Omega-3 Fatty Acid Supplementation for Perinatal Depression: A Meta-Analysis.

The Journal of clinical psychiatry
Q1
Sep 2020
Citations:38
Influential Citations:0
Systematic Reviews / Meta-Analyses
86
S2 IconPDF Icon

Enhanced Details

Methods
Pregnant or postpartum women across 18 randomized controlled trials (n = 4,052). Participants included with major depressive episode at baseline and without; study designs were randomized controlled trials with placebo comparisons (some double-blind). Outcomes were depression scales (EPDS, BDI, HDRS, PDSS).
Intervention
Omega-3 polyunsaturated fatty acids (EPA and/or DHA) supplementation regimens across 18 randomized trials. Doses varied: EPA 0–2,200 mg/day and DHA 120–1,638 mg/day; most trials used DHA+EPA; three used DHA-only; no EPA-only trials. Some regimens included alpha-linolenic acid (ALA), arachidonic acid (AA), docosapentaenoic acid (DPA), or eicosatetraenoic acid (ETA). Durations ranged from mid‑pregnancy to postpartum (up to several weeks postpartum) or until delivery; administration was oral in capsules or fish-oil products.
Results
Omega-3 PUFA supplementation yielded a small but significant reduction in depressive symptoms overall vs placebo (standardized difference in means −0.236; 95% CI −0.463 to −0.009; P = .042) with substantial heterogeneity (I2 ≈ 89%). Postpartum subgroups showed larger effects, including notable effects in postpartum major depressive episodes; pregnancy subgroups showed negligible effects. Do not prescribe omega-3 PUFAs during pregnancy to treat or prevent depressive symptoms; consider omega-3 PUFA as an add-on treatment for postpartum major depressive episodes, particularly EPA-rich formulations. For postpartum major depressive episodes, a supplement with >50% EPA providing about 2,200 mg EPA/day is advised. Overall evidence quality is limited by heterogeneity and imprecision.
Limitations
High heterogeneity across trials (I2 ≈ 89%), wide variation in dosing regimens and populations, some unclear risk of bias due to reporting and lack of prepublished protocols, potential unblinding from fish-taste, and overall low certainty of evidence in several subgroups.

Abstract

OBJECTIVE Several randomized controlled trials (RCTs) investigated omega-3 polyunsaturated fatty acids (PUFAs) (ie, fish oil) in perinatal depression, but their efficacy remains unclear. We performed a meta-analysis of RCTs on omega-3 PUFAs for perin...