It’s not surprising to me, that after all my years working in psychotropic medication management; I receive more questions about the efficacy, benefits, and risks of over-the-counter products for mental health concerns rather than their prescription counterparts. It’s rather natural for people to seek out drug options that are accessible and readily available to them, as opposed to scheduling an appointment with a prescriber and obtaining a prescription. Yet key questions about alternative medicines can’t help but arise: Do they really work? If so, for what, or are they most just sham products?
In this installment of my monthly newsletter, I’m discussing omega-3 fatty acids, (fish oil). Omega-3s tout broad benefits in both physical and mental health and have even been incorporated into a few treatment guidelines in psychiatry. However, most of the products you’ll find on pharmacy shelves or nutritional outlets lack the proper ingredients or don’t have enough of them to be effective.
How They Work
Omega-3s are categorized as “essential fatty acids,” meaning we can’t independently make them in our bodies, and thus must obtain via our diet. Most daily eating habits are omega-3 deficient, and omega-3 levels tend to be low in people with psychiatric disorders, yet science is still not clear about whether omega-3s work better in people with deficiencies, so obtaining levels isn’t recommended.
Omega-3 Augmentation with Antidepressants
The strongest research for omega-3 use is as augmentation with antidepressants in unipolar depression; their efficacy is mixed when used singularly. Their antidepressant effects are clearest in clinically diagnosed, DSM-5criteria-based depression, as opposed to non-descript depressive symptoms. Also, only the research that utilized a specific ratio of omega-3s was positive. There are two types of omega-3s – EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid). The formulations that work best are either all EPA or those containing at least twice as much EPA as DHA.
Other Uses
Omega-3s are also deemed effective as augmenting agents in conjunction with mood stabilizers in bipolar depression. Beyond depression, the best results are in ADHD. When used in children with ADHD, omega-3s have been shown to improve core symptoms as well as other features such as emotional lability and conduct-related problems.
Benefits and Possible Risks
Omega-3s are generally well tolerated, the most commonly reported side effects are nausea, belching and experiencing a “fishy” taste. These adverse effects can be mitigated by choosing an enteric-coated or “burpless” product and freezing the capsules before taking.
We can conceivably obtain a clinically-relevant dose of omega-3s via our dietary choices – such as consuming a 6-ounce serving of oily fish like salmon, herring, cod, or even anchovies twice a week. Other reliable dietary sources of omega-3s include walnuts, flaxseed, and dark green vegetables. However most dietary supplements don’t have the requisite amount of EPA to reach clinical dosing recommendations, but every little bit helps.
Recommended Omega-3 Products
The following products contain the proper EPA/DHA ratio, are approved by ConsumerLabs, and should be started at one capsule per day:
- GNC triple strength
- Nature Made 1400 (full disclosure: I take this one)
- Nordic Naturals ProOmega (liquid)
- Carlson Elite EPA Gems
- NutriGold Triple Strength
- Omega ViaUltra Concentrated
- Spring Valley Maximum Care 2000 (Walmart)
Omega-3s should be considered as adjuncts for unipolar depression, bipolar depression and ADHD. It’s imperative though to choose a product (see the list above) with a high concentration of EPA.
Attribution Statement:
Joe Wegmann is a licensed pharmacist & clinical social worker has presented psychopharmacology seminars to over 10,000 healthcare professionals in 46 states, and maintains an active psychotherapy practice specializing in the treatment of depression and anxiety. He is the author of Psychopharmacology: Straight Talk on Mental Health Medications, published by PESI, Inc.
To learn more about Joe’s programs, visit the Programs section of this website or contribute a question for Joe to answer in a future article: joe@thepharmatherapist.com.