Omega-3 Fatty Acid Supplementation for Perinatal Depression: A Meta-Analysis.
What this study found
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…
- Study & population
- Pregnant or postpartum women across 18 randomized controlled trials (n = 4,052).
- Intervention
- Omega-3 polyunsaturated fatty acids (EPA and/or DHA) supplementation regimens across 18 randomized trials.
- Key limitation
- 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.
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Open PDFOriginal 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 perinatal depression, comparing a priori defined subgroups: pregnant women vs postpartum women and prevention vs treatment of perinatal depression. METHODS We searched Web of Science, Embase, PsycINFO, and the Cochrane Library, combining omega-3 PUFAs and perinatal depression terms and including publications up to February 18, 2019, for RCTs on omega-3 PUFAs compared to placebo or any active comparator. RESULTS Data from 18 RCTs on 4,052 participants showed an overall significant small beneficial effect of omega-3 PUFAs on depressive symptoms compared to placebo (-0.236 standardized difference in means [SDM]; 95% CI = -0.463 to -0.009; P = .042). Heterogeneity was considerable (I² = 88.58; P < .001), with significant subgroup differences explaining 55% of between-study variance (P = .001). In depressed women, omega-3 PUFAs showed a medium effect (SDM = -0.545; 95% CI = -1.182 to 0.093; P = .094) vs no effect in nondepressed women (SDM = -0.073). Moreover, the effect was medium to large in postpartum women (SDM = -0.656; 95% CI = -1.690 to 0.378; P = .214) compared to a negligible effect during pregnancy (SDM = -0.071). RCTs specifically studying postpartum depression showed the largest effect (SDM = -0.886; 95% CI = -2.088 to 0.316; P = .149). CONCLUSIONS Omega-3 PUFAs have an overall significant small beneficial effect on perinatal depression, with important subgroup differences. We advise against prescribing omega-3 PUFAs for the treatment or prevention of depressive symptoms during pregnancy, given a lack of effect with low heterogeneity. In contrast, omega-3 PUFA supplementation may be a promising (add-on) treatment for postpartum depression.