Omega-3 supplementation offers small but significant effect on perinatal depression

Omega-3 polyunsaturated fatty acids appeared to have a small but significant beneficial effect on perinatal depression, according to results of a meta-analysis published in Journal of Clinical Psychiatry.

“The absence of recommendations is problematic because omega-3 PUFAs [polyunsaturated fatty acids] are currently widely used during pregnancy and the postpartum period (both to prevent and to treat depressive symptoms), and women ask their health care professionals for advice with regard to safety and effectiveness,” Roel J.T. Mocking, MD, PhD, of the department of psychiatry at University of Amsterdam, and colleagues wrote. “To facilitate clinical decision-making, we aimed at continuing the debate on the effectiveness of omega-3 PUFAs for the treatment of perinatal depressive symptoms by performing a meta-analysis of all available [randomized controlled trials] and performing a meta-regression.”

Specifically, the investigators compared published clinical results of omega-3 PUFA use among pregnant women vs. postpartum women and for prevention vs. treatment of perinatal depression. They searched four databases and combined terms related to omega-3 PUFAs and perinatal depression, and included data from 18 randomized controlled trials with 4,052 participants published up to Feb. 18, 2019.

Results showed omega-3 PUFAs exhibited an overall small but significant beneficial effect on depressive symptoms vs. placebo. Mocking and colleagues reported considerable heterogeneity, with 55% of between-study variance explained by significant subgroup differences. Omega-3 PUFAs exhibited a medium effect among women with depression and no effect among women without depression. Postpartum women had a medium to large effect vs. a negligible effect during pregnancy.

The investigators observed the largest effect among trials that specifically studied postpartum depression.

“We advise against prescribing omega-3 PUFAs for the treatment or prevention of depressive symptoms during pregnancy, given the observed negligible effect with low heterogeneity,” they wrote. “Alternatively, omega-3 PUFA supplementation appears a promising (add-on) treatment option for postpartum major depressive episodes.”

In a related editorial, Jerome Sarris, PhD, MHSc, of Western Sydney University’s NICM Health Research Institute in Australia, and Marlene P. Freeman, MD, of Harvard Medical School’s Ammon-Pinizzotto Center for Women’s Mental Health, provided clinical consideration for omega-3 PUFA use among this patient population.

“A balanced evidence-informed approach would be to advise women in the perinatal period to consume adequate dietary [omega-3], while supplementation can occur in marked deficiency,” they wrote. “An additional clinical consideration can also involve the potential use of [omega-3] in comorbid obesity and inflammatory conditions, [whereas] in those who are vegetarian, algal-based preparations may also be an option.

“Finally, while most studies have not shown a substantial nonselective benefit of [omega-3] for the acute or preventative treatment of perinatal [major depressive disorder], we can still suggest that other potential benefits to pregnancy, such as lengthening of the gestational period, may make the risk/benefit profile of [omega-3] still attractive in pregnancy,” they added. “This application may apply more judiciously as a potential adjunct to standard medications and psychotherapy.”