Perinatal depression is a complex mental health disorder that can manifest during pregnancy or after childbirth. Women with perinatal depression may not receive proper medical treatment because of concerns over teratogenic effects related to drug therapy. Evidence suggests that low levels of omega-3 fatty acids are correlated with depressive symptoms during pregnancy and after delivery. Omega-3 fatty acids may produce antidepressant effects due to their role in serotonin functioning. A literature search identified seven clinical trials of omega-3 fatty acids for the prevention or treatment of perinatal depression. Depression rating scale scores used in the studies improved, but results were statistically significant in only three trials. Four studies were randomized and placebo controlled, and three were open label. One study evaluating the prevention of postpartum depression in women with a history of depression was discontinued early due to relapse of depressive symptoms. In the trials we evaluated, the most common adverse effects were foul breath and/or unpleasant taste, and gastrointestinal complaints; no serious adverse events were reported. The seven studies were limited by small sample sizes and variable dosing and study durations. In the studies that demonstrated statistical significance, improvement in depression rating scale scores for omega-3 fatty acids was comparable to placebo. Overall, results have been inconclusive, but further investigation of omega-3 fatty acids is warranted because they did improve depression scores and appeared to be safe during pregnancy.
Perinatal depression can be difficult to manage because of the potential adverse effects associated with various classes of antidepressants. However, risks associated with untreated depression, including poor maternal care and physiologic adverse effects to the fetus, may produce an outcome worse than the risks of treatment. Omega-3 fatty acids may be an option for the treatment of perinatal depression because of their potential efficacy and favorable safety profile. However, additional randomized controlled trials are needed to establish the role of omega-3 fatty acids in the treatment and prevention of perinatal depression in various age groups, raceethnicities, and severities of depression—particularly mild depression. Concerns that must be addressed include the appropriate initial dosage of omega-3 fatty acids, the best ratio of EPA:DHA, the duration of therapy to determine treatment failure, and the best time to start therapy during the perinatal period.
Role of Omega-3 Fatty Acids for Prevention or Treatment of Perinatal Depression
Nancy L. Borja-Hart, Pharm.D; Jehan Marino, Pharm.D.
Posted: 04/05/2010; Pharmacotherapy. 2010;30(2):210-216. © 2010 Pharmacotherapy Publications