Skip to main content Accessibility help
×
Home

The efficacy of n-3 fatty acids DHA and EPA (fish oil) for perinatal depression

  • Linda A. W. Jans (a1), Erik J. Giltay (a2) and A. J. Willem Van der Does (a1) (a2)

Abstract

Depressive symptoms are common during pregnancy and the post-partum period. Although essential n-3 PUFA may have beneficial effects on depression, it remains unclear whether they are also effective for perinatal depression. The purpose of the present study was to assess the efficacy of n-3 supplementation for perinatal depression, by performing a meta-analysis on currently available data. After a thorough literature search, we included seven randomised controlled trials in the meta-analysis, all with EPA and/or DHA supplementation. Most studies were judged to be of low-to-moderate quality, mainly due to small sample sizes and failure to adhere to Consolidated Standards of Reporting Trials guidelines. Some studies were not primarily designed to address perinatal depression. A total of 309 women on n-3 fatty acid supplementation were compared with 303 women on placebo treatment. n-3 Supplementation was not found to be significantly more effective than placebo at post-treatment with a pooled effect size (Hedges's g) of − 0·03 (95 % CI − 0·18, 0·13; P = 0·76) using a fixed-effects model. Heterogeneity was low-to-moderate (I2 = 30 %). In a subgroup analysis of three small studies of pregnant women with major depression, there was some indication of effectiveness (effect size 0·17; 95 % CI − 0·21, 0·55). In conclusion, the question of whether EPA and DHA administration is effective in the prevention or treatment of perinatal depression cannot be answered yet. Future research should focus on women who are clinically depressed (or at risk). The quality of research in this area needs to improve.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      The efficacy of n-3 fatty acids DHA and EPA (fish oil) for perinatal depression
      Available formats
      ×

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      The efficacy of n-3 fatty acids DHA and EPA (fish oil) for perinatal depression
      Available formats
      ×

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      The efficacy of n-3 fatty acids DHA and EPA (fish oil) for perinatal depression
      Available formats
      ×

Copyright

Corresponding author

*Corresponding author: Dr L. A. W. Jans, fax +31 71 527 4678, email janslaw@fsw.leidenuniv.nl

References

Hide All
1 Das, UN (2008) Folic acid and polyunsaturated fatty acids improve cognitive function and prevent depression, dementia, and Alzheimer's disease – but how and why? Prostaglandins Leukot Essent Fatty Acids 78, 1119.
2 Kidd, PM (2007) Omega-3 DHA and EPA for cognition, behavior, and mood: clinical findings and structural–functional synergies with cell membrane phospholipids. Altern Med Rev 12, 207227.
3 Su, KP (2009) Biological mechanism of antidepressant effect of omega-3 fatty acids: how does fish oil act as a ‘mind-body interface’? Neurosignals 17, 144152.
4 Salem, N Jr, Litman, B, Kim, HY, et al. (2001) Mechanisms of action of docosahexaenoic acid in the nervous system. Lipids 36, 945959.
5 Valenzuela, A (2009) Docosahexaenoic acid (DHA), an essential fatty acid for the proper functioning of neuronal cells: their role in mood disorders. Grasas Y Aceites 60, 203212.
6 Farooqui, AA, Ong, WY & Horrocks, LA (2006) Inhibitors of brain phospholipase A2 activity: their neuropharmacological effects and therapeutic importance for the treatment of neurologic disorders. Pharmacol Rev 58, 591620.
7 Edwards, R, Peet, M, Shay, J, et al. (1998) Omega-3 polyunsaturated fatty acid levels in the diet and in red blood cell membranes of depressed patients. J Affect Disord 48, 149155.
8 Hibbeln, JR (1998) Fish consumption and major depression. Lancet 351, 1213.
9 Tanskanen, A, Hibbeln, JR, Tuomilehto, J, et al. (2001) Fish consumption and depressive symptoms in the general population in Finland. Psychiatr Serv 52, 529531.
10 Adams, PB, Lawson, S, Sanigorski, A, et al. (1996) Arachidonic acid to eicosapentaenoic acid ratio in blood correlates positively with clinical symptoms of depression. Lipids 31, S157S161.
11 McNamara, RK, Hahn, CG, Jandacek, R, et al. (2007) Selective deficits in the omega-3 fatty acid docosahexaenoic acid in the postmortem orbitofrontal cortex of patients with major depressive disorder. Biol Psychiatry 62, 1724.
12 Peet, M, Murphy, B, Shay, J, et al. (1998) Depletion of omega-3 fatty acid levels in red blood cell membranes of depressive patients. Biol Psychiatry 43, 315319.
13 Nemets, B, Stahl, Z & Belmaker, RH (2002) Addition of omega-3 fatty acid to maintenance medication treatment for recurrent unipolar depressive disorder. Am J Psychiatry 159, 477479.
14 Peet, M & Horrobin, DF (2002) A dose-ranging study of the effects of ethyl-eicosapentaenoate in patients with ongoing depression despite apparently adequate treatment with standard drugs. Arch Gen Psychiatry 59, 913919.
15 Su, KP, Huang, SY, Chiu, CC, et al. (2003) Omega-3 fatty acids in major depressive disorder. A preliminary double-blind, placebo-controlled trial. Eur Neuropsychopharmacol 13, 267271.
16 Freeman, MP, Hibbeln, JR, Wisner, KL, et al. (2006) Omega-3 fatty acids: evidence basis for treatment and future research in psychiatry. J Clin Psychiatry 67, 19541967.
17 Lin, PY & Su, KP (2007) A meta-analytic review of double-blind, placebo-controlled trials of antidepressant efficacy of omega-3 fatty acids. J Clin Psychiatry 68, 10561061.
18 Marangell, LB, Martinez, JM, Zboyan, HA, et al. (2003) A double-blind, placebo-controlled study of the omega-3 fatty acid docosahexaenoic acid in the treatment of major depression. Am J Psychiatry 160, 996998.
19 Rogers, PJ, Appleton, KM, Kessler, D, et al. (2008) No effect of n-3 long-chain polyunsaturated fatty acid (EPA and DHA) supplementation on depressed mood and cognitive function: a randomised controlled trial. Br J Nutr 99, 421431.
20 Silvers, KM, Woolley, CC, Hamilton, FC, et al. (2005) Randomised double-blind placebo-controlled trial of fish oil in the treatment of depression. Prostaglandins Leukot Essent Fatty Acids 72, 211218.
21 Al, MD, van Houwelingen, AC, Kester, AD, et al. (1995) Maternal essential fatty acid patterns during normal pregnancy and their relationship to the neonatal essential fatty acid status. Br J Nutr 74, 5568.
22 Holman, RT, Johnson, SB & Ogburn, PL (1991) Deficiency of essential fatty acids and membrane fluidity during pregnancy and lactation. Proc Natl Acad Sci U S A 88, 48354839.
23 Otto, SJ, van Houwelingen, AC, Badart-Smook, A, et al. (2001) Comparison of the peripartum and postpartum phospholipid polyunsaturated fatty acid profiles of lactating and nonlactating women. Am J Clin Nutr 73, 10741079.
24 Al, MD, van Houwelingen, AC & Hornstra, G (2000) Long-chain polyunsaturated fatty acids, pregnancy, and pregnancy outcome. Am J Clin Nutr 71, 285S291S.
25 Hibbeln, JR & Salem, N Jr (1995) Dietary polyunsaturated fatty acids and depression: when cholesterol does not satisfy. Am J Clin Nutr 62, 19.
26 Evans, J, Heron, J, Francomb, H, et al. (2001) Cohort study of depressed mood during pregnancy and after childbirth. BMJ 323, 257260.
27 O'Hara, MW & Swain, AM (1996) Rates and risk of postpartum depression – a meta-analysis. Int Rev Psychiatry 8, 3754.
28 Makrides, M, Neumann, MA & Gibson, RA (1996) Effect of maternal docosahexaenoic acid (DHA) supplementation on breast milk composition. Eur J Clin Nutr 50, 352357.
29 Hibbeln, JR (2002) Seafood consumption, the DHA content of mothers' milk and prevalence rates of postpartum depression: a cross-national, ecological analysis. J Affect Disord 69, 1529.
30 Golding, J, Steer, C, Emmett, P, et al. (2009) High levels of depressive symptoms in pregnancy with low omega-3 fatty acid intake from fish. Epidemiology 20, 598603.
31 De Vriese, SR, Christophe, AB & Maes, M (2003) 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 Sci 73, 31813187.
32 Browne, JC, Scott, KM & Silvers, KM (2006) Fish consumption in pregnancy and omega-3 status after birth are not associated with postnatal depression. J Affect Disord 90, 131139.
33 Miyake, Y, Sasaki, S, Yokoyama, T, et al. (2006) Risk of postpartum depression in relation to dietary fish and fat intake in Japan: the Osaka Maternal and Child Health Study. Psychol Med 36, 17271735.
34 Strom, M, Mortensen, EL, Halldorsson, TI, et al. (2009) Fish and long-chain n-3 polyunsaturated fatty acid intakes during pregnancy and risk of postpartum depression: a prospective study based on a large national birth cohort. Am J Clin Nutr 90, 149155.
35 Mattes, E, McCarthy, S, Gong, G, et al. (2009) Maternal mood scores in mid-pregnancy are related to aspects of neonatal immune function. Brain Behav Immun 23, 380388.
36 Krauss-Etschmann, S, Shadid, R, Campoy, C, et al. (2007) Effects of fish-oil and folate supplementation of pregnant women on maternal and fetal plasma concentrations of docosahexaenoic acid and eicosapentaenoic acid: a European randomized multicenter trial. Am J Clin Nutr 85, 13921400.
37 Chiu, CC, Huang, SY, Shen, WW, et al. (2003) Omega-3 fatty acids for depression in pregnancy. Am J Psychiatry 160, 385.
38 Freeman, MP, Hibbeln, JR, Wisner, KL, et al. (2006) Randomized dose-ranging pilot trial of omega-3 fatty acids for postpartum depression. Acta Psychiatr Scand 113, 3135.
39 Freeman, MP, Hibbeln, JR, Wisner, KL, et al. (2006) An open trial of omega-3 fatty acids for depression in pregnancy. Acta Neuropsychiatrica 18, 2124.
40 Marangell, LB, Martinez, JM, Zboyan, HA, et al. (2004) Omega-3 fatty acids for the prevention of postpartum depression: negative data from a preliminary, open-label pilot study. Depress Anxiety 19, 2023.
41 Doornbos, B, van Goor, SA, Dijck-Brouwer, DA, et al. (2009) Supplementation of a low dose of DHA or DHA+AA does not prevent peripartum depressive symptoms in a small population based sample. Prog Neuropsychopharmacol Biol Psychiatry 33, 4952.
42 Freeman, MP, Davis, M, Sinha, P, et al. (2008) Omega-3 fatty acids and supportive psychotherapy for perinatal depression: a randomized placebo-controlled study. J Affect Disord 110, 142148.
43 Llorente, AM, Jensen, CL, Voigt, RG, et al. (2003) Effect of maternal docosahexaenoic acid supplementation on postpartum depression and information processing. Am J Obstet Gynecol 188, 13481353.
44 Rees, AM, Austin, MP & Parker, GB (2008) Omega-3 fatty acids as a treatment for perinatal depression: randomized double-blind placebo-controlled trial. Aust N Z J Psychiatry 42, 199205.
45 Su, KP, Huang, SY, Chiu, TH, et al. (2008) Omega-3 fatty acids for major depressive disorder during pregnancy: results from a randomized, double-blind, placebo-controlled trial. J Clin Psychiatry 69, 644651.
46 Dunstan, JA, Mori, TA, Barden, A, et al. (2004) Effects of n-3 polyunsaturated fatty acid supplementation in pregnancy on maternal and fetal erythrocyte fatty acid composition. Eur J Clin Nutr 58, 429437.
47 Freeman, MP, Hibbeln, JR, Wisner, KL, et al. (2006) Omega-3 fatty acids: evidence basis for treatment and future research in psychiatry. J Clin Psychiatry 67, 19541967.
48 Appleton, KM, Hayward, RC, Gunnell, D, et al. (2006) Effects of n-3 long-chain polyunsaturated fatty acids on depressed mood: systematic review of published trials. Am J Clin Nutr 84, 13081316.
49 Appleton, KM, Rogers, PJ & Ness, AR (2010) Updated systematic review and meta-analysis of the effects of n-3 long-chain polyunsaturated fatty acids on depressed mood. Am J Clin Nutr 91, 757770.
50 Thase, ME (1999) How should efficacy be evaluated in randomized clinical trials of treatments for depression? J Clin Psychiatry 60, Suppl. 4, 2331.

Keywords

Related content

Powered by UNSILO

The efficacy of n-3 fatty acids DHA and EPA (fish oil) for perinatal depression

  • Linda A. W. Jans (a1), Erik J. Giltay (a2) and A. J. Willem Van der Does (a1) (a2)

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed.