Deficiencies and Feeling Down: Omega 3s and Post Partum Depression

Monday, November 21, 2011

For my gynecology class here at Bastyr University, I was required to complete a literature review on a topic of my choosing. I chose to peruse the available literature to determine if supplementation with omega-3 fatty acids decreased the incidence or severity of postpartum depression. The results of my review were somewhat startling so I decided to provide a brief synopsis of my review in this blog.

The current literature has established a correlation between incidence of depression and overall omega-3 fatty acid status. A large epidemiologic analysis of cross country data concluded that higher seafood consumption and/or higher breast milk DHA concentration was associated with a decreased risk of postpartum depression.(6) Animal studies have shown that an omega-3 fatty acid deficiency leads to reduced brain serotonin levels.(6) In addition, it has been discovered that patients with major depressive disorder have lower levels of omega-3 fatty acids than healthy patients.(7) In the brain, ‘DHA is important in neuronal membrane stability, neuroplasticity, signal transduction and neurotransmission, which might be connected to the etiology of mood and cognitive dysfunction of depression.’(7) Considering all of the evidence that omega-3 fatty acid depletion might play a role in depression, there is an alarming paucity of large, well-designed intervention trials investigating the efficacy of omega-3 fatty acid supplementation in the prevention and/or treatment of postpartum depression.

Approximately 12-16% of mothers experience postpartum depression.(5) Postpartum depression usually occurs within 6 – 12 weeks of delivery but it can occur up to one year after birth and studies have shown that it can last for years.(5) Evidence suggests that fatty acid supplementation should be critical and highly beneficial during both pregnancy and breast feeding since the metabolic demand for omega-3 fatty acids, especially DHA, increases significantly.(6) DHA demands are especially increased during the last trimester of pregnancy when DHA is being incorporated into the fetal brain and nervous system.(6) Post-mortem studies indicate that the fetus accumulates an average of 67mg of omega-3 fatty acids, mostly as DHA, per day during the last trimester of pregnancy.(6)

In all of the studies reviewed, omega-3 fatty acid supplementation was well tolerated by all participants with no significant adverse events reported. Collectively, the available data indicate that supplementation with up to three grams of omega-3 fatty acids per day did not lead to excessive blood loss during birth or any other possible adverse events.(6)

Since omega-3 fatty acid supplements are well tolerated during and after pregnancy and since several studies suggest a link between omega-3 fatty acid status and depression, the use of omega-3 fatty acids in lieu of pharmaceuticals to treat pregnancy-related depression is worthy of consideration.

To complete this review, I searched MEDLINE, The Cochrane Library, PsycINFO and EMBASE databases for relevant studies between October 2001 and October 2011. My search resulted in over 100 relevant papers, but only 4 were included in my review since all included studies had to be controlled intervention trials that supplemented participants with omega-3 fatty acids and then measured incidence or severity of postpartum depression.

Based on the four studies, I concluded that the literature showed no beneficial effect of omega-3 fatty acid supplementation over placebo on incidence of postpartum depression. Only one out of the four studies had a positive outcome but the positive study was quite unique when compared to the other three studies. In this positive study (4), the participants had postpartum depression before supplementation with omega-3 fatty acids while the three negative studies recruited healthy participants. Another unique feature of this positive study was the outcome measured. Rather than focusing on the incidence of postpartum depression as the other three studies did, this study measured the severity of the symptoms of postpartum depression. The positive study also supplemented with higher levels of omega-3 fatty acids.

In conclusion, supplementation with low levels of omega-3 fatty acids might not decrease the incidence of post-partum depression but if supplementation with higher levels significantly decreased the severity of postpartum depression then perhaps supplementing with even higher levels could reduce the overall incidence. The positive study supplemented with only 1,000 mg of omega-3 fatty acids while it has been proven that doses up to 3,000 mg per day are safe and well tolerated by pregnant women. In my personal opinion, these intervention trials did not intervene enough. I hope that future studies will supplement with increased levels of omega-3 fatty acids over a longer period of time and assess both the incidence and severity of postpartum depression.

Laura Firetag ND Student Bastyr University

References:

1. Doornbos B, van Goor SA, Dijck-Brouwer DA, et al. (2009) Supplementation of a low dose of DHA or DHA+AA does not prevent peripartum depressive symptoms in a small population based sample. Prog Neuropsychopharmacol Biol Psychiatry; 33: 49–52.
2. Makrides M, Gibson R, McPhee A, et al. (2010) Effect of DHA supplementation during pregnancy on maternal depression and neurodevelopment of young children. JAMA; 304(15): 1675-83.
3. Llorente AM, Jensen CL, Voigt RG, et al. (2003) Effect of maternal docosahexaenoic acid supplementation on postpartum depression and information processing. Am J Obstet Gynecol; 188: 1348–1353.
4. Nashidi F. (2009) A study on effects of omega-3 fatty acids on postpartum depression. International Journal of Gynecology & Obstetrics; 107S2: S501.
5. Brenda MY, Leung ND, Kaplan BJ. (2009) Perinatal depression: prevalence, risks and the nutrition link – a review of the literature. J Am Diet Assoc; 109: 1566-1575.
6. Makrides M. (2009) Is there a dietary requirement for DHA in pregnancy? Prostaglandins, Leukotrienes and Essential Fatty Acids; 81: 171-174.
7. Su K. (2009) Biological mechanism of antidepressant effect of omega-3 fatty acids:how does fish oil act as a ‘mind body interface?’ Neurosignals; 17: 144-152.

Labels: 3, anxiety, depression, DHA, EPA, Omega, pregnancy

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Deficiencies and Feeling Down: Omega 3s and Post Partum Depression

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