The subcommittee of the International Society for Nutritional Psychiatry Research organized an expert panel, conducted a literature review and a Delphi process to develop a consensus-based practice guideline for clinical use of polyunsaturated fatty acids in Major Depressive Disorder. This systematic review of the published literature emphasized randomized controlled trials, systematic reviews, and meta-analyses. As it currently stands, treatment for major depressive disorder is only mildly successful with many adverse and unpredictable effects. The goal of the panel was to create guidelines that would help create patient outcomes that are more tolerable and efficacious. What We Covered

• Several lines of evidence have suggested the efficacy of n–3 PUFAs as a preventive and treatment strategy in major depressive disorder, from epidemiological and case-controlled studies to randomized-controlled trials and meta-analyses.
• According to the currently available randomized controlled trials, the starting dose should be at least 1 g of net EPA in a pure EPA form or in an EPA/DHA combination (ratio higher than 2).
• The panel also reached a unanimous consensus on the recommendation of EPA/DHA ratio of ≥2: 1 to be crucial to polyunsaturated fatty acids antidepressant effects.
• The length of time to see these effects and the duration of the studies.
• The risk of theoretical adverse effects of excessive bleeding did not exist, and current evidence suggests that under concurrent usage of anti-platelet or anticoagulant agents, doses up to 4 g of polyunsaturated fatty acids daily are not associated with an increased risk of major bleeding.
• The authors encourage the consideration of polyunsaturated fatty acids for pregnant women and children with mood disorders since the current guidelines are not recommended for either with major depressive disorder.