Omega 3 Fatty Acids for Depression, Anxiety, and More

When your brain cells are functioning well, you are more likely to deal better with stress, think more clearly, have less anxiety, and be in a better mood. Two of the major elements your brain needs to function well are the Omega-3 fats DHA and EPA. 

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Disclaimer: The information in this article should not be taken as medical advice. It is always advisable to check with your personal medical professionals for individualized advice.

1. What are Essential Fatty Acids?

The term essential when talking about biochemicals used by your body signifies an element that you have to take in. It cannot be produced by your body. It has to be consumed in food or supplements. 

Omega-3 and omega-6 fats are the two main types of polyunsaturated fats in your body.

Essential fatty acids include Linoleic Acid (LA), an omega-6 fatty acid, and Alpha-Linolenic Acid (ALA), an omega-3 fatty acid.

2. Omega-3 Fatty Acids for Health

The Omega fatty acids we are most interested in for general health--and in particular brain health--are 2 of the Omega-3 fatty acids:

• Eicosapentaenoic Acid (EPA)

• Docosahexaenoic Acid (DHA) 

EPA is particularly anti-inflammatory and anti-oxidative--both of which help your general health as well as brain and mental health. 

DHA is particularly abundant in your brain's nerve cells.  

3. 10 Omega-3 Fatty Acid and Fish Oil Health Benefits 

Fish oil is the most common supplement source for omega-3s so the health benefits of fish oil are similar to the benefits of omega-3s.

Omega-3 fats may impact many mental health conditions, including (1-3):

• Anxiety,

• ADD and ADHD,

• Depression (major and post-partum),

• Bipolar disorder,

• Schizophrenia, and

• Alzheimer’s.

Besides helping your brain, optimizing omega-3 fat intake has been associated with reduced chronic illness, including (4):

• decreased inflammation,

• boosted immune response, and

• reduced risk of heart disease.

 And, omega-3 supplementation has been shown to help people quit smoking. (5)

4. EPA and DHA Omega-3 Fatty Acid Benefits for Depression, Anxiety, and Mental Health Research

Researchers in Israel found relatively low levels of omega-3 fats in twenty-seven people with social anxiety compared to control subjects, and a significant relationship between lower levels and the severity of social anxiety. (6)

A couple of projects demonstrate that omega-3 fats appear to help people deal with everyday stressors:

• Thirty healthy Italians given 4 g of fish oil per day (EPA:DHA ratio 2:1) for thirty-five days were compared to control subjects using mood assessments, attention tests, and EEGs. Supplemented subjects showed a reduction in response time and a decrease in anger, anxiety, and depression. (7)

• Seventy American medical students randomly divided into an omega-3 supplement group (2000 mg/day EPA and 350 mg/day DHA) and a control group were followed for twelve weeks, including a period of high-stress exams. The omega group had less inflammation markers in blood tests and a 20% reduction in anxiety symptoms compared to the control group. (8)

Anger and anxiety levels were significantly and “robustly” reduced in eleven substance abusers supplemented with omega-3s for three months (2.25 g/day EPA, 500 mg DHA, and 250 mg other omega-3s) compared to eleven given a placebo. (9)

In 2016, an inpatient psychiatric facility published results of blood tests and omega-3 supplementation on patients with mood and anxiety disorders. They found that these patients had relatively low omega-3 levels on entry and significant symptom relief with supplementation. (10)

Spurred on by an established link between stress and urges to smoke, researchers gave twenty-four smokers omega-3 supplements (2710 mg/day EPA and 2040 mg/day DHA). Compared to twenty-four control subjects given a placebo, supplemented smokers craved cigarettes less and smoked less. (11)

Researchers who performed a review of research in 2015 made this conclusion (12):

“accumulating evidence suggests a crucial role for membrane lipids [omega-3 fatty acids] in the pathogenesis of depression and anxiety disorders; these lipids could be exploited for improved prevention and treatment.” 

5. EPA vs. DHA Mental Health Benefits

Meta-analysis (analysis of research studies) projects in various parts of the world in the last several years have uncovered a reason why tests of omega-3’s impact on depression have given mixed results. High-dose EPA appears to be the key. EPA shows a more consistent positive impact on depression than DHA. (13)

Improvement in depressive symptoms has been seen in both mild and major depression with the use of mainly EPA in the EPA/DHA supplement mix. (14,15)

EPA was also shown to improve depression reduction in people taking antidepressants. (16)

These meta-analysis projects are a great example of how new research builds on past research.

A 2011 project concluded that an EPA content of 60% or greater in an EPA/DHA omega mix was important for a positive effect on depression. (17)

Then, a 2016 project concluded that it was not the relative mix that determined the result, but rather a general emphasis on EPA over DHA. (18)

6. Total Omega-3 vs. DHA and EPA Amounts

Reminders:

• There are 3 types of omega-3 fatty acids: ALA, EPA, and DHA.

• EPA and DHA are the ones that have been shown to be important for mental health

EPA and DHA omegas are predominantly found in seafood sources (i.e. fish, sardines, crab). ALA is predominantly found in plant sources (i.e. nuts and seeds). 

EPA and DHA are not officially classified as essential fatty acids because your body can make some of these fatty acids from ALA. However--while ALA omega-3 can be converted to EPA and DHA in your body, the conversion rate appears to be fairly low. 

A report presented at the Fourth International Congress on Vegetarian Nutrition in 2002 describes it this way: (19)

“Conversion of ALA by the body to the more active longer-chain metabolites is inefficient: approximately 5–10% for EPA and 2–5% for DHA.”

When assessing how much value a food or supplement has to meet omega-3 needs, do not just look at "total omega-3" as that number is the total of all three omegas.

7. How Much Fish Oil or Omega-3 for Depression, Anxiety, and Mental Health?

Omega-3s don't have a RDA (Recommended Daily Amount).

They have a different recommendation value, Adequate Intake (AI), which indicates a level assumed to provide nutritional adequacy. This value is for all omega-3s as a group. There are no daily requirement numbers for our target omegas, EPA and DHA.

Total Omega-3s AI (mg/day)

• Men: 1600

• Women: 1100

A UL (Upper Limit) for omega-3s has not been established.

Supplementation dosage recommendations (mg/day) for men and women

• American Psychiatric Association (20): 1000 EPA+DHA

• PDR for Nutritional Supplements (21): 3000 EPA+DHA

8. Best Omega-3 Fatty Acid Supplements for Depression, Anxiety, and Mental Health

Fish oil is the most common supplement source for EPA and DHA omega-3s.

Supplements vary in the amount of omega-3s present. For mental health, choose supplements that have EPA and DHA with particularly high values for EPA. (22)

Look for promises that the source fish are wild caught and tested for toxins such as heavy metals, and inclusion of natural-sourced antioxidant preservatives.

Keep your fish oil capsules in the fridge. You absolutely don’t want to consume rancid fish oil. Don’t use it past its expiration date. Ideally, spread the dosage consumed throughout the day.

Krill oil is an alternative that is supposed to have the advantage of being more stable because it naturally contains antioxidants. Some doctors say that you require less EPA and DHA when it is coming from krill oil versus fish oil. I tried it myself for quite a while, but honestly, I didn’t find it as helpful as fish oil for mental sharpness, so I went back to fish oil.

Nordic Naturals fish oil is the brand and form that I personally use and recommend to my clients. It is made from deep sea anchovies and sardines, and includes rosemary extract as a preservative.

Nordic Naturals also makes an algae-based omega-3 supplement. It doesn't contain as much EPA and DHA in 2 capsules as their fish oils but it is a vegan option.  

Nordic Naturals Omega-3 Supplements	Amount of EPA and DHA
	Nordic Naturals Ultimate Omega 1280 mg Omega-3 per 2 capsules (with 650 mg EPA and 450 mg DHA)
	Nordic Naturals ProOmega 2000 2150 mg Omega-3 per 2 capsules (with 1125 mg EPA and 875 mg DHA)
	Nordic Naturals Algae Omega 715 mg Omega-3 per 2 capsules (with 195 mg EPA and 390 mg DHA)

9. Contraindications for Supplementing with Omega-3s

Fish oil is a mild anti-coagulant:

• Use with caution if you are on “blood-thinning” medication.

• If you begin to bruise more easily after supplementing omega-3s, consider cutting back.

• Avoid taking it prior to surgery. 

It also lowers blood pressure, so isn't advisable if you already have low blood pressure. 

Consult with your personal medical professionals for individualized advice.

10. References for Fish Oil and Omega-3 Health Benefits

1. Rhonda P. Patrick and Bruce N. Ames, “Vitamin D and the Omega-3 Fatty Acids Control Serotonin Synthesis and Action, Part 2: Relevance for ADHD, Bipolar Disorder, Schizophrenia, and Impulsive Behavior,” FASEB Journal 29, no. 6 (2015): 2207–2222, https://doi.org/10.1096/fj.14-268342

2. Genevieve Young and Julie Conquer, “Omega-3 Fatty Acids and Neuropsychiatric Disorders,” Reproduction Nutrition Development 45, no. 1 (2005): 1–28, https://doi.org/10.1051/rnd:2005001

3. Kuan-Pin Su, Yutaka Matsuoka, and Chi-Un Pae, “Omega-3 Polyunsaturated Fatty Acids in Prevention of Mood and Anxiety Disorders,” Clinical Psychopharmacology and Neuroscience 13, no. 2 (2015): 129–137, https://doi.org/10.9758/cpn.2015.13.2.129.

4. P. Simopoulos, “Evolutionary Aspects of Diet, the Omega-6/Omega-3 Ratio and Genetic Variation: Nutritional Implications for Chronic Diseases,” Biomedicine & Pharmacotherapy 60, no. 9 (2006): 502–507, https://doi.org/10.1016/j.biopha.2006.07.080.

5. Sharon Rabinovitz, “Effects of Omega-3 Fatty Acids on Tobacco Craving in Cigarette Smokers: A Double-Blind, Randomized, Placebo-Controlled Pilot Study,” Journal of Psychopharmacology 28, no. 8 (2014): 804–809, https://doi.org/10.1177/0269881114536477.

6. Pnina Green et al., “Red Cell Membrane Omega-3 Fatty Acids Are Decreased in Nondepressed Patients with Social Anxiety Disorder,” European Neuropsychopharmacology 16, no. 2 (2006): 107–113, https://doi.org/10.1016/j.euroneuro.2005.07.005.

7. G. Fontani et al., “Cognitive and Physiological Effects of Omega-3 Polyunsaturated Fatty Acid Supplementation in Healthy Subjects,” European Journal of Clinical Investigation 35, no. 11 (2005): 691–699, https://doi.org/10.1111/j.1365-2362.2005.01570.x.

8. Janice K. Kiecolt-Glaser et al., “Omega-3 Supplementation Lowers Inflammation and Anxiety in Medical Students: A Randomized Controlled Trial,” Brain, Behavior, and Immunity 25, no. 8 (2011): 1725–1734, https://doi.org/10.1016/j.bbi.2011.07.229.

9. Laure Buydens-Branchey, Marc Branchey, and Joseph R. Hibbeln, “Associations between Increases in Plasma N-3 Polyunsaturated Fatty Acids Following Supplementation and Decreases in Anger and Anxiety in Substance Abusers,” Progress in Neuro-Psychopharmacology and Biological Psychiatry 32, no. 2 (2008): 568–575, https://doi.org/10.1016/j.pnpbp.2007.10.020.

10. Erik Messamore and Robert K. McNamara, “Detection and Treatment of Omega-3 Fatty Acid Deficiency in Psychiatric Practice: Rationale and Implementation,” Lipids in Health and Disease 15, no. 1 (2016), https://doi.org/10.1186/s12944-016-0196-5.

11. Sharon Rabinovitz, “Effects of Omega-3 Fatty Acids on Tobacco Craving in Cigarette Smokers: A Double-Blind, Randomized, Placebo-Controlled Pilot Study,” Journal of Psychopharmacology 28, no. 8 (2014): 804–809, https://doi.org/10.1177/0269881114536477.

12. Christian P. Müller et al., “Brain Membrane Lipids in Major Depression and Anxiety Disorders,” Biochimica et Biophysica Acta (BBA): Molecular and Cell Biology of Lipids 1851, no. 8 (2015), 1052–1065, https://doi.org/10.1016/j.bbalip.2014.12.014

13. E. Sublette et al., “Meta-Analysis of the Effects of Eicosapentaenoic Acid (EPA) in Clinical Trials in Depression,” Journal of Clinical Psychiatry 72, no. 12 (2011): 1577–1584, https://doi.org/10.4088/JCP.10m06634

14. R. J. Mocking et al., “Meta-Analysis and Meta-Regression of Omega-3 Polyunsaturated Fatty Acid Supplementation for Major Depressive Disorder,” Translational Psychiatry 6, no. 3 (2016): e756–e756, https://doi.org/10.1038/tp.2016.29.

15. Giuseppe Grosso et al., “Role of Omega-3 Fatty Acids in the Treatment of Depressive Disorders: A Comprehensive Meta-Analysis of Randomized Clinical Trials,” PLoS ONE 9, no. 5 (2014): e96905, https://doi.org/10.1371/journal.pone.0096905.

16. J. Mocking et al., “Meta-Analysis and Meta-Regression of Omega-3 Polyunsaturated Fatty Acid Supplementation for Major Depressive Disorder,” Translational Psychiatry 6, no. 3 (2016): e756–e756, https://doi.org/10.1038/tp.2016.29.

17. M. E. Sublette et al., “Meta-Analysis of the Effects of Eicosapentaenoic Acid (EPA) in Clinical Trials in Depression,” Journal of Clinical Psychiatry 72, no. 12 (2011): 1577–1584, https://doi.org/10.4088/JCP.10m06634

18. J. Mocking et al., “Meta-Analysis and Meta-Regression of Omega-3 Polyunsaturated Fatty Acid Supplementation for Major Depressive Disorder,” Translational Psychiatry 6, no. 3 (2016): e756–e756, https://doi.org/10.1038/tp.2016.29.

19. Brenda C. Davis and Penny M. Kris-Etherton, “Achieving Optimal Essential Fatty Acid Status in Vegetarians: Current Knowledge and Practical Implications,” American Journal of Clinical Nutrition 78, no. 3 (2003): S640, https://doi.org/10.1093/ajcn/78.3.640s.

20. Erik Messamore and Robert K. McNamara, “Detection and Treatment of Omega-3 Fatty Acid Deficiency in Psychiatric Practice: Rationale and Implementation,” Lipids in Health and Disease 15, no. 1 (2016): 6, https://doi.org/10.1186/s12944-016-0196-5.

21. Sheldon Saul Hendler and David M. Rorvik, PDR for Nutritional Supplements (Montvale, NJ: Thomson Reuters, 2008), 213.

22. R. J. Mocking et al., “Meta-Analysis and Meta-Regression of Omega-3 Polyunsaturated Fatty Acid Supplementation for Major Depressive Disorder,” Translational Psychiatry 6, no. 3 (2016): e756–e756, https://doi.org/10.1038/tp.2016.29.

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