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The interaction of omega-3 essential fatty acids and many other medicines, particularly
psychotropic medicines, remains to be studied.
As analyzed by Stoll, the studies as a whole suggest that a high EPA to DHA formula
(Brown et al suggest 2:1, but the usual fish oil concentration is 3:2, and more study is
needed to make a recommendation) of omega-3 essential fatty acids is potentially
beneficial as an adjunctive therapy, with very few side effects, when used with
psychotropic medications. However, a recent trial found no benefit, and the studies are
split. Also, many potential adjunctive medicines remain to be tested. Thus, caution is
advised in considering adjunctive use of omega 3s, even though no interaction has yet
been shown. This requires consultation with the prescribing physician.
Writing in Brown et al. II, Mischoulon, D. and Freeman, M.P. recommend a ratio of 3:2
or greater.^21
In one well-designed 2009 study, published in JAMA, treatment of patients with
coronary heart disease and major depression^ with sertraline (Zoloft) and omega-3 fatty
acids did not result in superior^ depression outcomes at 10 weeks, compared with
sertraline and^ placebo.^22 As stated by the researchers, this study has no bearing on
persons without coronary heart disease, and whether higher doses of omega-3 or
sertraline, a different^ ratio of EPA to DHA, longer treatment, or omega- 3
monotherapy^ can improve depression in patients with coronary heart disease remains
to be determined. It may be that omega-3s are less additive to SSRIs than to tricyclic
antidepressants, or the EPA/DHA formula may require adjustment, although it seems to
have followed the Stoll/Brown et al. ratio.
A 2010 study by Canadian researchers came to the opposite conclusion.^23 In the
Canadian study, the results were inconclusive until persons with anxiety were screened
out. The new figures showed that supplementation with EPA and DHA significantly
reduced the number of major depressive episodes reported by patients with major
depression without a comorbid anxiety disorder. One is left to wonder whether such
screening would affect other studies as well.