Which omega 3 is best for depression

They also have anti-inflammatory actions that may help relieve depression. More than 30 clinical trials have tested different omega-3 preparations in people with depression. Most studies have used omega-3s as add-on therapy for people who are taking prescription antidepressants with limited or no benefit. Fewer studies have examined omega-3 therapy alone.

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.

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 have been studied in various mood disorders, such as postpartum depression, with some promising results. In bipolar disorder manic depression , the omega-3s may be most effective for the depressed phase rather than the manic phase of the illness.

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.

I am more cautious in patients with bipolar depression, because the omega-3s may bring on mania, as can most antidepressants. In these individuals, I recommend using omega-3 cautiously, and preferably in combination with a prescription mood stabilizer. 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 to 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.

As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please note the date of last review or update on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician. While I think the article is good, it does not tell the reader that most of fish oil capsules sold over the counter are unregulated, and contain widely different ingredients and potency levels.

In the adult unipolar depression study, highly significant benefits were found by week 3 of EPA treatment compared with placebo. In the child study, an analysis of variance ANOVA showed highly significant effects of omega-3 on each of the three rating scales. No significant side effects were reported in any of the studies. In a study by Maes et al 17 , a comparison was made of 36 patients with major depression, 14 with minor depression, and 24 individuals with no reports of depression.

In the Maes et al 17 study, 34 patients with major depression and 14 normal volunteers were examined for their omega-3 and omega-6 levels. It has been suggested by a number of researchers that major depression is the outcome of the significantly lower concentration of omega-3 fatty acids in the body.

However, a considerable degree of boosting of depressive symptoms is also the result of higher levels of monosaturated fatty acids and omega-6 fatty acids in phospholipids. In another study, an estimation of erythrocyte membrane fatty acids in 10 depressed patients and 14 comparison individuals was made, in which researchers had taken into consideration full dietary analysis, in addition to age, sex, stress level, and smoking habits.

In another study by Peet et al, 19 similar results were repeated where the researchers studied 15 patients having depression and 15 properly matched healthy individuals as comparison group.

It was observed that omega-3 levels of erythrocytes in depressed patients were considerably poorer. The relationship between polyunsaturated fatty acids in mildly depressed individuals was examined by Mamalakis et al.

An increased amount of EPA and DHA intake is related to increased gray matter in those regions of the brain with an important role in regulating depression and other mood disorders. It should be noted that lower levels of membrane related omega-3 fatty acid and enhanced levels of omega-6 fatty acids may boost the rate of depression and alter the functioning of neurons.

Analogous proportions of omega-3 and omega-6 fatty acid, considered to be due to dietary intake, may clarify the low prevalence of mood disorders in the east, where large levels of fatty fish are consumed, against rates in the west where elevated levels of saturated fat acts as nutritional support. Formation of neurotransmitters and prostaglandin is affected by omega-3 and omega-6 fatty acid proportion, which is very important in the maintenance and regulation of normal functioning of the brain.

Valproic acid when given therapeutically on a long-term basis leads to a decline in arachidonate production in rat brain. The downregulation of gene expression and action of enzyme cytosolic phospholipase A2, an enzyme that particularly releases arachidonic but not omega-3 fatty acid from phospholipids, corresponded to the decline of lithium's arachidonate production.

The quantity of cyclooxygenase-2 and downstream metabolite prostaglandin E2 in the brain is reduced by lithium. This result indicates that lithium and anticonvulsants act by targeting part of the arachidonic acid inflammatory pathway, which may be highly expressed in mania. DHA and EPA seem to reduce the synthesis of eicosanoids from their precursor arachidonic acid by two possible pathways.

The first is that they combine with arachidonic acid for amalgamation into membrane-based phospholipids, declining both cellular and plasma concentrations of arachidonic acid. The other way may be that for cyclooxygenase enzyme system EPA may compete with arachidonic acid and help block the process of proinflammatory eicosanoid synthesis from arachidonic acid e. Diagrammatic view of omega-3 fatty acid inflammation pathway. Possible molecular mechanism of action of omega-3 fatty acids.

In addition to this, EPA inhibits the upstream mitogen activated protein kinase MAPK pathway, which then results in the reduction in the activity of protein-1 transcription factor. It is proposed that omega-3 fatty acids have a role in transcriptional regulation by phosphorylation inhibition of JNK, ERK, and MAPK proteins, which downregulates protein-1 expression. Omega-3 fatty acid transcriptional regulation mechanism. It has been shown that EPA has got a prohibitory effect on both.

A growing number of reports on omega-3 fatty acids and depression from the past few years have been added to the literature. There is evidence that omega-3 fatty acids are closely linked to mental health.

For major depressive disorder, omega-3 fatty acids have not, so far, proved significant as a monotherapy. Individuals experiencing the symptoms of depression also found to have lower serum concentrations of essential fatty acids, which was also revealed by several studies of EPA and DHA. In order to combat this problem, some foods are usually recommended.

Fish with red flesh such as salmon or mackerel are a good source of omega-3 oils. Omega-3 is also present in small amounts in some plant oils such as flaxseed oil. The more important is EPA, which is usually considered to provide more health benefits.

The long chains of unsaturated fatty acids from omega-3 oils are regarded as important for health because they are believed to decrease cholesterol levels and clear fatty deposits in the arteries. The cardiovascular system is also benefitted, 36 and it also helps in exacerbating dysfunctions in insulin receptor signaling in the brain and cognition.

There is also significant evidence which support that omega-3 oils can be used in the treatment for schizophrenia and bipolar depression disorder. Besides treating depression omega-3 fatty oils may also be useful in treating the symptoms of dementia. Omega-3 oil pills are used in combination with selective serotonin reuptake inhibitors SSRIs and are considered as more standard treatment for depression as recommend by some physicians.

Recently, Patrick et al 40 proposed a model whereby insufficient levels of vitamin D, omega-3 fatty acids, and various other genetic factors that play a role during critical periods of development, lead to dysfunction in serotonin activation and function, which may be an important underlying mechanism that may lead to depression and other neuropsychiatric disorders.

This model further suggests that optimizing the intake of omega-3 fatty acids from marine sources and vitamin D may help in modulating and preventing the severity of brain functions. A recent review by Deacon et al 41 formed variable conclusions by systematic review and meta-analysis.

Results from the research done on the effects of omega-polyunsaturated fatty acids on the depression related mood disorder have led to variable results.

Keeping in view the conflicting results from a number of studies there is a need for more research on omega-3 fatty acids and depression treatment through well-designed experiments. A number of nutrients was reviewed against pediatric depression. In a two-site placebo-controlled, randomized, double-blind clinical trial, 43 two omega preparations enriched with EPA versus DHA were examined as monotherapy for major depression disorder.

The authors found neither EPA-enriched nor DHA-enriched omega-3 to be superior to placebo for the treatment of major depression disorder. There is evidence that intake of omega-3 fatty acid is associated with reduction in the depression-like symptoms most often in women.

The researchers examined the effect of DHA sufficient and deficient diets on rat gestation, lactation and weaning periods; the findings suggest that increased resilience to emotional stressors and decreased propensity to mood disorders, which are common occurrences during adolescence, can be controlled by maintaining sufficient DHA levels in the diet throughout development. It was recommended that omega-3 fatty acids and mindfulness could be maintained for healthy mental state in nurses, for stress management program and reducing depression in nurses.

In a randomized controlled trail, prenatal stress in African American women was examined in association with supplementation of omega-3 fatty acid DHA. It was concluded that DHA can attenuate the effects of late-pregnancy maternal stress. Low EPA levels are found to be associated with heightened trait aggression and impetuous patients of major depression with history of substance-use disorder comorbidity.

Omega-3 fatty acids were evaluated with and without SSRI fluvoxamine and the findings suggest that the patients treated with a combination of omega-3 fatty acids and fluvoxamine showed a significant difference compared with those treated with fluvoxamine alone in improving depression symptoms. Higher intake of omega-3 fatty acids than omega-6 fatty acids was found to be associated with decreased risk of heightened symptoms of depression.

Omega-3 fatty acids—mostly DHA—were also found at increased levels in brain of fat-1 transgenic mice and is suggested to have influence on depression and mood. Further it is suggested that omega-3 fatty acids, particularly DHA helps in the hippocampal neurogenesis and may help to treat and prevent depression. Improvement of depression symptoms by using fatty acids were found proportional to using potential therapeutic agents such as lithium and lamotrigine.

One study 60 conducted a double-blind, placebo-controlled, randomized clinical trial among middle-aged women who were having psychological distress and depressive symptoms and were using ethyl-EPA E-EPA and supplementation against placebo.

It was observed that psychological distress and depressive symptoms improved significantly more with E-EPA than placebo. Another randomized double-blind placebo-controlled study examined the efficacy of E-EPA in depression treatment and bipolar depression patients in which the E-EPA was found to be an effective and well-tolerated intervention in bipolar depression. E-EPA is widely used and is believed to exhibit beneficial antipsychotic and antidepressive effects, so it receives special attention in the field of psychiatry.

In psychiatric disease such as schizophrenia, E-EPA has been examined in a number of trials, 63 , 64 , 65 , 66 , 67 , 68 , 69 although the evidence for recommendation of its use is still weak. Clinical depression has been found to have an association with low-grade inflammation. Omega-3 fatty acids were observed to smoothen the rigid cell membrane in participants.

Conflicting results have been reported in some studies, in which depression prevalence and severity after myocardial infarction were evaluated by the supplementation of the omega-3 fatty acids ECA and DHA. No effects on the symptoms of depression were reported. Neither fish oil nor omega-3 polyunsaturated fatty acid-enriched egg yolk phospholipid supplementation reversed disturbances caused by chronic mild stress in rats. An examination of whether there is an increase in the influence of serum base-brain derived neurotrophic factor in diabetes mellitus patients with major depression disorder using omega-3 E-EPA was made.

No evidence in improvement of brain derived neurotrophic factor was reported with supplementation or E-EPA in depressed patients. Another study tested the efficacy of omega-3 E-EPA added as antidepressant medication as adjuvant, in the treatment of depressive symptom in adults of diabetes mellitus. The authors found no evidence for the efficacy of E-EPA to antidepressants. Many products such as prostaglandins that are involved in omega-3 fatty acids synthesis are found to have a role in regulating information.

This has led to an attribution of the link between the omega-3 fatty acids and depression. Although the evidence regarding the role of omega-3 fatty acids in the treatment of depression is growing with continuous research, due to the systemic differences in the diet and participant recall, there arises a noteworthy difficulty in the interpretation of the literature.

Considering the evidence from the clinical trial data omega-3 fatty acids deserves extensive deliberation and more comprehensive studies for treatment of depression. The literature on omega-3 fatty acids and depression treatment consists of considerable claims about the efficacy of omega-3 fatty acids. However, there is a substantial number of studies that show no efficacy of omega-3 fatty acids against depression.

This can possibly be explained by many factors that may be responsible for the variable results, such as variable experimental designs, differences in sample size, biological and genetic differences among patients, environmental variability, and variability in response to omega-3 fatty acids. Depression is a multifactorial disorder and depression due to insufficient omega-3 fatty acids diets can be of one type. Those patients who may have depression because of insufficient omega-3 fatty acids can respond well to the diet containing high levels of omega-3 fatty acids and can show positive signs regarding treatment of depression.

However, for patients who have depression due to factors other than omega-3 fatty acids diet, expecting that type of depression can be treated due to omega-3 fatty acid supplement does not seem reasonable.

This could be the possible reason why the literature contains conflicting results on omega-3 fatty acid efficacy. To reach any conclusion regarding efficacy of omega-3 fatty acids on depression treatment, it is necessary to categorize the patients of depression based on their causes. Although it is very difficult in the present scenario to trace the exact cause of depression, it is encouraging that vital research can help us to categorize the patients of depression on the basis of their cause which can possibly help us to narrow down the use of omega-3 fatty acid on depression patients.

At present, it could be a premature decision to conclude anything about omega-3 fatty acids and treatment of depression. However, considering the individual variations in the onset of depression and response to certain treatment strategies would help us to reach a clearer conclusion.

The authors declare that no conflict of interest exists in publishing this article. This is commonly found in supermarkets like Costco and in less expensive grocery-store products. If it is cleaned up and processed one step further, it reaches a triglyceride form. The EE form is cheaper, but it oxidizes and turns rancid faster than the triglyceride form. Not all sources are the same. The best omega 3s are from reliable, tested , cold water fish sources.

The smaller the fish, the better, because small fish carry less toxic and heavy metal burden in general- but only some companies list the actual fish source. Here are some locally-available fish oil companies that either use the EE form, list the sources, or test for impurities:. Here is some more info about purity testing for different brands. Storage should be in a dark glass bottle to prevent sunlight from damaging the oils and from plastic leaching into it.

Some companies have produced omega 3 products from plants, making vegan consumers very happy. Plant-based omega 3 comes from algae, and typically contain more ALA than omega 3s sourced from fish, which is thought to be particularly healthy for the heart. This is important when choosing a fish oil. It is thought that EPA is more effective in treating depression than DHA, although the latter is still important to include. Some products actually have the ratio right on the front label to help you choose.

Conversely, research shows that EPA is more effective as an anti-inflammatory agent, whereas DHA is more effective at increasing membrane fluidity, both important qualities in a fish oil. Eating 3 servings of fish a week is equivalent to taking 1g of fish oil a day.

One of the best-tested brands, NutraSea, has a plant-based omega 3 called NutraVege.