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Nutritional medicine as mainstream in psychiatry

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Nutritional medicine as mainstream in psychiatry

Abstract

Psychiatry is at an important juncture, with the current pharmacologically focused model having achieved modest benefi ts in addressing the burden of poor mental health worldwide. Although the determinants of mental health are complex, the emerging and compelling evidence for nutrition as a crucial factor in the high prevalence and incidence of mental disorders suggests that diet is as important to psychiatry as it is to cardiology, endocrinology, and gastroenterology. Evidence is steadily growing for the relation between dietary quality (and potential nutritional defi ciencies) and mental health, and for the select use of nutrient-based supplements to address defi ciencies, or as monotherapies or augmentation therapies. We present a viewpoint from an international collaboration of academics (members of the International Society for Nutritional Psychiatry Research), in which we provide a context and overview of the current evidence in this emerging fi eld of research, and discuss the future direction. We advocate recognition of diet and nutrition as central determinants of both physical and mental health.
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271
Personal View
Nutritional medicine as mainstream in psychiatry
Jerome Sarris, Alan C Logan, Tasnime N Akbaraly, G Paul Amminger, Vicent Balanzá-Martínez, Marlene P Freeman, Joseph Hibbeln,
Yutaka Matsuoka, David Mischoulon, Tetsuya Mizoue, Akiko Nanri, Daisuke Nishi, Drew Ramsey, Julia J Rucklidge, Almudena Sanchez-Villegas,
Andrew Scholey, Kuan-Pin Su, Felice N Jacka, on behalf of The International Society for Nutritional Psychiatry Research
Psychiatry is at an important juncture, with the current pharmacologically focused model having achieved modest
benefi ts in addressing the burden of poor mental health worldwide. Although the determinants of mental health are
complex, the emerging and compelling evidence for nutrition as a crucial factor in the high prevalence and incidence
of mental disorders suggests that diet is as important to psychiatry as it is to cardiology, endocrinology, and
gastroenterology. Evidence is steadily growing for the relation between dietary quality (and potential nutritional
defi ciencies) and mental health, and for the select use of nutrient-based supplements to address defi ciencies, or as
monotherapies or augmentation therapies. We present a viewpoint from an international collaboration of academics
(members of the International Society for Nutritional Psychiatry Research), in which we provide a context and
overview of the current evidence in this emerging fi eld of research, and discuss the future direction. We advocate
recognition of diet and nutrition as central determinants of both physical and mental health.
Introduction
Pharmacologically focused approaches have achieved a
moderate reduction in the worldwide burden of poor
mental health; however, indicators suggest that the
burden of disease attributable to mental disorders will
continue to rise worldwide during the coming decades.1,2
Mental disorders in general, and major depression and
anxiety disorders in particular, account for a large burden
of disability worldwide.2 Rapid urbanisation, and an
overall transition from traditional lifestyles (concerning
diet, physical activity, and social structures), which are
some of the most pressing global and environmental
issues of our time, have both been linked to increases in
depression and other mental disorders.3 Indisputably,
depression and other common mental disorders are
already, and will probably become increasingly, part of an
epidemic of comorbidity between physical and mental ill-
health, with diet being a crucial common determinant.4
The current state, wherein populations in both
developed and emerging economies preferentially
consume nutrient-poor, energy-dense, highly processed
foods, is historically unique—many people are both
overfed and undernourished. Although caloric intake
has increased, many individuals in affl uent, developed
nations do not meet the recommended intakes of several
brain-essential nutrients, including B-group vitamins,
zinc, and magnesium.5 Although slight improvements
have been detected in the dietary intakes of sugar and
fats between 2003–04 and 2009–10, documented intakes
of nutrient-rich and fi bre-rich vegetables and whole
grains are far lower than recommended.6 These
profound changes in dietary habits, along with tobacco
use, insuffi cient physical activity, and harmful alcohol
and recreational drug use, have resulted in an epidemic
of ill health. The major non-communicable diseases,
along with mental disorders, are expected to cost the
worldwide economy US$47 trillion from 2014 to 2020, if
no substantial and eff ective action is taken.7
A traditional whole-food diet, consisting of higher
intakes of foods such as vegetables, fruits, seafood, whole
grains, lean meat, nuts, and legumes, with avoidance of
processed foods, is more likely to provide the nutrients
that aff ord resiliency against the pathogenesis of mental
disorders. The mechanisms by which nutrition might
aff ect mental health are, at least superfi cially, quite
obvious: the human brain operates at a very high
metabolic rate, and uses a substantial proportion of total
energy and nutrient intake; in both structure and
function (including intracellular and intercellular com-
munication), it is reliant on aminoacids, fats, vitamins,
and minerals or trace elements.3,8 Dietary habits modulate
the functioning of the immune system, which also
moderates the risk for depression.8 The antioxidant
defence system, which is also implicated in mental
disorders, operates with the support of nutrient cofactors
and phytochemicals. Additionally, neurotrophic factors
make essential contributions to neuronal plasticity and
repair mechanisms throughout life, and these too are
aff ected by nutritional factors.9
The purpose of this Personal View is to provide a
platform for robust debate in the specialty, particularly
regarding the need to move towards a new integrated
framework in psychiatry, whereby consideration of
nutritional factors should be standard practice. To provide
a well informed and respected consensus statement10 and
viewpoint on this position, we formed an international
collaboration of academic authors from members of the
International Society for Nutritional Psychiatry Research
(ISNPR). In this Personal View, we outline the supportive
evidence underpinning the proposed paradigm shift, and
present our perspective about the future direction of
nutritional medicine in psychiatry.
Current evidence
In the past several years, links have been established
between nutritional quality and mental health, and
scientifi cally rigorous studies have made important
contributions to the understanding of the role of
nutrition in mental health. Many epidemiological
studies, including prospective studies, have shown
Lancet Psychiatry 2015;
2: 271–74
Published Online
January 26, 2015
http://dx.doi.org/10.1016/
S2215-0366(14)00051-0
The Melbourne Clinic
(J Sarris PhD), and Royal
Melbourne Hospital
(F N Jacka PhD), Department of
Psychiatry, The University of
Melbourne, Richmond,
Melbourne, VIC, Australia;
Centre for Human
Psychopharmacology,
Swinburne University of
Technology, Hawthorn, VIC,
Australia (J Sarris,
A Scholey PhD);
Complementary Alternative
Medicine and Nutrition
Research (CAMNR), Calabasas,
CA, USA (A C Logan BA);
INSERM U710 (Institut
National de la Santé et de la
Recherche médicale),
University of Montpellier,
Montpellier, France
(T N Akbaraly PhD); Department
of Epidemiology and Public
Health, University College
London, London, UK
(T N Akbaraly); Orygen Youth
Health Research Centre,
Parkville, VIC, Australia
(G P Amminger MD); Teaching
Unit of Psychiatry and
Psychological Medicine, La Fe
University and Polytechnic
Hospital, University of Valencia
Medical School, Centro de
Investigación Biomédica En
Red de Salud Mental
(CIBERSAM), Valencia, Spain
(V Balanzá-Martínez MD);
Perinatal and Reproductive
Psychiatry (M P Freeman MD),
and Depression and Clincal
Research Program
(D Mischoulon MD),
Massachusetts General
Hospital, Boston, MA, USA;
National Institute on Alcohol
Abuse and Alcoholism,
National Institutes of Health,
Bethesda, MD, USA
(J Hibbeln MD); Department of
Clinical Epidemiology,
Translational Medical Center
(Y Matsuoka MD), and
Department of Mental Health
Policy and Evaluation, National
Institute of Mental Health
272
www.thelancet.com/psychiatry Vol 2 March 2015
Personal View
(D Nishi MD), National Center
of Neurology and Psychiatry,
Kodaira, Tokyo, Japan;
Department of Epidemiology
and Prevention, Center for
Clinical Sciences, National
Center for Global Health and
Medicine, Shijuku-ku, Tokyo,
Japan (T Mizoue MD,
A Nanri MD); Department of
Psychiatry, Columbia
University College of Physicians
and Surgeons, New York, NY,
USA (D Ramsey MD);
Department of Psychology,
University of Canterbury,
Christchurch, New Zealand
(J J Rucklidge PhD); Department
of Clinical Sciences, University
of Las Palmas de Gran Canaria,
Las Palmas de Gran Canaria,
Spain (A Sanchez-Villegas PhD);
Department of Psychiatry &
Mind-Body Interface
Laboratory (MBI-Lab), China
Medical University Hospital,
and Graduate Institute of
Neural and Cognitive Sciences,
China Medical University,
Taichung, Taiwan (K P Su MD);
School of Medicine, Deakin
University, IMPACT Strategic
Research Centre, Geelong, VIC,
Australia (F N Jacka); Murdoch
Children’s Research Centre,
Parkville, VIC, Australia
(F N Jacka); and Black Dog
Institute, Hospital Road Prince
of Wales Hospital, Randwick,
NSW, Australia (F N Jacka)
Correspondence to:
Dr Jerome Sarris, The Melbourne
Clinic, 2 Salisbury Street,
Richmond, Melbourne,
VIC 3121, Australia
jsarris@unimelb.edu.au
associations between healthy dietary patterns and a
reduced prevalence of, and risk for, depression11,12 and
suicide.13 Maternal and early-life nutrition is also
emerging as a determinant of later mental health
outcomes in children,14,15 and severe macronutrient
defi ciencies during crucial developmental periods have
long been implicated in the pathogenesis of both
depressive and psychotic disorders.16,17
A recent systematic review has now confi rmed a
relation between unhealthy dietary patterns and poorer
mental health in children and adolescents.18 In view of
the early age of onset for depression and anxiety, these
data suggest that diet is a key modifi able intervention
target for prevention of the initial incidence of common
mental disorders. Indeed, although not statistically
powered to assess the prevention of de-novo depression,
results from the large European PREDIMED study19
showed a strong trend towards a reduced risk for incident
depression for individuals randomly assigned to a
Mediterranean diet with nuts, and this protective eff ect
was particularly evident in those with type 2 diabetes.
Similarly, results of an indicated prevention trial20 showed
that dietary counselling was as eff ective as psychotherapy
at prevention of transition to case-level depression in
older adults. A randomised controlled trial designed to
test the effi cacy of dietary improvement as a treatment
for major depression is underway.21
Convincing data suggest that select nutrient-based
supplements (in isolation, or in combination),22 might
provide many neurochemical modulatory activities that
are benefi cial in the management of mental disorders.
Examples of these nutrient-based supplements include
omega-3 fatty acids, S-adenosyl methionine (SAMe),
N-acetyl cysteine (NAC), zinc, B vitamins (including
folic acid), and vitamin D. Various clinical investigations
support the potential usefulness of omega-3 fatty acids
for disorders including, but not limited to, bipolar
depression, post-traumatic stress disorder, and major
depression, and they are indicated in the prevention of
psychosis.23 Omega-3 fatty acids can provide a range of
neurochemical activities via the following mechanisms:
modulation of neurotransmitter (noradrenaline, dopa-
mine, and serotonin) re-uptake, degradation, synthesis,
and receptor binding; anti-infl ammatory and anti-
apoptotic eff ects; and the enhancement of cell mem-
brane fl uidity and neurogenesis via upregulation of
brain-derived neurotrophic factor (BDNF).23,24
SAMe is an endogenous sulphur-containing com-
pound that is an important neurochemical component
involved in the one-carbon cycle responsible for the
methylation of neurotransmitters that regulate mood.
Clinical trials have shown that SAMe is an eff ective
antidepressant,25 and clinically signifi cant augmentation
eff ects occur with antidepressants.26 NAC has evidence
of effi cacy in bipolar depression, schizophrenia,
trichotillomania, and other compulsive and addictive
behaviours.27 This aminoacid-based compound has
glutamate modulatory eff ects, and anti-infl ammatory,
antioxidant, and neuroprotective activity.27 Zinc is an
abundant trace element that is involved in cytokine
modulation and hippocampal neurogenesis via
upregulation of BDNF, and also modifi es N-methyl-D-
aspartate and glutamate activity.28 Zinc defi ciency has
been linked to increased depressive symptoms, and
evidence is emerging that zinc supplementation
improves depressed mood, mainly as an adjunctive
intervention with antidepressants.28
B vitamins are needed for proper neuronal function,
and a defi ciency of B9 (folate) has been reported in
depressed populations, and in poor responders to anti-
depressants.29 Several studies have assessed the
antidepressant eff ect of folic acid with concomitant
antidepressant use, and results of most either showed an
increase in the proportion of participants who had an
antidepressant response, or improved the onset
of response. Vitamin D is a neurosteroid, with data
suggesting that low maternal concentrations are
implicated in schizophrenia risk, and de ciency is
likewise linked to increased depressive symptoms.30 A
combination of nutrients that match the natural
physiological needs of the body, and also better represent
the broad range of nutrients present in food, might
prove even more eff ective than isolated nutrients alone.31
Future direction
During the past several years, high-quality research into
nutrition and mental health—a specialty that has been
neglected—has grown rapidly and is fi nally starting to
develop its potential. In view of the changes related to
rapidly growing urbanicity and the globalisation of the
food industry, resulting in profound shifts away from
traditional dietary patterns, the ways in which overall diet
and specifi c nutritional elements, multinutrient inter-
ventions, or both can aff ect mental health clearly need to
be identifi ed. In view of the widespread use of nutrient
supplements by individuals with and without mental
disorders, scientifi cally rigorous methods should be used
to assess the effi cacy of these supplements and to identify
what dose of a nutrient supplement is needed, by whom,
when, and under what circumstances. From this resultant
research, the evidence needs to be communicated to
clinicians via educational programmes, and to the wider
public via public health campaigns. Formal medical
education should include training that focuses on the role
of diet and nutrients in brain function and mental health.
Recommendations for governments to take more
substantive actions to improve food quality and promote
healthier dietary practices should be considered to
address the substantial burden of disease that results
from unhealthy diets. Importantly, the activities of the
food industry need to be examined at a governmental
level, and relevant policies need to be designed to reduce
the worldwide burden of physical and mental ill-health
attributable to poor diet.4 Such policies are advised to
www.thelancet.com/psychiatry Vol 2 March 2015
273
Personal View
stimulate substantial public change in dietary habits
back towards a traditional whole-food diet (dependent on
the culture). Further, better education of the public and
clinicians about the role of nutrients in the brain, and the
link to mental health, is crucially needed.
Conclusions
Present treatment of psychiatric disorders can be
improved and greater attention can be given to preventive
eff orts. As a result of the immense burden of mental
disorders, modifi able targets to reduce the incidence of
mental disorders are now urgently needed. Diet and
nutrition off er key modifi able targets for the prevention
of mental disorders, having a fundamental role in the
promotion of mental health. Now is time for the
recognition of the importance of nutrition and nutrient
supplementation in psychiatry. Nutritional medicine
should now be considered as a mainstream element of
psychiatric practice, with research, education, policy, and
health promotion supporting this new framework.
Contributors
JS, ACL, and FNJ drafted the initial version of this manuscript. All
authors contributed intellectual content to the manuscript, and read and
approved the fi nal manuscript.
Declaration of interests
JS has received honoraria, research support, royalties, consultancy, or
travel grant funding from Integria Health, Blackmores, Bioceuticals,
Taki Mai, Pepsico, HealthEd, Soho-Flordis, Pfi zer, Elsevier, the Society for
Medicinal Plant and Natural Product Research, CR Roper Fellowship,
and the National Health and Medical Research Council (NHMRC).
ACL has received consulting fees from Genuine Health (Toronto,
Canada). VB-M has received grants, and served as consultant, adviser, or
continuing medical education (CME) speaker during the past 3 years for
the following entities: Angelini, AstraZeneca, Bristol-Myers-Squibb,
Janssen, Juste, Lilly, Lundbeck, Otsuka, the Spanish Ministry of Science
and Innovation, and Fundación Alicia Koplowitz. MPF has received
funding for advisory board positions, or consulting, from: Takeda,
Otsuka, Lundbeck, Genentech, Johnson & Johnson, and JDS
Therapeutics; pending research support from Takeda; and for medical
editing for DSM Nutritionals and GOED Omega-3. YM has received
research support from the Japan Science and Technology Agency,
National Center of Neurology and Psychiatry (Japan), the Ministry of
Health, Labour, and Welfare of Japan, and has been a paid speaker for
Mochida Pharmaceutical Co, Takeda Pharmaceutical Company,
Suntory Wellness, Eli Lilly Japan KK, Otsuka Pharmaceutical Co, and
DHA & EPA Association. DM has received research support from the
Bowman Family Foundation, FisherWallace, Nordic Naturals,
Methylation Sciences, and PharmoRx Therapeutics. He has received
honoraria for consulting, speaking, and writing from Pamlab, and the
Massachusetts General Hospital Psychiatry Academy. He has received
royalties from Lippincott Williams & Wilkins for the published book
Natural medications for psychiatric disorders: considering the alternatives.
TM has received research grants from the Japan Society for the
Promotion of Science, the National Center for Global Health and
Medicine (Japan), the National Cancer Center (Japan), the Ministry of
Health, Labour, and Welfare of Japan, the Industrial Health Foundation,
the Uehara Memorial Foundation, and Otsuka Pharmaceutical Co.
DN has received research support from the Japan Society for the
Promotion of Science and the Foundation for Total Health Promotion,
and lecture fees from Qol Co, DHA & EPA Association, NTT DoCoMo,
and Emotional Quotient Academy. AS has received funding from the
Biotechnology and Biological Sciences Research Council (UK), The
Australian Research Council, the NHMRC, the British Psychological
Society, the Australian Wine Research Institute, Abbott Nutrition,
Arla Foods, Bayer Healthcare, Cognis, Cyvex, GlaxoSmithKline Nutrition,
Masterfoods, Martek, Naturex, Nestlé, Neurobrands, Sanofi , Verdure
Sciences, and Wrigley, and received speaker fees from Abbott Nutrition,
Barilla, Bayer Healthcare, Danone, Flordis, GlaxoSmithKline Healthcare,
Kraft, Masterfoods, Martek, Novartis, Unilever, and Wrigley. K-PS has
received research grants from the National Science Council, National
Health Research Institute, and China Medical University in Taiwan, and
joint research grants from the Royal Society (UK) and National Centre for
Research and Development (Poland). FNJ has received grants and
research support from the Brain and Behaviour Research Institute
(USA), the NHMRC, Australian Rotary Health, the Geelong Medical
Research Foundation, the Ian Potter Foundation, Eli Lilly, the Meat and
Livestock Board Australia, and The University of Melbourne, and has
been a paid speaker for Sanofi -Synthelabo, Janssen Cilag, Servier, Pfi zer,
Health Ed, Network Nutrition, Angelini Farmaceutica, and Eli Lilly.
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... These effects were unlikely due to differences in study design, as the laboratory protocol of both groups was identical (i.e., caloric/ macronutrient intake, physical activity, posture, sleep duration, lighting conditions), except for the timing of meals. The relevance of diet on sleep, circadian rhythms and mental health is receiving growing awareness with the emergence of a new field, nutritional psychiatry (9,10). A recent population-based cross-sectional study with 502,494 individuals showed an association of unhealthy diet with worse sleep quality and mental health symptomatology (11). ...
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Background Mental disorders are conditions that affect the usual function of the brain, causing a huge burden on societies. The causes are often unclear, but previous research has pointed out, as is the case with many other diseases, that nutrition could have a major role in it. Amino acids, the building blocks of proteins, are the main precursor of neurotransmitters (the chemical messengers in the brain) malfunction of which is heavily associated with a wide range of brain disorders. Methods We assumed different sources of dietary protein could have different impacts on mental wellbeing. Hence, we decided to collect the nutritional data (with a validated and reliable semi-quantitative food-frequency questionnaire) from a sample of 489 Iranian women and investigate the association between animal and plant protein sources and the risk of depression, anxiety, and stress. Symptoms of these mental disorders were assessed using a validated Depression, Anxiety, Stress Scales (DASS) questionnaire with 21 items. Results After multivariable adjustment, it was shown that women in the highest tertile of animal protein intake were more likely to show symptoms of depression (OR: 2.63; 95% CI: 1.45, 4.71; P = 0.001), anxiety (OR: 1.83; 95% CI: 1.04, 3.22; P = 0.03), and stress (OR: 3.66; 95% CI: 2.06, 6.50; p < 0.001). while no significant association was seen between plant protein and any of the studied mental disorders. Conclusion Overall, our findings suggest that a diet high in animal protein could predispose individuals to mental illnesses.
... In the absence of suitable antidotal medicines against COVID-19, nutritional dietary supplements containing vitamins and other essential elements could be the best way to strengthen immunity, especially in adults [22]. However, the pandemic-induced lockdown has had severe implications for health issues, including irregular or unhealthy diets, absence of physical exercise, and substance use; all of these could increase the risk of being infected with the disease and also trigger fear, anxiety, depression, and other mental disorders [23,24,25,26]. Anxiety, depression, and other negative emotions associated with COVID-19 could also lead to overeating, mostly food full of carbohydrates; namely 'food cravings' or 'emotional eating' [27,28,29]. ...
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Background The home confinement induced by the COVID-19 pandemic affects individuals’ mental wellbeing and increases unhealthy behaviors, such as minimum to no physical activity, overeating, and substance use. Objective This study aimed to assess the changes in dietary patterns among the Bangladeshi adult population during the COVID-19 pandemic and identify their determinants. Methods This web-based cross-sectional survey was carried out from 10–17 December 2020 using an e-questionnaire based on Google Forms. A semi-structured e-questionnaire was forwarded to the participants – Bangladesh citizens aged above 18 years – through social media platforms and email in order to collect information about socio-demographic issues and multidimensional dietary patterns. From the initial 817 responses gathered through snowball sampling, 748 responses were retained. Bivariate and multivariate analyses were executed. Results The findings suggest that 50% of the participants reported a reduction in weight and physical activities, while approximately 52% experienced increased sleep time. One in three participants (31.4%) experienced a decrease in food buying capacity. The findings further indicate that women were 1.65 times more likely to reduce food consumption than men. Meanwhile, employed people were about 34% less likely to increase food consumption than their unemployed counterparts. People who were getting more than 6 h of sleep per day were nearly 61% less likely to increase food consumption than people who slept for less than 6 h per day. People struggling to buy food items were 2.31 times more likely to reduce food intake than people with no such limitations. Conclusions The study shows that COVID-19 has substantially affected Bangladeshi people's common food consumption patterns. Being confined within the household, primarily due to countrywide lockdowns and ‘general holidays’, has affected both the dietary patterns and the financial wellbeing of people. Therefore, the concerned authorities should promote effective nutrition education and healthy dietary behaviors; meanwhile, financial support or incentives for people in need are also strongly advocated. Keywords: COVID-19 Lockdown dietary patterns Physical activities Bangladesh
... Over the last decade, increasing evidence has emerged suggesting a connection between diet and mental health, which gives rise to a burgeoning field that uses food and food supplements as an alternative treatment to intervene in mental health disorders, so-called "nutritional psychiatry" (Sarris et al., 2015;Zepf et al., 2015). Both cross-sectional and prospective studies have demonstrated that certain dietary habits are potential contributors or modifiers of many common mental disorders (Jacka et al., 2014). ...
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This study investigated the relationship between lifestyle choices and substance addiction in young adults by applying the Relapse Prevention model of addiction. Data were obtained from a cross-sectional online survey of 926 young adults aged 18∼24 residing in 24 countries. Of these, 17.6% reported that they had serious substance addiction, with alcohol addiction being the highest (11.2%), followed by nicotine (10.3%) and illicit drug (8.7%) addiction. Results of chi-square test and logistic regression analysis revealed a significant association between all lifestyle factors (spirituality, regular exercise, intake of nutrients like tryptophan, folic acid, omega-3 fatty acids, and micronutrients) and substance addiction (illicit drugs, alcohol, nicotine). And depression was also found to be a significant factor influencing substance addiction. In particular, the risk of alcohol addiction was the highest at 9.870 (95% CI: 4.525-21.525) times among those who said they did not read the spiritual content than those who did. And the risk of nicotine and illicit drug addiction was the highest among those who said their intake of micronutrients was ‘less than 1 serving’ per day compared to ‘more than 5 servings,’ with odds ratios of 9.606(95% CI: 2.726-30.111) and 8.642(95% CI: 2.022-37.378) respectively. These findings suggest that holistic lifestyle interventions may help prevent and reduce substance addiction in young adults.
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Mental healthcare disparities are routinely documented, yet they remain wider than in most other areas of healthcare services and common mental disorders (depression and anxiety) continue to be one of the highest health burdens for older people of color. To address disparities in mental health services for older people of color, the narrative must move beyond simply documenting these inequities and attain a better understanding of the internalized, interpersonal, systemic, and medical racism that have harmed these communities and excluded them from its services in the first place. It is imperative that researchers, clinicians, and policymakers acknowledge the realities of racism and discrimination as leading causes of mental healthcare disparities. Therefore, this review is a call-to-action. Authors adopt an antiracist and health equity lens in evaluating the differing needs of Blacks/African-Americans, Asian Americans, and Latinos by exploring psychiatric comorbidity, experiences with seeking, accessing, and engaging in treatment, and the unique cultural and psychosocial factors that affect treatment outcomes for these diverse groups. Further, authors offer researchers and practitioners tangible tools for developing and implementing culturally-sensitive, mental health focused interventions for older people of color with special attention placed on cultural adaptations, models of care, prevention, and practical strategies that can be implemented to reduce disparities and increase equity in mental healthcare.
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Prevention of major depressive disorder is important because current treatments are only partially adequate in reducing symptom burden and promoting health-related quality of life. Lifestyle interventions may be a desirable prevention strategy for reasons of patient preference, particularly among older patients from minority groups. Using evidence from a randomized depression prevention trial for older adults, the authors found that coaching in healthy dietary practices was potentially effective in protecting at-risk older adults from developing incident episodes of major depression. The authors describe the dietary coaching program (highlighted in a case example) as well as the feasibility and potential efficacy of the program within the context of evidence-based interventions for preventing episodes of major depression and mitigating symptoms of depression. Older adults receiving dietary coaching experienced a low incidence of major depressive episodes and exhibited a 40%-50% decrease in depressive symptoms, as well as enhanced well-being, during the initial 6-week intervention; these gains were sustained over 2 years. The authors also describe why lifestyle interventions like coaching in healthy dietary practices may hold promise as effective, practical, nonstigmatizing interventions for preventing episodes of major depressive disorder in older adults with subsyndromal depressive symptoms.
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• We tested the hypothesis that first-trimester exposure to acute food deprivation is a risk factor for schizophrenia. A sharp and time-limited decline in the food intake of the Dutch population following a Nazi blockade in 1944 to 1945 created a unique if tragic natural experiment to test this hypothesis in three regions of Holland (west, north, and south). In the west, or famine region, birth cohorts exposed to severe food deprivation (an average daily ration under 4200 kJ) during the first trimester showed a substantial increase in hospitalized schizophrenia for women but not for men. Relative risks for women were 2.17 for "broad" and 2.56 for "restricted" schizophrenia. Moderate food deprivation during the first trimester (average daily ration under 6300 kJ) was not associated with increased risk of schizophrenia in the famine region. In the north and south regions, numbers were smaller and there was no exposure to severe famine. Birth cohorts exposed to moderate food deprivation during the first trimester showed a trend toward increased risk of schizophrenia for women. These findings give plausibility to the proposition that early prenatal nutrition can have a gender-specific effect on the risk of schizophrenia.
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Objective To assess the antidepressant efficacy of S-adenosyl methionine (SAMe), a naturally occurring methyl donor, versus the selective serotonin reuptake inhibitor (SSRI) escitalopram and a placebo control; and to determine whether serum histamine or carnitine levels modified treatment response. Methods We examined a subsample (n=144) from one site of a two-site study of adults with diagnosed Major Depressive Disorder (MDD), recruited from 4/13/05 to 12/22/09, who consented to the additional blood draw for serum histamine and carnitine levels. After washout, eligible subjects were randomized to SAMe (1600–3200 mg/daily), escitalopram (10–20 mg/daily), or matching placebo for 12 weeks of double-blind treatment (titration at week 6 in non-response). Results On the primary outcome of the Hamilton Depression Rating Scale (HAMD-17), a significant difference in improvement was observed between groups from baseline to week 12 (p=0.039). The effect size from baseline to endpoint was moderate to large for SAMe versus placebo (d=0.74). SAMe was superior to placebo from week 1, and to escitalopram during weeks 2, 4, and 6. No significant effect was found between escitalopram and placebo or SAMe. Response rates (HAMD-17≥50% reduction) at endpoint were 45%, 31%, and 26% for SAMe, escitalopram, and placebo, respectively; while remission rates (HAM-D≤7) were 34% for SAMe (p=0.003), 23% for escitalopram (p=0.023), and 6% for placebo. No correlation between baseline histamine level and reduction of HAMD-17 score was found for either the SAMe or escitalopram groups. Baseline carnitine levels were also not found to moderate response to either treatment. Limitations While SAMe appears to be an effective antidepressant agent, the overall findings from the parent study (which showed no significant difference between groups due to site differences) must be taken into consideration. Conclusions These preliminary results provide encouraging evidence for the use of SAMe in the treatment of MDD. Histamine and carnitine serum level may not necessarily moderate response to SAMe.