Depression and nutrition

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Literature on the relationship between depression and nutrition
Authors abstract’s

 

Popa, T. A., & Ladea, M. (2012). Nutrition and depression at the forefront of progressJournal of medicine and life5(4), 414.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3539842/

Depression is a debilitating disorder estimated to become the second cause of morbidity worldwide by the year 2020. The limited efficacy of antidepressant therapy, as well as the major negative consequences of this disorder, has stimulated additional research in order to determine possible adjunctive treatments. There is mounting evidence linking dietary patterns to major depression development. This article presents some of the most significant findings concerning the role of nutrition in major depressive disorder. Although more focused and clear results are needed, the correlation between nutrition and mental health is gaining attention. Now, there is evidence supporting the importance of nutrition in maintaining good mental health. We emphasize multiple findings that support adherence to healthy dietary patterns, taking into account that the production of neurotransmitters need, among others, right amounts of nutrients, a lot of which can only be supplied through diet. Not only certain nutrients are needed for proper brain functioning, but also others can be harmful, promoting depression. The Mediterranean diet has been linked to a low prevalence of depression while fast-food consumption has been found to increase the risk of developing and aggravating this disorder, hence the need for nutritional interventions. From the perspective of discovering modifiable risk factors, the role of nutrition in psychiatry could be more important than it was initially considered.

 

Akbaraly, T. N., Brunner, E. J., Ferrie, J. E., Marmot, M. G., Kivimaki, M., & Singh-Manoux, A. (2009). Dietary pattern and depressive symptoms in middle age. The British Journal of Psychiatry, 195(5), 408-413.
https://hal.inria.fr/file/index/docid/432097/filename/Akbaraly_et_al_Diet_Depression_BJP.pdf

Studies on diet and depression have focused primarily on individual nutrients. This paper examines the association between dietary patterns and depression using an overall diet approach. Method : Analyses were carried on 3486 participants (26.2% women, mean age 55.6 years) from the Whitehall II prospective cohort, in which two dietary patterns were identified: “whole food” (vegetables/fruits/fish) and “processed food” pattern (eg sweetened desserts/fried food/processed meat/refined grains/ high fat dairy products). Self-reported depression was assessed five years later using the CES-D scale. Results: After adjusting for potential confounders, participants in the highest tertile of the “whole food” pattern had lower odds of CES-D depression [Odds Ratio=0.74 (95% CI:0.56-0.99)] than those in the lowest tertile. In contrast, high consumption of “processed food” was associated with an increased odds of CES-D depression [Odds Ratio=1.58 (95% CI:1.11-2.23)]. Conclusion: In middle-aged participants, a “processed food” dietary pattern is a risk factor for CES-D depression five years later, while a “whole food” pattern is protective.

 

Le Port, A., Gueguen, A., Kesse-Guyot, E., Melchior, M., Lemogne, C., Nabi, H., … & Czernichow, S. (2012). Association between dietary patterns and depressive symptoms over time: a 10-year follow-up study of the GAZEL cohort. PLoS One, 7(12), e51593.
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0051593

Data on the association between dietary patterns and depression are scarce. The objective of this study was to examine the longitudinal association between dietary patterns and depressive symptoms assessed repeatedly over 10 years in the French occupational GAZEL cohort. A total of 9,272 men and 3,132 women, aged 45–60 years in 1998, completed a 35-item Food Frequency Questionnaire (FFQ) at baseline. Dietary patterns were derived by Principal Component Analysis. Depressive symptoms were assessed by the Center for Epidemiologic Studies Depression scale (CES-D) in 1999, 2002, 2005 and 2008. The main outcome measure was the repeated measures of CES-D. Longitudinal analyses were performed with logistic regression based on generalized estimating equations. The highest quartile of low-fat, western, high snack and high fat-sweet diets in men and low-fat and high snack diets in women were associated with higher likelihood of depressive symptoms at the start of the follow-up compared to the lowest quartile (OR between 1.16 and 1.50). Conversely, the highest quartile of traditional diet (characterized by fish and fruit consumption) was associated with a lower likelihood of depressive symptoms in women compared to the lowest quartile, with OR = 0.63 [95%CI, 0.50 to 0.80], as the healthy pattern (characterized by vegetables consumption) with OR = 0.72 [95%CI, 0.63 to 0.83] and OR = 0.75 [95%CI, 0.61 to 0.93] in men and women, respectively. However, there was probably a reverse causality effect for the healthy pattern. This longitudinal study shows that several dietary patterns are associated with depressive symptoms and these associations track over time.

 

Bodnar, L. M., & Wisner, K. L. (2005). Nutrition and depression: implications for improving mental health among childbearing-aged womenBiological psychiatry58(9), 679-685.
https://www.spectracell.com/media/uploaded/0/0e2010521_022fullpaper2005biolpsychiatrynutritionanddepressionpdf-.pdf

Adequate nutrition is needed for countless aspects of brain functioning. Poor diet quality, ubiquitous in the United States, may be a modifiable risk factor for depression. The objective was to review and synthesize the current knowledge of the role of nutrition in depression, and address implications for childbearing-aged women. Poor omega-3 fatty acid status increases the risk of depression. Fish oil and folic acid supplements each have been used to treat depression successfully. Folate deficiency reduces the response to antidepressants. Deficiencies of folate, vitamin B12, iron, zinc, and selenium tend to be more common among depressed than nondepressed persons. Dietary antioxidants have not been studied rigorously in relation to depression. Childbearing-aged women are particularly vulnerable to the adverse effects of poor nutrition on mood because pregnancy and lactation are major nutritional stressors to the body. The depletion of nutrient reserves throughout pregnancy and a lack of recovery postpartum may increase a woman’s risk of depression. Prospective research studies are needed to clarify the role of nutrition in the pathophysiology of depression among childbearing-aged women. Greater attention to nutritional factors in mental health is warranted given that nutrition interventions can be inexpensive, safe, easy to administer, and generally acceptable to patients.

 

Scapagnini, Giovanni & Davinelli, Sergio & Drago, Filippo & De Lorenzo, Antonino & Oriani, Giovannangelo. (2012). Antioxidants as Antidepressants. CNS drugs. 26. 477-90. 10.2165/11633190-000000000-00000.
https://www.researchgate.net/publication/225271908_Antioxidants_as_Antidepressants

Depression is a medical condition with a complex biological pattern of aetiology, involving genetic and epigenetic factors, along with different environmental stressors. Recent evidence suggests that oxidative stress processes might play a relevant role in the pathogenic mechanism(s) underlying many major psychiatric disorders, including depression. Reactive oxygen and nitrogen species have been shown to modulate levels and activity of noradrenaline (norepinephrine), serotonin, dopamine and glutamate, the principal neurotransmitters involved in the neurobiology of depression. Major depression has been associated with lowered concentrations of several endogenous antioxidant compounds, such as vitamin E, zinc and coenzyme Q10, or enzymes, such as glutathione peroxidase, and with an impairment of the total antioxidant status. These observations introduce new potential targets for the development of therapeutic interventions based on antioxidant compounds. The present review focuses on the possible role of oxidative stress processes in the pathogenesis of depression. The therapeutic potential of antioxidant compounds as a co-adjuvant treatment to conventional antidepressants is discussed. For instance, N-acetyl-cysteine has been shown to have a significant benefit on depressive symptoms in a randomized placebo-controlled trial. Additionally, curcumin, the yellow pigment of curry, has been shown to strongly interfere with neuronal redox homeostasis in the CNS and to possess antidepressant activity in various animal models of depression, also thanks to its ability to inhibit monoamine oxidases. There is an urgent need to develop better tolerated and more effective treatments for depressive disorders and several antioxidant treatments appear promising and deserve further study.
Bell, I. R., Edman, J. S., Morrow, F. D., Marby, D. W., Mirages, S., Perrone, G., … & Cole, J. O. (1991). B complex vitamin patterns in geriatric and young adult inpatients with major depression. Journal of the American Geriatrics Society, 39(3), 252-257.
https://www.ncbi.nlm.nih.gov/pubmed/2005338

This study compared the B complex vitamin status at time of admission of 20 geriatric and 16 young adult non-alcoholic inpatients with major depression. Twenty-eight percent of all subjects were deficient in B2 (riboflavin), B6 (pyridoxine), and/or B12 (cobalamin), but none in B1 (thiamine) or folate. The geriatric sample had significantly higher serum folate levels. Psychotic depressives had lower B12 than did non-psychotic depressives. Poorer blood vitamin status was not associated with higher scores on the Hamilton Depression Rating Scale or lower scores on the Mini-Mental State Examination in either age group. The data support the hypothesis that poorer status in certain B vitamins is present in major depression, but blood measures may not reflect central nervous system vitamin function or severity of affective syndromes as measured by the assays and scales in the present study.

 

Eby, G. A., & Eby, K. L. (2006). Rapid recovery from major depression using magnesium treatmentMedical hypotheses67(2), 362-370.
http://www.sciencedirect.com/science/article/pii/S0306987706001034

Major depression is a mood disorder characterized by a sense of inadequacy, despondency, decreased activity, pessimism, anhedonia and sadness where these symptoms severely disrupt and adversely affect the person’s life, sometimes to such an extent that suicide is attempted or results. Antidepressant drugs are not always effective and some have been accused of causing an increased number of suicides particularly in young people. Magnesium deficiency is well known to produce neuropathologies. Only 16% of the magnesium found in whole wheat remains in refined flour, and magnesium has been removed from most drinking water supplies, setting a stage for human magnesium deficiency. Magnesium ions regulate calcium ion flow in neuronal calcium channels, helping to regulate neuronal nitric oxide production. In magnesium deficiency, neuronal requirements for magnesium may not be met, causing neuronal damage which could manifest as depression. Magnesium treatment is hypothesized to be effective in treating major depression resulting from intraneuronal magnesium deficits. These magnesium ion neuronal deficits may be induced by stress hormones, excessive dietary calcium as well as dietary deficiencies of magnesium. Case histories are presented showing rapid recovery (less than 7 days) from major depression using 125–300 mg of magnesium (as glycinate and taurinate) with each meal and at bedtime. Magnesium was found usually effective for treatment of depression in general use. Related and accompanying mental illnesses in these case histories including traumatic brain injury, headache, suicidal ideation, anxiety, irritability, insomnia, postpartum depression, cocaine, alcohol and tobacco abuse, hypersensitivity to calcium, short-term memory loss and IQ loss were also benefited. Dietary deficiencies of magnesium, coupled with excess calcium and stress may cause many cases of other related symptoms including agitation, anxiety, irritability, confusion, asthenia, sleeplessness, headache, delirium, hallucinations and hyperexcitability, with each of these having been previously documented. The possibility that magnesium deficiency is the cause of most major depression and related mental health problems including IQ loss and addiction is enormously important to public health and is recommended for immediate further study. Fortifying refined grain and drinking water with biologically available magnesium to pre-twentieth century levels is recommended.

 

Coppen, A., & Bailey, J. (2000). Enhancement of the antidepressant action of fluoxetine by folic acid: a randomised, placebo controlled trial. Journal of affective disorders, 60(2), 121-130.
http://www.sciencedirect.com/science/article/pii/S0165032700001531#

Background: A consistent finding in major depression has been a low plasma and red cell folate which has also been linked to poor response to antidepressants. The present investigation was designed to investigate whether the co-administration of folic acid would enhance the antidepressant action of fluoxetine. Methods: 127 patients were randomly assigned to receive either 500 μg folic acid or an identical looking placebo in addition to 20 mg fluoxetine daily. All patients met the DSM-III-R criteria for major depression and had a baseline Hamilton Rating Scale (17 item version) score for depression of 20 or more. Baseline and 10-week estimations of plasma folate and homocysteine were carried out. Results: Patients receiving folate showed a significant increase in plasma folate.This was less in men than in women. Plasma homocysteine was significantly decreased in women by 20.6%, but there was no significant change in men. Overall there was a significantly greater improvement in the fluoxetine plus folic acid group. This was confined to women where the mean Hamilton Rating Scale score on completion was 6.8 (S.D. 4.1) in the fluoxetine plus folate group, as compared to 11.7 (S.D. 6.7) in the fluoxetine plus placebo group (P<0.001).A percentage of 93.9 of women, who received the folic acid supplement, showed a good response (>50% reduction in score) as compared to 61.1% of women who received placebo supplement (P<0.005). Eight (12.9%) patients in the fluoxetine plus folic acid group reported symptoms possibly or probably related to medication, whereas in the fluoxetine plus placebo group 19 (29.7%) patients reported such symptoms (P<0.05). Limitations and conclusions: Folic acid is a simple method of greatly improving the antidepressant action of fluoxetine and probably other antidepressants. Folic acid should be given in doses sufficient to decrease plasma homocysteine. Men require a higher dose of folic acid to achieve this than women, but more work is required to ascertain the optimum dose of folic acid.

 

Dimopoulos, N., Piperi, C., Salonicioti, A., Psarra, V., Gazi, F., Papadimitriou, A., … & Kalofoutis, A. (2007). Correlation of folate, vitamin B 12 and homocysteine plasma levels with depression in an elderly Greek population. Clinical biochemistry, 40(9), 604-608.
http://www.sciencedirect.com/science/article/pii/S0009912007000586#

Alterations in folate, vitamin B12 and homocysteine plasma levels have been associated with aging, neuronal development and depressive symptomatology. Nevertheless, the associations are not strong enough to suggest the use of these parameters in every day practice for diagnostic or therapeutic purposes. The aim of the study was to investigate the relationship between plasma folate, vitamin B12 and homocysteine in depressive states in the elderly. Community-dwelling, elderly individuals over 60 years of age were screened with the Geriatric Depression Scale. The study population was divided into two groups: (a) 33 subjects with depression and (b) 33 healthy controls. All participants were clinically evaluated and completed a questionnaire for socio-demographic and clinical data. Measurements of folate, vitamin B12 and homocysteine were estimated in all blood samples and results were statistically evaluated at p < 0.05 level of significance. No statistical significance emerged for the socio-demographic data between the two groups. Chronic diseases such as stroke, hypercholesterolemia, hypertension and diabetes also did not differ between the depression and control group. Group (a) had significantly lower levels of folate and vitamin B12 than group (b). Homocysteine was significantly higher in depressed individuals than in controls. Lower levels of plasma folate and/or vitamin B12, and higher levels of plasma homocysteine are associated with depression in elderly individuals.

 

Eby, G. A., & Eby, K. L. (2006). Rapid recovery from major depression using magnesium treatmentMedical hypotheses67(2), 362-370.
http://www.sciencedirect.com/science/article/pii/S0306987706001034

Major depression is a mood disorder characterized by a sense of inadequacy, despondency, decreased activity, pessimism, anhedonia and sadness where these symptoms severely disrupt and adversely affect the person’s life, sometimes to such an extent that suicide is attempted or results. Antidepressant drugs are not always effective and some have been accused of causing an increased number of suicides particularly in young people. Magnesium deficiency is well known to produce neuropathologies. Only 16% of the magnesium found in whole wheat remains in refined flour, and magnesium has been removed from most drinking water supplies, setting a stage for human magnesium deficiency. Magnesium ions regulate calcium ion flow in neuronal calcium channels, helping to regulate neuronal nitric oxide production. In magnesium deficiency, neuronal requirements for magnesium may not be met, causing neuronal damage which could manifest as depression. Magnesium treatment is hypothesized to be effective in treating major depression resulting from intraneuronal magnesium deficits. These magnesium ion neuronal deficits may be induced by stress hormones, excessive dietary calcium as well as dietary deficiencies of magnesium. Case histories are presented showing rapid recovery (less than 7 days) from major depression using 125–300 mg of magnesium (as glycinate and taurinate) with each meal and at bedtime. Magnesium was found usually effective for treatment of depression in general use. Related and accompanying mental illnesses in these case histories including traumatic brain injury, headache, suicidal ideation, anxiety, irritability, insomnia, postpartum depression, cocaine, alcohol and tobacco abuse, hypersensitivity to calcium, short-term memory loss and IQ loss were also benefited. Dietary deficiencies of magnesium, coupled with excess calcium and stress may cause many cases of other related symptoms including agitation, anxiety, irritability, confusion, asthenia, sleeplessness, headache, delirium, hallucinations and hyperexcitability, with each of these having been previously documented. The possibility that magnesium deficiency is the cause of most major depression and related mental health problems including IQ loss and addiction is enormously important to public health and is recommended for immediate further study. Fortifying refined grain and drinking water with biologically available magnesium to pre-twentieth century levels is recommended.

 

Gariballa, S., & Forster, S. (2007). Effects of dietary supplements on depressive symptoms in older patients: a randomised double-blind placebo-controlled trial. Clinical Nutrition, 26(5), 545-551.
http://www.sciencedirect.com/science/article/pii/S0261561407000994

The effect of nutritional supplements on mental health in older patients has received little attention so far. The aims of this trial were therefore to test the effect of nutritional support on older patient’s depressive symptoms and cognitive function. In this prospective, double-blind, placebo-controlled study, we randomly assigned 225 hospitalised acutely ill older patients to receive either normal hospital diet plus 400 mL oral nutritional supplements (106 subjects) or normal hospital diet plus a placebo (119 subjects) daily for 6 weeks. The composition of the supplement was such as to provide 995 kcal for energy and 100% of the Reference Nutrient Intakes for a healthy old person for vitamins and minerals. Outcome measures were 6 weeks and 6 months changes in nutritional status, depressive symptoms and cognitive state. Randomisation to the supplement group led to a significant increase in red-cell folate and plasma vitamin B12 concentrations, in contrast to a decrease seen in the placebo group. There were significant differences in symptoms of depression scores in the supplement group compared with the placebo group at 6 months (p=0.021 for between groups difference). The effect of supplement was seen in all patient groups including those with no symptoms of depression, mild depression and those with severe depression (p=0.007). There was no evidence of a difference in cognitive function scores at 6 months. Oral nutritional supplementation of hospitalised acutely ill older patients led to a statistically significant benefit on depressive symptoms.

 

Parker, G., Gibson, N. A., Brotchie, H., Heruc, G., Rees, A. M., & Hadzi-Pavlovic, D. (2006). Omega-3 fatty acids and mood disorders. American Journal of Psychiatry, 163(6), 969-978.
http://ajp.psychiatryonline.org/doi/abs/10.1176/ajp.2006.163.6.969

Objective: This article is an overview of epidemiological and treatment studies suggesting that deficits in dietary-based omega-3 polyunsaturated fatty acids may make an etiological contribution to mood disorders and that supplementation with omega-3 fatty acids may provide a therapeutic strategy. Method: Relevant published studies are detailed and considered. Results: Several epidemiological studies suggest covariation between seafood consumption and rates of mood disorders. Biological marker studies indicate deficits in omega-3 fatty acids in people with depressive disorders, while several treatment studies indicate therapeutic benefits from omega-3 supplementation. A similar contribution of omega-3 fatty acids to coronary artery disease may explain the well-described links between coronary artery disease and depression. Conclusions: Deficits in omega-3 fatty acids have been identified as a contributing factor to mood disorders and offer a potential rational treatment approach. This review identifies a number of hypotheses and studies for consideration. In particular, the authors argue for studies clarifying the efficacy of omega-3 supplementation for unipolar and bipolar depressive disorders, both as individual and augmentation treatment strategies, and for studies pursuing which omega-3 fatty acid, eicosapentaenoic acid (EPA) or docosahexaenoic acid (DHA), is likely to provide the greatest benefit.