Children exposed to a certain condition experience a greater likelihood of problems with behavior, cognitive development and mental health.  They may start life at a disadvantage - born too early or with more complications even before delivery.  This serious condition is maternal depression.

A mother's depression affects her child profoundly.  Treating a mother's depression has a dramatic impact on her child, investigators showed in a recent, large, federally funded study at the University of Arizona.

Children of mothers who recovered from major depression experienced significantly decreased symptoms and diagnosis of mental illness compared with children of mothers who did not respond to treatment over three months.   
Successful treatment of a depressed mother has a rapid effect on a child's mental health. This finding is particularly important considering the controversy over psychiatric medication for children. Mothers and families are burdened by untreated maternal psychiatric problems, including major depressive disorder.

Women of reproductive age are at high risk for depression and other disorders.  With 20 percent of all women experiencing depression, and more than 80 percent of women in the U.S. having children, a great number will experience depression during pregnancy and postpartum.

The risks and benefits of medications are complex. Recent studies have raised concerns about exposure to antidepressants during pregnancy.  For most women with depression serious enough to affect their work, home and relationships, antidepressants remain an important part of treatment considerations.

The ideal option would be to treat depression while providing benefits to mother and child.  Omega-3 fatty acids, common in fish, seafood and fish oil, appear to be an attractive intervention for depression, particularly during pregnancy and postpartum.  That was the tentative finding of an American Psychiatric Association subcommittee I recently headed.  Definitive conclusions cannot be reached on how effective omega-3 fatty acids are for depression, especially as a sole treatment, because of the varying designs of the studies thus far.  The fatty acids have been best studied as an add-on treatment for patients who were on an antidepressant but had not responded.  Omega-3 fatty acids have health benefits for adults, especially in cardiovascular health.  And higher omega-3 fatty acid intake during pregnancy has been associated with better neurodevelopment in infants and toddlers. It may also lengthen gestation and play a role in the prevention of prematurity.  The picture has been complicated, though, by U.S. Food and Drug Administration recommendations on fish intake during pregnancy.

In an aim to decrease in-utero mercury exposure, the FDA recommends pregnant women avoid tilefish, swordfish, shark and king mackerel and limit other seafood intake to 12 ounces per week. Thus fish consumption has declined among pregnant women.  Babies depend on their mothers' omega-3 fatty acids in utero and while nursing. So at the very time mothers need to consume more omega-3 fatty acids, they are eating less than ever.

Over the past seven years, I have been the lead investigator on this research at the UA College of Medicine Women's Mental Health Program.  The omega-3 fatty acids under study are those found in fish and fish oil capsules.  More than 100 women from our community have participated in these studies. Two published studies from this endeavor suggested that omega-3 fatty acid capsules are well tolerated and appear to alleviate up to 50 percent of symptoms of perinatal depression (during pregnancy and postpartum).  However, no placebo groups were used for comparison, so these studies must be considered preliminary.  Results from our larger, placebo-controlled trial are not yet available.  Still, there is plenty to conclude.

Women want and deserve treatment options for major depressive disorder, and for other conditions, that are effective, safe, accessible and acceptable.  One patient articulated this in a way I will never forget. She participated in our pilot study for the maximum time allowed but did not recover from depression.  She and I knew she was receiving omega-3 fatty acids and not a placebo.  At several points, we reassessed her clinical symptoms and offered her other treatments, including medication. She refused and stayed in the study until she concluded breastfeeding.  At that point, she started on an antidepressant and experienced an impressive improvement over several weeks.  I felt terrible that we had postponed this treatment. Asked whether she wished she had started taking it earlier, she looked me straight in the eye and said, "If I would not have been in the omega-3 study, I would have done nothing. There was no way I was going to take an antidepressant while I was pregnant or breast-feeding." 

We can have the most effective treatments for depression, but they don't help anyone if left on the shelf.  We owe it to women and their children to seek meaningful solutions used practically to improve lives.