About UsOur servicesPublicationsSample taking & ShipmentLinks & MediaFAQ

HS-Omega-3 Index and psychiatric diseases


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low HS-Omega-3 Index in children with ADHD, and a therapeutic effect of EPA plus DHA (Widenhorn-Müller et al, 2014, and unpublished data).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.

Depression in adolescents

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).

Depression in adults

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).

Other psychiatric diseases

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%.


Amin AA, Menon RA, Reid KJ, Harris WS, Spertus JA. Acute Coronary Syndrome Patients With Depression Have Low Blood Cell Membrane Omega-3 Fatty Acid Levels. Psychosom Med 2008;70:856-62.
Ali S, Garg SK, Cohen BE, Bhave P, Harris WS, Whooley MA. Association between omega-3 fatty acids and depressive symptoms among patients with established coronary artery disease: Data from the Heart and Soul Study. Psychother Psychosom. 2009;78:125-7.
Baghai TC, Varallo-Bedarida G, Born C, Häfner S, Schüle C, Eser D, Rupprecht R, Bondy B, von Schacky C. Major depression is associated with cardiovascular risk factors and low Omega-3 Index. J Clin Psychiat 2011;72:1242-7
Bondi CO, Taha AY, Tock JL, Totah NK, Cheon Y, Torres GE, Rapoport SI, Moghaddam B. Adolescent behavior and dopamine availability are uniquely sensitive to dietary omega-3 fatty acid deficiency. Biol Psychiatry. 2014;75:38-46
Carney RM, Freedland KE, Rubin EH, Rich MW, Steinmeyer BC, Harris WS. Omega-3 Augmentation of Sertaline in Treatment of Depression in Patients with Coronary Heart Disease JAMA 2009;302:1651-53.
Carney RM, Freedland KE, Stein PK, Steinmeyer BC, Harris WS, Rubin EH, Krone RJ, Rich MW. Effect of Omega-3 Fatty Acids on Heart Rate Variability in Depressed Patients with Coronary Heart Disease. Psychosom Med 2010;72:748-54.
Gillies D, Sinn JKh, Lad SS, Leach MJ, Ross MJ. Polyunsaturated fatty acids (PUFA) for attention deficit hyperactivity disorder (ADHD) in children and adolescents. Cochrane Database Syst Rev. 2012;11;7:CD007986
Grosso G, Pajak A, Marventano S, Castellano S, Galvano F, Bucolo C, Drago F, Caraci F. Role of omega-3 fatty acids in the treatment of depressive disorders: a comprehensive meta-analysis of randomized clinical trials. PLoS One. 2014;9:e96905.
Hawkey E, Nigg JT. Omega-3 fatty acid and ADHD: blood level analysis and meta-analytic extension of supplementation trials. Clin Psychol Rev. 2014;34:496-505
Hibbeln JR, Gow RV. The potential for military diets to reduce depression, suicide, and impulsive aggression: a review of current evidence for omega-3 and omega-6 fatty acids. Mil Med. 2014;179(11 Suppl):117-28
Jamilian H, Solhi H, Jamilian M. Randomized, placebo-controlled clinical trial of omega-3 as supplemental treatment in schizophrenia. Glob J Health Sci. 2014;6(7 Spec No):103-8.
Lin PY, Huang SY, Su KP. A meta-analytic review of polyunsaturated fatty acid compositions in patients with depression. Biol Psychiatry. 2010;68:140-7
Long SJ, Benton D. A double-blind trial of the effect of docosahexaenoic acid and vitamin and mineral supplementation on aggression, impulsivity, and stress. Hum Psychopharmacol. 2013;28:238-47.
Montgomery P, Burton JR, Sewell RP, Spreckelsen TF, Richardson AJ. Low blood long chain omega-3 fatty acids in UK children are associated with poor cognitive performance and behavior: a cross-sectional analysis from the DOLAB study. PLoS One. 2013;8(6):e66697
Nemets H, Nemets B, Apter A, Bracha Z, Belmaker RH. Omega-3 treatment of childhood depression: a controlled, double-blind pilot study. Am J Psychiatry. 2006;163:1098-100
Park Y, Kim M, Baek D, Kim SH. Erythrocyte n-3 polyunsaturated fatty acids and seafood intake decrease risk of depression: Case-control study in Korea. Ann Nutr Metab 2012;61:25-31
Pottala JV, Churchill SW, Talley JA, Lynch DA, von Schacky C, Harris WS. Red Blood Cell Fatty Acids are Associated with Depression in a Case-Control Study of Adolescents. Prostaglandins Leukot Essent Fatty Acids 2012;86:161-5
Raine A, Portnoy J, Liu J, Mahoomed T, Hibbeln JR. Reduction in behavior problems with omega-3 supplementation in children aged 8-16 years: a randomized, double-blind, placebo-controlled, stratified, parallel-group trial. J Child Psychol Psychiatry. 2014, e-pub Aug 22.
Sarris J, Mischoulon D, Schweitzer I. Omega-3 for bipolar disorder: meta-analyses of use in mania and bipolar depression. J Clin Psychiatry. 2012;73:81-6
Schuchardt JP, Huss M, Stauss-Grabo M, Hahn A. Significance of long-chain polyunsaturated fatty acids (PUFAs) for the development and behaviour of children. Eur J Pediatr. 2010;169:149-64
Stoffers JM, Lieb K. Pharmacotherapy for borderline personality disorder--current evidence and recent trends. Curr Psychiatry Rep. 2015;17:534.
Sublette ME, Ellis SP, Geant AL, Mann JJ. Meta-analysis of the effects of eicosapentaenoic acid (EPA) in clinical trials in depression. J Clin Psychiatry. 2011;72:1577-84
Swenne I, Rosling A, Tengblad S, Vessby B. Omega-3 polyunsaturated essential fatty acids are associated with depression in adolescents with eating disorders and weight loss. Acta Paediatr. 2011;100:1610-5
Voggt A, Berger M, Obermeier M, Löw A, Seemueller F, Riedel M, Moeller HJ, Zimmermann R, Kirchberg F, Von Schacky C, Severus E. Heart rate variability and Omega-3 Index in euthymic patients with bipolar disorders. Eur Psychiatry. 2015;30:228-32
Widenhorn-Müller K, Schwanda S, Scholz E, Spitzer M, Bode H. Effect of supplementation with long-chain ω-3 polyunsaturated fatty acids on behavior and cognition in children with attention deficit/hyperactivity disorder (ADHD): A randomized placebo-controlled intervention trial. Prostaglandins Leukot Essent Fatty Acids. 2014;91:49-60