Omega-3s Boost Mood Throughout Pregnancy

SCOTTSDALE, ARIZ. — With growing concerns about treatment of depression in pregnancy, omega-3 fatty acids are gaining attention as a possible treatment that might be without risk and exceptionally healthful for mother and child, Marlene Freeman, M.D., said at a psychopharmacology conference sponsored by the University of Arizona.

Omega-3 fatty acids, best known for their cardiovascular benefits (including reduction of triglyceride levels and thrombosis risk) gained even more attention when epidemiologic studies showed lower rates of depression in countries with high consumption of omega-3-rich seafood and higher depression rates in countries where fish consumption is lowest (Lancet 1998;351:1213 and J. Affect. Disord. 2002;69:15–29).

Omega-3 fatty acids can become depleted during pregnancy and lactation anyway, so the suggestion that they might play a role preventing depression in pregnancy is even more intriguing—especially with recent research raising concerns of a possible neonatal withdrawal syndrome associated with use of selective serotonin reuptake inhibitors during pregnancy, said Dr. Freeman, director of the university's women's mental health program in Tucson.

In addition to the epidemiologic research, studies looking at omega-3s and depression have included four double-blind, placebo-controlled trials. In three of the studies, involving treatment-resistant patients, a significant response was seen in the omega-3 groups, who received widely varying doses of marine sources of omega-3 fatty acids, including eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA).

Dosages in the three positive studies ranged from 1 g of EPA all the way up to 9.6 g of EPA and DHA.

In a fourth study involving 35 subjects, however, there was no separation seen between the treatment group receiving 2 g of DHA and placebo (Am. J. Psychiatry 2003;160:996–8).

A non-peer reviewed study looking specifically at the role of omega-3 fatty acids in depression among pregnant women and involving nearly 14,000 pregnant British women showed higher depression scores correlating with lower seafood intake. The study indicated a protective effect of omega-3 acids not only at 18 weeks' gestation but also at 8 weeks and 32 weeks post partum.

The most recent findings out of Dr. Freeman's lab shed more light on issues such as palatability and efficacy. In a small, open-label, flexible-dose study of 15 patients using doses up to 2.8 g/day of EPA and DHA, patients showed a mean decrease on the Edinburgh Postnatal Depression Scale (EPDS) of 39% and a mean decrease of 34% on the Hamilton Rating Scale for Depression.

The longer patients stayed in the study, the better they did, with a 40% EPDS decrease at 4 weeks and a 49% decrease at 8 weeks; however, Dr. Freeman said the figures were very biased, and she emphasized that more follow-up is necessary.

“We do think omega-3s look like an acceptable potential treatment option, but more research is needed,” Dr. Freeman said.

The study also indicated that the dosage of omega-3 tablets, which included up to six large capsules a day, was surprisingly well tolerated.

“We were concerned about giving pregnant women these big capsules because of problems like morning sickness, heartburn, and other gastrointestinal symptoms that can go along with pregnancy,” she said. “Overall, the doses were amazingly well tolerated.”

The highest levels of omega-3 fatty acids are found in fatty fish. In addition to their known cardiovascular benefits, the compounds have been associated with benefits ranging from brain and retinal development to prevention of breast and lung cancer.

The news gets even better, she said, in terms of their possible benefits for infants, with reports linking omega-3 intake in pregnant mothers to better sleep patterns in infants and higher IQs.

In terms of the role of omega-3 fatty acids in depression, theories on the possible mechanisms of action vary widely and include increased serotonergic activity, inhibition of protein kinase C, anti-inflammatory properties, suppression of phosphatidylinositol-associated second messenger activity, and increases in heart-rate variability.

Plant sources such as flaxseed offer some omega-3s, but seafood has far richer concentrations. Supplements such as fish oil tablets are also beneficial.

SCOTTSDALE, ARIZ. — With growing concerns about treatment of depression in pregnancy, omega-3 fatty acids are gaining attention as a possible treatment that might be without risk and exceptionally healthful for mother and child, Marlene Freeman, M.D., said at a psychopharmacology conference sponsored by the University of Arizona.

Omega-3 fatty acids, best known for their cardiovascular benefits (including reduction of triglyceride levels and thrombosis risk) gained even more attention when epidemiologic studies showed lower rates of depression in countries with high consumption of omega-3-rich seafood and higher depression rates in countries where fish consumption is lowest (Lancet 1998;351:1213 and J. Affect. Disord. 2002;69:15–29).

Omega-3 fatty acids can become depleted during pregnancy and lactation anyway, so the suggestion that they might play a role preventing depression in pregnancy is even more intriguing—especially with recent research raising concerns of a possible neonatal withdrawal syndrome associated with use of selective serotonin reuptake inhibitors during pregnancy, said Dr. Freeman, director of the university's women's mental health program in Tucson.

In addition to the epidemiologic research, studies looking at omega-3s and depression have included four double-blind, placebo-controlled trials. In three of the studies, involving treatment-resistant patients, a significant response was seen in the omega-3 groups, who received widely varying doses of marine sources of omega-3 fatty acids, including eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA).

Dosages in the three positive studies ranged from 1 g of EPA all the way up to 9.6 g of EPA and DHA.

In a fourth study involving 35 subjects, however, there was no separation seen between the treatment group receiving 2 g of DHA and placebo (Am. J. Psychiatry 2003;160:996–8).

A non-peer reviewed study looking specifically at the role of omega-3 fatty acids in depression among pregnant women and involving nearly 14,000 pregnant British women showed higher depression scores correlating with lower seafood intake. The study indicated a protective effect of omega-3 acids not only at 18 weeks' gestation but also at 8 weeks and 32 weeks post partum.

The most recent findings out of Dr. Freeman's lab shed more light on issues such as palatability and efficacy. In a small, open-label, flexible-dose study of 15 patients using doses up to 2.8 g/day of EPA and DHA, patients showed a mean decrease on the Edinburgh Postnatal Depression Scale (EPDS) of 39% and a mean decrease of 34% on the Hamilton Rating Scale for Depression.

The longer patients stayed in the study, the better they did, with a 40% EPDS decrease at 4 weeks and a 49% decrease at 8 weeks; however, Dr. Freeman said the figures were very biased, and she emphasized that more follow-up is necessary.

“We do think omega-3s look like an acceptable potential treatment option, but more research is needed,” Dr. Freeman said.

The study also indicated that the dosage of omega-3 tablets, which included up to six large capsules a day, was surprisingly well tolerated.

“We were concerned about giving pregnant women these big capsules because of problems like morning sickness, heartburn, and other gastrointestinal symptoms that can go along with pregnancy,” she said. “Overall, the doses were amazingly well tolerated.”

The highest levels of omega-3 fatty acids are found in fatty fish. In addition to their known cardiovascular benefits, the compounds have been associated with benefits ranging from brain and retinal development to prevention of breast and lung cancer.

The news gets even better, she said, in terms of their possible benefits for infants, with reports linking omega-3 intake in pregnant mothers to better sleep patterns in infants and higher IQs.

In terms of the role of omega-3 fatty acids in depression, theories on the possible mechanisms of action vary widely and include increased serotonergic activity, inhibition of protein kinase C, anti-inflammatory properties, suppression of phosphatidylinositol-associated second messenger activity, and increases in heart-rate variability.

Plant sources such as flaxseed offer some omega-3s, but seafood has far richer concentrations. Supplements such as fish oil tablets are also beneficial.

SCOTTSDALE, ARIZ. — With growing concerns about treatment of depression in pregnancy, omega-3 fatty acids are gaining attention as a possible treatment that might be without risk and exceptionally healthful for mother and child, Marlene Freeman, M.D., said at a psychopharmacology conference sponsored by the University of Arizona.

Omega-3 fatty acids, best known for their cardiovascular benefits (including reduction of triglyceride levels and thrombosis risk) gained even more attention when epidemiologic studies showed lower rates of depression in countries with high consumption of omega-3-rich seafood and higher depression rates in countries where fish consumption is lowest (Lancet 1998;351:1213 and J. Affect. Disord. 2002;69:15–29).

Omega-3 fatty acids can become depleted during pregnancy and lactation anyway, so the suggestion that they might play a role preventing depression in pregnancy is even more intriguing—especially with recent research raising concerns of a possible neonatal withdrawal syndrome associated with use of selective serotonin reuptake inhibitors during pregnancy, said Dr. Freeman, director of the university's women's mental health program in Tucson.

In addition to the epidemiologic research, studies looking at omega-3s and depression have included four double-blind, placebo-controlled trials. In three of the studies, involving treatment-resistant patients, a significant response was seen in the omega-3 groups, who received widely varying doses of marine sources of omega-3 fatty acids, including eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA).

Dosages in the three positive studies ranged from 1 g of EPA all the way up to 9.6 g of EPA and DHA.

In a fourth study involving 35 subjects, however, there was no separation seen between the treatment group receiving 2 g of DHA and placebo (Am. J. Psychiatry 2003;160:996–8).

A non-peer reviewed study looking specifically at the role of omega-3 fatty acids in depression among pregnant women and involving nearly 14,000 pregnant British women showed higher depression scores correlating with lower seafood intake. The study indicated a protective effect of omega-3 acids not only at 18 weeks' gestation but also at 8 weeks and 32 weeks post partum.

The most recent findings out of Dr. Freeman's lab shed more light on issues such as palatability and efficacy. In a small, open-label, flexible-dose study of 15 patients using doses up to 2.8 g/day of EPA and DHA, patients showed a mean decrease on the Edinburgh Postnatal Depression Scale (EPDS) of 39% and a mean decrease of 34% on the Hamilton Rating Scale for Depression.

The longer patients stayed in the study, the better they did, with a 40% EPDS decrease at 4 weeks and a 49% decrease at 8 weeks; however, Dr. Freeman said the figures were very biased, and she emphasized that more follow-up is necessary.

“We do think omega-3s look like an acceptable potential treatment option, but more research is needed,” Dr. Freeman said.

The study also indicated that the dosage of omega-3 tablets, which included up to six large capsules a day, was surprisingly well tolerated.

“We were concerned about giving pregnant women these big capsules because of problems like morning sickness, heartburn, and other gastrointestinal symptoms that can go along with pregnancy,” she said. “Overall, the doses were amazingly well tolerated.”

The highest levels of omega-3 fatty acids are found in fatty fish. In addition to their known cardiovascular benefits, the compounds have been associated with benefits ranging from brain and retinal development to prevention of breast and lung cancer.

The news gets even better, she said, in terms of their possible benefits for infants, with reports linking omega-3 intake in pregnant mothers to better sleep patterns in infants and higher IQs.

In terms of the role of omega-3 fatty acids in depression, theories on the possible mechanisms of action vary widely and include increased serotonergic activity, inhibition of protein kinase C, anti-inflammatory properties, suppression of phosphatidylinositol-associated second messenger activity, and increases in heart-rate variability.

Plant sources such as flaxseed offer some omega-3s, but seafood has far richer concentrations. Supplements such as fish oil tablets are also beneficial.