From the Editor-in-Chief’s Desk: Are Omega-3 Fatty Acid Supplements an Effective,Safe,and Scalable Treatment for Depression in Children and Adolescents?

To Our Readers:

There is an ongoing need for safe, effective, and scalable treatments for children and adolescents with mood disorders (Radecki et al., 2024; Zhang et al., 2024). Omega-3 polyunsaturated fatty acid supplements have been extensively studied in adults with mood disorders and increasingly examined in pediatric populations (McNamara et al., 2022). However, there are ongoing knowledge gaps related to the use of omega-3 polyunsaturated fatty acid supplements in children and adolescents. In this issue, Lam and colleagues (Lam et al., 2024) report on a systematic review and network meta-analysis focused on evaluating the effectiveness of omega-3 polyunsaturated fatty acid supplements in improving depressive symptoms and remission rates (operationalized as a greater than 50% improvement in symptom severity).

This effort identified nine placebo-controlled, randomized controlled trials with a total of 561 participants treated with omega-3 polyunsaturated fatty acid supplements. The analyses did not consistently demonstrate significant improvement in depressive symptoms with omega-3 polyunsaturated fatty acid supplement treatment, but a clustered ranking plot suggested that omega-3 plus and inositol had 77% efficacy. Concurrent omega-3 supplement and a psychotherapeutic treatment also had significantly greater remission rates as compared to placebo. The side effect burden of omega-3 supplement also appears to be minimal. The authors advocated for future research focused on omega-3 monotherapy studies for depression in children and adolescents (Lam et al., 2024).

There is a pressing need to address health care inequities in our field and understand the profound impact of social determinants of health on treatment outcomes. These considerations are particularly relevant and inadequately understood in young patients with autism spectrum disorder and intellectual disabilities (Valicenti-McDermott et al., 2024). In this issue, Weiss and colleagues examine the intersectionality of race, ethnicity, and language with neurodevelopmental disorders and how these complexities drive ongoing inequities in child and adolescent psychopharmacology. This key paper provides real world examples and a thought-provoking research agenda to foster health care equity and improved frameworks for shared decision-making in the treatment of youth with neurodevelopmental disorders (Weiss et al., 2024).

Bayesian hierarchical models are an important tool for understanding heterogeneity across patients and studies. This is particularly important for understanding findings from child and adolescent psychopharmacology research. Mills and colleagues have championed ongoing efforts to provide pragmatic information for clinical decision-making with the analyses of large existing datasets (Mendez et al., 2023). This issue includes their recent meta-analytic study focused on characterizing trajectories of response in children, adolescents, and adults with anxiety treated with selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs). The authors also sought to characterize placebo response in patients with anxiety disorders. Notably, SSRIs had similar treatment effects in children, adolescents, and adults with anxiety. However, SNRIs for the treatment of anxiety conferred greater responses for adult patients. However, the placebo response for anxiety disorders was similar across age ranges (Mills et al., 2024).

There are ongoing efforts to better understand and address the side effect burden of antipsychotics in children and adolescents (Lyu et al., 2024). West and colleagues present an interrupted time series analysis to examine at a population level effects of an intervention designed to mitigate antipsychotic use. This study examined a pre and post intervention sample with more than 11,000 patients. While it was not clear that the “Safer Use of Antipsychotics in Youth” trial had a direct impact on prescribing rate of antipsychotics, this study provides important insights regarding health system level prescribing patters from 2013–2018, the impact of the COVID-19 pandemic, and future approaches to enhance the safety of clinical practice. (West et al., 2024).

This issue also includes a study focused on the impact of age on risk for adverse events during treatment with antipsychotics and a letter highlighting safety considerations for ketamine treatment in young patients.

We hope you enjoy this issue of Journal of Child and Adolescent Psychopharmacology