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Nutr Neurosci. 2019 Jan;22(1):63-71. doi: 10.1080/1028415X.2017.1354540. Epub 2017 Jul 28.

Differences between Japan and Taiwan in the treatment of pregnant women with depressive symptoms by omega-3 fatty acids: An open-label pilot study.

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a Department of Obstetrics and Gynecology , Tokyo Medical University , Tokyo , Japan.
b National Institute of Mental Health, National Center of Neurology and Psychiatry , Tokyo , Japan.
c Department of Psychiatry & Mind-Body Interface Laboratory (MBI-Lab) , China Medical University Hospital & College of Medicine, China Medical University , Taichung , Taiwan.
d Department of Public Health, Faculty of Medicine, University of Toyama, Toyama, Japan.
e Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Miyagi, Japan.
f Department of Rehabilitation, Faculty of Health Science, Tohoku Fukushi University, Miyagi, Japan.
g Division of Clinical Neuroscience, Chiba University Center for Forensic Mental Health, Chiba, Japan.
h Department of Medicine, Toyama Jonan Onsen Daini Hospital, Toyama, Japan.
i Division of Health Care Research, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan.



Although safe approaches for improving depression in pregnancy are required and the efficacy of omega-3 polyunsaturated fatty acids (PUFAs) has been suggested, the amount of supplemental omega-3 PUFAs has varied among previous studies and adequate amount might be different among countries. The aim of this pilot study is to explore the feasibility of using 1800 mg of omega-3 PUFAs supplementation for our future double-blind, placebo-control trial, and to clarify the clinical difference and the similarity between two sites of Japan and Taiwan.


Pregnant women between 12 and 24 weeks' gestation with depressive symptoms were recruited. Participants were supplemented daily with omega-3 PUFAs capsules containing 1206 mg eicosapentaenoic acid and 609 mg docosahexaenoic acid for 12 weeks. The primary outcome was change in total score on the 17-item Hamilton Rating Scale for Depression (HAMD) at 12 weeks after supplementation.


Eight pregnant women in Japan and five in Taiwan participated in the study. A substantial proportion of pregnant women reported high consumption of omega-3 supplements and dietary fish were excluded in Taiwan rather than in Japan sites. The decrease in HAMD score from baseline to 12 weeks after the start of the intervention was significantly larger in Japanese participants than in Taiwanese participants (Wilcoxon rank sum test; P = 0.045).


The improvement of depressive symptoms was smaller at the Taiwan site than at the Japan site. Differences in psychopathology of recruited participants identified by self-rating scales might affect the degree of population heterogeneity and the treatment efficacy. A randomized-controlled trial is needed to confirm these findings.

TRIAL REGISTRATION: Identifier: NCT01948596.


Clinical trial; Cultural difference; Depressive symptoms; Eicosapentaenoic acid; Nutritional psychiatry; Omega-3 fatty acids; Pregnant women; Prevention

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