A claim you hear on longevity podcasts

Does fish oil help depression when nothing else works?

The claim checked: A one-year study found EPA, an omega-3 fat, helped treat depression when nothing else worked Hear it at 4:23

What do the studies say?

Conflicting

Five of ten studies, mostly pooled trials, found omega-3 eased depression, chiefly formulas with at least 60% EPA; three found small or no benefit.

Computed from 10 studies that test this point, each judged by two readers, in full. Sources land on both sides. 7 more studies are waiting for a full read and do not count yet.

What was said on the podcast?

“it's also been shown that fish consumption is universally related to depression and that a one one- year study of EPA which is an omega-3 fat was helpful in treating treatment resistant depression meaning when everything else doesn't work fish all works it's also helpful in treating postpartum depression”
Mark Hyman, The Dr. Hyman Show · The Missing Fat You Need to Survive and Thrive · 4:23 on YouTube
Comes up in 30 episodes of the show.
The point checked Conflicting

Omega-3 (EPA) supplementation helps treat depression, including treatment-resistant depression

Agree 5

pooled analysis · 2014 · landmark

“To sum up, trials conducted in individuals with a diagnosis of MDD provided evidence that omega-3 PUFA supplementation has beneficial clinical effects on depressive status.”

Role of omega-3 fatty acids in the treatment of depressive disorders: a comprehensive meta-analysis of randomized clinical trials. PLoS One
Who: Placebo-controlled RCTs of omega-3 in people with depressive symptoms (MDD, non-MDD depression, bipolar, perinatal, comorbid disease) and healthy subjects
PMID 24805797

pooled analysis · 2019 · landmark

“Omega-3 PUFAs with formulations containing ≥60% EPA demonstrated antidepressant effects when EPA ≤ 1 g/d.”

Efficacy of omega-3 PUFAs in depression: A meta-analysis. Transl Psychiatry
Who: Adults with clinical depression (DSM-III-R/DSM-IV) or depressive symptoms on validated scales, with or without comorbid medical conditions; perinatal and secondary depression excluded
PMID 31383846

pooled analysis · 2016 · landmark

“Overall, with an standardized mean difference of 0.398 present meta-analysis shows a beneficial effect of omega-3 PUFAs that is comparable to effects reported in meta-analyses of antidepressants.”

Meta-analysis and meta-regression of omega-3 polyunsaturated fatty acid supplementation for major depressive disorder. Transl Psychiatry
Who: Adults with DSM-diagnosed major depressive disorder confirmed by structured clinical interview
PMID 26978738

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pooled analysis · 2011

“Supplements containing EPA ≥ 60%, in dose range 200 to 2200 mg EPA in excess of DHA, were effective against primary depression.”

Meta-analysis of the effects of eicosapentaenoic acid (EPA) in clinical trials in depression. J Clin Psychiatry
Who: 15 double-blind placebo-controlled trials of omega-3 PUFA in patients with a depressive episode as primary complaint (MDD, bipolar depression, perinatal, comorbid Parkinson's or CHD; one pediatric trial)
PMID 21939614

pooled analysis · 2016

“This systematic review and exploratory hypothesis-testing meta-analysis, testing multiple, predefined ordered hypotheses demonstrated that EPA-predominant formulations are more efficacious than placebo for treatment of clinical depression.”

Efficacy of omega-3 highly unsaturated fatty acids in the treatment of depression. Br J Psychiatry
Who: Children and adults in double-blind placebo-controlled trials of omega-3 for depressive symptoms in affective disorders, with and without diagnosed depression
PMID 27103682

Partly agree 2

controlled trial · 2016 · landmark

“While overall treatment group differences for the entire sample were negligible (ES=−0.13 to +0.04), subjects with one or more “high” biomarker of inflammation improved more on EPA than placebo (ES=−0.39) or DHA (ES=−0.60) and less on DHA than placebo (ES=+0.21).”

Inflammation as a predictive biomarker for response to omega-3 fatty acids in major depressive disorder: a proof-of-concept study. Mol Psychiatry
Who: 155 adults aged 18-80 with DSM-IV major depressive disorder (HAM-D-17 >=15); those with an adequate antidepressant trial in the current episode were excluded
PMID 25802980

pooled analysis · 2015

“At present, we do not have sufficient high quality evidence to determine the effects of n-3PUFAs as a treatment for MDD.”

Omega-3 fatty acids for depression in adults. Cochrane Database Syst Rev
Who: adults with a diagnosis of major depressive disorder in randomised controlled trials
PMID 26537796

Disagree 3

pooled analysis · 2012

“Our meta-analysis demonstrates a small, non-significant benefit of omega-3 fatty acids for the treatment of MDD.”

Omega-3 fatty acids for the treatment of depression: systematic review and meta-analysis. Mol Psychiatry
Who: adults with major depressive disorder (including peripartum MDD and MDD with medical comorbidity) in randomized double-blind placebo-controlled trials; bipolar, schizophrenia and other primary disorders excluded
PMID 21931319

controlled trial · 2008

“The main finding of the present trial is the lack of a therapeutically important effect of n-3 LCPUFA supplementation on depressed mood among people with mild to moderate depression.”

No effect of n-3 long-chain polyunsaturated fatty acid (EPA and DHA) supplementation on depressed mood and cognitive function: a randomised controlled trial. Br J Nutr
Who: 218 mildly to moderately depressed adults aged 18-70 from the general population (mostly Bristol primary care), not taking antidepressants, low habitual EPA/DHA intake
PMID 17956647

controlled trial · 2009

“In conclusion, this randomized, double-blind, placebo-controlled trial found no evidence that omega-3 augmentation of sertraline is superior to sertraline plus placebo capsules for depression in patients with major depression and established CHD.”

Omega-3 augmentation of sertraline in treatment of depression in patients with coronary heart disease: a randomized controlled trial. JAMA
Who: patients with major depression and documented coronary heart disease, St. Louis area
PMID 19843899

What else was said but not tested?

  • Fish oil helps treat postpartum depression
  • Low omega-3 levels / fish intake are associated with depression (incl. lower postpartum depression with higher DHA)
  • DHA raises infant IQ by seven points

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