Omega 3 (Fish oil)
CAM (30% of the brain by weight, involved in neuronal cell membranes, neuroprotective)
- Major Depression1
- Non-specific irritability1 and anxiety2
- Hypertriglyceridemia (FDA approved)1
- Autism3
- Bipolar Depression2
- Borderline1
- ADHD3
- Lithium induced psoriasis1 and acne1
Features
Dosing
For all psychiatric disorders except cognitive decline, use a product that is high in EPA (ie, 67-100% EPA or an EPA:DHA ratio of at least 2:1). To prevent cognitive decline, use a product high in DHA (50-100% DHA).
Depression: 1,000-3,000 mg; with inflammation (hs-CRP ≥ 3 mg/L ): 4,000-6,000 mg
Anxiety: 2,000–3,000 mg/day of EPA+DHA
ADHD: 1,000–2,000 mg/day of EPA+DHA (may take up to 4 months) (combine with phosphatidylserine)
Prevention of cognitive decline: 1,000–2,000 mg/day of EPA+DHA (higher DHA)
Elevated triglycerides and psoriasis: 3,000–4,000 mg/day of EPA+DHA
Take with large meal to improve absorption.
$15-20/month.
Management
Advice patient it can improve weight loss among many other medical benefits.
“Omega–3s comprise 30% of the human brain, where they coat and protect brain cells. The brain is derived from the same embryonic cells as the skin, and like the skin—or like a leather chair—it needs oil to stay supple and healthy. Most people don’t get enough omega–3s from their diet, forcing the brain to substitute other oils like cholesterol. On neuroimaging, the brain cells are less flexible, and the person is less flexible as well—more irritable and depressed.”
TOLERABILITY: Fishy burps (improve with enteric coated form, keep in fridge), indigestion.
RISKS: Atrial fibrillation. Anticoagulant (hold 2 weeks before surgery).
MEDICAL BENEFITS: Elevated triglycerides (FDA cleared), hypertension, insulin sensitivity, obesity, migraines, menopausal symptoms, arthritis, muscle strength, fatty liver, inflammatory bowel disease, macular degeneration, dry eyes, retinal disease, psoriasis, acne, periodontitis, cancer prevention.
EMR Text
Depression
Omega-3 use based on multiple, randomized controlled trials and practice guidelines in depression (Guu TW et al, Psychother Psychosom. 2019;88(5):263-273).
Omega-3 side effects reviewed with patient.
Bipolar
Omega-3 use based on randomized controlled trials in bipolar disorder, where it treated depression and prevented new episodes of mania and depression (Psara E et al, Mar Drugs. 2025;23(2):84).
Omega-3 side effects reviewed with patient.
Borderline
Omega-3 use based on randomized controlled trials in borderline personality disorder (Karaszewska DM et al, J Clin Psychiatry. 2021;82(3):20r13613).
Omega-3 side effects reviewed with patient.
Anxiety
Omega-3 use based on randomized controlled trials in non-specific anxiety (Bafkar N et al, BMC Psychiatry. 2024;24(1):455).
Omega-3 side effects reviewed with patient.
Irritability
Omega-3 use based on randomized controlled trials in non-specific irritability and aggression (Raine A et al, Aggress Violent Behav 2024;78:101956).
Omega-3 side effects reviewed with patient.
Metabolic syndrome (weight, triglycerides, HDL, insulin sensitivity, hypertension)
Omega-3 use based on randomized controlled trials where it improved metabolic syndrome on antipsychotics (Goh KK et al, J Psychopharmacol. 2021 ;35(3):221-235). Omega-3’s are FDA approved for hypertriglycerides. They lowers blood pressure and improved weight loss in depression (Keshavarz SA et al, Clin Nutr ESPEN. 2018;25:37-43).
Omega-3 side effects reviewed with patient.
ADHD
Omega-3 use based on small randomized controlled trials in ADHD, where it improves attention, irritability, and mood (Chang JP et al, Neuropsychopharmacology. 2018;43(3):534-545).
Omega-3 side effects reviewed with patient.
Autism
Omega-3 use based on small randomized controlled trials in autism, where it improved social, behavioral, and cognitive symptoms (Sumra B et al, Cureus. 2025;17(3):e80291).
Omega-3 side effects reviewed with patient.
Anorexia
Omega-3 use based on small randomized controlled trials in anorexia, where it improved mood and anxiety (Candido ACR et al, J Hum Nutr Diet. 2023;36(5):1970-1981).
Omega-3 side effects reviewed with patient.