Please select the eligibility criteria that correspond to the clinical trial below.
Title: Does EPA or DHA Prevent Depressive Symptoms in Pregnancy and Postpartum?
Brief Summary: This study is designed to test whether an alternative medicine treatment, fish oil, will prevent depressive symptoms in pregnant and postpartum women who have been found to be at risk for depression. Epidemiologists have observed that people who live in countries where people on average eat a diet high in fish have a lower risk of depression than people who live in populations that eat less fish. Postpartum depression is also less common in these countries. The omega-3 fatty acids found in fish oil are thought to be responsible for this beneficial effect of eating fish. The two major omega-3 fatty acids found in fish are eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). DHA is an essential building block of the brain and nerve tissue. EPA may act to optimize the electrical signals between nerve cells and brain cells and may help the immune system to function well.

Some researchers have treated people who are already suffering from depression with fish oil. Some of these studies have shown a benefit for the fish oil treatment and others have not. These studies have tested EPA and DHA alone and in various combinations. Currently, it is not known whether EPA or DHA is more effective in preventing and treating depression. Some of the researchers involved in this study have learned how to identify mothers who are most at risk for developing depression during and after pregnancy. This study is designed to learn whether EPA-rich and DHA-rich fish oil supplements will prevent depressive symptoms in women who are at risk to develop depression.


Options:
A: Inclusion Criteria:- Meet criteria for a current major depressive episode with an HRSD(17) score of at least 14.

* Ambulatory women (age³18) with a viable pregnancy,
* Pregnancy between 22 and 30 weeks of gestation
* Fluent in English

Exclusion Criteria:- Meeting criteria for a primary Axis I disorder in past 2 months, other than unipolar depression or social phobia

* Seasonal affective disorder or episode duration of 2 years or more (chronic depression)
* Abnormal results on a laboratory screen that will include a thyroid panel and a drug screen.
* Serious uncontrolled medical conditions or conditions that may be a medical basis of a depression.
* Cluster B personality disorders.
* Confounding treatments for depression, including any psychotherapy, herbs, or pharmacotherapy.
* Current use of any prescribed psychotropic medication or any medication that impacts mood.
* Treatment with ECT or vagal nerve stimulation during the last year.
* Current active suicidal potential necessitating immediate treatment.
* Absence of prenatal care from an OBGYN practitioner in the community.
* Any condition that necessitates bed rest.
B: Inclusion Criteria:

* German-speaking
* Medically healthy with normal ocular function
* Pregnancy 4 through 32 weeks gestation based on first trimester ultrasound
* DSM-IV diagnosis of major depressive disorder
* SIGH-ADS \[Structured Interview Guide for the Hamilton Depression Rating Scale (HAMD) with Atypical Depression Supplement\] score of \>20
* Able to provide informed consent
* Preferably untreated; exception when on antidepressant for more than 3 months without any improvement, keeping medication constant during the study

Exclusion Criteria:

* DSM-IV diagnoses of bipolar 1 or 2 disorder or any psychotic episode
* Substance abuse within the last 6 months
* Primary anxiety disorder
* Recent history of suicide attempt (6 months)
* Delayed sleep phase disorder or hypersomnia with habitual sleep onset later than 1 a.m. or wakening later than 9 a.m.
* Obstetrical care or medications for medical disorders which might confound treatment results
* Fetal malformations and intrauterine fetal death
C: Inclusion Criteria:

* Ethnic Hong Kong Chinese aged 18 years or above;
* Within 6 months of giving birth;
* Edinburgh Postnatal Depression Scale (EPDS) (Cox et al., 1987) score higher than or equal to 12 or being diagnosed as depressed by their obstetrician;
* Meeting the Diagnostic and Statistical Manual of Mental Disorders-IV diagnosis criteria for major depressive disorder;
* 17-item Hamilton Depression Rating Scale (HDRS17) (Hamilton, 1960) score of between 12 and 19 at screening and baseline assessment;
* Willingness to give informed consent and comply with trial protocol.

Exclusion Criteria:

* Suffering from other psychiatric disorders such as schizophrenia, other psychotic disorders, bipolar disorder or substance use disorder;
* Serious physical illnesses or mental disorders due to a general medical condition which are judged by the investigator to render unsafe;
* A significant risk of suicide according to the rating of HDRS17 item 3 (score higher than 2), i.e., presence of ideas or gesture of suicide;
* A presence of idea of self-harming according to the rating of EPDS item 10 (score higher than 0);
* A significant risk of infanticide according to the investigator assessment;
* Any acupuncture treatment during the previous 12 months prior to baseline;
* Valvular heart defects, bleeding disorders or taking anticoagulant drugs;
* Infection or abscess close to the site of selected acupoints;
* Herbal remedies or psychotropic drugs that are intended for depression are taken within the last 2 weeks prior to baseline or during the study.
* Receiving counseling or psychological therapies at baseline or during the study;
* Participation in any clinical trial within the previous 3 months prior to baseline;
D: Inclusion Criteria:

* Women who are more than 12 weeks pregnant but less than 20 weeks pregnant
* Women who are found to be at risk for depression
* Women who have been treated for depression in the past
* Women with depression after a previous pregnancy
* Women planning to deliver at University of Michigan Hospital

Exclusion Criteria:

* Women who have major depression or other psychiatric disorders (current substance abuse, schizophrenia, bipolar disorder) at the time of screening
* Women who are currently taking anti-depressant or other psychiatric medications
* Women who routinely eat more than 2 fish meals per week
* Women on anticoagulants (blood thinners)
* Women currently taking omega-3 fatty acid dietary supplements (fish oil, flaxseed oil or cod liver oil)
* Women with bleeding disorders such as von Willebrand's disease
* Women under the age of 18
* Women with a multiple gestation (twins, for example)
* Women planning to deliver at another hospital
* Women planning to move away before 6 weeks after delivery

Answer: D