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Background: Rural communities suffer signifi cant disadvantage in accessing mental health services. Conversely, these communities may have greater capacity

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Background: Epidemiological studies assessing rates of postnatal depression in relation to levels of fi sh consumption and reduced levels of omega-3 in the perinatal period indicate a possible link between lowered long-chain omega-3 fatty acids and perinatal depression. Aim: To assess whether omega-3 fatty acid treatment is superior to placebo in the treatment of perinatal depression. Methods: In a double-blind, randomized, placebocontrolled treatment trial, we recruited women from third trimester to 6 months postpartum with a diagnosis of major depression. Treatment was for 6 weeks with either 6 g of fi sh oil or placebo. Weekly followup was carried out by a psychiatrist and depression rating scales recorded. Fatty acid analysis was conducted on blood samples collected at baseline and posttreatment trial. Results: There was signifi cant improvement in depression scores for the treatment group during the trial. However, a repeated-measures ANOVA showed no statistically signifi cant difference between treatment and placebo groups using intention-to-treat analysis. Trend for effi cacy differentiation were noted when nonresponders and rapid remitters were excluded. Conclusions: These results are likely to be affected by a strong placebo response, which is a common problem in clinical trials for the treatment of depression. Further study is needed in this area because treatment options are limited for perinatal depression.