtorno bipolar não especificado (BP-NOS) e ciclotimia demonstraram que ômega-3 combinado com psicoterapia (IF-PEP) reduziu sintomas depressivos com tamanho de efeito grande, embora não houve diferença significativa nos sintomas maníacos, de acordo com o Annual Review of Clinical Psychology 10

Para depressão bipolar tipo 2, considere ômega-3 (EPA ≥1-2g diários, EPA:DHA >2:1) como adjuvante ao tratamento farmacológico estabelecido, especialmente em pacientes com sintomas depressivos residuais apesar de tratamento farmacológico adequado, como recomendado por Psychotherapy and Psychosomatics [11] [12]
Não esperar efeitos dramáticos, pois os tamanhos de efeito são pequenos a moderados (0.23-0.56), similares aos antidepressivos convencionais, de acordo com Psychotherapy and Psychosomatics 12