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Editorials

Treatment of postnatal depression

BMJ 2003; 327 doi: https://doi.org/10.1136/bmj.327.7422.1003 (Published 30 October 2003) Cite this as: BMJ 2003;327:1003

Postnatal depression: omega-3 fatty acids may be important

EDITOR - It was surprising to see, in the editorial by Hendrick on
postnatal depression [1], no mention of the increasing recognition that
omega-3 polyunsaturated fatty acids (PUFA) may play an important role in
the pathophysiology of this condition.

Patients with depression have been shown to have a deficiency of
omega-3 PUFA [2, 3, 4]. From the epidemiological data, societies with a
high consumption of fish, which contains more omega-3 fatty acids than do
other foods, appear to have a lower rate of major depression [5]. Omega-3
supplementation has been reported to have highly significant anti-
depressant effects in double-blind, placebo-controlled trials (in patients
already on maintenance medication) [6, 7].

Mothers selectively transfer docosahexaenoic acid (DHA) to their
foetuses to support optimal neurological development during pregnancy.
Without sufficient dietary intake, mothers become depleted of DHA. Women
developing depressive symptoms in the postnatal period have been shown to
have reduced availability of DHA [8].Higher concentrations of DHA in
mothers’ milk and greater seafood consumption are associated with lower
prevalence rates of postpartum depression [9].

Chiu and colleagues report the case of a pregnant patient with major
depressive disorder who was treated with omega-3 fatty acid monotherapy (4
g of eicosapentaenoic acid (EPA) and 2 g of DHA per day); she experienced
remarkable improvement [10].

In a randomised, double-blind trial, DHA supplementation for 4
months after delivery did not influence self-ratings of depression,
diagnostic measures of depression, or information processing [11].
However, the low dose of DHA used in this study (approximately 200 mg/day)
was perhaps only one tenth of what might be an effective therapeutic dose.
In addition, it is not currently clear whether DHA, EPA or EPA/DHA in
combination has the greatest anti-depressant effect.

Although further studies are needed, increasing the intake of omega-3
fatty acids before, during and after pregnancy, through diet and/or
supplementation (via low-mercury sources), is a promising approach for
both prevention and treatment of postnatal depression.

Dr Peter J Lewis integrative physician

15 South Steyne, Manly, NSW 2095, Australia

drlewis@yourhealth.com.au

1. Hendrick V. Treatment of postnatal depression. BMJ 2003; 327: 1003
-4.

2. Edwards R, Peet M, Shay J, Horrobin D. Omega-3 polyunsaturated
fatty acid levels in the diet and in red blood cell membranes of depressed
patients. J Affective Disorders 1998: 48(2-3): 149-55.

3. Peet M, Murphy B, Shay J, Horrobin D. Depletion of omega-3 fatty
acid levels in red blood cell membranes of depressive patients. Biological
Psychiatry 1998; 43(5): 315-319.

4. Maes M, Christophe A, Delanghe J, Altamura C, Neels H, Meltzer HY.
Lowered omega-3 polyunsaturated fatty acids in serum phospholipids and
cholesterol esters of depressed patients. Psychiatry Research 1999: 85(3):
275-291.

5. Hibbeln JR. Fish consumption and major depression. Lancet 1998;
351: 1213 (letter).

6. Su K-P, Huang S-Y, Chiu C-C, Shen WW. Omega-3 fatty acids in
depressive disorder: a preliminary double-blind, placebo-controlled trial.
European Neuropsychopharmacology 2003; 13: 267-271.

7. Nemets B, Stahl Z, Belmaker RH. Addition of omega-3 fatty acid to
maintenance medication treatment for recurrent unipolar depressive
disorder. Am J Psychiatry 2002; 159: 477-479.

8. Otto SJ, de Groot RH, Hornstra G. Increased risk of postpartum
depressive symptoms is associated with slower normalization after
pregnancy of the functional docosahexaenoic acid status. Prostaglandins
Leukot Essent Fatty Acids 2003: 69(4): 237-43.

9. Hibbeln JR. Seafood consumption, the DHA content of mothers’ milk
and prevalence rates of postpartum depression: a cross-national,
ecological analysis. J Affective Disorders 2002; 69(1-3) 15-29.

10. Chiu C-C, Huang S-Y, Shen WW, Su K-P. Omega-3 fatty acids for
depression in pregnancy. Am J Psychiatry 2003; 160: 385 (letter).

11. Llorente AM, Jensen CL, Voigt RG, Fraley JK, Berretta MC, Heird
WC. Effect of maternal docosahexaenoic acid supplementation on postpartum
depression and information processing. Am J Obstet Gynecol 2003; 188(5):
1348-53.

Competing interests:
None declared

Competing interests: No competing interests

04 November 2003
Peter J Lewis
Integrative physician
15 South Steyne, Manly, NSW 2095, Australia