Omega-3 fatty acids for mood disorders
Omega-3 fatty acids are found primarily in fish oil and are essential to optimal brain functioning. They also play an important role in multiple other organ systems. Most commonly they are recommended for lowering cholesterol, but a large body of evidence suggests that they have anti-depressant effects and can be used to treat depression. In fact, depression appears less common in regions where people’s diet is high in the fish intake. This additionally suggest that fish oil may play a preventative role in depression. benefits people with mood disorders.
How might omega-3s improve depression?
Different mechanisms of action have been proposed. For example, omega-3s can easily travel through the brain cell membrane and interact with mood-related molecules inside the brain. They also have anti-inflammatory actions that may help relieve depression. Recent work at Massachusetts General Hospital and Emory University suggests that depressed individuals who are overweight and have elevated inflammatory activity may be particularly good candidates for EPA treatment.
More than 30 clinical trials have tested different omega-3 preparations in people with depression. Most studies have used omega-3s as an add-on therapy for people who are taking prescription antidepressants with limited or no benefit. Fewer studies have examined omega-3 therapy alone. Clinical trials typically use EPA alone or a combination of EPA plus DHA, at doses from 0.5 to 1 gram per day to 6 to 10 grams per day. To give some perspective, 1 gram per day would correspond to eating three salmon meals per week.
Meta-analyses (research that combines and analyzes results of multiple studies) generally suggest that the omega-3s are effective, but the findings are not unanimous because of variability between doses, ratios of EPA to DHA, and other study design issues. The most effective preparations appear to have at least 60% EPA relative to DHA. While DHA is thought to be less effective as an antidepressant, it may have protective effects against suicide. Recent work at Massachusetts General Hospital and Emory University suggests that depressed individuals who are overweight and have elevated inflammatory activity may be particularly good candidates for EPA treatment.
Children and adolescents with depression may also benefit from omega-3 supplementation. At Harvard, there is a large study underway examining whether omega-3 supplementation (alone or in combination with vitamin D can prevent depression in healthy older adults.
Omega-3s for other mental health conditions
The omega-3s have also been proposed to alleviate or prevent other psychiatric conditions including schizophrenia, borderline personality disorder, obsessive-compulsive disorder, and attention deficit disorder. However, there is still not enough evidence to recommend the omega-3s in these conditions.
What dose of omega-3s is beneficial?
Doses for depression range from less than 1 g/day to 10 g/day, but most studies use doses between 1 and 2 g/day. Your psychiatrist may recommend a higher dose than what is typical of over the counter supplementation as well recommend DHA in combination, with at least 60% EPA, for major depression.
Side effects and other safety considerations
Omega-3s are generally safe and well-tolerated. Stomach upset and “fishy taste” have been the most common complaints, but they are less frequent now thanks to manufacturing methods that reduce impurities. Past concerns about omega-3s increasing the risk of bleeding have been largely disproven, but caution is still advised in people taking blood thinners or who are about to undergo surgery. As mentioned, caution is needed in people with bipolar disorder to prevent cycling from mania. Because Omega-3s are important to brain development, and pregnancy depletes omega-3 in expectant mothers, supplementation should theoretically benefit pregnant women and their children. Fish consumption in pregnancy is supported by the FDA, but because we do not have long-term data on safety or optimal dosing of omega-3s in pregnancy, expectant mothers should consider omega-3 supplements judiciously. Omega-3 fatty acids are promising natural treatments for mood disorders, but we need more research about how they work, how effective they really are, and their long-term safety before we can make conclusive recommendations for people managing mental health conditions or who wish to improve mood.
Sources:
https://www.heartfoundation.org.au/images/uploads/main/Programs/Sources_of_omega_3.pdf
https://www.fammed.wisc.edu/files/webfm-uploads/documents/outreach/im/handout_omega3_fats_patient.p df https://www.ncbi.nlm.nih.gov/pmc/articles/PMC533861/
https://www.mayoclinic.org/diseases-conditions/depression/expert-answers/fish-oil-supplements/faq-200581 43 https://www.webmd.com/depression/features/fish-oil-to-treat-depression#1
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2186366/
https://psycheducation.org/treatment/mood-stabilizers/omega-3-fatty-acids
