This article was first published on January 20, 2017. It was last reviewed, updated, or edited on December 2, 2023.
Mental health clinicians often recommend omega-3 fatty acid supplements to their patients. But, we need some guidance about which specific product(s) to recommend.
Why is this so important?
It is important to recommend a specific product because:
1. The product must be extremely pure (not contain mercury or other toxins).
2. The product must be manufactured without exposure to oxygen, which causes fish oil to deteriorate.
3. Plant sources do not contain the right EPA/DHA ratio that is recommended for mental health.
4. Taking too much DHA can raise LDL levels.
This is why I don’t recommend just telling the patient to buy “any omega-3” or “any fish oil”.
DON’T recommend the following
The following products are recommended by others but they do not have the high EPA/DHA ratio that is recommended for persons with mood disorders.
1. Lovaza® (also called Omacor®), which is a prescription medication
2. Fish oil from Vital Nutrients® (recommended by a leading guide to alternative medicines in mental health)
Consider recommending the following:
I have spent many hours researching specific omega-3 fatty acid products and consulted experts in complementary medicine.
Here are my top choices:
1. OmegaBrite®
2. ProEPA by Nordic Naturals®
3. Nature Made® brand fish oil is a cheaper alternative to the first two.
Note: This article is for general informational purposes only. Also, the products are listed in no particular order.
OmegaBrite®
From the manufacturer’s website (www.omegabrite.com):
“Developed by Carol Locke, MD while on faculty at Harvard Medical School, OmegaBrite has a specific 7:1 EPA to DHA ratio. Only OmegaBrite provides you with 70% EPA (eicosapentanoic acid)…”
The manufacturer claims that the product is of pharmaceutical-grade quality, etc. (https://www.omegabrite.com/about-us/)
Their signature product for adults is OmegaBrite Gelcaps, which can be bought on Amazon.com using the link below. At one gram of omega-3 per day, i.e., 60 gelcaps per month, the cost per month is about $30.
OmegaBrite, 60 soft gelcaps (500mg)
Nordic Naturals® ProEPA®
The serving size is 2 softgels. Each softgel contains 605 mg of omega-3 of which 425 mg is EPA. So, the ratio of EPA to DHA is more than 2:1, which is good.
Cost: on Amazon.com, 120 count for about $45. At two softgels per day, a one-month supply will cost about $23.
Nordic Naturals ProEPA, 120 Count
Nature Made brand fish oil
Contains 540 mg of omega-3 fatty acids of which 365 mg is EPA. So, the ratio of EPA to DHA is greater than 2:1, which is good. However, the dose of one capsule per day recommended by the manufacturer is probably too low. At least one capsule twice daily with food is probably more appropriate. So, at one gram per day (i.e., two softgels per day), a one-month supply costs about $23.
Nature Made Super Omega-3 Fish Oil Full Strength Softgels, Mini, 60 Count
The same company also offers a “burp-less” version of the product, which is available at the following link:
Nature Made Burp-Less Fish Oil, 1000 mg, 300 mg Omega-3, 150 Liquid Softgels
Don’t get confused—it is 1000 mg of fish oil, which contains 300 mg of omega-3. So, three to four capsules per day should be recommended. Unfortunately, the manufacturer does not list the ratio of EPA to DHA for this product.
Vascepa®
Vascepa is an ethyl ester of eicosapentaenoic acid (EPA) that has an FDA-indication as an adjunct to diet to reduce triglyceride levels in adult patients with severe (≥ 500 mg/dL) hypertriglyceridemia. For that indication, its recommended dose is 4 grams per day taken as four 0.5-gram capsules or two 1-gram capsules twice daily with food.
Vascepa® contains only EPA and no DHA.
It is available by prescription only.
Even the generic version is somewhat expensive—60 capsules of 1 gram each (that is, a one-month supply) costs about $48 according to goodrx.com.
For more on this product, please see the full Prescribing Information.
Related Pages
Which omega-3 fatty acid products should we recommend?
Omega-3 fatty acids in mental health
What are the BEST books on each topic related to psychiatry/ mental health?
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Hello Dr.!
I was curious as to your thoughts on selenium brands? A beloved colleague who has since passed once told me many years ago that selenium 200mcg twice daily was effective in hair loss from divalproex.
I have been taking Vascepa 2g/day because of hypercholesterolemia and extreme sensitivity to statins.I have SCLO1B1 genetic polymorphism. This puts me at a significant higher risk of statin intolerance. My doctor prescribes Vascepa. I have normal triglyceride level. Since taking Vascepa I have developed IBS. Could that be related?
Hi Dr. Mago. Thanks for the great article on omega 3s. I often warn patients about the great potential disparity within the supplement industry with regards to quality control. Therefore, I recommend, and subscribe to myself, a website called ConsumerLab.com that routinely tests supplements for verification of providing what they purport to provide, and whether certain products have been shown to contain potentially harmful contaminants. Highly recommend it, ConsumerLab is akin to the Consumer Reports of the supplement industry. Keep up the good work.
Thanks, Adam! For the same reason, I also subscribe to Consumerlab.com and to Natural Medicines. Best wishes, Raj
Hello sir. Thanks for this nice article. Maudsly prescribing guideline recommend omega 3 fatty acids for negative symptoms of schizophrenia also. They even recommend a brand name Maxepa by Merk pharmaceutical company. I would like to hear your thoughts on this.
Regards,
Shreyas
Simple and Practical Medical Education has not done an independent review of the literature on the use of omega-3 fatty acids in schizophrenia. But, let’s look at what the Maudsley guidelines say. As of March 2020 when I am writing this, the latest edition of The Maudsley Prescribing Guidelines in Psychiatry is the 13th edition. Regarding the possible role of omega-3 fatty acids in schizophrenia, it very briefly reviews the literature and then states: “On balance, evidence now suggests that EPA (2 – 3 g daily) is unlikely to be a worthwhile option in schizophrenia when added to standard treatment.” It also states: “PUFAs are no longer recommended for the treatment of residual symptoms of schizophrenia or for the prevention of transition to psychosis in young people at high risk.” Lastly, in its Recommendations, it states that omega-3 fatty acids are “not recommended” for “residual symptoms of multi-episode schizophrenia (added to an antipsychotic)” or for “patients with high risk of first-episode psychosis”.