Skip to main content
Browse Subject Areas

Click through the PLOS taxonomy to find articles in your field.

For more information about PLOS Subject Areas, click here.

  • Loading metrics

Omega-3 supplements in the prevention and treatment of youth depression and anxiety symptoms: A scoping review

  • Natalie M. Reily ,

    Roles Conceptualization, Data curation, Formal analysis, Funding acquisition, Methodology, Project administration, Supervision, Writing – original draft, Writing – review & editing

    Affiliation Black Dog Institute, University of New South Wales Sydney, Sydney, NSW, Australia

  • Samantha Tang,

    Roles Conceptualization, Data curation, Formal analysis, Funding acquisition, Methodology, Writing – original draft, Writing – review & editing

    Affiliation Black Dog Institute, University of New South Wales Sydney, Sydney, NSW, Australia

  • Ashlee Negrone,

    Roles Formal analysis, Methodology, Writing – original draft, Writing – review & editing

    Affiliation Black Dog Institute, University of New South Wales Sydney, Sydney, NSW, Australia

  • Daniel Z. Q. Gan,

    Roles Data curation, Formal analysis, Writing – original draft, Writing – review & editing

    Affiliation Black Dog Institute, University of New South Wales Sydney, Sydney, NSW, Australia

  • Veronica Sheanoda,

    Roles Data curation, Methodology, Writing – review & editing

    Affiliation Black Dog Institute, University of New South Wales Sydney, Sydney, NSW, Australia

  • Helen Christensen

    Roles Funding acquisition, Supervision, Writing – review & editing

    Affiliation Black Dog Institute, University of New South Wales Sydney, Sydney, NSW, Australia



Omega-3 supplements may be efficacious in reducing symptoms of depression and anxiety in adults, particularly as an adjunct to antidepressant medication. However, research in young people is limited. Thus, this scoping review aimed to summarise existing evidence on the efficacy of omega-3 supplementation in treating depression and anxiety symptoms in young people aged 14–24. A secondary aim was to determine whether grey literature intended for the general public accurately reflects the evidence.


Four databases (Cochrane CENTRAL, EmBASE, PsycINFO, PubMed) were searched from inception to 4th August 2021. Eligible peer-reviewed studies were empirical studies which examined the efficacy of omega-3 supplements in preventing/treating anxiety and/or depression symptoms in young people aged 14–24. Risk of bias was assessed for randomised studies using the Cochrane Risk of Bias Tool. Selected grey literature databases were also searched, with eligible sources assessed for quality. A stakeholder group including young people with lived experience of anxiety/depression, parents/carers and mental health professionals informed the research questions and data interpretation. Findings were summarised using narrative synthesis.


17 empirical studies (N = 1240 participants) meeting inclusion criteria were identified. Studies varied in treatment and participant characteristics. In general, the data did not support the view that omega-3 supplements were efficacious in improving symptoms of anxiety or depression in young people aged 14–24. In contrast, most grey literature sources recommended the use of omega-3 supplements in young people.


Evidence for efficacy of omega-3 supplementation in reducing symptoms of depression and anxiety in young people was inconclusive. More research is needed to identify potential mechanisms and moderators of the effect of omega-3 supplements on depression and anxiety symptoms in young people.


Depression and anxiety are among the most common mental illnesses in young people, with 50% of lifetime cases of mental illness beginning before age 14, and 75% beginning before age 24 [1]. There is also significant comorbidity between depression and anxiety, and other mental health disorders [2]. Standard evidence-based treatments for depression and anxiety in young people typically involve cognitive behavioural therapy, pharmacotherapy, or a combination of both [3, 4]. However, a significant minority of young people do not benefit from such treatments, leading to high rates of relapse [57]. This highlights the need to explore other treatments, which can be offered as an alternative or adjunct to standard treatments.

Omega-3 polyunsaturated fatty acids, found in oily fish, flax seeds, walnuts, and oils such as canola and walnut oils, have gained attention for their potential in reducing symptoms of depression and anxiety both in research (for recent meta-analyses see [810]) and in the media [11]. Recognition of poor diet quality as a modifiable risk factor implicated in psychological illnesses [12, 13] has led to increasing interest in whether dietary supplements such as omega-3 supplements may be beneficial in preventing or treating common mental health disorders [14]. Over-the-counter omega-3 fish oil capsules typically contain 300mg-600mg of a combination of docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) in varying ratios, as well as small amounts of other long-chain omega-3s such as docosapentaenoic acid. There is evidence to show that omega-3 fatty acids interact with a variety of physiological processes implicated in common mood disorders such as the inflammatory response and the regulation of neurotransmitters such as serotonin. Specifically, omega-3 suppresses the upregulation of several proinflammatory cytokines and eicosanoids and related lipid mediators, which may reduce chronic inflammation, a known risk factor for depression [1517]. Omega-3 supplements may also reduce depression symptoms through its upregulation of serotonin activity [18], given that serotonin pathways are implicated in mood regulation [19].

Several reviews and meta-analyses have examined the efficacy of omega-3 supplements in the prevention and treatment of depression and anxiety in adults. Many have reported that omega-3 supplements are efficacious in treating depression [8, 2023], and the International Society for Nutritional Psychiatry endorses it as a treatment for depression [24]. However, one recent meta-analysis found that the evidence is imprecise, and concluded that the benefits of omega-3 as a treatment for depression in adults are likely to be non-clinical in magnitude [25]. Additionally, a meta-analysis of four studies examining omega-3 supplements as an adjunct to sertraline found no effect on depressive symptoms [26] and another meta-analysis in adults aged 60 or above had mixed findings [27]. For anxiety, the efficacy of omega-3 supplements in adults has been explored to a lesser extent. However, one meta-analysis found that omega-3 supplements were effective for adults with anxiety symptoms, particularly for those with clinical diagnoses [28]. Regarding prevention of depression and anxiety, a recent meta-analysis suggested that omega-3 supplements had little or no effect on risk of developing depression or anxiety in healthy adult populations [10].

As compared to research in adults, there is substantially less research on whether omega-3 supplements can prevent and treat depression and anxiety symptoms in young people, aged 14–24. A recent meta-analysis of four studies of children aged 6–18 found no evidence of efficacy for omega-3 supplements as a stand-alone depression treatment [9]. However, this review was narrow in scope and excluded non-randomised controlled trials, studies examining anxiety, studies conducted in non-clinical populations, studies that assessed omega-3 as an adjunct rather than a primary, standalone treatment, and studies conducted in clinical samples with mental health disorders other than depression. It is of interest to examine how omega-3 supplements affect depression and anxiety symptoms in the context of other mental health disorders given the prevalence of comorbidity among people with a mental health disorder [2]. An upcoming Cochrane review with a similar scope also stands to investigate the efficacy of omega-3 supplementation for children and adolescents aged 6–19 years (for protocol see [29]).

Critically, there is a gap in knowledge as to the efficacy of omega-3 supplements in young people aged 14–24 –no systematic reviews or meta-analyses, to our knowledge, have focused specifically on this age group, despite their high risk of depression and anxiety. While there are some guidelines on the use of omega-3 in adult depression [24], there are no such guidelines for young people. The primary aim of this review was therefore to synthesise the current literature on the efficacy of omega-3 supplements for depression and anxiety symptoms in young people, including potential mechanisms of action and moderators of efficacy. A secondary aim and novel contribution to the literature was to investigate whether grey literature commentary aimed at the general public on omega-3 supplements for depression and anxiety symptoms in youth was consistent with the available evidence from scientific literature. Given the two aims, a scoping review approach was taken which also incorporated lived experience input in its design and interpretation of findings. Lived experience can aid in facilitating translatable and human-centered research in the mental health sphere [30].



We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist [31]; see S1 Table for the PRISMA-ScR Checklist. The protocol was registered with the Open Science Framework (OSF.IO/WFB7D).

Lived experience stakeholder consultation

A group of 11 stakeholders—consisting of four young people with lived experience of depression and/or anxiety, three parents of young people with lived experience of depression and/or anxiety, and four healthcare professionals—were recruited online through social media (e.g., Facebook) to share their insights and perspectives during two online workshops. After seeing the online advertisement, potential stakeholders filled out an expression of interest form which included questions about demographic characteristics (e.g., age, gender), profession (for health professionals only) and asked about their availability to attend various potential workshop dates. Stakeholders were selected on the basis of their availability, and to ensure there was as much diversity as possible amongst the group in terms of age, gender, profession, and experience with using omega-3 or other dietary supplements. Following our organisations’ Lived Experience Policy, ethics approval was not sought given that lived experience stakeholders were engaged in an advisory capacity. However, all stakeholders provided written informed consent to attend advisory workshops. These workshops were held on Zoom (San Jose, California) and used the online collaborative tool Miro (San Jose, California). The first workshop, held on 13th July 2021, prior to database searching, sought stakeholders’ input on (i) types of information sources from which they would seek information about the efficacy of omega-3, (ii) what they were interested in understanding about omega-3 supplementation for depression and anxiety symptoms, and (iii) relevant search terms that could be used in the search strategy. The second workshop was held on 13th September 2021, after data were extracted from randomised controlled trials (RCTs) identified in the search. The purpose of this workshop was to obtain input on data interpretation, insights on how to use grey literature and ways of communicating study findings.

Search strategy and selection criteria

During the first workshop, stakeholders expressed interest in understanding the effectiveness of omega-3 supplements in preventing and treating depression and anxiety symptoms. Thus, we systematically searched four online academic databases for articles published from database inception to 4th August 2021: Cochrane CENTRAL EmBASE (from 1947), PsycINFO (from 1806), and PubMed (from 1996). The search comprised of three blocks of search terms organised around (i) omega-3 polyunsaturated fatty acids, (ii) young people, and (iii) depression and anxiety (see S2 Table for search terms used in each database).

We adapted the above strategy to search the grey literature (see S3 Table). Government and health authority databases were selected from the Canadian Agency for Drugs and Technologies in Health (CADTH) grey literature checklist [32]. A Google advanced search was also conducted and results of the first 10 pages were extracted.

Eligible peer-reviewed studies met the following inclusion criteria: (i) mean participant age between 14 and 24 years, (ii) administered omega-3 supplements containing DHA and EPA, (iii) measured anxiety and/or depression symptoms using validated measures, (iv) published in the English language, and (v) contained empirical data (i.e., reviews, commentaries and case studies were excluded). Both non-clinical and clinical samples were included, with no restrictions placed on psychiatric diagnoses. Studies that administered omega-3 supplements as an adjunct to treatment as usual were included, with no restrictions placed on the type of usual treatment. Correlational studies examining intake of fish and mental health outcomes or biomarkers of omega-3 in the body and mental health outcomes were excluded. Studies that altered components of diet (e.g., amount of fish consumed) rather than delivering tablets/supplements were also excluded as it was not possible to precisely measure omega-3 dosage.

Grey literature information sources were eligible if they met the following criteria: (i) described the impact of omega-3 on depression and/or anxiety in young people, and (ii) targeted potential consumers, policymakers, or health professionals. Sources that targeted academic audiences (e.g., clinical trial protocols) were excluded.


Two authors (DZQG and NMR or AN) independently screened the titles and abstracts identified through peer reviewed literature searches, and the titles only for the grey literature searches for a subset of 10% of the articles, with disagreements resolved through discussion. All remaining titles and abstracts were screened by DZQG. At the full-text stage, all articles were independently screened by two authors (DZQG, NMR, ST, AN; Cohen’s kappa = 0.58–0.87), with disagreements resolved through discussion, and a third author consulted if consensus could not be reached.

Data extraction

Data extracted from the peer-reviewed literature included: authors and year of publication, country, sample characteristics (size, age, gender, diagnosis), study type, dosage and duration of omega-3 supplementation, other treatments administered, outcomes assessed, main findings, and information on side effects and compliance. Data extracted from the grey literature included: authors, publisher, and year of publication, country, target audience, and key messages on the use of omega-3 for depression and anxiety in young people. Two authors (AN and DZQG) independently extracted and coded data sources using Covidence (Veritas Health Innovation, 2020) for all eligible peer reviewed articles and a customised Microsoft Excel spreadsheet for grey literature sources. Disagreements were resolved through discussion. Corresponding authors of studies were contacted by email if more information was needed to determine eligibility.

Quality assessment

Risk of bias of included studies is not typically assessed in scoping reviews [31]. Nonetheless, we conducted quality assessment ratings of the included RCTs using Version 2 of the Cochrane risk-of-bias tool for randomised trials [33]. This tool assesses possible sources of bias in RCTs, including: (1) randomisation sequence generation and allocation concealment, (2) blinding of participants, personnel and outcome assessors, (3) incomplete outcome data, (4) measurement of outcome and (5) selective reporting. Risk of bias ratings for RCTs (see S4 Table) were independently performed by AN and DZQG, and disagreements were resolved through discussion.

Grey literature information sources were also assessed by two raters (AN and DZQG) on three criteria: comprehensiveness, accuracy of information, and the extent to which references to the peer-reviewed literature were incorporated. The criteria selected were informed by the stakeholder group and adapted from a previous rating system developed by Wade et al. [34]. Each criterion was rated Poor, Moderate, or Excellent (see S5 Table).

Synthesis of results

Significant variability in the design of included studies precluded a meta-analytic approach. A narrative synthesis approach was therefore undertaken to summarise findings in relation to each identified variable.


Peer-reviewed literature

Study characteristics.

The search yielded a total of 5264 articles. Following removal of duplicates and screening, 17 studies met inclusion criteria (see Fig 1), of which 13 were RCTs. Table 1 displays key characteristics of each included RCT study. All examined depression symptoms as an outcome, but only five measured anxiety symptoms. Studies varied in the daily dosage of omega-3 administered (1000mg/day-6400mg/day of EPA and DHA combined), the ratio of EPA to DHA in each dosage (50% EPA-85.7% EPA), and duration of treatment (3 weeks-12 months). Most studies were conducted in the United States (n = 7), and only one study was conducted in a low- to middle-income country (Iran).

Fig 1. PRISMA flow diagram: Scientific literature screening process.

Table 1. Characteristics of randomised controlled trials investigating the effect of omega-3 supplementation on depression and/or anxiety (n = 13).

Of the 13 RCTs, six administered omega-3 supplements as an adjunct to pharmacological or psychosocial interventions. Two RCTs used a combination of omega-3 and vitamin supplements. The remaining five RCTs administered omega-3 supplements exclusively. Sample populations varied across studies with the majority in clinical samples including people with depression (n = 4), and people with, or at risk of, a mental illness other than depression or anxiety, including psychosis, schizophrenia, bipolar disorder, borderline personality disorder, and anorexia (n = 6). The remaining three studies used non-clinical samples, described as healthy individuals, women with polycystic ovarian syndrome, and medical students respectively. No RCTs were focused specifically on identifying moderators of efficacy or differentiating between potential mechanisms of action. Table 2 presents a summary of results of all included RCTs.

Table 2. Results from randomised controlled trials investigating the effect of omega-3 supplementation on depression and/or anxiety (n = 13).

In addition to the thirteen RCTs, there were two open label trials [35, 36] and one observational study [37]. Finally, one other report identified in the grey literature search was included with these additional studies because it reported on empirical data, despite not being peer-reviewed [38]; see S6 Table for non-RCT characteristics.

Efficacy of omega-3 supplements on depression.

Two RCTs in young people with depression found that omega-3 supplementation led to greater reductions in depressive symptoms relative to placebo. These studies differed in dosage and duration of treatment, with one administering 1400mg/day for 3 weeks as a standalone treatment [39] and the other administering 2400mg/day for 12 weeks in addition to standard antidepressant therapy [40]. One of these studies also found that depressed participants had significantly lower baseline levels of EPA and DHA compared to healthy controls [40]. A third study in young women with polycystic ovarian syndrome found that a low dose of 1000mg/day of omega-3 co-supplemented with vitamin E led to lower levels of depressive symptoms relative to the placebo control group [41]. The remaining ten RCTs found null effects [4251]. In addition to finding no significant effect on general symptoms of depression, one study also found no effect on specific symptoms of depression, including irritability, suicidality and anhedonia [44].

The effect of omega-3 supplementation was also examined by four non-randomised controlled trials in young people with depression (n = 3) and bipolar disorder (n = 1). All four studies found omega-3 supplementation reduced depressive symptoms over time, however, none included an adequate placebo control (see S7 Table).

Overall, there is weak evidence to suggest that omega-3 supplements are effective in reducing depressive symptoms among young people diagnosed with depression or other mental illnesses, or in non-clinical populations.

Efficacy of omega-3 supplements on anxiety.

Of the five RCTs that assessed anxiety outcomes, three found that omega-3 reduced anxiety symptoms, including two studies in non-clinical populations [41, 46] and one study in young people taking risperidone for recent onset psychosis, schizophrenia, or bipolar disorder [51]. Dosage and duration of treatment was varied, with one administering 1000 mg/day with vitamin E for 12 weeks [41], another administering 2496 mg/day for 12 weeks as a standalone treatment [46], and the third administering 1140mg omega-3 with tocopherol in addition to patients’ standard treatments for recent onset psychosis [51]. One of these studies also found plasma omega-6 to omega-3 ratios were positively correlated with anxiety symptoms after supplementation [46]. Two studies found no effect of omega-3 supplementation on anxiety symptoms, including one in a non-clinical sample [45] and one in adolescents with anorexia nervosa [47].

Secondary outcomes (inflammation, metabolism, other mental health symptoms).

Two studies that found an effect of omega-3 supplementation on anxiety symptoms [46], or both anxiety and depression symptoms [41] also found corresponding changes in inflammatory biomarkers. Specifically, Kiecolt-Glaser et al. [46] found that omega-3 supplementation reduced stimulated interleukin-6 levels (IL-6), but not serum IL-6 levels or tumor necrosis factor alpha (TNF-α) production, and Jamilian and colleagues [41] found that omega-3 supplementation downregulated interleukin-8, TNF-α and serum insulin, and upregulated peroxisome proliferator-activated receptor expression. A third study, which reported a reduction in anxiety symptoms with omega-3 supplementation, found no between-group differences in metabolic outcomes including weight, BMI, cholesterol, triglycerides, haemoglobin levels, and fasting glucose [51].

Other outcomes assessed included psychosis-related symptoms [42, 43, 48, 51], general psychological distress [41], global functioning [42, 48], self-esteem [50], and neural activity [49]. These secondary outcomes are reported in Table 2.

Side effects and adherence to intervention.

There was little evidence of side effects attributable to omega-3 supplementation. One study reported that participants receiving omega-3 supplements were more likely to experience muscle cramps compared to placebo [49], whereas another observed a greater number of adverse events in the placebo group, but no statistical analyses were performed [51]. The remaining studies either found no differences in side effects between omega-3 and placebo groups (n = 8) or did not report on side effects (n = 3). Adherence to the intervention also did not differ significantly between omega-3 and placebo conditions.

Quality assessment.

Only two of the RCTs had low risk of bias across all 5 domains (see S3 Table). Selective reporting of results was identified to be the largest source of possible bias, with 9 studies (69.2%) not reporting sufficient information (such as a prospectively published trial protocol) to rule out bias in this domain. The second most common source of potential bias was associated with the randomisation process, with 6 studies (46.2%) not reporting sufficient detail on randomisation sequence generation or allocation concealment. Risk of bias relating to the other domains was mostly low.

Grey literature

Source characteristics.

Twelve grey literature sources met inclusion criteria, including seven online articles, three blogs, one fact sheet and one practice guideline, all published from 2005–2021 (see Fig 2). The majority were from the United States (n = 7). See Table 3 for grey literature source characteristics.

Fig 2. PRISMA flow diagram: Grey literature screening process.

Table 3. Summary of grey literature reporting on the effect of omega-3 supplementation on depression and/or anxiety (n = 12).

Key messages.

As with the peer-reviewed literature, most grey literature discussed the effect of omega-3 on depression as opposed to anxiety. However contrary to peer-reviewed literature, most sources recommended omega-3 to alleviate depression or anxiety symptoms (83%). Specifically, seven websites recommended omega-3 for low mood or depression [5258], one for anxiety [59], and two for both anxiety and depression ([60, 61]. The remaining two sources were neutral [62, 63], with none advising against the use of omega-3.

Sources that recommended a specific dosage of omega-3 supplements recommended between 500-2000mg/day with a high ratio of EPA to DHA [52, 56, 60]. However, other sources advised for omega-3 to be obtained through diet rather than in supplement form [55, 59, 61]. Most sources mentioned benefits of omega-3 intake for other aspects of health, such as cognitive ability [53, 61]. Thus, promotion of omega-3 in grey literature often centered around omega-3 as a part of a healthy diet, which was stated to indirectly contribute to better mental health. Side effects of supplementation reported in grey literature were predominately similar to those noted in peer-reviewed literature, including fishy aftertaste, gastrointestinal disturbances [53] and increased risk of bleeding [54, 58].

Quality assessment.

Quality assessment of grey literature sources revealed variation in accuracy, comprehensiveness, and extent to which peer-reviewed literature was referenced (see S4 Table). Reference to peer reviewed literature was the highest scoring domain, with 58% of grey literature sources rated as excellent. However, despite many sources referencing peer reviewed literature, only 17% of sources were rated as excellent in accuracy. The majority of remaining sources unreservedly promoted the use of omega-3 supplements for as a treatment for depression and anxiety in young people, failing to acknowledge the lack of consistent evidence for its effectiveness. In terms of comprehensiveness, 33% of sources had an excellent amount of detail, including detail on contexts in which omega-3 was found to be effective, and potential mechanisms for its efficacy. However, 50% of sources provided a poor level of detail.


This scoping review was the first to summarise the existing evidence on the efficacy of omega-3 supplementation in treating depression and anxiety symptoms in young people aged 14–24. We found little evidence to support the use of omega-3 supplements in reducing depressive symptoms in young people, consistent with one previous meta-analysis which found that omega-3 supplements were not effective in treating depression among children aged 6–18 [9]. We also found some evidence that omega-3 supplements may reduce symptoms of anxiety, however, none of the included studies were conducted in populations with clinically diagnosed anxiety or depression. Studies were highly heterogenous in intervention characteristics (e.g., dosage) and participant characteristics (e.g., diagnosis) and there was no evidence to suggest that any such characteristics moderated the efficacy of omega-3 supplements. None of the included studies systematically examined mechanisms of action for omega-3, but two studies found evidence to suggest that omega-3 reduced inflammatory biomarkers which may be implicated in reduction of anxiety and depression symptoms, at least in populations without diagnosed mental illness [41, 46]. Our review also suggests that consumption of omega-3 supplements is not associated with significant side effects in young people. Compared with lack of evidence for supplement efficacy in peer-reviewed literature, grey literature information sources generally supported the use of omega-3 in reducing symptoms of depression and anxiety in young people. However, these sources differed in whether they recommended omega-3 be obtained through the diet or with the use of supplements, and they typically recommended lower dosages than were used in randomised controlled trials.

Potential contextual moderators of omega-3 efficacy

There was little evidence to suggest that contextual variables such as baseline symptom severity, treatment characteristics (e.g., dosage, ratio of EPA to DHA, duration), whether omega-3 was administered alongside other treatments, or participant characteristics (e.g., sex, diagnosis) moderated the efficacy of omega-3 supplements. Moreover, no included studies were specifically designed to identify moderators of efficacy. However, research conducted among adults suggests that omega-3 may be more effective when administered as an adjunct to antidepressant medication, rather than as a standalone treatment [14, 21] and when EPA is administered at a higher dose [22].

With regard to treatment dosage and duration, the International Society for Nutritional Psychiatry Research Practice [24] recommends a daily dose of 1000-2000mg of omega-3 for at least 8 weeks. Based on a cut-off of 2000mg/day to distinguish between high and low doses [64], approximately half of the included RCTs in the current review administered a ‘high’ dose of omega-3 (> 2000mg/day [40, 4447, 49, 50]) while the other half administered a ‘low’ dose (< 2000mg/day [39, 4143, 48, 51]). We found no difference between high-dose and low-dose studies in terms of treatment efficacy. Furthermore, two studies that compared the efficacy of different doses did not find significant effects [36, 50]. There was also a wide range of treatment durations in the included studies. Notably, however, only two of the RCTs had a treatment duration of six months or longer [48, 50]. This is despite evidence showing that six months is the minimum period needed to ensure equilibration of omega-3 throughout the body [65]. As such, the absence of a clear effect of omega-3 supplementation on depression and anxiety symptoms may be due to an insufficient amount of time allowed for omega-3 supplements to reduce symptoms. Future studies should further investigate whether a certain dosage and duration of omega-3 supplementation is optimal to treat symptoms of depression and anxiety in young people.

There are a number of other factors not assessed in this review that may moderate efficacy of omega-3 supplementation in depression and anxiety. Previous research in adults with depression has found that omega-3 supplementation might be most effective for people with high red blood cell levels of EPA and DHA at baseline [66], however no included studies assessed this. Baseline ratios of omega-3 to omega-6 may also be relevant to risk of depression and anxiety due to their differing effects on inflammation [67, 68]. Specifically, omega-3 acids produce eicosanoids and related substances which suppress inflammation, while omega-6 acids produce eicosanoids and related substances that stimulate inflammation [69]. In this review, one study found that higher omega-3 to omega-6 ratios were associated with lower levels of anxiety- and depression-related symptoms [46]. As such, it may be of interest for future studies to examine how the efficacy of omega-3 supplementation in treating depression and/or anxiety symptoms may be moderated by baseline omega-3 levels and baseline ratio of omega-3 to omega-6.

As mentioned earlier, some previous meta-analyses have found that omega-3 supplements may reduce symptoms of both depression [8, 2023] and anxiety [28] in adult populations, albeit the evidence is not of a sufficiently high quality [25]. Our findings raise the question of whether omega-3 supplementation may be even less effective for young people. Indeed, a recent longitudinal study found an association between baseline levels of omega-3 and omega-6 polyunsaturated fatty acids and symptoms of depression and anxiety in a 24-year-old cohort, but not for a 17-year-old cohort [70]. Age-dependent effects of omega-3 may relate to changes in the brain that occur during adolescence and young adulthood [71]. For instance, research in adult populations suggests that omega-3 supplements may be particularly effective as an adjunct to antidepressant treatment such as selective serotonin reuptake inhibitors (SSRIs) given that they also interact with serotonin receptors [14, 21]. However, adolescent brain development is characterised by lower expression of serotonin transporters, which may limit the potential adjunctive effect of omega-3 administered with SSRIs [72]. Longitudinal prospective studies that examine the effect of omega-3 over time are needed to better understand how age may moderate efficacy.

Mismatch between peer-reviewed and grey literature

There was a clear discrepancy between the peer-reviewed and grey literature in the main message communicated about the efficacy of omega-3 in mitigating anxiety and depression among young people. Specifically, the grey literature overwhelmingly recommended the use of omega-3 for treating depression and anxiety, whereas the peer-reviewed literature reported scant evidence in support of this claim. Based on our ratings, grey literature sources that substantiated their claims with reference to peer-reviewed studies presented content that was more closely aligned with the scientific literature. To our knowledge, no other reviews on omega-3 supplements have assessed grey literature sources. However, our findings are consistent with a recent systematic review, which found that online health information intended for public consumption is generally poorly aligned with scientific evidence [73].

Strengths and limitations

Strengths of the current scoping review included the broad scope, the use of a rigorous systematic search strategy, and the thorough assessment of the quality of eligible RCTs and grey literature sources. The assessment of whether grey literature sources aimed at the general public accurately reflected the peer reviewed evidence is an important novel contribution of this review. The review was also enhanced by the involvement of a diverse group of stakeholders comprising of young people with lived experience of anxiety or depression, parents and caregivers, and healthcare professionals, which ensured that the review scope addressed research questions relevant to both lay and academic audiences.

The current review also had a several limitations. Only five studies in the review investigated anxiety outcomes, but none were in clinically anxious populations, and all but two RCTs had risk of bias from at least one source. The heterogeneity of studies included in the review made it difficult to determine whether participant characteristics (e.g., sex, diagnosis) or intervention characteristics (e.g., dosage and duration of treatment, adjunctive vs. standalone treatment) influenced the efficacy of omega-3 supplementation. Furthermore, although several RCTs in this review permitted continuation of current antidepressant medications and therapeutic treatments, they did not assess whether the type of treatment-as-usual that was combined with omega-3 was a moderator of the effect. Additionally, no studies systematically compared the effect of omega-3 supplements as a standalone treatment to their effect as an adjunct to other treatments. Finally, with the exception of one study, all studies included in this review were conducted in high income countries, and all stakeholders were Australian, which may limit the generalisability of findings to other populations.

Implications for future research and policy

The findings of the current review have implications for clinical practice. Current practice guidelines relating to omega-3 supplements recommend a higher ratio of EPA to DHA and daily dosages that exceed 1000mg [24, 64]. However, these guidelines are not age-specific. Our review suggests that further research on the efficacy of omega-3 supplementation is warranted before it is recommended as a treatment for depression and anxiety symptoms in young people. In particular, it would be important for future studies to test whether omega-3 supplementation over a longer duration improves symptoms, given the duration of treatment in many studies included in this review may have been insufficient. Furthermore, trials should investigate different adjunct treatments or potential moderators to identify contexts under which omega-3 supplements are most effective to inform practitioners, and practice guidelines.

With the inclusion of grey literature, this scoping review also identified that online sources often did not appropriately represent the evidence of efficacy of omega-3 supplements for depression and anxiety in young people. Therefore, improving the accuracy and accessibility of evidence-based online health information about the effectiveness of current and emerging potential treatments for common mental illness should be a priority for policymakers. This is critical given that information from such sources can significantly impact help-seeking related beliefs and behaviours [73]. Concurrently, public health resources should be allocated to improve the health literacy of the general public including providing education to the general public on how they can ascertain the credibility of online health information.


This scoping review of academic and grey literature is the first to synthesise the evidence on the efficacy of omega-3 supplementation in treating symptoms of depression and anxiety in young people. We found limited evidence that omega-3 supplementation reduces symptoms of depression, and some evidence supporting the efficacy of omega-3 in reducing symptoms of anxiety. No clear patterns emerged regarding whether the efficacy of omega-3 supplementation was moderated by such factors as dosage, ratio of EPA to DHA, participant characteristics and treatment duration. Additionally, the heterogeneity in sample demographics made moderators difficult to identify. In contrast to peer-reviewed literature, most grey literature sources recommended omega-3 supplements to improve symptoms of anxiety and depression. Despite most grey literature sources including reference to peer-reviewed literature, few accurately described the evidence. Further research is needed to investigate specific mechanisms that might underlie omega-3 supplementation and to systematically test how factors such as dosage, duration of treatment, age, and clinical characteristics may moderate its effectiveness.

Supporting information

S1 Table. Preferred reporting items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist.


S2 Table. Search terms for academic databases.


S3 Table. Grey literature search terms and databases.


S4 Table. Cochrane risk of bias ratings for randomised controlled trials (n = 13).


S5 Table. Ratings of grey literature according to comprehensiveness, accuracy of information, and reference to peer-reviewed literature (n = 12).


S6 Table. Characteristics of included non-randomised controlled trials (n = 4).


S7 Table. Findings from non-randomised controlled trials investigating the effect of omega-3 supplementation on depression and/or anxiety (n = 4).



We would like to acknowledge the key contributions made by our stakeholder advisory group in informing the scope and approach taken in this review. The valuable insights provided by this group of young people with lived experience, parents and carers, and health professionals shaped the search strategy and interpretation of the results of the review. We would also like to acknowledge Ms Helen Glover (Enlightened Consultants) for her expert facilitation of the stakeholder workshops.


  1. 1. Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62(6):593–602. pmid:15939837
  2. 2. Teesson M, Slade T, Mills K. Comorbidity in Australia: Findings of the 2007 National Survey of Mental Health and Wellbeing. Australian & New Zealand Journal of Psychiatry. 2009;43(7):606–14. pmid:19530017
  3. 3. Zhou X, Teng T, Zhang Y, Del Giovane C, Furukawa TA, Weisz JR, et al. Comparative efficacy and acceptability of antidepressants, psychotherapies, and their combination for acute treatment of children and adolescents with depressive disorder: a systematic review and network meta-analysis. The Lancet Psychiatry. 2020;7(7):581–601. pmid:32563306
  4. 4. Zhou X, Zhang Y, Furukawa TA, Cuijpers P, Pu J, Weisz JR, et al. Different types and acceptability of psychotherapies for acute anxiety disorders in children and adolescents: A network meta-analysis. JAMA Psychiatry. 2019;76(1):41–50. pmid:30383099
  5. 5. Cuijpers P, Cristea IA, Karyotaki E, Reijnders M, Huibers MJH. How effective are cognitive behavior therapies for major depression and anxiety disorders? A meta-analytic update of the evidence. World Psychiatry. 2016;15(3):245–58. pmid:27717254
  6. 6. Locher C, Koechlin H, Zion SR, Werner C, Pine DS, Kirsch I, et al. Efficacy and safety of selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, and placebo for common psychiatric disorders among children and adolescents: A systematic review and meta-analysis. JAMA Psychiatry. 2017;74(10):1011–20. pmid:28854296
  7. 7. Weisz JR, Kuppens S, Ng MY, Eckshtain D, Ugueto AM, Vaughn-Coaxum R, et al. What five decades of research tells us about the effects of youth psychological therapy: A multilevel meta-analysis and implications for science and practice. Am Psychol. 2017;72(2):79–117. pmid:28221063
  8. 8. Liao Y, Xie B, Zhang H, He Q, Guo L, Subramanieapillai M, et al. Efficacy of omega-3 PUFAs in depression: A meta-analysis. Transl Psychiatry. 2019;9(1):190. pmid:31383846
  9. 9. Zhang L, Liu H, Kuang L, Meng H, Zhou X. Omega-3 fatty acids for the treatment of depressive disorders in children and adolescents: A meta-analysis of randomized placebo-controlled trials. Child Adolesc Psychiatry Ment Health. 2019;13:36. pmid:31534476
  10. 10. Deane KHO, Jimoh OF, Biswas P, O’Brien A, Hanson S, Abdelhamid AS, et al. Omega-3 and polyunsaturated fat for prevention of depression and anxiety symptoms: systematic review and meta-analysis of randomised trials. Br J Psychiatry. 2021;218(3):135–42. pmid:31647041
  11. 11. OmegaQuant. New research highlights omega-3 as top mental health nutrients… and not a moment too soon: OmegaQuant; 2019 Available from:
  12. 12. Li Y, Lv MR, Wei YJ, Sun L, Zhang JX, Zhang HG, et al. Dietary patterns and depression risk: A meta-analysis. Psychiatry Res. 2017;253:373–82. pmid:28431261
  13. 13. O’Neil A, Quirk SE, Housden S, Brennan SL, Williams LJ, Pasco JA, et al. Relationship between diet and mental health in children and adolescents: A systematic review. Am J Public Health. 2014;104(10):e31–e42. pmid:25208008
  14. 14. Firth J, Teasdale SB, Allott K, Siskind D, Marx W, Cotter J, et al. The efficacy and safety of nutrient supplements in the treatment of mental disorders: A meta-review of meta-analyses of randomized controlled trials. World Psychiatry. 2019;18(3):308–24.
  15. 15. Berk M, Williams LJ, Jacka FN, O’Neil A, Pasco JA, Moylan S, et al. So depression is an inflammatory disease, but where does the inflammation come from? BMC Medicine. 2013;11(1):200. pmid:24228900
  16. 16. Simopoulos AP. Omega-3 fatty acids in inflammation and autoimmune diseases. J Am Coll Nutr. 2002;21(6):495–505. pmid:12480795
  17. 17. Logan AC. Neurobehavioral aspects of omega-3 fatty acids: possible mechanisms and therapeutic value in major depression. Altern Med Rev. 2003;8(4):410–25. pmid:14653768
  18. 18. Patrick RP, Ames BN. Vitamin D and the omega-3 fatty acids control serotonin synthesis and action, part 2: relevance for ADHD, bipolar disorder, schizophrenia, and impulsive behavior. FASEB J. 2015;29(6):2207–22. pmid:25713056
  19. 19. Cowen PJ, Browning M. What has serotonin to do with depression? World Psychiatry. 2015;14(2):158–60. pmid:26043325
  20. 20. Bae JH, Kim G. Systematic review and meta-analysis of omega-3-fatty acids in elderly patients with depression. Nutr Res. 2018;50:1–9. pmid:29540267
  21. 21. Grosso G, Pajak A, Marventano S, Castellano S, Galvano F, Bucolo C, et al. Role of omega-3 fatty acids in the treatment of depressive disorders: A comprehensive meta-analysis of randomized clinical trials. PLoS One. 2014;9(5):e96905. pmid:24805797
  22. 22. Mocking RJ, Harmsen I, Assies J, Koeter MW, Ruhé HG, Schene AH. Meta-analysis and meta-regression of omega-3 polyunsaturated fatty acid supplementation for major depressive disorder. Transl Psychiatry. 2016;6(3):e756. pmid:26978738
  23. 23. Schefft C, Kilarski LL, Bschor T, Köhler S. Efficacy of adding nutritional supplements in unipolar depression: A systematic review and meta-analysis. Eur Neuropsychopharmacol. 2017;27(11):1090–109. pmid:28988944
  24. 24. Guu T-W, Mischoulon D, Sarris J, Hibbeln J, Robert , Hamazaki K, et al. International Society for Nutritional Psychiatry Research Practice Guidelines for Omega-3 Fatty Acids in the Treatment of Major Depressive Disorder. Psychother Psychosom. 2019;88(5):263–73. pmid:31480057
  25. 25. Appleton KM, Voyias PD, Sallis HM, Dawson S, Ness AR, Churchill R, et al. Omega‐3 fatty acids for depression in adults. Cochrane Database of Systematic Reviews. 2021(11). pmid:34817851
  26. 26. Chambergo-Michilot D, Brañez-Condorena A, Falvy-Bockos I, Pacheco-Mendoza J, Benites-Zapata VA. Efficacy of omega-3 supplementation on sertraline continuous therapy to reduce depression or anxiety symptoms: A systematic review and meta-analysis. Psychiatry Res. 2021;296:113652. pmid:33348198
  27. 27. Bai Z-G, Bo A, Wu S-J, Gai Q-Y, Chi I. Omega-3 polyunsaturated fatty acids and reduction of depressive symptoms in older adults: a systematic review and meta-analysis. J Affect Disord. 2018;241:241–8. pmid:30138808
  28. 28. Su KP, Tseng PT, Lin PY, Okubo R, Chen TY, Chen YW, et al. Association of use of omega-3 polyunsaturated fatty acids with changes in severity of anxiety symptoms: A systematic review and meta-analysis. JAMA Netw Open. 2018;1(5):e182327. pmid:30646157
  29. 29. Campisi SC, Zasowski C, Shah S, Bradley-Ridout G, Szatmari P, Korczak D. Omega‐3 fatty acid supplementation for depression in children and adolescents. Cochrane Database Syst Rev. 2021(6).
  30. 30. Roennfeldt H, Byrne L. Skin in the game: The professionalization of lived experience roles in mental health. Int J Ment Health Nurs. 2021;30(S1):1445–55. pmid:34137149
  31. 31. Tricco AC, Lillie E, Zarin W, O’Brien KK, Colquhoun H, Levac D, et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation. Ann Intern Med. 2018;169(7):467–73. pmid:30178033
  32. 32. CADTH. Grey matters: A practical tool for searching health-related grey literature. Ottawa; 2018.
  33. 33. Sterne JAC, Savović J, Page MJ, Elbers RG, Blencowe NS, Boutron I, et al. RoB 2: A revised tool for assessing risk of bias in randomised trials. Br Med J. 2019;366:l4898. pmid:31462531
  34. 34. Wade TD, Egan SJ, Wleklinski M, O’Brien A, Fitzallen G, Shafran R. A realist synthesis of websites containing content on perfectionism: Are the descriptions and advice empirically supported? BMC Psychology. 2021;9(1):119. pmid:34429163
  35. 35. Clayton EH, Hanstock TL, Hirneth SJ, Kable CJ, Garg ML, Hazell PL. Reduced mania and depression in juvenile bipolar disorder associated with long-chain omega-3 polyunsaturated fatty acid supplementation. Eur J Clin Nutr. 2009;63(8):1037–40. pmid:19156158
  36. 36. McNamara RK, Strimpfel J, Jandacek R, Rider T, Tso P, Welge JA, et al. Detection and treatment of long-chain omega-3 fatty acid deficiency in adolescents with SSRI-resistant Major Depressive Disorder. PharmaNutrition. 2014;2(2):38–46. pmid:24772386
  37. 37. Fristad MA, Roley-Roberts ME, Black SR, Arnold LE. Moody kids years later: Long-term outcomes of youth from the Omega-3 and therapy (OATS) studies. J Affect Disord. 2021;281:24–32. pmid:33285389
  38. 38. Amminger GP. The Fish Oil Youth Depression Pilot Study. A randomised, double blind, placebo-controlled treatment trial (6515:10659). 2015.
  39. 39. Ginty AT, Conklin SM. Short-term supplementation of acute long-chain omega-3 polyunsaturated fatty acids may alter depression status and decrease symptomology among young adults with depression: A preliminary randomized and placebo controlled trial. Psychiatry Res. 2015;229(1–2):485–9. pmid:26188642
  40. 40. Trebatická J, Hradečná Z, Surovcová A, Katrenčíková B, Gushina I, Waczulíková I, et al. Omega-3 fatty-acids modulate symptoms of depressive disorder, serum levels of omega-3 fatty acids and omega-6/omega-3 ratio in children. A randomized, double-blind and controlled trial. Psychiatry Res. 2020;287:112911.
  41. 41. Jamilian M, Shojaei A, Samimi M, Afshar Ebrahimi F, Aghadavod E, Karamali M, et al. The effects of omega-3 and vitamin E co-supplementation on parameters of mental health and gene expression related to insulin and inflammation in subjects with polycystic ovary syndrome. J Affect Disord. 2018;229:41–7. pmid:29306057
  42. 42. Amminger GP, Schäfer MR, Papageorgiou K, Klier CM, Cotton SM, Harrigan SM, et al. Long-chain omega-3 fatty acids for indicated prevention of psychotic disorders: a randomized, placebo-controlled trial. Arch Gen Psychiatry. 2010;67(2):146–54. pmid:20124114
  43. 43. Amminger GP, Chanen AM, Ohmann S, Klier CM, Mossaheb N, Bechdolf A, et al. Omega-3 fatty acid supplementation in adolescents with borderline personality disorder and ultra-high risk criteria for psychosis: a post hoc subgroup analysis of a double-blind, randomized controlled trial. Can J Psychiatry. 2013;58(7):402–8. pmid:23870722
  44. 44. Gabbay V, Freed RD, Alonso CM, Senger S, Stadterman J, Davison BA, et al. A Double-Blind Placebo-Controlled Trial of Omega-3 Fatty Acids as a Monotherapy for Adolescent Depression. J Clin Psychiatry. 2018;79(4):17m11596. pmid:29985566
  45. 45. Giles GE, Mahoney CR, Urry HL, Brunyé TT, Taylor HA, Kanarek RB. Omega-3 fatty acids and stress-induced changes to mood and cognition in healthy individuals. Pharmacol Biochem Behav. 2015;132:10–9. pmid:25732379
  46. 46. Kiecolt-Glaser JK, Belury MA, Andridge R, Malarkey WB, Glaser R. Omega-3 supplementation lowers inflammation and anxiety in medical students: a randomized controlled trial. Brain Behav Immun. 2011;25(8):1725–34. pmid:21784145
  47. 47. Manos BE, Bravender TD, Harrison TM, Lange HLH, Cottrill CB, Abdel-Rasoul M, et al. A pilot randomized controlled trial of omega-3 fatty acid supplementation for the treatment of anxiety in adolescents with anorexia nervosa. Int J Eat Disord. 2018;51(12):1367–72. pmid:30367519
  48. 48. McGorry PD, Nelson B, Markulev C, Yuen HP, Schäfer MR, Mossaheb N, et al. Effect of ω-3 Polyunsaturated Fatty Acids in Young People at Ultrahigh Risk for Psychotic Disorders: The NEURAPRO Randomized Clinical Trial. JAMA Psychiatry. 2017;74(1):19–27.
  49. 49. McNamara RK, Strawn JR, Tallman MJ, Welge JA, Patino LR, Blom TJ, et al. Effects of fish oil monotherapy on depression and prefrontal neurochemistry in adolescents at high risk for Bipolar I Disorder: A 12-week placebo-controlled proton magnetic resonance spectroscopy trial. J Child Adolesc Psychopharmacol. 2020;30(5):293–305. pmid:32167792
  50. 50. van der Wurff ISM, von Schacky C, Bergeland T, Leontjevas R, Zeegers MP, Kirschner PA, et al. Effect of one year krill oil supplementation on depressive symptoms and self-esteem of Dutch adolescents: A randomized controlled trial. Prostaglandins Leukot Essent Fatty Acids. 2020;163:102208. pmid:33232912
  51. 51. Robinson DG, Gallego JA, John M, Hanna LA, Zhang JP, Birnbaum ML, et al. A potential role for adjunctive omega-3 polyunsaturated fatty acids for depression and anxiety symptoms in recent onset psychosis: Results from a 16 week randomized placebo-controlled trial for participants concurrently treated with risperidone. Schizophr Res. 2019;204:295–303.
  52. 52. Bartholomew R. Top 10 Reasons to Give Your Kids Omega-3: Nutri Advanced; 2021 updated June 10. Available from:
  53. 53. Link R. Should Kids Take Omega-3 Supplements?: Healthline; 2019 updated October 9. Available from:
  54. 54. Kemper KJ. Does fish oil help with ADHD?: Contemporary Pediatrics; 2005 updated October 1. Available from:
  55. 55. Miller L. Managing Anxiety and Building Resilience in Kids: How Nutrition Can Help: Hey Sigmund; 2017 Available from:
  56. 56. Sparks A, Cohen A., Adjao S., Adekola L., Chan J., Freidman B., et al. Adult & Adolescent Depression Screening, Diagnosis, and Treatment Guideline: Kaiser Permanente; 2021 updated April. Available from:
  57. 57. Newport Academy. Food and Mood: Teen Nutrition and Mental Health: Newport Academy; 2017 updated May 10. Available from:
  58. 58. Pediatric Partners. Omega-3 Fatty Acids: Fish and Nut Oils: Pediatric Partners; n.d. Available from:
  59. 59. British Diet Association. Food Fact Sheet: Diet, behaviour and learning in children: British Diet Association; 2020 Available from:
  60. 60. Amen Clinics. New Evidence on Omega-3s for Behavioral Problems in Children: Amen Clinics; 2020 updated October 12. Available from:
  61. 61. Headspace. The best foods for mental health: Headspace; 2019 updated April 24. Available from:
  62. 62. Heyes SB, Hiu CF. The adolescent brain: vulnerability and opportunity: UNICEF; 2015 updated April 20. Available from:
  63. 63. Weatherby C. Omega-3s Linked to Lower Teen Anxiety: Vital Choice; 2014 [updated April 5. Available from:
  64. 64. Luo X-D, Feng J-S, Yang Z, Huang Q-T, Yang B, Su K-P, et al. High-dose omega-3 polyunsaturated fatty acid supplementation might be more superior than low-dose for major depressive disorder in early therapy period: A network meta-analysis. BMC Psychiatry. 2020;20(1):1–8.
  65. 65. Browning LM, Walker CG, Mander AP, West AL, Madden J, Gambell JM, et al. Incorporation of eicosapentaenoic and docosahexaenoic acids into lipid pools when given as supplements providing doses equivalent to typical intakes of oily fish. A J Clin Nutr. 2012;96(4):748–58. pmid:22932281
  66. 66. Carney RM, Steinmeyer BC, Freedland KE, Rubin EH, Rich MW, Harris WS. Baseline blood levels of omega-3 and depression remission: a secondary analysis of data from a placebo-controlled trial of omega-3 supplements. J Clin Psychiatry. 2016;77(2). pmid:26930527
  67. 67. DiNicolantonio JJ O’Keefe JH. Importance of maintaining a low omega–6/omega–3 ratio for reducing inflammation. Open Heart. 2018;5(2):e000946. pmid:30564378
  68. 68. Berger ME, Smesny S, Kim SW, Davey CG, Rice S, Sarnyai Z, et al. Omega-6 to omega-3 polyunsaturated fatty acid ratio and subsequent mood disorders in young people with at-risk mental states: a 7-year longitudinal study. Transl Psychiatry. 2017;7(8):e1220–e. pmid:28850110
  69. 69. Schmitz G, Ecker J. The opposing effects of n−3 and n−6 fatty acids. Prog Lipid Res. 2008;47(2):147–55. pmid:18198131
  70. 70. Mongan D, Healy C, Jones HJ, Zammit S, Cannon M, Cotter DR. Plasma polyunsaturated fatty acids and mental disorders in adolescence and early adulthood: cross-sectional and longitudinal associations in a general population cohort. Transl Psychiatry. 2021;11(1):321. pmid:34059620
  71. 71. Johnson SB, Blum RW, Giedd JN. Adolescent maturity and the brain: the promise and pitfalls of neuroscience research in adolescent health policy. J Adolesc Health. 2009;45(3):216–21. pmid:19699416
  72. 72. Murphy SE, Capitão LP, Giles SLC, Cowen PJ, Stringaris A, Harmer CJ. The knowns and unknowns of SSRI treatment in young people with depression and anxiety: efficacy, predictors, and mechanisms of action. Lancet Psychiatry. 2021;8(9):824–35. pmid:34419187
  73. 73. Daraz L, Morrow AS, Ponce OJ, Beuschel B, Farah MH, Katabi A, et al. Can patients trust online health information? A meta-narrative systematic review addressing the quality of health information on the internet. J of Gen Intern Med. 2019;34(9):1884–91. pmid:31228051