Based on the putative relationship between depleted omega-3 fatty acids and postpartum depression, we initiated an open-label pilot study of omega-3 fatty acid supplementation with the aim of preventing postpartum depression. Euthymic pregnant females with a past history of depression in the postpartum period were started on 2960 mg of fish oil (1.4:1 eicosapentaenoic acid:docosahexaenoic acid) per day between the 34th to 36th week of pregnancy and assessed through 12 weeks postpartum. Four of seven participants had a depressive episode during the study period. No participants withdrew from the study due to adverse events. This preliminary, small, open-label pilot study failed to show promising results for the use of omega-3 fatty acid monotherapy beginning at 34 to 36 weeks gestation for the prevention of postpartum depression in patients with a prior postpartum depression history. Controlled studies are lacking.
"Indeed, in a population screening study conducted among pregnant women attending antenatal clinics at our own institution, only 14% of those with a positive depression screen received any formal treatment for depression. Women with a history of postpartum depression in a previous pregnancy have a 25-50% risk of depression recurrence . Complications such as preterm birth, preeclampsia, need for cesarean delivery, and poor pregnancy outcome may be increased in women experiencing depression during pregnancy. "
[Show abstract][Hide abstract] ABSTRACT: Major depressive disorder (MDD) during pregnancy and postpartum depression are associated with significant maternal and neonatal morbidity. While antidepressants are readily used in pregnancy, studies have raised concerns regarding neurobehavioral outcomes in exposed infants. Omega-3 fatty acid supplementation, most frequently from fish oil, has emerged as a possible treatment or prevention strategy for MDD in non-pregnant individuals, and may have beneficial effects in pregnant women. Although published observational studies in the psychiatric literature suggest that maternal docosahexaenoic acid (DHA) deficiency may lead to the development of MDD in pregnancy and postpartum, there are more intervention trials suggesting clinical benefit for supplementation with eicosapentaenoic acid (EPA) in MDD.
The Mothers, Omega-3 and Mental Health study is a double blind, placebo-controlled, randomized controlled trial to assess whether omega-3 fatty acid supplementation may prevent antenatal and postpartum depressive symptoms among pregnant women at risk for depression. We plan to recruit 126 pregnant women at less than 20 weeks gestation from prenatal clinics at two health systems in Ann Arbor, Michigan and the surrounding communities. We will follow them prospectively over the course of their pregnancies and up to 6 weeks postpartum. Enrolled participants will be randomized to one of three groups: a) EPA-rich fish oil supplement (1060 mg EPA plus 274 mg DHA) b) DHA-rich fish oil supplement (900 mg DHA plus 180 mg EPA; or c) a placebo. The primary outcome for this study is the Beck Depression Inventory (BDI) score at 6 weeks postpartum. We will need to randomize 126 women to have 80% power to detect a 50% reduction in participants' mean BDI scores with EPA or DHA supplementation compared with placebo. We will also gather information on secondary outcome measures which will include: omega-3 fatty acid concentrations in maternal plasma and cord blood, pro-inflammatory cytokine levels (IL-1β, IL-6, and TNF-α) in maternal and cord blood, need for and dosage of antidepressant medications, and obstetrical outcomes. Analyses will be by intent to treat.
This study compares the relative effectiveness of DHA and EPA at preventing depressive symptoms among pregnant women at risk.
Clinical trial registration number: NCT00711971.
"In a double-blind, placebo-controlled trial, however, treatment with DHA and EPA (0.8 and 1.1 g/day, resp.) for 8 weeks was of no additional benefit in women with perinatal major depression when all subjects received concomitant psychotherapy . Fish oil (2960 mg/day [EPA : DPA, 1.4 : 1] from week 34–36 of pregnancy through 12 weeks postpartum)  or DHA supplements (200 mg/day for 4 months after delivery  or 220 mg/day from week 16 of pregnancy through 3 months postpartum ) also failed to prevent the development of postpartum depressive symptoms [91–93]. "
[Show abstract][Hide abstract] ABSTRACT: A growing body of clinical and epidemiological evidence suggests that low dietary intake and/or tissue levels of n-3 (
-3) polyunsaturated fatty acids (PUFAs) are associated with postpartum depression. Low tissue levels of n-3 PUFAs, particularly docosahexaenoic acid (DHA), are reported in patients with either postpartum or nonpuerperal depression. Moreover, the physiological demands of pregnancy and lactation put childbearing women at particular risk of experiencing a loss of DHA from tissues including the brain, especially in individuals with inadequate dietary n-3 PUFA intake or suboptimal metabolic capabilities. Animal studies indicate that decreased brain DHA in postpartum females leads to several depression-associated neurobiological changes including decreased hippocampal brain-derived neurotrophic factor and augmented hypothalamic-pituitary-adrenal responses to stress. Taken together, these findings support a role for decreased brain n-3 PUFAs in the multifactorial etiology of depression, particularly postpartum depression. These findings, and their implications for research and clinical practice, are discussed.
Depression research and treatment 01/2011; 2011(2090-1321):467349. DOI:10.1155/2011/467349
"These met the defined inclusion criteria and investigated dietary and/or supplemental sources of n-3 in relation to the development of PND (Table 2). Three studies support the theory that dietary and supplemental sources of n-3 are associated with fewer PND symptoms (Hibbeln 2002; Makrides et al. 2003; Freeman et al. 2006a) and five studies contest this theory (Llorente et al. 2003; Marangell et al. 2004; "
[Show abstract][Hide abstract] ABSTRACT: Prevalence of postnatal depression (PND) occurs in approximately 13-20% of women after birth and has detrimental consequences for both the mother and the offspring. The causes of PND remain unclear, with research suggesting a multifactorial aetiology. It is believed that some dietary constituents may, in part, be related to the onset of PND. The possible protective roles of folate, riboflavin, calcium, magnesium and zinc intake have been investigated, as well as the role of a high glycaemic index diet, with conflicting results. Most of the literature appears to have focused on the symptoms of PND in relation to patterns of fish consumption and intake of n-3(omega-3) fatty acids. A review of studies published through MEDLINE indicated that riboflavin, calcium and zinc may play a role in alleviating symptoms of PND. Although a greater number of published papers have studied associations between n-3 intake and PND incidence, findings are somewhat contradictory. Further research is now required to develop these preliminary research findings with an aim to reducing the health costs of PND through the application of nutritional interventions
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