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Omega-3 fatty acids and depression
PAVIA, ITALY. A new study on the relationship of omega-3 fatty acids and depression has been reported, which
examined patients not on psychiatric drugs. The subjects were female, between the age of 65 and 95, not obese,
and had been in a nursing home for at least 3 months prior to enrolment. All subjects had been diagnosed by a
senior psychiatrist as being depressed and met the criteria for major depression as set forth in the DSM-IV, the
universal diagnostic manual. Exclusion criteria included the presence of current comorbid psychotic symptoms,
current use of psychiatric drugs aside from benzodiazepines (e.g. valium), and the presence of psychotic
symptoms. Forty-six patients were randomized to receive 2.5 g/day of long-chain omega-3 fatty acids (1.67g EPA,
0.83g of DHA) or a placebo. The two-month study had as the primary endpoint the improvement of depressive
symptoms as evaluated by a standard measures. Secondary endpoints included modification of red blood cell fatty-
acid profile (a test of compliance and bioavailability) and quality of life.
After 2 months only the omega-3 group showed significant lower depressive symptoms, significantly improved
quality of life, and elevated red blood cell fatty acid levels. The researchers point out that lower concentrations of
omega-3 fatty acids have been reported in both plasma and red blood cell membranes of patients with DSM-IV
diagnosed major depressive disorders compared to matched non-depressed controls. They also emphasize that
depression is not, in their view, a natural part of aging and is often reversible with prompt and appropriate treatment.
They also point out that the improvement in quality of life found in the treatment group had never been achieved
before and appears to be of great value from a clinical point of view due to the importance of increased satisfaction
with a number of key quality of life aspects and a general improvement in the feeling of well-being. Treatment with
2.5 g/day of EPA/DHA was also free of side effects, which is not in general the case with antidepressant drugs.
Incidentally, this would not be an unusual long-chain omega-3 fatty acid intake for individuals who take fish oil
supplements.
Rondanelli M, et al. Long chain omega 3 polyunsaturated fatty acids supplementation in the treatment of elderly
depression: effects on depressive symptoms, on phospholipids fatty acids profile and on health-related quality of
life. Journal of Nutrition, Health & Aging, Vol. 15, Number 1, 2011, pp. 37-44
Low levels of EPA and DHA associated with depression
TAIPEI, TAIWAN. Major depressive disorder (MDD) is a serious illness that by 2020 is expected to be the second
leading cause of disability, second only to heart disease. Numerous studies have been done to elucidate the
possible connection between depression and blood levels of omega-3 and omega-6 long-chain polyunsaturated
fatty acids (PUFAs), more specifically eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), and arachidonic
acid (AA). EPA and DHA are the main components of fish oils and there is evidence that societies with a high fish
consumption tend to have a lower incidence of MDD. In addition, several, but not all, clinical trials have found that
fish oil supplementation is as effective in treating MDD as is medication with standard antidepressants such as
fluoxetine (Prozac).
A group of Chinese researchers report the results of a meta-analysis of 14 studies dealing with the association
between depression and intake of long-chain PUFAs. Their main finding is that patients with depression have
significantly lower levels of EPA and DHA and moderately lower levels of total omega-3 PUFAs than do non-
depressed control subjects. The levels of AA and total omega-6 PUFAs were not significantly different between
controls and patients. Limiting the analysis to patients diagnosed with major depressive disorder further
strengthened the association between low levels of EPA and DHA and depression. NOTE: Fatty acid levels were
measured in the phospholipid phase of cells or in serum cholesteryl esters.
The authors conclude that long-chain omega-3 PUFAs play an important role in the etiology of depression and
suggest that this provides a rationale for using fish oils in the treatment of patients with depression.
Lin, PY, et al. A meta-analytic review of polyunsaturated fatty acid compositions in patients with depression.
Biological Psychiatry, Vol. 68, 2010, pp. 140-47
Fish oils in anger management
NEW YORK, NY. Omega-3 long-chain fatty acid deficiency has been implicated in several psychiatric disorders
including depression, suicidal tendencies, and aggressive behaviour. Supplementation with fish oils (EPA and
DHA) has been found effective in combating depression and bipolar disease. Now researchers at the New York
Harbor Healthcare System report that supplementation with eicosapentaenoic acid (EPA) and docosahexaenoic
acid (DHA), the main components of fish oil, is effective in defusing anger and decreasing hostility.
The double-blind, randomized trial involved 24 patients who had a lifelong history of aggressive behaviour and
problems with the law, and had been admitted to substance abuse clinics. The average age of the patients was 51
years, 80% were unemployed, and 60% were either separated, divorced or widowed. Eight patients (4 in the
treatment group and 4 in the placebo group) had a history of assaultive behaviour and 7 patients in each group had
served jail sentences for various offences. Baseline fish intake was low at 36 grams a day average yielding about
150 mg/day of long-chain omega-3 fatty acids, predominantly EPA and DHA. The researchers made the interesting
observation that patients with a history of assaultive behaviour consumed only about half the amount of fish
consumed by those who had not exhibited this behaviour.
The study participants were randomly assigned to receive placebo capsules (soybean oil) or 5 fish oil capsules a
day providing a total of 2250 mg/day of EPA and 500 mg of DHA. All capsules contained vitamin E as an
antioxidant and lemon oil to mask their taste. At the end of the 3-month supplementation period, the anger score in
the group of patients given fish oil had dropped by over 50% and this improvement persisted for another 3 months
after ceasing supplementation. The anger score for those given the placebo did not change. The researchers
speculate that the beneficial effects of fish oils may be due to their ability to improve membrane fluidity and increase
brain levels of serotonin. They suggest that fish oil supplementation should be considered in treatment protocols for
patients displaying aggressive behaviours.
Buydens-Branchey, L and Branchey, M. Long-chain n-3 polyunsaturated fatty acids decrease feelings of anger
in substance abusers. Psychiatry Research, Vol. 157, 2008, pp. 95-104
Fish oil helps combat childhood depression
BEER-SHEVA, ISRAEL. It is estimated that 2-4% of children suffer from major depressive disorder sometimes leading to substance abuse or suicide. Israeli researchers now report that fish oils are effective in relieving childhood depression. Their randomized, placebo-controlled clinical trial involved 20 children (15 boys and 5 girls) between the ages of 8 and 12 years. The study participants were assigned to receive capsules containing either fish oil (providing 400 mg/day of EPA [eicosapentaenoic acid] and 200 mg/day of DHA [docosahexaenoic acid]) or a placebo (olive or safflower oil) for a total of 16 weeks.
After the first 4 weeks of supplementation the researchers noted that the children on fish oil had significantly improved their rating on the Childhood Depression Rating Scale (CDRS) with 7 out of 10 showing an improvement of greater than 50%. None of the children in the placebo group experienced a 50% or better improvement. Four of the 10 children in the fish oil group were classified as being no longer depressed whereas none of the children in the placebo group achieved this goal. The researchers conclude that fish oils may have therapeutic benefits in childhood depression.
Nemets, Hanah, et al. Omega-3 treatment of childhood depression. American Journal of Psychiatry, Vol. 163, June 2006, pp. 1098-1100
Fish oil derivative reduces depression
SHEFFIELD, UNITED KINGDOM. There is considerable evidence that fish oils help in combating
depression and other mental illnesses. What is not quite clear is whether it is eicosapentaenoic acid
(EPA) or docosahexaenoic acid (DHA) that is the most active component.
The standard medical therapy for depression involves the use of tricyclic antidepressants or selective
serotonin reuptake inhibitors (SSRIs). These drugs, however, are not terribly effective. Prozac, for
example, produces a 50% improvement in symptoms in only 38% of patients starting treatment. This is
not much better than the placebo effect, which provides 50% improvement in about 25% of patients.
A team of British and Scottish researchers has just completed a study aimed at determining if the ethyl
ester of EPA, ethyl-eicosapentaenoate (EEP), would be effective in strengthening the beneficial effect of
standard antidepressants. The study involved 60 patients who were already being treated with SSRIs or
tricyclic antidepressants. Fourteen patients received a placebo while the remaining 46 received either 1,
2 or 4 grams/day of EEP. All participants were evaluated for depression using several different scales at
the beginning of the experiment and after 12 weeks. At the end of the study it was clear that the
1gram/day dosage of EEP was highly effective in reducing depression and associated conditions such as
sadness, pessimism, inability to work, sleep disturbances, and diminished sex drive. In most cases, 60-
70% of patients receiving 1 gram/day of EEP showed an improvement of 50% or better. This compares
to only 25% of the patients on the placebo showing a 50% improvement. The degree of improvement
was substantially less in the 2 grams/day and 4 grams/day groups. The researchers speculate that this
could be due to the depletion of the omega-6 fatty acid, arachidonic acid, by an excess of omega-3 fatty
acid (EPA), indicating that the balance between omega-3 and omega-6 is important when it comes to
depression.
The researchers conclude that concurrent treatment with 1 gram/day of EEP is effective in reducing
depression in patients who are still depressed despite treatment with standard medications. They are
now planning on evaluating EEP on its own as a treatment for depression.
Peet, M. and Horrobin,
DF. A dose-ranging study of the effects of ethyl-eicosapentaenoate in patients with ongoing depression
despite apparently adequate treatment with standard drugs. Archives of General Psychiatry, Vol. 59,
October 2002, pp. 913-19
Fish oils: A cure for depression?
WASHINGTON, DC. On a worldwide basis more working days are lost to depression than to any other
illness. The incidence of depression is growing with people born within the last 50 years being twice as
likely to suffer from it than were their parents. Dr. Joseph Hibbeln of the National Institutes of Health
believes that the reason for the increase in depression can be directly attributed to a major shift in dietary
patterns, specifically fat intake. He points out that the vast increase in the use of soy, corn, palm and
cottonseed oils in the last 100 years has totally changed the traditional ratio of omega-6 to omega-3 fatty
acids in the diet. Soy oil consumption in the US, for example, has increased thousand-fold in the last 100
years helping to skew the omega-6 to omega-3 ratio from about 1:1 to today's 16:1. This, Dr. Hibbeln
believes, spells trouble. The brain consists pretty well entirely of fat so clearly one's fat intake could affect
one's brain composition, particularly the ion channels which channel signals in and out of the brain.
There is also evidence that low levels of omega-3 fatty acids are associated with low levels of the mood
hormone serotonin. Dr. Hibbeln's hypothesis is supported by the fact that the incidence of depression is
considerably lower in countries with a high fish consumption.
Fish, particularly fatty ocean fish, is an excellent source of omega-3 fatty acids and its frequent
consumption would help to nudge the ratio back towards the optimum 1:1. At least three clinical trials
have observed a marked improvement in depressed patients given relatively high doses of fish oils. This
has spurred other scientists to look closer at the potential benefits of fish oil supplementation. At the
moment there are at least 10 clinical trials underway evaluating fish oils in the treatment of depression,
attention deficit disorder, and schizophrenia.
Small, Meredith F. The happy fat. New Scientist, August 24, 2002, pp. 34-37
Editor's comment: Daily supplementation with 1-3 grams of a high quality fish oil is entirely safe
and may not only improve your mood, but help protect you from heart disease, stroke and arthritis as well.
Fish consumption reduces suicide risk
KUOPIO, FINLAND. Researchers at the University of Kuopio report that regular fish consumption
reduces the risk of depression and suicide. Their study involved 1767 Finnish men and women who were
evaluated for depression and suicidal tendencies using the 21-item Beck Depression Inventory. They
were also asked about their fish consumption. The researchers conclude that people who consume fish
twice a week or more have a 37 per cent lower risk of being depressed and a 43 per cent lower risk of
having thoughts of harming themselves (suicidal tendencies).
The results are consistent with those of a large Japanese study involving 265,000 subjects who were
followed up for 17 years. This study found a decreased risk of suicide among people who consumed fish
daily. Dr. Andrew Stoll, MD of the Harvard Medical School points out that Icelanders who consume a lot
of seafood have far lower rates of seasonal affective disorder (SAD) than do inhabitants of other countries
situated at similar latitudes. Both Dr. Stoll and the Finnish researchers urge large-scale trials to
conclusively determine whether it is appropriate to recommend increased fish intake or fish oil
supplementation to depressed people or indeed to the population as a whole.
Tanskanen, Antti, et al. Fish consumption, depression, and suicidality in a general population. Archives
of General Psychiatry, Vol. 58, May 2001, pp. 512-13
Dieting and depression
TUCSON, ARIZONA. Low-fat diets have been widely promoted for lowering cholesterol levels, for
reducing body weight, and for preventing certain types of cancer. At least one study, however, has found
that although a reduction in cholesterol may reduce mortality from heart disease it may increase the
incidence of fatal accidents, violent deaths, suicides, and depression. Researchers at the University of
Arizona now believe that they may have found an explanation for this phenomenon. They point out that
fat restriction and cholesterol-lowering drugs may change the concentrations of polyunsaturated fatty
acids (PUFAs) in the tissues including nerve tissue (neurons). Fat-restricting diets usually lead to a
relative increase in the intake of omega-6 PUFAs and a relative decrease in the intake of omega-3 fatty
acids. This can have serious consequences inasmuch as the omega-3 fatty acids, eicosapentaenoic acid
(EPA) and docosahexaenoic acid (DHA) found in fish oils, are crucial for the proper functioning of the
nervous system. Several large-scale studies have found a clear association between low blood levels of
EPA and DHA and an increased risk of depression, violence and suicide; a recent study in Japan found
that DHA supplementation reduced aggression among healthy Japanese students.
Epidemiologic studies have found a clear correlation between a low intake of EPA and DHA and the
prevalence of depression. In two studies of population groups in the USA the incidence of depression
was found to be 3.7% and 2.9%. Average intake of EPA and DHA in the USA is estimated to be about
0.1 gram per day. In two Japanese studies, on the other hand, the incidence of depression was only
0.9% and 0% and the intake of EPA plus DHA was 1.5 grams per day and 4.2 grams/day respectively.
Other studies have shown that on-off dieting can produce a serious imbalance in the ratio of fatty acids
and may lead to depression
The researchers conclude that an extremely low-fat diet may be counter-productive and have deleterious
psychological ramifications. They stress that dietary advice regarding cholesterol reduction, weight loss,
and cancer prevention should emphasize the importance of an adequate intake of omega-3 fatty acids.
Bruinsma, Kristen A. and Taren, Douglas L. Dieting, essential fatty acid intake, and depression.
Nutrition Reviews, Vol. 58, April 2000, pp. 98-108 [116 references]
Omega-3 fatty acids: the missing link?
BERLIN, GERMANY. Dr. Emanuel Severus of the Berlin University points out that major depression is
characterized by a deficiency of omega-3 fatty acids and that these acids possess powerful
antiarrhythmic properties. He suggests that the missing link in the recently established association
between major depression and sudden cardiac death may be the omega-3 fatty acid deficiency which
characterizes both conditions.
Severus, W. Emanuel, et al. Omega-3 fatty acids: the missing link? Archives of General Psychiatry,
Vol. 56, April 1999, pp. 380-81 (letter to the editor)
Fish consumption and depression
ROCKVILLE, MARYLAND. Dr. Joseph Hibbeln, a researcher at the National Institute on Alcohol Abuse
and Alcoholism reports in a letter to The Lancet that he has found a convincing correlation
between fish consumption and the incidence of major depression. Dr. Hibbeln correlated the annual
incidence of major depression per 100 people in nine countries with the consumption of fish. He found a
high incidence of depression in countries with low fish consumption. New Zealand with an annual fish
consumption of only 40 lbs had an annual incidence rate of depression of 5.8 per cent while Korea with a
fish consumption of more than 100 lbs/year had an annual incidence rate of only 2.3 per cent. Japan with
a fish consumption of almost 150 lbs/year had the lowest incidence of major depression (0.12 per cent).
Dr. Hibbeln cautions that various economic, social, cultural and other factors could have influenced his
results, but points out that high blood plasma concentrations of docosahexaenoic acid, an essential fatty
acid found in fish, has been linked to increased serotonin turnover and lower incidences of depression
and suicide.
Hibbeln, Joseph R. Fish consumption and major depression. The Lancet, Vol. 351, April 18, 1998, p.
1213 (correspondence)
Omega-3 fatty acid deficiency linked to depression
SHEFFIELD, UNITED KINGDOM. The composition of cell membranes has a profound effect on
membrane-related proteins such as enzymes and receptors and there is considerable evidence that cell
membrane structure is a significant factor in depression. This structure in turn is highly dependent on the
presence of certain essential fatty acids, notably docosahexaenoic acid (DHA).
Researchers at the University of Sheffield and the Efamol Research Institute in Nova Scotia now report
that they have found a highly significant association between severity of depression and the levels of
omega-3 fatty acids in both the diet and the red blood cell membranes.
Their study involved 10 patients with major depression and 14 healthy control subjects with no history of
psychiatric disorder (average age of participants was 39 years). All participants had blood samples taken
and analyzed for essential fatty acid (EFA) content and also completed a questionnaire to determine their
dietary intake of EFAs over the 7 days prior to enrollment.
The severity of depression was found to be inversely proportional with the red blood cell level and dietary
intake of omega-3 fatty acids. The correlation between a low level of alpha-linolenic acid in blood cells
and depression and between low blood cell levels of DHA and depression were particularly strong. No
correlation was found between red blood cell levels of omega-6 fatty acids and depression. However,
there was a slight positive correlation between dietary intake of omega-6s and severity of depression
when both patients and controls were considered in one group. The researchers conclude that low levels
of omega-3 fatty acids in cell membranes are associated with depression. They speculate that
supplementation with omega-3 fatty acids may be useful in alleviating depression.
Edwards, Rhian, et al. Omega-3 polyunsaturated fatty acid levels in the diet and in red blood cell
membranes of depressed patients. Journal of Affective Disorders, Vol. 48, 1998, pp. 149-55
DHA levels linked to suicide and violence
BETHESDA, MARYLAND. Several studies have found a link between low cholesterol levels and an
increased tendency to violence, suicide, and depression. Scientists at the National Institute on Alcohol
Abuse and Alcoholism believe that the real culprit in this association is low concentrations of 5-
hydroxyindoleacetic acid (5-HIAA) in the cerebrospinal fluid and that it is the blood level of
polyunsaturated fatty acids rather than the levels of cholesterol which affect 5-HIAA levels. 5-HIAA is a
metabolite of serotonin.
To test this hypothesis the researchers measured the levels of cerebrospinal 5-HIAA and the levels of
blood plasma polyunsaturated fatty acids in a group of 176 subjects. Forty-nine of the subjects were
healthy volunteers, 88 were early-onset alcoholics (excessive alcohol use prior to their 25th birthday), and
39 were late-onset alcoholics. None of the alcoholics had been drinking for at least 21 days prior to the
test. The researchers found a strong positive correlation between blood levels of docosahexaenoic acid
(DHA) and the level of 5-HIAA in the healthy volunteers. In other words, the higher the DHA levels the
higher the 5-HIAA levels and as a corollary, the lower the tendency to depression, violence and suicide.
In the early-onset alcoholics the situation was completely reversed. Higher DHA levels corresponded to
lower 5-HIAA levels and thus a possibly increased tendency to violence, suicide and depression. The
researchers found no correlation between 5-HIAA levels and total cholesterol levels. They conclude that
further studies are required to determine if supplementation with essential fatty acids, notably DHA, can
influence central nervous system serotonin and dopamine metabolism and modify impulsive behaviour
related to these neurotransmitters.
Hibbeln, Joseph R., et al. Essential fatty acids predict metabolites of serotonin and dopamine in
cerebrospinal fluid among healthy control subjects, and early- and late-onset alcoholics. Biological
Psychiatry, Vol. 44, 1998, pp. 235-42
Your brain needs DHA
NEW YORK, NY. Dr. Barbara Levine, Professor of Nutrition in Medicine at Cornell University, sounds the
alarm concerning a totally inadequate intake of DHA (docosahexaenoic acid) by most Americans. DHA is
the building block of human brain tissue and is particularly abundant in the grey matter of the brain and
the retina. Low levels of DHA have recently been associated with depression, memory loss,
dementia, and visual problems. DHA is particularly important for fetuses and infants; the DHA
content of the infant's brain triples during the first three months of life. Optimal levels of DHA are
therefore crucial for pregnant and lactating mothers. Unfortunately, the average DHA content of breast
milk in the United States is the lowest in the world, most likely because Americans eat comparatively little
fish. Making matters worse is the fact that the United States is the only country in the world where infant
formulas are not fortified with DHA. This despite a 1995 recommendation by the World Health
Organization that all baby formulas should provide 40 mg of DHA per kilogram of infant body weight. Dr.
Levine believes that postpartum depression, attention deficit hyperactivity disorder (ADHD), and low IQs
are all linked to the dismally low DHA intake common in the United States. Dr. Levine also points out that
low DHA levels have been linked to low brain serotonin levels which again are connected to an increased
tendency to depression, suicide, and violence. DHA is abundant in marine phytoplankton and
cold-water fish and nutritionists now recommend that people consume two to three servings of fish every
week to maintain DHA levels. If this is not possible, Dr. Levine suggests supplementing with 100 mg/day
of DHA.
Levine, Barbara S. Most frequently asked questions about DHA. Nutrition Today, Vol. 32,
November/December 1997, pp. 248-49
Fatty acid profile linked to depression
MELBOURNE, AUSTRALIA. Depression is becoming increasingly prevalent in Western society. Some
researchers believe that part of the reason for this can be traced to major dietary changes which have
taken place over the past century. During this time there has been a large increase in the intake of
saturated fats and linoleic acid (LA)-rich vegetable oils at the expense of alpha-linolenic acid (ALA)-rich
foods such as fish and wild game. It is estimated that the ratio between LA-type (n-6) polyunsaturated
fatty acids (PUFAs) and ALA-type (n-3) PUFAs has risen from 1:1 to 10:1 or higher. Some researchers
have postulated that the sharp rises in depression and other neurological disorders are closely related to
the increased intake of LA-rich vegetable oils.
Now researchers at the Royal Melbourne Institute of Technology report that the severity of depression is
indeed directly associated with the ratio of LA- to ALA-type PUFAs in red blood cells. Their study
involved 20 moderately to severely depressed patients. The severity of depression was determined using
the 21-item Hamilton depression rating scale and a second scale which omitted anxiety symptoms. All
patients had blood samples drawn and analyzed for arachidonic acid (AA) - the major metabolite of
linoleic acid, and EPA - the major metabolite of alpha-linolenic acid and the main constituent of fish oils.
The researchers found a clear correlation between a high AA/EPA ratio and increased severity of
depression. There was also a significant association between a low level of EPA in the red blood cells
and increased severity of depression.
The researchers conclude that there is a definite relationship between high AA/EPA ratios and increased
severity of depression, but are not certain whether the fatty acid imbalance causes depression or whether
depression results in a high AA/EPA ratio. They suggest that further studies be done to determine the
benefits of supplementation aimed at increasing tissue levels of EPA and thereby decreasing the AA/EPA
ratio.
Adams, Peter B., et al. Arachidonic acid to eicosapentaenoic acid ratio in blood correlates positively with
clinical symptoms of depression. Lipids, Vol. 31 (suppl), 1996, pp. S157-S61
Docosahexaenoic acid fights depression
ROCKVILLE, MARYLAND. Researchers at the National Institute of Alcohol Abuse and Alcoholism
believe that the increasing rates of depression seen in North America over the last 100 years are due to a
significant shift in the ratio of n-6 (arachidonic acid, linoleic acid) to n-3 (docosahexaenoic acid, linolenic
acid) fatty acids in the diet. The human race evolved on a diet having a ratio of about 1:1 of these acids;
it is now estimated to be between 10:1 and 25:1. Docosahexaenoic acid (DHA) is a main component of
the synaptic membranes and a lack of it has been linked to depression. Fish oils are a rich source of
DHA and it can also be biosynthesized in the body from linolenic acid. The researchers speculate that
the depressions which often accompany alcoholism, multiple sclerosis, and childbirth (postpartum
depression) are all due to a lack of DHA and can be corrected by increasing the dietary intake of DHA or
linolenic acid (flax seed oil). They also point out that depression and coronary heart disease are strongly
associated and that a low intake of n-3 fatty acids has been linked to both.
Hibbeln, Joseph R. and Salem, Norman. Dietary polyunsaturated fatty acids and depression: when
cholesterol does not satisfy. American Journal of Clinical Nutrition, Vol. 62, July 1995, pp. 1-9
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Pilot trial of fish oil for post-partum depression
TUCSON, ARIZONA. Post-partum depression (PPD) affects about 10-15% of mothers in the USA, usually within the first month following delivery. Children of affected mothers may experience impaired attachment and PPD may adversely affect their behavioral and cognitive development. Several studies have shown that mothers with PPD tend to be deficient in long-chain omega-3 fatty acids, specifically EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid). Other studies have found that women with an adequate intake of DHA (from seafood or supplements) tend to be less likely to develop PPD. Based on these observations researchers at the University of Arizona Medical School decided to evaluate if fish oil supplementation would diminish depression in women diagnosed with PPD.
Their 8-week pilot study involved 16 women with PPD. The extent of depression was evaluated using the Edinburgh Postnatal Depression Scale (EPDS) and the Hamilton Rating Scale for Depression (HRSD). The EPDS scores ranged from 15.3 to 19.0 at the start of the study (a score equal to or greater than 9.0 indicates depression). The HRSD scores ranged from 18 to 20.3 with a score equal to or greater than 15 signifying depression.
The study participants were randomized to receive placebo capsules (corn oil + 1% fish oil) or 0.5, 1.4 or 2.8 grams/day of a fish oil having an EPA:DHA ratio of 1.5:1 (EPAX 5500, Pronova, Lysker, Norway) for 8 weeks. The participants were followed up and checked for depression scores at weeks 1, 2, 4, 6, and 8. At week 8 the average EPDS score had decreased to 9.3 (a 51.5% reduction) and the HRSD score had fallen by 48.8% to an average of 10 in the fish oil groups. Improvement was most noticeable in the group receiving 1.4 grams/day of EPA + DHA and no advantage was seen by taking 2.8 grams/day. However, just 0.5 gram/day also was successful in reducing both EPDS scores and HRSD scores to normal (non-depressed) levels. The researchers conclude that fish oil supplementation in women with PPD is well tolerated and effective in reducing symptoms of depression.
Freeman, MP, et al. Randomized dose-ranging pilot trial of omega-3 fatty acids for postpartum depression. Acta Psychiatrica Scandinavica, Vol. 113, January 2006, pp. 31-35
Fatty acid status and post-partum depression
MAASTRICHT, THE NETHERLANDS. There is substantial evidence that major depression is associated with changes in the fatty acid composition of serum lipids. Researchers have noted that the ratio of omega-6 fatty acids (linoleic acid, arachidonic acid) to omega-3 fatty acids (linolenic acid, eicosapentaenoic acid, docosahexaenoic acid) is substantially higher in depressed patients than in normal controls. There is also evidence that omega-3 fatty acid levels and, more specifically, DHA (docosahexaenoic acid) levels are substantially lower in depressed patients. Researchers at Maastricht University have now extended these findings to include post-partum depression (PPD).
Their study included 48 healthy, pregnant women who had blood samples taken shortly after delivery. These blood samples were analyzed to determine the fatty acid profile in serum phospholipids (PL) and cholesteryl esters (CE). The women were also interviewed within 6 to 10 months after delivery to ascertain whether they suffered from PPD. Ten of the women (21%) had indeed developed PPD with most reporting depressive symptoms immediately following delivery. Analyses of the blood samples showed that DHA concentration and total omega-3 level were significantly lower in both the PL and CE fractions of blood serum taken from women who developed PPD.
The Dutch researchers speculate that the milder form of PPD, post-partum blues, also is related to a fatty acid imbalance and is currently investigating this in a separate study involving 98 women. They conclude that pregnant women at risk for developing PPD may benefit from preventive supplementation with DHA, perhaps in combination with its precursor docosapentaenoic acid.
De Vriese, SR, et al. Lowered serum n-3 polyunsaturated fatty acid (PUFA) levels predict the occurrence of postpartum depression: further evidence that lowered n-PUFAs are related to major depression. Life Sciences, Vol. 73, 2003, pp. 3181-87
Post-partum depression and functional DHA status
MAASTRICHT, THE NETHERLANDS. About 20% of Dutch women develop post-partum depression shortly after giving birth with the peak incidence reached about 32 weeks post-partum. There is growing evidence of an association between low blood levels of docosahexaenoic acid (DHA), a major component of fish oil, and post-partum depression (PPD). Dutch researchers report that it may not be DHA level per se that is the important factor, but rather the increase in DHA availability, or DHA functional status following birth. Availability is expressed as the ratio of DHA to DPA (docosapentaenoic acid). DPA is the intermediary step in the conversion of EPA (eicosapentaenoic acid) to DHA. DHA availability is reduced during pregnancy and normalizes following delivery; however, it this normalization is slow depression may result.
The Dutch study involved 112 pregnant women who had blood samples collected at week 36 of pregnancy, immediately following delivery, and 32 weeks post-partum. At week 32 post-delivery the women were assessed for the presence of PPD using the Edinburgh Postnatal Depression Scale (EPDS) questionnaire. Twenty-four of the women (21%) were found to suffer from depression (EPDS score equal to or greater than 10). Seventy-five percent of the depressed women rated themselves as “not healthy” in the months following delivery as compared to only 6% in the non-depressed group (EPDS score less than 10).
The researchers did not observe any statistically significant relationship between post-partum depression and DHA level as such; however, they did find a significant correlation between PPD and the increase in DHA:DPA ratio between delivery and 32 weeks post-partum. Women with a slower increase in this ratio had a 10% higher risk of PPD. There was no indication that breast-feeding increased the risk of PPD. The researchers recommend further studies, but suggest that women who have recently given birth increase their intake of DHA.
Otto, SJ, et al. Increased risk of postpartum depressive symptoms is associated with slower normalization after pregnancy of the functional docosahexaenoic acid status. Prostaglandins, Leukotrienes and Essential Fatty Acids, Vol. 69, 2003, pp. 237-43
Post-partum depression linked to DHA deficiency
ROCKVILLE, MARYLAND. Mothers selectively transfer docosahexaenoic acid (DHA) to their fetus during pregnancy to support optimal neurological development. If the dietary intake of DHA is insufficient to meet the needs of both mother and fetus, then the needs of the fetus are met first. This may result in the mother becoming deficient and the subsequent development of major depression and other affective disorders. Dr. Joseph Hibbeln of the US National Institutes of Health report that the incidence of post-partum depression (PPD) is clearly linked to DHA status and seafood consumption.
Dr. Hibbeln evaluated the results of 41 relevant studies involving over 14,000 women located in 23 different countries. He compared the incidence of post-partum depression in new mothers in each country with the average seafood consumption and average DHA concentration in the mothers’ milk in the country. The results were remarkable. Dr. Hibbeln found a clear correlation between the incidence of PPD and seafood consumption. The highest incidence of PPD (24.5%) was found in South Africa, which also reported the lowest seafood intake at 8.6 lb/person/year. In comparison, Japan reported a PPD incidence of only 2% and an average seafood consumption of 147.7 lb/person/year. In the United States average seafood intake amounted to 48.1 lb/person/year with a corresponding PPD incidence of 11.5%. Numbers for Canada were similar at 50.7 lb/person/year seafood consumption and 12.7% PPD.
Analyses of fatty acid content of mothers’ milk were available for 16 countries. While there was no correlation between PPD and the content of arachidonic acid and eicosapentaenoic acid, there was a clear correlation between PPD and low DHA level. South Africa reported the lowest DHA content (0.15% of total fats in mothers’ milk) and the highest PPD incidence at 24.5%. The average DHA level in mothers’ milk in Japan was 0.81% versus a PPD incidence of 2%. Average DHA level in the USA was 0.17% (PPD incidence of 11.5%).
Although there are clearly other factors predisposing to post-partum depression, Dr. Hibbeln found that the effects of low socioeconomic status, young maternal age, no partner, and poor education were minor when compared to the effect of seafood consumption and low DHA status. He points out that numerous studies have shown that DHA status can be safely and effectively improved by supplementation with fish oil. Specifically, studies have found that supplementation with 1.1 gram/day of DHA will increase breast milk concentration to 0.8% without any adverse effects. A level of 0.8% is equivalent to the average level observed in Japan and is associated with a low 2.0% risk of PPD.
Hibbeln, J. Seafood consumption, the DHA content of mothers’ milk and prevalence rates of postpartum depression: a cross-national, ecological analysis. Journal of Affective Disorders, Vol. 69, 2002, pp. 15-29
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EPA cures schizophrenia
LONDON, UK. There is evidence that schizophrenia is associated with an abnormal metabolism of
unsaturated fatty acids in both blood plasma and red blood cells. This abnormality, in turn, is associated
with extraordinary low levels of long-chain unsaturated fatty acids such as EPA (eicosapentaenoic acid),
DHA (docosahexaenoic acid), and AA (arachidonic acid) in cell membranes.
Researchers at the Imperial College School of Medicine now report that fatty acid levels can be restored
to normal and schizophrenia symptoms eliminated or at least vastly diminished by oral supplementation
with EPA, the major component of fish oils. Their experiment involved a 30-year-old man who had
suffered from schizophrenia for over 10 years. He had frequent (at least daily) hallucinations and also
suffered from persecutory delusions and thought disorder. The patient was put on 2 grams/day of EPA
and was evaluated for schizophrenia symptoms and blood plasma and red blood cell membrane levels of
fatty acids at monthly intervals for 6 months. The results were spectacular. After 6 months the overall
score for schizophrenia symptoms had dropped by a factor of 6 (an 85% reduction in severity). Episodes
of delusions were completely eliminated and there was an 88% reduction in the number of hallucinatory
episodes.
The remarkable clinical improvement in symptoms was associated with substantial increases in the levels
of EPA, DHA and AA in red blood cell membranes and with significant increases in EPA and DHA levels
in blood plasma. The researchers conclude that EPA supplementation is able to reverse the abnormal
fatty acid profiles found in schizophrenics and that this reversal is associated with, and is likely to be the
cause of, the clinical improvement.
Richardson, A.J., et al. Red cell and plasma fatty acid changes accompanying symptom remission in a
patient with schizophrenia treated with eicosapentaenoic acid. European Neuropsychopharmacology,
Vol. 10, 2000, pp. 189-93
Fish oil supplementation helps schizophrenia patients
OXFORD, UK. The Cochrane Library, a prestigious medical think-tank dedicated to the development of
evidence-based medicine, has just released a review of the evidence concerning the use of
polyunsaturated fatty acids (fish oils and evening primrose oil) in the treatment of schizophrenia. A wide-
ranging literature survey revealed 4 studies that met the Library's stringent quality measures. The most
recent study (Shah 2000) included 30 newly diagnosed schizophrenia patients who were not on
antipsychotic drugs at the beginning of the trial. The patients were randomized to receive either a
placebo or a daily dose of eicosapentaenoate (quantity not specified). At the end of the 12 weeks all the
patients in the placebo group needed to be placed on antipsychotic drugs. Only 9 of the 15 patients in
the active treatment group needed these drugs after the 12 weeks.
Another study (Peet 1997) compared evening primrose oil supplementation with placebo in 43
schizophrenics. The patients' mental state was not improved in either the placebo or the treatment group
after 12 weeks. A third study involving 29 schizophrenics compared supplementation with fish oil to
evening primrose oil and found fish oil superior.
The researchers conclude that fish oils may be useful in the treatment of schizophrenia and that medical
doctors should not discourage their patients from taking fish oil supplements. They add that fish oils
seem to be well tolerated and free of adverse effects.
Joy, CB, et al. Polyunsaturated fatty acid (fish or evening primrose oil) for schizophrenia. The Cochrane
Library, Issue 4, 2000
Fish oils alleviate schizophrenia symptoms
SHEFFIELD, UNITED KINGDOM. Schizophrenia is a serious mental illness characterized by such
symptoms as delusions, hallucinations, emotional blunting, and social withdrawal. There is growing
evidence that abnormalities in cell membrane fatty acid composition is involved in the disease.
Researchers at the Northern General Hospital have just completed a study of the composition of red
blood cell membranes in 23 drug-treated schizophrenic patients. They found that the patients had low
levels of arachidonic acid (AA), linoleic acid (LA), eicosapentaenoic acid (EPA), and docosahexaenoic
acid (DHA) when compared to healthy controls. They also noted that the schizophrenics had higher
levels of thiobarbituric acid reactive substances (TBARS) in their blood plasma indicating that the
depletion of the fatty acids in the red blood cells might be due to an increase in oxidative breakdown
reactions rather than to impaired incorporation of the fatty acids into the membranes.
A more recent study by the same researchers evaluated the effect of fish oil supplementation on the
severity of schizophrenic symptoms in a group of 24 patients. They were given 10 grams/day of
concentrated fish oil for a six-week period. The supplementation resulted in a marked increase in EPA
and other omega-3 fatty acids in the red blood cell membranes and a concomitant decrease in omega-6
fatty acid levels. The researchers also noted a significant decrease in the severity of symptoms during
the supplementation period. Interestingly enough, none of the patients were clinically deficient in fatty
acid intake prior to supplementation, but a correlation between higher EPA intake and less severe
symptoms was clearly evident. The researchers conclude that schizophrenia is somehow related to an
abnormal fatty acid metabolism and urge larger clinical trials to evaluate the potential benefits of omega-3
fatty acid supplementation in the treatment of this disorder.
Laugharne, J.D.E., et al. Fatty acids and schizophrenia. Lipids, Vol. 31 (suppl), 1996, pp. S163-S65
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Fish oils and manic-depressive illness
BOSTON, MASSACHUSETTS. Manic-depressive illness (bipolar disorder) is a common, severe mental
illness involving repeated episodes of depression, mania (rapid mood changes, hyperactivity, and
excessive cheerfulness) or both. It is usually treated with drugs such as lithium carbonate or valproate.
Unfortunately, these drugs are not very effective and recurrence rates are high. It is generally believed
that bipolar disorder involves an overactivity in the neuronal signal pathways. Omega-3 fatty acids are
known to dampen this overactivity and the hypothesis has been advanced that they may be useful in the
treatment of bipolar disorder. Medical scientists have now confirmed this in a landmark study just
completed at the Harvard Medical School.
The double-blind, placebo-controlled study involved 30 patients (men and women 18 to 65 years of age)
who had all been diagnosed with bipolar disorder. Half the patients were given seven fish oil capsules
twice a day while the placebo group were given seven olive oil capsules twice a day. Each fish oil
capsule contained 440 mg of eicosapentaenoic acid and 240 mg of docosahexaenoic acid. All of the
participants except four in the fish oil group and four in the placebo group also continued to receive a
standard mood-stabilizing drug prescribed previously. The mental state of the participants was measured
using four scales (Clinical Global Impression Scale, Global Assessment Scale, Young Mania Rating
Scale, and the Hamilton Rating Scale for Depression) at the start of the study and after two, four, six,
eight, twelve and sixteen weeks. Twelve of the 14 participants in the fish oil group completed the four-
month study without major episodes of mania or depression as compared to only six out of 16 participants
in the placebo group. Also, while nine of the placebo group members experienced worsening depression
none of the fish oil group members did. The four patients in the fish oil group who had not been
prescribed mood-stabilizing drugs all completed the study without major episodes, but only one member
in the placebo group not on mood-stabilizing drugs did. The average decline in depression rating on the
Hamilton Scale was almost 50 per cent in the fish oil group as compared to an increase of 25 per cent in
the control group. The Harvard researchers urge further trials of fish oils in the treatment of depression
and manic-depressive illness.
Stoll, Andrew L., et al. Omega 3 fatty acids in bipolar disorder. Archives of General Psychiatry, Vol.
56, May 1999, pp. 407-12 and pp. 415-16 (commentary)
Calabrese, Joseph R., et al. Fish oils and bipolar disorder. Archives of General Psychiatry, Vol. 56,
May 1999, pp. 413-14 (commentary)
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