FISH OIL FOR DEPRESSION.  (This information sheet is somewhat disorganized and redundant because I have added it and altered it over the years).  (The best source of EPA is fish oil  The other excellent source is eating the brain. Animals have the amount of EPA and DHA  that we should have.   In contrast to us, cows can manufacture their own EPA and DHA.)   For depression take EPA  (also called ethyl eicosapentaenoic acid,E-EPA, icosapent ethyl) 1-2 grams per day.  It would be better to use much more for the first month. If it seems to help, then try lower doses.  For 20 years one of my patients has required 18 pills per day  of fish oil for — the equivalent of about 6 grams of EPA.  [EPA may constitute only 1/3 of one gram [1000mg].

• Andrew Stoll used 9.6 grams of omega-3 fats in 1999. That was the first double-blind study showing that fish oil helps depression. The results were dramatically positive. He was using all the omega-three fats that fish oil and did not court what portion was EPA, which we have since found his own omega three that depression helps depression.  If you take regular fish oil pills that would be well over 10 pills, maybe close to 18 pills.  If you take pure EPA pills, I do not know what the amount would be, but probably 6 to 10 pills.
• The eminent Robert Post, MD said,  “If you just count the EPA, then the dose should be at least 1 to 2 grams/day;  if you are counting the EPA plus DHA, the total should be more like 2 to 5 grams.”
• For heart attacks and stroke, 4 grams of EPA per day significantly decreased cardiovascular events in patients with high triglycerides.  —Bhatt, 1/3/19, p 11, NEJM

Omega via—a small 500mg/pill with 500mg of EPA in it, so 3 to 4  pills may be enough for depression, but try to take a much higher dose the first month.  It is a smaller capsule than generic fish oil, but with more EPA— the only fat that helps depression.   DHA has no antidepressant effect.  Ordinary fish oil pills have both EPA than DHA.     There is are other brands with only EPA. 

• SOME TIME, PICK A WEEK, AND FOR THAT ONE WEEK INCREASE THE FISH OIL DRAMATICALLY TO 6 TO 7 PILLS /DAY.  when it works for depression, it often works in < one week in my experience, so a one week trial is usually enough to find out if you need more. But if you can stomach it, take it 2-4 weeks in high dose.  It is only a food.

          Benefit for depression is frequently in  ≤ one week.  Since it may take a long time for fish oil to replace corn oil (omega 6’s) in the brain, it may take months for fish oil to have maximum benefit. -rdm    —–22% of our brain [without the water] is made of  two omega essential fatty acids: EPA and DHA. They are called essential because we need them and we don’t make them. The brains of other mammals also have a huge amount EPA and DHA –but cows, for instance, can make their own. There are omega 3’s from land plants [e.g., flax seed oil and canola oil], but they are 18 carbons long and the brain will only use them if they 20 carbon long.  It is interesting that ocean plants have 20 carbon long omega 3.    45% of the walls [where all transmission occurs]  of brain cells is made of EPA and DHA.  We get EPA and DHA when we eat meat or eggs, but we now eat so much corn oil and olive oil, that those fats [omega 6’s] are used in a large extent by the brain instead of the EPA and DHA.  Corn oil is in everything—e.g., it is what keeps bread from getting hard in one day.   We eat 12 to 15 times as much omega 6’s as we do omega 3’s, whereas the ratio a hundred years ago may have been 4:1.

• Y.I.: These are my previous usual instructions if I am having people use omega 3 essential fatty acids [found in the fatty oils of  ocean fish] to aggressively  treat or prevent depression:
• Do omega 3’s —e.g., 5-7 fish oil pills per day—aggressively for 3 months, and then maybe we will stop them abruptly to evaluate if they were working [if every time you stop fish oil you slump and if you recover when you restart, we know it is helping].   You could skip the fish oil pills the days you eat ocean fish.  EPA plus DHA should equal 2-5 grams per day = 2000 to 5000mg.   The EPA (eicosapentaenoic acid) should be maybe double the DHA  (docosahexaenoic acid) .  If 2 capsules is a “serving”  containing EPA 300mg and DHA 200mg , you are only getting 500mg per two capsules. So you would need 8 capsules to get 2 grams, and 20 capsules to get 5000mg.   If eat fish instead of taking pills, then you need to average a minimum of 2 ounces per day, but 4 to 6 ounces is preferable.   4 ounces of ocean fish gives you about 2 grams=2000mg of the omega 3’s, which is usually equal to about 4 capsules.   So, you would need to eat about 4 to 10 ounces of ocean fish per day for a good antidepressant effect.]
• Twin EPA is a brand with a high amount of EPA and DHA. It  has total of 840mg of EPA and DHA.  NordicNaturals.com  has a brand called Ultimate Omega 3 has 550mg of  EPA plus DHA in each capsule.   Liquid Ultimate Omega has 1376mg in each teaspoon.  Note: EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid) are the omega 3’s found in ocean fish, and they are the very omega 3’s we preferentially use as building blocks to build the walls of brain cells.  EPA is the more important one for depression.  [I have heard it said that DHA is more important in brain development, such as in fetuses and infants.]    The omega 3’s found on land (e.g., from flax seed oil and canola oil) are only 18 carbons long whereas EPA is 20 carbons long and DHA is 22 carbons long.  Basic scientists think it is unlikely that we efficiently add those 2 carbon atoms to produce the desired EPA and DHA.  Hence, all the research has been done with fish oil, as we know we are getting a substantial amount of the right omega 3’s.   [One ounce =28.35 grams.]

It has been shown [Lancet, vol 369, 2/17/07, pages 578 to 585 that eating 340 grams [12 ounces] or more of fish per week when pregnant significantly raises I.Q., social development and fine motor coordination.  [The FDA wrongly says you should eat less than 12 ounces per week during pregnancy to avoid excessive mercury.   Mercury toxicity is actually quite rare–if you are worried about it, get a mercury level for $20. There is no mercury in fish oil pills—mercury is mainly in the meat, not the fat.] F.Y.I.: re fish oil:    3 tablespoons of fish oil twice a week = ~50 pills/week= ~7 pills/day;  3 tbsps once a week thus = ~ 3-4 pills/day.  They emulsified so there is virtually no fish flavor.  There is no “repeating”.  They flavor it with lemon-lime.   It tastes like oil—like corn oil.  You can wash it down with water immediately.

• Buy some little cups that you can pour in the approximate amount. The fish oil is emulsified into tiny droplets so that the fishy taste is almost eliminated.    It is usually flavored with lemon or lime.  Fish oil lifts depression, reduce heart attacks and Alzheimer’s.  It helps depression either b/o the anti-inflammatory effect or because 22% of the brain is made from EPA and DHA.  These are omega 3 essential fatty acids.  Omega 3’s from land plants do not work for depression because they are 18 carbons long and EPA and DHA are 20 carbons long.
• g., Nutri-Supreme Omega 3 EPA/DHA liquid fish oil – a kosher brand; you want a lot more EPA than DHA in the oil. — If you go to Nutri-Supreme Reseach, 4315 14th Ave, Brooklyn, NY 11219  Phone : 718 853 0644;   888 68NUTRI fax 718 853 4344   egruber.nutrisupreme@verizon.net, then Mr Eliezer Gruber will give you a 50% discount on fish oil or NAC (N-acetyl cysteine) if you say Dr McMullen referred you.

high concentration fish oil is NSI liquid omega-3 purified  17 oz for $17 at www.vitacost.com    www.nordicnaturals.com   has ProOmega-D [with a lemon taste] as well as other choices of high potency fish oil pills. The EPA IS THE OMEGA 3 THAT MATTERS for depression;  NSI brand of fish oil through Vitacost on the internet is high potency   Coromega 3 Squeeze – is tasty and orange flavored—and other flavors.   Omega-3 blood levels are considered deficient at 5% and below. Health omega-3 levels start at 6% with optimum levels between 8%-9%.2/24/2012:  Nutratec from Canada is good?  Nutrasea HP (high potency) is a good liquid brand.   The new Rx Vascepa (vas-EE-puh, icosapent ethyl) will compete with Lovaza and fish oil supplements for lowering triglycerides. Vascepa [and Omegavia] contains only EPA (eicosapentaenoic acid)…instead of both EPA and DHA (docosahexaenoic acid) like Lovaza and most supplements. EPA alone doesn’t increase LDL like EPA/DHA combos can…but it seems a little less effective for lowering triglycerides (TGs). Vascepa 4 g/d lowers TGs about 27% compared to baseline in patients with very high triglycerides. Lovaza 4 g/d lowers TGs about 45%…but sometimes increases LDL. For patients with high triglycerides, emphasize lifestyle changes…weight loss, exercise, limiting alcohol and sugar, controlling blood glucose, etc. Start with a statin if triglycerides are LESS than 500 mg/dL…and patients need one anyway to lower LDL and CV risk. Explain that statins can also reduce triglycerides up to 30%. Save fish oil, fibrates, or niacin for patients with triglycerides OVER 500 mg/dL. There’s no proof that using these drugs to lower triglycerides improves cardiovascular outcomes. Also point out that lowering triglycerides with meds doesn’t seem to decrease pancreatitis risk, unless TGs are over 1000 mg/dL. Use either Lovaza or Vascepa if you want to prescribe fish oil to lower triglycerides. Both cost about $185 a month. Don’t be overly concerned about Lovaza‘s effect on LDL. Most of these patients will be on a statin, which can counteract any LDL increase. If patients want to use a supplement to save money, recommend a USP Verified product to assure quality. Advise them to make sure they get enough omega-3s…most supplements contain less than the Rx products. Simply Right Double Strength Fish Oil w D3 (1200mg + vit D 2000 I.U). – #200. $19  Amazon