Dr. Hakkarainen and Colleagues Reply

To the Editor: We appreciate Dr. Astorg’s comments on our article. To answer his first question, we did record the use of fish oil supplements in the cohort. At baseline, 448 (1.5%) of the 29,133 participants reported the use of fish oil supplements. This use was, however, so infrequent that it did not allow for meaningful analysis of its association with the risk of depression.

To address the second comment, we have reported that the trial supplementation had no influence on subsequent self-reported depression or hospital treatment due to major depressive disorder (1). This finding implies that alpha-tocopherol supplementation did not modify the association between the intake of omega-3 fatty acids and the risk of depression.

Our results disagree with some earlier findings about the association of dietary fish with depression. However, we also have cross-sectional data that were assessed at study baseline showing no link between the dietary intake of fish and the self-report of depressed mood (39.3 g/day for both participants with depressed mood and those with no symptoms). Taking these facts together, we still see that our conclusions were justified.