Nutrient and genetic biomarkers of nutraceutical treatment response in mood and psychotic disorders: a systematic review

ABSTRACT

Objective: Nutrient and genetic biomarkers in nutraceutical trials may allow for the personalisation of nutraceutical treatment and assist in predicting treatment response. We aimed to synthesise the findings of trials which have included these biomarkers to determine which may be most useful for predicting nutraceutical response in mood and psychotic disorders.

Methods: A systematic review was conducted assessing available literature concerning nutraceutical clinical trials in mood and psychotic disorders (major depression, bipolar disorder, schizophrenia) with baseline and endpoint blood nutrient markers or genetic data available.

Results: We identified 35 eligible studies (total n = 3836 participants) examining baseline and endpoint nutrient biomarkers and/or genetic polymorphisms. The key result, as reported in 10 out of 11 omega-3 studies, was a strong association between polyunsaturated fatty acid concentrations (mostly EPA and DHA) and psychiatric outcomes, although the exact nature of the association varied between studies and diagnoses. There was no consistent evidence for levels of other nutrients (including Vitamin D, SAM/SAH ratios, carnitine, folate and vitamin B12) relating to treatment response. The evidence for associations between one-carbon cycle genotypes (e.g. MTHFR C677 T, MTR and FOLH1) and treatment response was also inconsistent.

Discussion: The available data tentatively supports omega-3 indices as biomarkers of response to omega-3 treatments in mood disorders. Further research with larger samples examining combinations of polymorphisms is required to determine if any genetic factors influence nutraceutical response in mood and psychotic disorders.

KEYWORDS:

• Psychiatry
• diet
• biomarker
• folate
• omega 3
• schizophrenia
• depression

Acknowledgements

JS is supported by an NHMRC Clinical Research Fellowship (APP 1125000). JF is supported by a Blackmores Institute Fellowship. Thanks are extended to Jenifer Murphy for reading the manuscript and making valuable suggestions for its improvement.

KvdB drafted the initial version of this manuscript. KvdB performed the initial systematic review. All authors contributed intellectual content to the manuscript and read and approved the final manuscript.

Disclosure statement

J.S has received either presentation honoraria, travel support, clinical trial grants, book royalties, or independent consultancy payments from: Integria Healthcare & MediHerb, Pfizer, Scius Health, Key Pharmaceuticals, Taki Mai, FIT-BioCeuticals, Blackmores, Soho-Flordis, Healthworld, HealthEd, HealthMasters, Kantar Consulting, Research Reviews, Elsevier, Chaminade University, International Society for Affective Disorders, Complementary Medicines Australia, SPRIM, Terry White Chemists, ANS, Society for Medicinal Plant and Natural Product Research, Sanofi-Aventis, Grunbiotics, Omega-3 Centre, the National Health and Medical Research Council, CR Roper Fellowship.

Additional information

Funding

JS is supported by an NHMRC Clinical Research Fellowship (APP 1125000). JF is supported by a Blackmores Institute Fellowship.

Notes on contributors

Kiki P. van der Burg

Kiki P. van der Burg is undertaking her residency at the University Medical Center Utrecht, Utrecht, the Netherlands.

Lachlan Cribb

Lachlan Cribb received his Bachelor of Science in neuroscience at the University of Melbourne in 2017. His research interests are in the field of psychiatry.

Joseph Firth

Dr. Joseph Firth is a Research Fellow at the NICM Health Research Institute at Western Sydney University. His research investigates novel interventions for improving physical and mental health outcomes in young people with psychiatric conditions, particularly psychotic disorders.

Diana Karmacoska

Diana Karmacoska is at NICM Health Research Institute, Western Sydney University, Westmead, Australia.

Jerome Sarris

Jerome Sarris is Professor of Integrative Mental Health and Deputy Director at NICM Health Research Institute. He holds an NHMRC Clinical Research Fellowship. His research investigates nutraceutical psychopharmacology as well as lifestyle medicine in psychiatry, and psychotropic plant research.