Depression is a risk for women during, and especially after pregnancy … a condition called postpartum depression.
By some estimates, postpartum depression affects as many as one in four new mothers in the first year after childbirth.
It can make a mother feel sad, worthless, and hopeless, and make it more difficult to care for and bond with her baby.
Back in 2007, an expert panel appointed by the American Psychiatric Association concluded that people who consume higher amounts of omega-3s from fish (EPA and DHA) generally enjoy reduced risks of depression and other mood disorders.
But what about postpartum depression?
Although most of the several epidemiological and clinical studies published to date produced positive evidence, the results are considered encouraging but inconclusive … in part because of the paucity of sound, reliable studies.
As a researcher at Emory University put it in a review published in April of 2011, “The results are mixed, but one recently completed large trial found no evidence of benefit among women who received DHA during pregnancy.” (Ramakrishnan U 2011)
The authors of two other recent evidence reviews reached similar conclusions:
“In conclusion, the question of whether EPA and DHA administration is effective in the prevention or treatment of perinatal depression cannot be answered yet. The quality of research in this area needs to improve.” (Jans LA et al. 2010)
“Overall, results have been inconclusive, but further investigation of omega-3 fatty acids is warranted because they did improve depression scores and appeared to be safe during pregnancy.” (Borja-Hart NL, Marino J 2010)
(The perinatal period is the time immediately before and after birth … starting at about the 20th week of gestation and ending about one month after birth.)
Recently, a small clinical trial from the University of Connecticut (UConn) found that omega-3 fish oil appears to reduce symptoms of postpartum depression, adding more pressure to conduct large, well-controlled trials.
As the authors wrote, “These results offer a basis for guidelines for DHA consumption by pregnant women and for community-based efforts to increase awareness of the value of DHA/fish consumption for maternal mental health.” (Judge MP et al. 2011)
UConn study finds positive indications
For the past several years, Michelle Price Judge, an assistant professor-in-residence at the UConn School of Nursing, has been looking into how omega-3s derived from fish impact maternal and infant health.
In a recent study, Judge focused on whether DHA – the omega-3 essential to brain development and function – lowers the risk of postpartum depression when it is consumed during pregnancy (Judge MP et al. 2011).
Her coauthors included UConn Professor Cheryl Beck – an international expert on postpartum depression – and Carol Lammi-Keefe of Louisiana State University.
They conducted a randomized, double-blind study involving 42 pregnant women, monitored from the 24th week of pregnancy to birth. The results were presented at Experimental Biology 2011 in Washington, D.C. in April.
Dr. Judge’s team found that, compared with women who took a placebo pill, those who took 300mg of DHA five days a week had lower scores on a standardized postpartum depression screening scale (developed by Beck).
The women in the fish oil group had significantly lower scores for symptoms of anxiety/insecurity, emotional liability (characterized by excessive emotional reactions and frequent mood changes), and “sense of loss of self”.
However, because their study was quite small, Judge said that her group could not conclude that fish oil supplements reduce the risk or severity of major postpartum depression.
Omega-3s, fish fat, and pregnancy
In some animals, a deficiency of omega-3 DHA has been associated with lower brain levels of important neurotransmitters such as dopamine and serotonin, which play key roles in mood elevation.
Additionally, high blood levels of omega-3s can reduce levels of certain messenger proteins “cytokines” that promote systemic inflammation, which also is considered a factor in depression.
Dr. Judge made these cogent comments:
“Generally, experts agree that the omega-3 fatty acids derived from fish are beneficial to maternal and infant health. Yet on average, pregnant women consume less than half of the level considered optimal during pregnancy. If women consume 12 ounces (two to three servings) of fish weekly, there is no need for fish oil supplementation. Women who consume very little or no fish should consider supplementation.” (UConn 2011)
Worldwide, health authorities recommend that pregnant women consume at least 200 mg of DHA daily. In fact, experts recommend from 260mg to 660mg per day for all adult women, pregnant or otherwise.
Fatty fish such as wild salmon, sardines, herring, tuna, including canned light tuna, are excellent sources of DHA and EPA … the omega-3 fatty acids found only in fish oil.
Some fish, such as shark, swordfish, king mackerel, and marlin can contain high amounts of mercury, and should be avoided.
Fish oil supplements provide a safe alternative, either because they have been chemically refined to remove almost all mercury, or because they come from naturally pure fish such as wild Alaskan salmon.
Prior research has shown that the omega-3 fatty acids found in the primary fat of fish like salmon and tuna are preferentially transferred through the placenta during the later stages of pregnancy in order to help the baby grow and mature.
As a result, expectant mothers often show a depletion of maternal stores of omega-3s in their bodies.
According to Dr. Judge, this lack of DHA in mothers is compounded by the fact that pregnant women tend to eat only a fraction of the amount of fish and DHA considered optimal during pregnancy.
The research was funded by the Patrick and Catherine Weldon Donaghue Medical Research Foundation.
Borja-Hart NL, Marino J. Role of omega-3 Fatty acids for prevention or treatment of perinatal depression. Pharmacotherapy. 2010 Feb;30(2):210-6. Review.
Freeman MP. Complementary and alternative medicine for perinatal depression. J Affect Disord. 2009 Jan;112(1-3):1-10. Epub 2008 Aug 8. Review.
Jans LA, Giltay EJ, Van der Does AJ. The efficacy of n-3 fatty acids DHA and EPA (fish oil) for perinatal depression. Br J Nutr. 2010 Dec;104(11):1577-85. Epub 2010 Nov 16. Review.
Judge MP et al. Maternal docosahexaenoic acid (DHA, 22:6n-3) consumption during pregnancy decreases postpartum depression (PPD) symptomatology. The FASEB Journal. 2011;25:349.7 Accessed at http://www.fasebj.org/cgi/content/meeting_abstract/25/1_MeetingAbstracts/349.7?sid=722a0ce8-35e9-4a7e-b5ae-625ef03534f3
Judge MP, Harel O, Lammi-Keefe CJ. A docosahexaenoic acid-functional food during pregnancy benefits infant visual acuity at four but not six months of age. Lipids. 2007 Mar;42(2):117-22. Epub 2007 Jan 19.
Judge MP, Harel O, Lammi-Keefe CJ. Maternal consumption of a docosahexaenoic acid-containing functional food during pregnancy: benefit for infant performance on problem-solving but not on recognition memory tasks at age 9 mo. Am J Clin Nutr. 2007 Jun;85(6):1572-7.
Ramakrishnan U. Fatty acid status and maternal mental health. Matern Child Nutr. 2011 Apr;7 Suppl 2:99-111. doi: 10.1111/j.1740-8709.2011.00312.x. Review.
University of Connecticut (UConn). Fish Oil May Reduce Postpartum Depression Symptoms. June 1, 2011. Accessed at http://today.uconn.edu/blog/2011/06/fish-oil-may-reduce-postpartum-depression-symptoms/