Improve Depression by Reducing Inflammation: The powerful impact of omega-3 on mental health
Omega 3 and Omega 6 are essential fatty acids needed for optimal health and functioning. Humans obtain these fats through diet and supplementation .
Omega 3 fatty acids reduce inflammation, while omega 6 fatty acids promote inflammation. Americans consume too much omega 6 and not enough omega 3.
People with mental health conditions , such as depression, are usually deficient in omega 3. Studies have found that using omega 3 supplementation can improve symptoms and augment medications like SSRIs.
The best sources of omega 3 in the diet are coldwater fatty fish, such as salmon, herring, mackerel, and trout.
Essential fatty acids (EFAs) are a group of fats that most mammals, including humans, cannot synthesize on their own but are required for proper functioning. This means they are essential in the diet for good health. EFAs for humans include linoleic acid (better known as omega 6) and alpha- linolenic acid (better known as omega 3). Omega 3 fatty acids play an important role in reducing inflammation, producing energy, and maintaining cell structures.(5) Omega 6 fatty acids play a role in inflammation, vasoconstriction (constricting of the blood vessels), and platelet aggregation (blood clotting).(5) It may sound like omega 6 fatty acids are bad, but remember that a certain level of inflammation is necessary to reduce the impact of injury and trauma.
In order for our bodies to get the most benefit from EFAs, there needs to be a certain ratio of omega 6 to omega 3 intake. Currently, most Americans consume a ratio anywhere between 12:1 and 25:1 of omega 6 to omega 3. This ratio is much too high for proper health- the proper ratio should be 5:1 or less!(3) Intake is influenced by a variety of factors. Omega 6 is rich in vegetable oils, particularly corn, canola, sunflower, and soybean oils. These oils are used heavily in the manufacturing and processing of packaged foods, which Americans consume far too much of on a daily basis. Additionally, the standard American diet tends to be low in fatty fish, which is the best source of omega 3 fatty acids. Lastly, the factory farming of domesticated animals for food has changed the content of omega 3 fatty acids in animal products. Animals are now fed a corn based diet, lowering their intake of omega 3 fatty acids, which in turn lowers the content of their meat products. For example, eggs from free range, pasture raised chickens have an omega 6: omega 3 ratio of 1:1, while a traditional USDA corn- fed chicken’s egg has a ratio of 19:1.(3)
Omega 3 can be categorized into three main forms- ALA (alpha linolenic acid), EPA (eicosapentaenoic acid), and DHA (docosahexaenoic acid). ALA is found in plant foods, while EPA and DHA are found in animal foods. The most “useful” forms in the body are EPA and DHA. The body can easily convert EPA to DHA, but the conversion from ALA → EPA → DHA is extremely inefficient (only 15% of ALA consumed is converted). For this reason, vegetarians and vegans must consume higher quantities of ALA to maintain proper levels of EPA and DHA in the body. Most research done on omega 3 intake, supplementation, and medications uses EPA or EPA and DHA.
Inflammation is indicated in most mental health conditions, including depression, bipolar, schizophrenia, Parkinson’s, and Alzheimers. Chronic, low grade inflammation can alter neurotransmitter production and cell signaling pathways. Pro-inflammatory cytokines IL-1, TNFα, and IL-6 are associated with depression, Alzheimer's, and Parkinsons. When widespread inflammation in the body is reduced, symptoms of mental illness can be alleviated. EPA, a form of omega 3, can block these inflammatory pathways linked with various mental health conditions. (2)
Numerous studies have found correlations between omega 3, omega 6, and mental health conditions. People who consume a diet rich in omega 3s are less likely to have depression. (6) People with severe depression have been shown to have elevated levels of omega 6 and depressed levels of omega 3. (6) There is strong evidence that shows mother’s whose breast milk contains high levels of DHA have reduced rates of postpartum depression.(6) New research is looking into the correlation of omega 3 and gray matter in the brain. Omega 3 seems to promote an increase in gray matter.(6) Gray matter areas are brain tissues that house major components of the central nervous system, particularly nerve synapses and neurons. It is where major cognitive processing takes place. Patients with mental health disorders have decreased gray matter.
Randomized trials have found that people with depression treated with an SSRI plus omega 3 supplementation improved symptoms of depression at a higher rate than people just taking an SSRI alone.(6) Similar results have been found with people on medications for ADHD, Alzhiemers, and Parkinsons, indicating that omega 3 can be a great additive treatment for those who need medication. (1) The evidence supporting the use of omega 3 with medications is strongest for women with depression, but it can help most people.(6) Research has also found that the more inflammation that is present (as measured by C-reactive protein, a marker of inflammation, the greater the impact of omega 3 supplementation will be on people with mental health conditions. (1)There are prescription doses of omega 3 available. They usually come in the form of EPA alone or EPA + DHA, usually at a dose of 4000 milligrams. The most effective versions usually have higher levels of EPA than DHA. (1) Prescription doses were originally intended for people with high triglyceride levels (4), but it is becoming more common in psychiatric practice.
Even if you do not have a prescription for omega 3s, you can still increase your intake by taking a daily fish oil supplement (a usual dose of 1800mg-2300mg/ day) and increasing your intake of foods rich in omega 3s. When choosing a fish oil supplement, be sure to make sure the brand is reputable and has a robust quality control program to ensure purity of the product. Algae supplements are available for vegetarians and vegan, but be aware that they contain mostly DHA and little EPA.(3) Whatever supplement you choose should be stored in a cool, dry place that is not exposed to direct light. Nordic Naturals and Pure Encapsulations are quality brands with an array of omega 3 supplement options. The best dietary sources of EPA and DHA are coldwater fatty fish, such as salmon, herring, sardines, mackerel, and trout. Vegan sources of omega 3 (ALA form) include flax and flaxseed oil, chia seeds, and walnuts. ALA is not converted readily to EPA/ DHA in the body, so you will have to eat more of it to increase your omega 3 levels.
At Modyfi, we offer more than traditional therapy and medication management. We consider exercise, nutrition, sleep, community, and mindfulness when crafting mental health treatment plans (including your omega 3 status). Reach out today to get started by texting “Ready” to 470-536-8388.
Aiken, C. (Ed.). (2022, March). How to prescribe omega 3s. The Carlat Report, 20(3).
Giacobbe, J., Benoiton, B., Zunszain, P., Pariante, C. M., & Borsini, A. (2020). The anti-inflammatory role of omega-3 polyunsaturated fatty acids metabolites in pre-clinical models of psychiatric, neurodegenerative, and neurological disorders. Frontiers in Psychiatry, 11. https://doi.org/10.3389/fpsyt.2020.00122
Guilliams, T. G. (2014). Supplementing Macronutrients: Fatty Acids. In Supplementing dietary nutrients: A guide for healthcare professionals (2nd ed., pp. 66–75). essay, Point Institute.
Prescription omega-3 fatty acid medications effectively lower high triglycerides. American Heart Association. (2019, August). Retrieved May 13, 2022, from https://newsroom.heart.org/news/prescription-omega-3-fatty-acid-medications-effectively-lower-high-triglycerides
U.S. Department of Health and Human Services. (2021). Omega-3 fatty acids. NIH Office of Dietary Supplements. Retrieved 2022, from https://ods.od.nih.gov/factsheets/Omega3FattyAcids-HealthProfessional/
Wani, A. L., Bhat, S. A., & Ara, A. (2015). Omega-3 fatty acids and the treatment of depression: A review of scientific evidence. Integrative Medicine Research, 4(3), 132–141. https://doi.org/10.1016/j.imr.2015.07.003
