Today is Part Two of my thoughts on utilizing nutrition to aid in the treatment of depression. Part One can be read here.
As a disclaimer, I DO NOT think simply modifying the diet can “cure” depression. Depression is an incredibly complex disease, not to be taken lightly. I do believe there is efficacy in nutritional therapy for the treatment and prevention of depression
The Standard American Diet and Depression
The prevalence of Depression has been on the rise in the last 50 years. Another disease that is on the rise is obesity. The trend of poor nutrition in our country that contributes to obesity could also be associated with higher rates of depression. The diets of Americans are full of artificial ingredients, trans fats, sugars and an excess of calories. While nothing is wrong with a little bit of theses things, the problem is many do not practice moderation with these types of foods.
Many Americans don’t meet the daily recommendation for fruits and vegetables and their diets are devoid of critical vitamins, minerals and essential fatty acids. There are several vitamins and nutrients that research suggests may have an effect on depression. Perhaps it is a lack of these nutrients that is causing more and more people to develop depression. I believe that in many cases depression is caused by an interaction between genes and environment. Perhaps when someone is biologically predisposed to depression, then they eat a poor diet and have other life stressors, it triggers something in the brain that leads to depression. People can not control many stressors in life, but they can control what they eat.
Those struggling with depression often have diets lacking in essential nutrients. When someone is in the depths of the disease, they often make poor food choices that could even be contributing to the maintenance of their depression. Sometimes they don’t eat at all or eat very little, which also leads to nutritional deficiencies. Dietary intervention is often overlooked and doctors turn to medication. However, medication cannot work properly if the diet is poor.
The Role of Fatty Acids
The first nutrient I would like to discuss is omega-3 polyunsaturated fatty acids, or PUFAs. Fats are critical for the brain to function correctly. Studies show that sufficient long chain PUFAs may decrease the development of depression. When the brain does not get enough omega-3 PUFAs there is significant disturbance in neural functioning (Rao et al, 2008). There is evidence to support the idea that chronic inflammation influences the development of depression. The standard American diet is full of inflammatory foods such as caffeine, sugar, refined carbohydrates and alcohol. The brain releases inflammatory cytokines under stress. Many Americans live with chronic stress just in their everyday lives, so when you combine an inflammatory diet, the results are quite detrimental. Chronic stress wreaks havoc on the brain, and a diet rich in omega-3s may help to reduce the inflammation as omega-3 fatty acids have anti-inflammatory properties as they decrease the number of cytokines produced (Bergmans & Malecki, 2017).
Folate and Antidepressents
The second nutrient that I believe to be important in the treatment and prevention of depression is folate. Folate has a critical role in brain metabolic pathways. The diets of depressed patients are generally lacking in folate. This could be because a patient’s diet is usually poor in general when they are depressed, or a diet lacking in folate could have some influence in the development of depression. Low levels of folate are also associated with poor response to antidepressants (Coppen & Bailey, 2000). Supplementing folic acid (the synthetic form of folate) may improve the effects of certain antidepressants. In a study, 500 μg folic acid was prescribed to a group of depressed individuals along with 20 mg of fluoxetine daily. There was a significant improvement in symptoms in the group that took the folic acid along with the fluoxetine (Coppen & Bailey, 2000).
A Traditional Way of Eating
The final dietary intervention that could be important in the treatment of depression is the Mediterranean diet. A Mediterranean diet is a traditional way of eating that focuses on consuming mostly plant-based foods such as fruits, vegetables, whole grains, legumes and nuts. Fish is moderately consumed, while red meat and dairy are limited. Olive oil is the predominate source of fat which is rich in monounsaturated fatty acids (MUFAs). MUFAs may improve the binding of serotonin to its receptors. Studies have shown that in countries such as Greece and Spain where olive oil intake is high there are much lower rates of suicide (Sanchez et al, 2009). I believe that this whole food diet, full of antioxidants and lacking in inflammatory foods could be very beneficial when coupled with psychotherapy in the treatment of depression. Mediterranean diets are also inherently rich in folate and omega-3 fatty acids, both believed to be beneficial in the treatment and prevention of depression.
Food as Medicine
We know food is medicine and that a healthy diet leads to a healthy body. When the body becomes deprived of healthy nutritious foods it begins to suffer. Mental health and physical health are not completely separate. A healthy body correlates to a healthy mind and vice versa. Think about it, you feel good on the inside so you are able to go out and enjoy life! You have sustained energy to engage in work and leisure. Depression is an incredibly complex, multifaceted disorder. Relapse rates are high.
While I do not think nutritional therapy is the end all be all cure, I am convinced that it is a critical tool in preventing and treating depression. Prescribing antidepressants to patients can be helpful to alleviate symptoms, but that is the problem- they are only scratching the surface of the disease.
Instead of reaching for pills, I would like to see the medical community gravitate towards instilling health eating behaviors in their patients. A brain that is not adequately nourished cannot fully engage in, and reap the full benefits of psychotherapy. If medication is prescribed, the body has difficulty metabolizing the medication and using it to its full potential if it lacks the nutrients that guide the metabolic process.
When the patient begins to eat in a way that supports proper bodily functioning, then therapy and medication have the potential to work for the patient. Until then, money and time is being wasted on interventions that will not hold up in the long term and the patient is likely to relapse. This becomes a vicious cycle of managing symptoms for a little while, but then relapse follows the brief period of remission. As the cycle continues, the patient becomes more and more frustrated with the process, and they risk losing the support of friends and family who feel exasperated.
It shocks me that there is still no dietary recommendation for the treatment of depression. It is time to change that. The scientific community pours millions of dollars into other interventions for depression, but somehow, the age old “Let food be thy medicine,” falls under the radar. Food can be medicine, if we give it the chance. It is time to invest in the whole body, and start fueling the body, mind and soul in a way that will allow it to heal.
Bergmans, R. S., & Malecki, K. M. (2017). The association of dietary inflammatory potential with depression and mental well-being among U.S. adults. Preventive Medicine, 99313-319. doi:10.1016/j.ypmed.2017.03.016
Coppen, A., & Bailey, J. (2000). Research report: Enhancement of the antidepressant action of fluoxetine by folic acid: a randomised, placebo controlled trial. Journal Of Affective Disorders, 60121-130. doi:10.1016/S0165-0327(00)00153-1
Rao, T. S. S., Asha, M. R., Ramesh, B. N., & Rao, K. S. J. (2008). Understanding nutrition, depression and mental illnesses. Indian Journal of Psychiatry, 50(2), 77–82. http://doi.org/10.4103/0019-5545.42391
Sánchez-Villegas, A., Delgado-Rodríguez, M., Alonso, A., Schlatter, J., Lahortiga, F., Majem, L. S., & Martínez-Gonzalez, M. A. (2009). Association of the Mediterranean Dietary Pattern With the Incidence of Depression. Archives Of General Psychiatry, 66(10), 1090.