Epidemiologic studies found deficits of EPA plus DHA in pregnancy and/or lactation in cognitive dysfunctions like attention-deficit hyperkinetic disorder (ADHD), dyslexia, dyspraxia or autism (Schuchardt et al, 2010). Results of studies in which we participated consistently demonstrated a low HS-Omega-3 Index in children with ADHD, and a therapeutic effect of EPA plus DHA (Widenhorn-Müller et al, 2014, and unpublished data). These results are supported by a meta-analysis, demonstrating that children with ADHD have low levels of EPA plus DHA, and that treatment with EPA plus DHA is effective in these children (Hawkey & Nigg, 2014). A previous Cochrane-analysis could not yet have this result (Gillies et al, 2012). Proficiency in reading and emotional stability correlated with blood levels of EPA plus DHA in children, as did aspects of social behavior like oppositional or anti-social behavior (Montgomery et al, 2013). The data are less clear for autism or dyspraxia.

Adolescents with a low HS-Omega-3 Index have an increased risk to develop major depression (Pottala et al, 2012). For one % higher HS-Omega-3 Index, the probability to develop depression was reduced by 28% (odds ratio 0.72; 95%CI 0.55 – 0.95). Similar data were found elsewhere (Swenne et al, 2011). In an intervention trial, omega-3 fatty acids improved symptoms of depression in adolescents (Nemets et al, 2006).

A low HS-Omega-3 Index predisposes to major depression (Amin et al, 2008, Ali et al, 2009, Carney et al, 2009, Carney et al, 2010, Baghai et al, 2011 Park et al, 2012). This is supported by meta-analytic data, demonstrating that low levels of EPA plus DHA, as measured in various fatty acid compartments, predispose to major depression (Lin et al, 2010). Risk of suicide also depends on levels of omega-3 fatty acids: Risk for suicide was 14% higher per standard deviation lower DHA (odds ratio 1,14, 95%CI 1,02 – 1,27, p=0,03), (Gow & Hibbeln 2014). Several meta-analyses found EPA plus DHA to be effective in treatment of major depression (Sublette et al, s2011, Grosso G et al, 2014). A low HS-Omega-3 Index therefore has a causal role in major depression, and we feel that the HS-Omega-3 Index should be in the target range of 8 – 11% in individuals wishing to avoid major depression, as well as in treated patients with major depression.

In patients with bipolar depression, we found the HS-Omega-3 Index in the normal range (Voggt et al, 2014). According to a meta-analysis, the depressive component of bipolar depression in the adult can be improved (Sarris et al, 2012). 

Currently, there is a great interest in the possibility in using EPA plus DHA in children, adolescents and adults for treatment of other psychiatric diseases or problems in social behavior. There are some positive results: Supplementation with EPA plus DHA in children improved their social behavior as well as the delinquency of their parents (Raine et al, 2014). Impulsivity and aggressive behavior were improved (Long et al, 2013). Children and adolescents seem to be specifically sensitive to a deficit in EPA plus DHA, since this deficit interacts with dopamine metabolism in the brain (Bondi et al, 2014). In collaboration with the German army, we investigate the relation of the HS-Omega-3 Index to post-traumatic stress disorder. Other topics currently investigated are borderline personality disorder (Stoffers et al, 2015), schizophrenia, and others, even issues of social behavior (Jamilian et al, 2014, also clinicaltrials.gov).

To summarise, a low HS-Omega-3 Index is a risk for psychiatric diseases like ADHD or major depression throughout life. According to our results, a target range of 8 – 11% for the HS-Omega-3 Index also seems to be optimal to minimized the risk for these psychiatric diseases. Many psychiatric diseases are currently investigated, however intervention trials and their meta-analyses leave no doubt that supplementation with EPA plus DHA is effective in ADHD and major Depression. In view of the uncertainties about the correct dose, we suggest targeting a HS-Omega-3 Index of 8 – 11%.

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