Omega-3 and Magnesium: Can They Help with Antidepressant Withdrawal?
By Layne A. Gritti, DO
Board Certified Adult and Addiction Psychiatrist, Fellowship Trained Reproductive Psychiatrist
Often there is a need or want for a patient to stop an antidepressant. For some antidepressants, like fluoxetine, this is easy. For other antidepressants, such as venlafaxine, this is notoriously difficult and uncomfortable with symptoms such as malaise, fatigue, nausea, achiness, and more. When discontinuing antidepressants, many people search for ways to minimize potential withdrawal symptoms, referred to as “discontinuation syndrome.” Two supplements recently began appearing on social media claiming to minimize these symptoms: high-dose omega-3 fatty acids and magnesium. Both have been studied for their potential benefits in treating depressive symptoms, but is there any evidence to support their use specifically for minimizing discontinuation syndrome?
Magnesium supplementation has been studied extensively for its effects on mood, especially for those with magnesium deficiency. Several studies, including randomized clinical trials, have shown that magnesium can help reduce depressive symptoms in adults. For example, a clinical trial demonstrated that magnesium chloride significantly improved depression and anxiety symptoms in adults with mild-to-moderate depression. Additionally, a systematic review and meta-analysis supported the idea that magnesium supplementation could improve depression scores. However, these studies focus on general depressive symptoms and do not address discontinuation syndrome. There are no studies that specifically focus on it.
Omega-3 fatty acids (aka Omega-3s), particularly eicosapentaenoic acid (EPA), have also been studied as a treatment for depression. Some research suggests that omega-3 supplements can be beneficial for depressive symptoms, but the evidence is mixed when used alone. However, when used in addition to another medication (aka “augmenting”), such as a selective serotonin reuptake inhibitor (SSRI) or serotonin-norepinephrine reuptake inhibitor (SNRI), they can be helpful, especially for patients with elevated inflammatory biomarkers. They are also used in the treatment of attention deficit hyperactivity disorder (ADHD), borderline personality disorder, schizophrenia, and general irritability. They might even help as an augmenting agent for bipolar depression. Unfortunately, there is currently no direct evidence supporting the use of omega-3s specifically to minimize discontinuation syndrome for anti-depressants.
Does that mean you should ditch these supplements or shouldn’t try them when discontinuing antidepressants? No. It just means we don’t know if they can be helpful in discontinuation syndrome because it hasn’t been studied. Could they be helpful? Maybe. Would it be harmful to try them? Probably not. They actually may be beneficial for the reasons above and more. Omega-3s, particularly, are essential fats that are crucial for maintaining overall health. Because the body cannot produce them on its own, it's vital to obtain these fats through diet or supplementation.
The benefits of omega-3s are wide-ranging, from reducing triglycerides and raising healthy cholesterol levels, which can decrease the risk of heart attack and stroke. Omega-3s have also been linked to better cognitive development in infants, enhanced reading scores in children, and reduced symptoms of ADHD. Additionally, these fats reduce inflammation, improve bone health by boosting calcium levels, and even alleviate menstrual cramps more effectively than ibuprofen. Recent studies also suggest that omega-3 supplementation as part of a Mediterranean diet may help improve acne, adding yet another benefit to their long list of health advantages. Whether through diet or supplements, incorporating omega-3s into your daily routine can provide significant benefits for both your physical and mental well-being.
In my experience, individuals often begin taking a supplement with good intentions but may discontinue it after a few months, either because they forget to reorder it or because they don’t perceive a significant difference in their well-being. The effects of supplements are typically more subtle and can be challenging to quantify in terms of tangible benefits. This is where working with a professional becomes valuable, as regular monitoring and reassessment of symptoms, such as those related to depression, are recommended.
Magnesium supplementation can be particularly confusing because there are many types of magnesium. Your local supplement aisle you may see: magnesium glycinate, magnesium taurinate, magnesium oxide, magnesium chloride, and magnesium aspartate. All these different types of magnesium have been studied and shown to be effective with doses ranging from 120 mg to 500 mg per day and continued for at least 6 to 8 weeks to observe for improvements in depression. However, the specific dose and duration may vary depending on the type of magnesium and based on the individual patient’s response.
Omega-3 supplementation can be just as confusing. Between the dosing of EPA and docosahexaenoic acid (DHA) and the total dose of the omega-3s (mg of EPA + mg of DHA = total omega-3 dose), what is the right one to choose? Sometimes other omega-3 fatty acids such as docosapentaenoic acid (DPA) is thrown into the supplement too (DPA may have some potential benefits for general health but not depression). For improving depressive symptoms, the data supports a daily dose of 1500 mg to 2000mg of total omega-3 fatty acids with the EPA being at least twice as much as DHA. For example, a supplement may have 1,350 mg of EPA + 600 mg of DHA + 150 mg of DPA. Therefore, the total omega-3 dose is 2,100 mg. However, someone with inflammation may have more benefit at 4000mg total daily. It’s essential to keep in mind the importance of working with the healthcare professional. For example, patients on anticoagulant and antiplatelet medication may require additional monitoring if they take an omega-3.
There are lots of concerns with supplements as well. Issues include lack of regulatory oversight, questionable efficacy, potential safety risks, interactions with medications, and misleading marketing. These factors necessitate careful consideration and monitoring by healthcare providers. Supplements may be contaminated with harmful substances or may not contain the advertised active ingredients. Supplements are often marketed with exaggerated claims that are not supported by scientific evidence. This can mislead patients into believing that these products are effective and safe. Websites like ConsumerLab.com Provide independent test results and information to help people identify quality health and nutrition products.
In conclusion, while omega-3 fatty acids and magnesium offer various health benefits and have shown promise in managing depressive symptoms, their role in minimizing antidepressant discontinuation syndrome remains uncertain due to the lack of specific research. This does not mean they are without value during the withdrawal process. Given their overall benefits, they may still be worth considering as part of a broader strategy to support mental and physical well-being. As always, it's essential to consult with a healthcare professional before starting any new supplement, especially during a period of medication discontinuation, to ensure safety and effectiveness tailored to individual needs.
To have assistance with supplements and with antidepressant withdrawal, we are at your service at Sweetgrass Psychiatry if you are in the state of South Carolina. We have locations in Mount Pleasant, SC and Isle of Palms, SC.
