High potency fish oil can be used for the treatment of mild to moderatedepression, or to help prevent and treat postpartum depression. Several studies have determined that a higher ratio ofEPA toDHA is actually the most effective for the treatment ofdepression.
EPA For Depression
An 8-week trial examining the short-term efficacy of omega 3 fatty acids in patients with major depressive episodes (MDE) was conducted. Patients in the treatment group received 1050 mg/d ofEPAand 150 mg/dDHA, with the control group receiving a placebo. Researchers found that for patients with MDE, the omega 3 supplementation was superior to placebo for symptom improvement. In patients withanxiety and MDE, the omega 3 supplementation was not found to be statistically significantly beneficial. A study comparing omega 3 fatty acids, as monotherapy and in combination with fluoxetine (an antidepressant), examined patients' depressive symptoms and their cortisol levels. Patients received either 1000 mgEPA, 20 mg fluoxetine, or both, for 8 weeks. Plasma cortisol (stress hormone) levels decreased in all 3 treatment groups, without a significant difference between the 3 groups. This suggests that the therapeutic effect ofEPA may be exerted through its ability to lower cortisol levels.
Depression In Elderly
A placebo-controlled double-blinded study was performed for elderly women between 66–95 years of age with symptoms ofdepression. Women were given either 1.67 g/d ofEPA and 0.83 g/d ofDHA or placebo. Results were based on an improvement indepression symptoms based on the GeriatricDepression Scale after 8 weeks of treatment. Researchers concluded that the omega 3 supplementation was effective for improving symptoms ofdepression as well as quality of life in elderly female patients.
Depression In Heart Disease
The leading cause of mortality for patients with majordepression is coronary heart disease. Patients who have experienced a cardiovascular event are also more likely to experience majordepression and an increased risk of mortality. Researchers have proposed that a deficiency of omega 3 fatty acids plays a role in the pathology of both cardiovascular disease and majordepression. After an acute coronary event (ACE), patients who developeddepression had lower serum levels of omega 3 fatty acids than patients who did not experiencedepression after an ACE. Prospective studies have found that the lower the dietary or membrane levels ofEPA andDHA, the higher the risk for both majordepression and cardiovascular disease. This area needs further research but it does provide a strong amount of evidence to warrant exploring the effect of increasing the omega 3 status of patients with cardiovascular disease or majordepression.
A study examined the effect of the combination of omega 3s and sertraline for treatment of patients withdepression and coronary heart disease. The study was a randomized, double-blind study where all patients were given 50 mg/d sertaline (an antidepressant), and either 2 g/day of omega 3—930 mgEPA and 750 mgDHA—for 10 weeks, or placebo. Outcome was measured using the BeckDepression Inventory and the Hamilton Rating Scale forDepression. No significant differences were noted between the groups. In a study using a 1:4 ratio ofEPA (420 mg):DHA(1680 mg) per day for 6 weeks in women with perinataldepression, researchers found no benefit from the therapy for these women. These studies suggest that supplementation of lower ratios ofEPA:DHA is not effective for the treatment ofdepression, and highlights the importance of high-ratioEPA:DHA omega 3 supplementation in this population.
In a review article exploring the data of omega 3 supplementation and its benefit ondepression, the authors investigated whetherEPA orDHA or both are the beneficial component of the omega 3 supplement. The summary of the meta-analysis found thatEPA was likely more efficacious thanDHA in the treatment ofdepression.
Depression duringpregnancy is quite common and treatment can be challenging. As fetal demand of omega 3 fatty acids remains very high duringpregnancy, the associated decrease in the mother may leave them prone todepression. A study exploring monotherapy for the treatment ofdepression duringpregnancy was performed. The study was an 8 week double-blind, placebo-controlled comparing the treatment with 2.2 g/dEPA and 1.2 g/dDHA to placebo for major depressive disorder inpregnancy. At the end of the study, subjects on the omega 3 treatment had significantly lower depressive symptoms than subjects consuming the control group. Also important to note was that the treatment was well tolerated and there were no adverse effects on either the women or newborns.
In a study in women with postpartumdepression (PPD), subjects were given either 0.5 g, 1.4 g or 2.8 g/d of a 1.5:1 ratioEPA:DHAsupplement for 8 weeks. Women were assessed before and after treatment with the Edinburgh PostnatalDepressionScale and the Hamilton Rating Scale forDepression. Before treatment, the mean scores were 18 and 19, while the after-treatment mean scores were 9 and 10 (a big improvement). It has emerged in the scientific literature that oral supplementation of omega 3 fatty acids in higher ratios ofEPA:DHA are more effective than lower ratios for the treatment ofdepression. WhileEPA:DHAratio may not play as important a role in cardiovascular protection or the mitigation of inflammation, there is a need for this specificity in the treatment ofdepression, and possibly in other mental emotional, psychological or psychiatric conditions.