Omega-3 Fatty Acids against Depression

Clinical Case

This post on the potential benefits of Omega-3 for depression treatment we will start from the clinical case review. While once case does not prove the solution is efficient, it will give some insight on how it can help, at least in one stand-alone case.

21-year-old male student with a 7-year history of unremitting depressive symptoms has been admitted for trial of the Omega-3 in his treatment plan. At age 19 years, pharmacotherapy was commenced owing to increasing illness severity, with prominent low self-esteem, insomnia, sadness, inner tension, poor appetite, poor concentration, increasing social phobia, lethargy, pessimistic thoughts, and suicidal thoughts. During the following year there was no response to a variety of antidepressants, hypnotics, and antipsychotic medication; his condition continued to deteriorate. A 2-month trial involving the addition of lithium carbonate to his anti-depressant treatment was unsuccessful.

The patient was then referred to one of the trial developers Basant K. Puri, Hammersmith Hospital, London. At this time, he was actively suicidal, although he had been taking paroxetine hydrochloride (20-30 mg/d) for 10 months. His symptoms met the DSM-IV criteria for “major depressive disorder, recurrent.” His score on the Montgomery-Asberg Depression Rating Scale (MADRS) was 32. Owing to very good parental support, it was decided not to admit the patient compulsorily to the hospital, despite the severity of his illness and the very high suicide risk. He agreed to take pure ethyl-EPA at a dose of 4 g/d (Omega-3 part).

Administration of ethyl-EPA led to a rapid improvement, including cessation of the previously unremitting severe suicidal ideation, within 1 month. Social phobia also improved dramatically. There was a progressive benefit, and after 9 months, his symptoms had disappeared altogether, giving the patient a MADRS score of zero. Both he and his mother reported how different he had become. He no longer had any suicidal thoughts and was actively making plans for his future studies and career. The patient reported no adverse effects of the medication.

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While the case results are very impressing, the one success story cannot be accepted as background for practical recommendations to include Omega-3 Fatty Acids in your daily diet, especially if you do have depression. However, this suggestion is getting more and more scientific validation from the respectable sources.

Omega-3 fatty acids are a type of good fat which is required for normal brain function. Our bodies can't make omega-3s on their own, so we must obtain them through our diet. Studies have linked depression with low dietary intake of omega-3 fatty acids. In countries with higher fish consumption, such as Japan and Taiwan, the depression rate is 10 times lower than in North American. Postpartum depression is also less common.

Latest studies suggest that people whose diets contain dramatically more of one kind of polyunsaturated fatty acid than another may be at greater risk for both clinical depression and certain inflammatory diseases. For example, the report, published 2007 in the journal Psychosomatic Medicine, suggests that we need to balance out our intake of omega-6 and omega-3 fatty acids. The current typical American diet contains 20 times more omega-6 than omega-3, a ratio that researchers say should be lowered to 4-to-1, or even 2-to-1.

Also, multiple studies suggest that omega-3's together with antidepressants may be much more effective than antidepressants alone.

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How Does EPA Work?

EPA is part of the Omega 3 chain of ecosanoids and is most commonly found in fatty fish such as fresh salmon, mackerel, pilchards and sardines. While the benefits of high grade EPA have been well documented, the scientific community still don t know exactly how EPA works on the brain. One theory released by Dr Basant Puri (lead developer of the clinical trial, we mentioned earlier) is that it eases the passage of the signals over the tiny gaps in the brain called synapses. Another theory was that the high grade EPA actually worked similarly to lithium and had anti-depressant properties of its own.

Until recently it was widely accepted in the medical community that once a human reached maturity that the adult brain could not grow anymore. However, a paper, released by Dr. Puri, proves that was inaccurate. Dr. Puri scanned a 21 year patient before treating him with high grade Pure EPA. After the course of treatment he rescanned the young man, only to find that the grey matter of the brain had increased in size.

There is also a theory that omega-3 fatty acids are of great assistance to neuronal membranes. Omega-3 fatty acids can alter membrane fluidity by displacing cholesterol from the membrane. An optimal fluidity, influenced by EFAs, is required for neurotransmitter binding and the signaling within the cell. EFAs can act as sources for second messengers within and between neurons.

Omega-3 fatty acids may also have significant influence in major depression via cytokine modulation. A growing body of research has documented an association between depression and the production these proinflammatory immune chemicals. Psychological stress can cause an elevation of these cytokines. And Omega-3 fatty acids, and EPA in particular, are well documented inhibitors of proinflammatory cytokines


Cold water fish such as salmon, sardines, and anchovies are the richest food source of omega-3 fatty acids. But instead of eating more fish which contain mercury, PCBs, and other chemicals, fish oil capsules are considered a cleaner source of omega-3 fatty acids. Many companies filter their fish oil so that these chemicals are removed.

Fish oil capsules are sold in health food stores, drug stores, and online. Most brands should be stored in the fridge to prevent the oil from going rancid. When comparing brands, the key active components for depression are EPA and DHA.

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Andrew Stoll, Ph.D., Harvard researcher on Omega 3 and depression recommends 4 grams of EPA per day for those with depression. The advice of 4 grams of EPA fish oil for depression each day is quite a bit but important to refill what has been missing in our diet.

Generally, practitioners are recommending 2-4 grams of EPA a day.


Fish oil capsules may interact with blood-thinning drugs such as warfarin and aspirin. Side effects may include indigestion and bleeding. Fish oil should not be taken 2 weeks before or after surgery. Fish oil can also cause a fishy aftertaste. To prevent this, try taking the fish oil just before meals.

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Sources and Additional Recommendations:


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