PPD - defined as a major depressive episode with onset within one month of live childbirth - has broad, long-lasting consequences for a woman and her infant. Studies have shown that children of affected mothers may experience impaired attachment, and PPD may adversely affect behavioral and cognitive development.
Omega-3 fatty acids are polyunsaturated essential fatty acids found in fish and associated with several health benefits in humans, including prevention and treatment of heart disease. In mood disorders, studies have reported higher rates of both major depression in general, and also specifically PPD, associated with lower per capita seafood consumption.
Omega-3 fatty acids also play a role in pregnancy and infant health, including optimal neurodevelopment in the developing baby and in infants. Women's stores of essential fatty acids progressively decrease due to the developing baby's high demand for omega-3 fatty acids in utero and during breastfeeding.
"Because of the demands placed on the mother's supply of omega-3 fatty acids during pregnancy and lactation, omega-3 fatty acids are intriguing as a treatment option for PPD," says study Principal Investigator Marlene P. Freeman, MD, director, UA Women's Mental Health Program, and assistant professor, psychiatry, obstetrics and gynecology, and nutrition, UA College of Medicine. "Minimal data are available regarding standard antidepressant efficacy for the treatment of PPD. Some women refuse medications during pregnancy and/or breastfeeding because the long-term effects of antidepressants on the infant are unknown. Omega-3 fatty acid supplementation is associated with health benefits and is an attractive potential treatment."
The eight-week pilot study assessed the effectiveness of omega-3 fatty acids - specifically a combination of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) - in 16 women who were experiencing PPD. Participants were assigned randomly to one of three different dosage groups: 0.5, 1.4, or 2.8 grams per day. A placebo-only group was not included because of the exploratory purposes of the study. The study used EPAX Omega-3 oil (with a ratio of EPA to DHA of 1.5 to 1) provided by Epax AS, the leading supplier of concentrated Omega-3 EPA/DHA fatty acids and previously a division of Pronova Biocare AS.
Among all three doses, patients with PPD improved substantially during the trial, says Dr. Freeman. "Scores on depression measures decreased by approximately 50 percent, and differences were statistically significant." The omega-3 fatty acids were well-tolerated.
"The interpretation of our findings is limited by small sample size and lack of a placebo-control group, but the improvements observed among all treatment groups suggest omega-3 fatty acids may have efficacy as a treatment for PPD," says Dr. Freeman. "These findings especially are compelling, considering that omega-3 fatty acids offer health benefits to the mother and also to her infant if she is breastfeeding."
A larger, placebo-controlled study of omega-3 fatty acids and PPD, in which participants also receive supportive psychotherapy (talk therapy), now is under way at the UA. To find out if you qualify, contact Marcy, UA Department of Psychiatry, (520) 626-3273.
