Something Fishy About Fish-Oils, Menopause and Depression?

Here’s a nice Medscape review (although, fair warning, you must register to access the article!) of both the existing data, and a well-designed current study that looks at whether or not fish-oils can improve depressive symptoms in perimenopausal women. The problem is, some of the results were…well…kind of fishy.

See, the authors begin by giving you a nice, detailed review of the data on whether or not there really is an increase in depressive symptoms with menopause and conclude there’s no good answer to that question, other than the fact that whatever symptoms there are, it tends to resolve a year after menopause is over – that’s not a fishy conclusion, but a generally widely regarded one.

However, the authors then review a recent study in detail that shows:

1) fish oils signficantly improve depressive symptoms in menopausal women WITHOUT  a history of major depression

2) BUT fish oils do no better than placebo in treating depressive symptoms in women WITH a history of major depression

Based on those two results, the authors conclude that the results do not support recommending fish oil. Wait? Hello?

See the same thing in their own words (E-EPA is an abbreviation for a specific type of fish-oil, ethyl-eicosapentaenoic acid):

• Depressive symptoms are more common in the perimenopausal period, although the prevalence of depression among women does not increase significantly after menopause.
• In the current study, E-EPA failed to improve psychological distress and measures of depression in a cohort of middle-aged women with moderate-to-severe psychological distress at baseline.
• However, when the study analysis was limited to women without a major depressive episode, E-EPA was associated with significant improvements in psychological distress and depression scores.
• The body of clinical data regarding the efficacy of fish oil in improving mood is mixed and does not currently support a recommendation to use fish oil for this indication.

Personally, I’d come up with a different (let’s say “opposite”) conclusion. Why? Fish oils are generally well tolerated, with minimal-to-no side effects. Fish oil is reasonably afffordable and widely available. It would be no surprise (to me) if fish oil was less effective in women with a history of major depression – given the assumption that these women possibly may have a slightly different “type” of depression during menopause (worse, more refractory, more genetic – pick your choice). The fact that placebo helped these same women with a history of major depression should also not be a surprise to researchers (see the recent Doc Gurley post Embrace Your Placebo Effect? for more).

Finally, the researchers seem to have completely neglected (in the way one-topic, narrow-focus researchers tend to!) the fact that fish oils have many other potential health benefits BESIDES improving depressive symptoms in peri-menopausal women WITHOUT a history of major depression. While I can’t give out individual medical advice, my personal take home message/interpretation, with these same study results, would be:

For all serious depression, see your doctor! But if you don’t have a history of major depression, and do have relatively minor depressive symptoms when your periods begin to stutter, try fish oils – if there’s no improvement, see your doctor. If you do have a history of major depression, and you start to feel down when your menopause kicks in, see your doctor – you don’t want to wait until your symptoms get severe.

On a side note, omega-3 fatty acids (a completely different kind of oil) were also associated with reduced depression – which leads us all to wonder – have you had your oil checked lately?

Hmm – was I the only one who thought those conclusions were fishy? Weigh in with the comments section below.