Submitted to: American Journal of Obstetrics and Gynecology
Publication Type: Other
Publication Acceptance Date: 11/12/2003
Publication Date: 2/10/2004
Citation: Llorente, A., Jensen, C.L., Heird, W.C. 2004. Reply: Omega-3 polyunsaturated fatty acids for postpartum depression. American Journal of Obstetrics and Gynecology. 190:583. Interpretive Summary:
Technical Abstract: To the Editors: We appreciate the interest and the comments of Chiu et al. concerning our recently published study investigating the effect of maternal docosahexaenoic acid (DHA) supplementation to prevent postpartum depression (PPD). We agree with many of their criticisms and, in fact, discussed these in our paper (pages 1352 and 1353), cautioning against concluding from our findings that DHA has no role in preventing PPD. Were we beginning the study today, we probably would choose a larger supplement. However, it is unlikely that we would choose a dose in excess of 1 g per day. The small dose of DHA used in our recently published study (i.e., 200 mg of DHA for 4 months) resulted in a 50% higher DHA content of plasma phospholipid in the supplemented versus the placebo group (P < .001). This, of course, was independent of the women’s usual dietary intake, including fish intake. We cannot comment intelligently on the efficacy of DHA versus a combination of DHA and EPA, either for prevention of PPD or for treatment of severe depression. We chose to study a supplement without EPA because of concern that the resulting higher EPA content of the women’s milk might interfere with the growth of the infants, as observed by Carlson et al. We are aware of arguments for and against DHA alone versus DHA plus EPA, not only in treatment/prevention of depression but also for the cardioprotective effects of omega-3 fatty acids. It is very likely that some of the EPA will be converted to DHA, making it difficult to attribute effects to one versus the other. Just as we cautioned against interpreting our data as showing definitively that DHA supplementation does not decrease PPD, we caution against concluding from the reports cited by Chiu et al. that a large dose of a combination of DHA and EPA is effective in treating the symptoms of severe depression, particularly the two single case reports, because such data hardly provide conclusive evidence that DHA alone, or in combination with EPA, is capable of benefitting patients with PPD. Further, we note that any agent that is effective in treating or preventing PPD may well be ineffective in decreasing severe depressive symptoms and vice versa. The two conditions may be related, but they are not necessarily the same. Clearly, the role of omega-3 fatty acids in treating and/or preventing any type of depression raises a number of intriguing but as yet unresolved questions.