What would you think is the leading cause of disability worldwide? Arthritis? Back pain? Maybe cancer or heart disease? Good guesses all, but no free passes to Coachella for you.
The leading cause of disability worldwide is depression, which in turn is a major contributor to some of those other major causes of disability you might have just tossed out there as guesses.
And don't think the U.S. gets a pass, that it's all sunny in Philadelphia or, for that matter, all sunny in any American city. Next to China and India, the U.S. is the most depressed country in the world, and 10% of all doctor visits are some way related to depression.
There are, of course, plenty of treatments for depression, the most common being cognitive therapy (sitting down with a therapist for an indeterminate amount of time) and prescription drugs. Hormone therapy can also have some beneficial effects in some cases, as can IV ketamine and lots of other less common treatments.
When all else fails, they often try doing the watered-down Frankenstein's monster thing where they hook electrodes to the side of the patient's head and zap it with current to cause a 30 to 60 second brain seizure, the goal being to "normalize" the patient in 6 to 12 treatments.
But nearly one third of patients don't respond to any therapy, and for those that do, the remission rates are downright... well, depressing.
Clearly what's needed is for medicine to look elsewhere for answers and there's one clue that's caught the attention of a lot of researchers: the fact that depression is a lot less common in countries where people eat a lot of fish.
What Does the Research Show?
The anti-depressive properties of fish have to do with its rich (at least in certain species) complement of omega-3 fatty acids, specifically, docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA).
You may know all about the anti-inflammatory effects of these fatty acids in general, how they have anti-platelet activity and improve heart function in general, or that they improve the outcome of critically ill patients with lung injury or acute respiratory distress syndrome, or any of a hundred other proven or purported benefits.
The role of fatty acids in treating depression isn't as well known, which is a little odd since one of the first studies to look at the connection between fish oil and mental disorders was completed in 1999. In it, researchers gave fish oil to 30 manic depressives and 64% of them reported marked improvement, as compared to 19% on placebo.
Since then, more than 30 clinical trials have been undertaken, most showing unequivocally that fish oil helps treat depression. A number of them did, however, use fish oil as an add-on for people who were already taking prescription antidepressants with limited or no benefit. Somehow, the fish oil helped the antidepressants do what they otherwise couldn't.
But there have been a number of studies where fish oil worked fine just on its lonesome, showing beneficial effects in treating ordinary depression, borderline personality disorder, obsessive compulsive disorder, postpartum depression, and attention deficit disorder.
A meta-analysis of 10 different trials found that fish oil even had a significant effect on people with bipolar disorder where it smoothed out the mood swings that are characteristic of the mental disorder.
Even mentally troubled children and adolescents have seen benefits from fish oil. It's even believed to "protect" people from thoughts of suicide.
Then there's the observational, Sherlock Holmesian-type evidence. Joseph Hibbeln, a psychiatrist at the NIH, thinks that omega-3 fatty acids, or the lack thereof, might help explain why the U.S. rate of depression is rising.
Since Americans are all babadooked-out about saturated fats and cholesterol, they've been eating less red meat and eggs, which are normally pretty good sources of omega-3s. They've also been switching to using oils like corn, soybean, and sunflower, which are all anemic when it comes to omega-3s.
Of course, you can't rule out the psychic devastation caused by plain old modern living when it comes to the increasing rate of depression, i.e., social strife, politics, the economy, social distancing, inequality, the TV news, etc.
How Does Fish Oil Help With Depression?
There are at least three ways omega-3 fatty acids may help with cognitive disorders. The first and most basic has to do with the anti-inflammatory effect omega-3s have on neural cells, which has a direct affect on depression.
A second mechanism involves cell permeability. The cell membranes themselves are partly made up of omega-3s, so adding more omega-3s to the mix, courtesy of fish, other high omega-3 foods, or fish oil supplements, makes the cell membrane squishier, i.e. more permeable.
This increased permeability allows serotonin – the "feel good" chemical that carries messages from one brain cell to another – to more easily pass through the membranes.
The third mechanism is a little more complicated, but it involves indirect membrane modification through the modification of signaling proteins.
What Kinds of Doses Are We Talking About?
The doses of fish oils used in clinical studies range from 0.5 grams a day all the way up to 10 grams a day, but the high end of that range is an outlier, used in a study of bipolar patients for whom the researchers figured they had to pull out the really big fish-oil guns.
One randomized study tried to determine whether 1 gram a day, 2, or 4 worked the best and they settled on 4. Another compared those same amounts and found that 1 gram a day worked best.
Most, however, agreed that 1 to 2 grams a day works best in combating depression.
Are There Any Side Effects I Need to Worry About?
Nearly all of the prescription drugs used to treat depression and other cognitive disorders have significant side effects, from minor things like nausea, dry mouth, constipation, and fatigue to more serious things like loss of sexual desire, erectile dysfunction, and, seemingly paradoxically, increased thoughts of suicide.
Fish oils, however, have no known serious side effects, although caution should be used in people taking blood thinners or about to undergo surgery, as omega-3 fatty acids are natural anti-coagulants.
Can I Just Start Eating Lots of Fish?
Here's where the fish waters get murky. The trouble is, fish vary enormously in their fatty acid content, with coldwater fish (salmon, trout, herring, mackerel, etc.) being the fatty acid champs.
So sure, if you ate three or four servings (3.5 ounces per serving) of one or more of those species of fatty fish a week, it might go a long way in treating depression and you probably wouldn't need to take fish oil supplements.
But, like most things, it's not that easy.
For one, you sometimes don't know if the fish you're eating is wild or farm raised, and there can be stark differences in the two, nutrition and health-wise. It's generally believed that wild fish, salmon for instance, have higher levels of omega-3 fatty acids than farm raised.
However, fish farmers have, of late, been telling consumers that their fish are higher in omega-3 fatty acids. It's possible, but it comes down to the individual farmers. Most feed fish high-protein pellets when they're young, but switch to the more expensive fish and fish-oil enhanced pellets later in the fish's lifespan.
When they make the switch is highly individual, thus preventing anyone from knowing with any certainty what exactly the fish are ingesting, omega-3 fatty acid-wise.
One study found huge variations in the amount of fatty acids in two farm-raised varieties of salmon as the omega-3 content ranged from 717 mg to 1533 mg per 3.5 ounce serving. That's a difference of over 100%!
If someone forced me to make a recommendation by threatening to hit me in the head with a frozen mackerel, I'd recommend splitting the difference by eating farm-raised at restaurants (especially since that's all most of them serve, anyhow) and wild at home.
But even that approach is somewhat dicey. As I said, it's hard to know how many omega-3s you'd be getting in a meal, and eating fish 3 or 4 times a week might be challenging for all but the most devout pescatarian. Taking a fish oil supplement may be a lot easier and definitely a lot more consistent, dosage wise.
A More Realistic Approach
Biotest's entry in the fish oil market is Flameout® (named for its anti-inflammatory effect), which, to my knowledge, is the most concentrated omega-3 fatty acid supplement available.
It has the following attributes that make it more than worthy of your consideration:
- It contains highly concentrated forms of the purest fatty forms of DHA and EPA (re-esterified triglycerides). You'd have to double or triple the dosages of similar products to even come close to one serving of Flameout® (4 capsules).
- Flameout®'s been purified by molecular distillation and stringently tested for PCBs, dioxins, mercury, and other heavy-metal contaminants.
- Due the unique self-emulsifying delivery system, Flameout® softgels are better absorbed than almost any other formulation and it's virtually odorless. There's no fishy aftertaste or "fish burps."
Do You Need Fish Oil?
Sometimes, temporary depression is perfectly normal. Who among us is immune to feeling a little blue from being unemployed, a breakup, loss of a loved one, social isolation, or any one of thousands of other of life's major or minor irritants?
However, depression that has nonspecific underpinnings or that won't let up might need to be treated, and using fish oil in an attempt to ameliorate it seems like a sane, low-risk approach that's pretty easy to put into action.
- Dennis Cladis, "Fatty Acid Profiles of Commercially Available FinFish in the United States," Lipids, 2014 Oct;49(10):1005-18.
- Julie Corliss, "Finding omega-3 fats in fish: Farmed versus wild," Harvard Health Publishing, December 23, 2015.
- Gertsik, et al. "Omega-3 Fatty Acid Augmentation of Citalopram Treatment for Patients With Major Depressive Disorder," Journal of Clinical Psychopharmacology, February 2012, Volume 32, Issue 1, pp. 61–64.
- David Mischoulon, MD, PhD, "Omega-3 fatty acids for mood disorders," Harvard Health Publishing, August 03, 2018.
- Mansoor Burhani and Mark Rasenick, "Fish oil and depression: The skinny on fats," J Integr Neurosci, 2017, 16(Supp 1): S115-124.