ArticlePDF Available

International Society for Nutritional Psychiatry Research consensus position statement: Nutritional medicine in modern psychiatry

International Society for Nutritional Psychiatry
Research consensus position statement: nutritional
medicine in modern psychiatry
In recent years, there has been an unprecedented growth
in both the quantity and methodological quality of research
directed at exploring the relationship between nutrition and
mental health. Indeed, the strength of data has now afforded
nutritional medicine a place in the mainstream psychiatric
discourse (1).
Robust associations have been established between nutri-
tional quality and mental health, with the bulk of this evi-
dence indicating a protective effect of healthy diets on
depressed mood (2), and the newest research supporting a
detrimental impact of unhealthy diets on the mental health
of young people (3,4) and adults (5,7).
There are also convincing data supporting the applica-
tion of certain nutrient-based supplements (nutraceuti-
cals) as monotherapy or combined therapy (8), or as aug-
mentation therapy (9).
Although the growth in scientific research related to nutri-
tion in psychiatry may be recent, it is now at a stage where it
can no longer be ignored. In light of this, we aim to provide a
platform to move towards a new integrated paradigm in psy-
chiatry whereby nutritional considerations (both education-
al and prescriptive) can be considered “mainstream” (1). To
this end, we present a consensus position statement from the
International Society for Nutritional Psychiatry Research
In brief, the ISNPR was formed in 2013 with the aim to
advance research and communication on nutritional med-
icine in the field of psychiatry. One of its first goals was to
formulate a position statement that embodied the princi-
ples of the organization, allowing for codification of the
society’s underpinning tenets.
In order to develop this, we employed a Delphi-based
model by which ISNPR researcher and clinician members
could vote on a select list of 110 statements created by an
expert steering committee.
The committee provided a list of sub-statements con-
cerning three main topics/areas: the current general needs
and challenges in psychiatry; key elements of diet and
nutraceutical evidence related to mental health/psychia-
try; potential public health and clinical applications. These
were transcribed and tabulated in Survey Monkey for online
voting by the wider ISNPR membership.
A Likert scale (0–10) was used for each statement
(05don’t include, 55don’t know/depends, 105definitely
include), and statements that received a mean score of
>6.5/10 by ISNPR members were reviewed by the steer-
ing committee for inclusion in the position statement,
which is presented below.
Present treatment of mental disorders is achiev-
ing sub-optimal outcomes; in addition little atten-
tion is given to preventative efforts. Due to the
immense burden of mental disorders, there is now
an urgent need to identify modifiable targets to
reduce the incidence of these disorders. Diet and
nutrition offer key modifiable targets for the preven-
tion of mental disorders and have a fundamental
role in the promotion of mental health.
Epidemiological data, basic science, and clinical
evidence suggest that diet influences both the risk
for and outcomes of mental disorders. As such, we
advocate that evidence-based nutritional change
should be regarded as an efficacious and cost-
effective means to improve mental health.
In addition to dietary modification, we recognize
that nutrient-based (nutraceutical) prescription has
the potential to assist in the management of mental
disorders at the individual and population level.
Many of these nutrients have a clear link to brain
health, including: omega-3s, B vitamins (particu-
larly folate and B12), choline, iron, zinc, magne-
sium, S-adenosyl methionine (SAMe), vitamin D,
and amino acids. While we advocate for these to
be consumed in the diet where possible, additional
select prescription of these as nutraceuticals may
also be justified.
Ongoing research (including randomized con-
trolled trials) in the area is recognized as critical,
using methodologically rigorous designs. Further
explication of the biological pathways affected by
nutritional modification is also required. Clinical
trials of nutraceuticals should include assessment
of biomarkers in tandem with clinical outcomes.
Global research and health promotion activities
focused on improving population health should
also include mental health parameters as priority
targets and measured outcomes.
Importantly, the activities of the food industry need
to be examined at a governmental level and relevant
policies designed to reduce the global burden of physi-
cal and mental ill-health attributable to poor diet.
Such policies are advised to stimulate significant pub-
lic change in dietary habits back towards a traditional
wholefood diet (dependent on the culture). Further,
there is now a vital need for better public and clinician
education to communicate current research findings
from the field.
In summary, nutrition and nutraceuticals should
now be considered as mainstream elements of psychi-
atric practice, with research, education, policy, and
health promotion reflecting this new paradigm.
370 World Psychiatry 14:3 - October 2015
As detailed in our consensus statement, we advocate for
the pursuit of an integrative psychiatric model, with diet as a
key element. Further, the select use of evidence-based nutra-
ceuticals should be a mainstay of treatment as either stand-
alone therapies (mainly in cases of less severe mental disor-
ders, non-tolerance to medication, nutrient deficiencies, or
patient choice), or as adjunctive interventions with psycho-
tropic medications to augment treatment efficacy. We recog-
nize the importance of clinician and public education regard-
ing evidence-based nutrition and nutraceuticals to drive
mainstream acknowledgement of their impact on mental
It is the intention that this position statement and the
ongoing work of ISNPR will assist in facilitating a trans-
formation in psychiatry to better address the substantial
global burden of mental illness, recognizing and embrac-
ing diet and nutrition as central determinants of both
physical and mental health.
Jerome Sarris
, Alan C. Logan
, Tasnime N.
, G. Paul Amminger
, Vicent Balanz
, Marlene P. Freeman
, Joseph Hibbeln
Yutaka Matsuoka
, David Mischoulon
, Tetsuya
, Akiko Nanri
, Daisuke Nishi
, Natalie
, Drew Ramsey
, Julia J. Rucklidge
Almudena Sanchez-Villegas
, Andrew Scholey
Kuan-Pin Su
, Felice N. Jacka
Department of Psychiatry, University of Melbourne,
Melbourne Clinic, Melbourne, Australia;
Centre for
Human Psychopharmacology, Swinburne University of
Technology, Hawthorn, Australia;
CAMNR, Calabasas,
Inserm U1198, Montpellier, France; EPHE,
Paris, France; University Montpellier 2, Montpellier,
Department of Epidemiology and Public
Health, University College London, London, UK;
gen, The National Centre of Excellence in Youth Men-
tal Health, Australia;
Teaching Unit of Psychiatry and
Psychological Medicine, La Fe University and Polytech-
nic Hospital, University of Valencia Medical School,
CIBERSAM, Valencia, Spain;
Perinatal and Reproduc-
tive Psychiatry, Massachusetts General Hospital, Bos-
ton, MA, USA;
National Institute on Alcohol Abuse
and Alcoholism, NIH, Bethesda, MD, USA;
ment of Clinical Epidemiology, Translational Medical
Center, National Center of Neurology and Psychiatry,
Tokyo, Japan;
Depression Clinical and Research Pro-
gram, Massachusetts General Hospital, Boston, MA,
Department of Epidemiology and Prevention,
National Center for Global Health and Medicine,
Tokyo, Japan;
Department of Mental Health Policy
and Evaluation, National Institute of Mental Health,
School of Population Health, University of
South Australia, Adelaide, Australia;
Columbia Uni-
versity College of Physicians and Surgeons, New York,
Department of Psychology, University of
Canterbury, Christchurch, New Zealand;
Institute of Biomedical and Health Sciences, University
of Las Palmas de Gran Canaria, Las Palmas de Gran
Canaria, Spain;
CIBEROBN, Instituto de Salud Car-
los III, Madrid, Spain;
Department of Psychiatry and
Mind-Body Interface Laboratory, China Medical Uni-
versity Hospital, Taichung, Taiwan;
Graduate Insti-
tute of Neural and Cognitive Sciences, China Medical
University, Taichung, Taiwan;
of Medicine, Deakin University, Geelong, 3220, Austra-
Murdoch Children’s Research Centre, Parkville,
Department of Psychiatry, University of
Melbourne, Royal Melbourne Hospital, Melbourne,
Black Dog Institute, Road Prince of Wales
Hospital, Randwick, Australia
1. Sarris J, Logan A, Akbaraly T et al. Nutritional medicine as main-
stream in psychiatry. Lancet Psychiatry 2015;2:271-4.
2. Lai JS, Hiles S, Bisquera A et al. A systematic review and meta-
analysis of dietary pattern and depression in community-dwelling
adults. Am J Clin Nutr 2013;99:181-97.
3. O’Neil A, Quirk SE, Housden S et al. Relationship between diet
and mental health in children and adolescents: a systematic
review. Am J Public Health 2014;104:e31-42.
4. Jacka FN, Ystrom E, Brantsaeter AL et al. Maternal and early
postnatal nutrition and mental health of offspring by age 5 years:
a prospective cohort study. J Am Acad Child Adolesc Psychiatry
5. Akbaraly TN, Brunner EJ, Ferrie JE et al. Dietary pattern and
depressive symptoms in middle age. Br J Psychiatry 2009;195:
6. Sanchez-Villegas A, Delgado-Rodr
ıguez M, Alonso A et al. Asso-
ciation of the Mediterranean dietary pattern with the incidence of
depression: the Seguimiento Universidad de Navarra/University
of Navarra follow-up (SUN) cohort. Arch Gen Psychiatry 2009;
7. Jacka FN, Pasco JA, Mykletun A et al. Association of Western and
traditional diets with depression and anxiety in women. Am J Psy-
chiatry 2010;167:305-11.
8. Rucklidge JJ, Kaplan BJ. Broad-spectrum micronutrient formulas
for the treatment of psychiatric symptoms: a systematic review.
Expert Rev Neurother 2013;13:49-73.
9. Sarris J, Kavanagh D, Byrne G. Adjuvant use of nutritional and
herbal medicines with antidepressants, mood stabilizers and ben-
zodiazepines. J Psychiatr Res 2010;44:32-41.
DOI 10.1002/wps.20223
... Our extensive database allowed us to further adjust for these lifestyle factors which slightly attenuated the beneficial effect from MDP. Similarly, metabolic diseases can result in dietary habits which could modulate the risk of depression in turn [7,14]. As obesity is known to stimulate chronic pro-inflammatory status, it is a plausible pathway linking together diet and risk of depression [39]. ...
Full-text available
Background Depression imposes immense public health burden, demonstrating an urgent need of the identification of modifiable risk factors. Only a few cohort studies have analyzed the association between Mediterranean dietary pattern (MDP) and depression but with mixed results. We examined the impact of MDP on clinically ascertained depression in a large population-based dataset. Methods In 1991/92, detailed information on diet, using a food frequency questionnaire, and potential confounding factors (body weight, height, educational attainment, smoking, previous diabetes and hypertension, and physical activity) was collected, in a random sample of 49,261 Swedish women aged 29-49. Adherence to MDP was calculated. Clinical depression was extracted from the National Patient Register. Study participants were followed up through 2012. Results During an average follow-up of 20.4 years, 1677 incident cases of depression were diagnosed. We observed a lower risk of depression for medium (score 4-5) and high (6-9) adherence to MDP, compared with low (0-3) adherence (Medium: hazard ratio (HR) = 0.90, 95% confidence interval (CI) = 0.81-1.00; High: HR = 0.82, 95%CI = 0.71-0.94). Per unit increase of adherence, the risk of depression was reduced by 5% (HR = 0.95, 95%CI = 0.92-0.98). The association became stronger when restricting to severe form of depression (HR = 0.51, 95%CI = 0.33-0.76). The HRs were higher from age 50 onward both over the first and the second 10-year follow-up period, compared with before age 50, indicating stronger association with increasing age. Results remained after extensive sensitivity analyses. Conclusion Higher adherence to a Mediterranean diet at middle age was associated with a lower risk of depression later in life among Swedish women.
... A recent cross-sectional study of adults residing in Vietnam found a relationship between poorer diet quality and depression during COVID-19 lockdown [16]. Mechanisms explaining the link between nutrition and depression are unclear, but metabolic, immunological, and neurotrophic involvement have been hypothesized [29]. ...
Full-text available
Background The COVID-19 pandemic has resulted in unprecedented disruptions, restrictions, and concerns about physical and mental health. Emerging adulthood, including the first year of college, is associated with declines in healthy eating and physical activity, as well as possible heightened distress. The impact of COVID-19 may exacerbate these concerns. Purpose The purpose of this study was to examine changes in health behaviors and perceived stress in emerging adults over the first year of college and to determine whether prepandemic health behaviors were protective for mental health and stress during the initial changes after the COVID-19 pandemic. Methods First-year college students (N = 234, 58.6% female) completed three surveys during their first year of school, the third being after the onset of COVID-19 and during a stay-at-home order. At Time 3, we also assessed symptoms of anxiety and depression. Results Using linear mixed modeling, sedentary time increased and physical activity decreased over time, but 20%–35% of students reported improvements in these behaviors. Dietary changes appeared mixed, with some improvements noted early during COVID-19. Perceived stress increased over time. Multiple regression indicated that of the health behaviors examined for protective effects on mental health and stress during the pandemic, only diet quality emerged as a significant predictor. Conclusions Although notable declines in some health habits were observed over time, including following COVID-19 disruptions, some students reported improved health behaviors. Efforts should be directed at identifying and intervening with students most at risk for poor functioning.
... Among the modifiable factors, diet is one of the main lifestylerelated factors for mental disorders that individuals are exposed to daily. Of note, the experts from the International Society for Nutritional Psychiatry Research state that "diet and nutrition are central determinants of mental health" (4). It has been increasingly recognized that diet could serve as a key source of inflammation due to the ability of specific food parameters to regulate inflammatory biomarkers (5)(6)(7). ...
Objective: We aimed to systematically evaluate the association between Dietary Inflammatory Index (DII) and mental health. Methods: We searched PubMed, Embase, and Web of Science from their inception to December 31, 2020. Categorical meta-analysis and dose–response meta-analysis were performed to evaluate the association between DII and mental health. Results: A total of 16 studies were included in this meta-analysis. Compared with the lowest DII category, the highest category was significantly associated with a variety of mental health outcomes, with the following pooled odds ratios (ORs) and 95% confidence intervals (95% CIs): 1.28 (1.17–1.39) for symptoms of depression, 1.27 (1.08–1.49) for symptoms of anxiety, 1.85 (1.43–2.40) for distress, and 4.27 (1.27–14.35) for schizophrenia. Furthermore, there was a linear dose–response relationship between DII and symptoms of depression in that a 1-unit increment in DII was associated with an increased risk of 6% for symptoms of depression (OR: 1.06, 95% CI: 1.03–1.19). Conclusion: The present study indicates that more pro-inflammatory diet, as estimated by the higher DII score, is associated with symptoms of mental disorder. It may be of clinical and public health significance regarding the development of novel nutritional psychiatry approaches to promote good mental health.
... Recently, epidemiological data have highlighted the association between nutrition and mental health, which raises up more studies in the nascent eld of nutritional psychiatry (6). Although diet has been reported in many studies to potentially prevent or treat mental illness, mostly major depression (7,8), information about the causality or underlying mechanism is still unclari ed. ...
Full-text available
Emerging findings highlighted the associations of mental illness to nutrition and dysbiosis in the intestinal microbiota, but the underlying mechanisms, especially in schizophrenia (SZ), remain unclarified. Here we conducted a case-control study of SZ by performing gut metagenome, fecal and plasma non-targeted metabolome, short-, medium-, and long-chain fatty acids, and targeted metabolite analysis. The results uncovered an apparent contradiction in SZ patients between inadequate protein intake and protein-fermentation-dominated intestinal microbial metabolism, which shifted from carbohydrate fermentation and protein synthesis in healthy conditions. Moreover, the extent of protein fermentation represented as the abundance of related enzymes and fecal levels of related products, usually nitrogenous and neurologically active, correlated with the severity of psychiatric symptoms. These findings provide a previously uncharacterized pathophysiological process in SZ related to the dysbiosis of gut microbiota and dysregulation in macronutrient metabolism, highlighting the importance of nutrition care and the potentials for developing microbiota-targeted therapeutics in SZ.
Full-text available
Resumen Los denominados trastornos mentales comunes (trastornos depresivos y de ansiedad) son patologías muy frecuentes en la población y tienen un impacto notable en las personas afectadas. Se revisarán la prevalencia de estos trastornos, así como los tratamientos clásicos y otros más novedosos basados en la nutrición. La OMS estima que la depresión afecta al 4,4% de la población mundial y los trastornos de ansiedad al 3,6%. Los tratamientos clásicos para estos trastornos se han basado principalmente en la combinación de psicoterapia y el uso de antidepresivos y ansiolíticos. Sin embargo, los incómodos efectos secundarios que presentan estos fármacos reducen su adherencia, contribuyendo a la disminución de su eficacia y a la cronificación de la enfermedad. Tras el descubrimiento del eje intestino-microbiota-cerebro y la postulación de la comunicación bidireccional de la microbiota del tracto digestivo y del sistema nervioso central, los trabajos más recientes están centrando sus investigaciones en la influencia de la dieta sobre el estado anímico. De esta manera se han recabado evidencias científicas que promueven el uso de nutracéuticos de diferentes tipos como posibles coadyuvantes de las terapias farmacológicas para los trastornos mentales. Estos nutracéuticos están basados en probióticos de los géneros Lactobacillus y Bifidobacterium. Las últimas tendencias exploran el campo de los insectos como fuente de principios activos para la salud mental. Aunque se necesitan más estudios en este campo, existen ya evidencias de que la nutracéutica podría ser una alternativa para el tratamiento de la depresión y la ansiedad. Healthy nutrition and mental disorders. New treatment alternatives Summary The so-called common mental disorders (depressive and anxiety disorders) are very common pathologies among the population and their impact is very striking on the affected people. The prevalence of these disorders will be reviewed, as well as the classic and other novel treatments based on nutrition. WHO estimates that depression affects 4.4% and anxiety disorders 3.6% of the world's population. Classic treatments are mainly based on the combination of psychotherapy and antidepressants and anxiolytics. However, the unpleasant side-effects of these drugs reduce patients' adherence, decreasing their efficacy and increasing the chronicity of the disease. Since the discovery of the brain-gut-microbiota axis and the bidirectional communication between gut microbiota and the central nervous system, most recent researches are focusing on the influence of the diet on the mood. In this way, scientific evidences have been collected promoting the use of nutraceuticals as possible adjuvants for the treatment of mental disorders. These kinds of nutraceuticals are based on Lactobacillus and Bifidobacterium probiotics. The latest trends explore the field of insects as source of active ingredients for mental health. Although more studies are needed in this field, there are already clear evidences supporting nutraceuticals as an alternative treatment for depression and anxiety.
Aim This scoping review aimed to explore the extent of the evidence of experimental studies evaluating the cost effectiveness of dietary interventions in individuals with mental disorders. Methods Five databases (CINAHL, EMBASE, MEDLINE, PsycINFO and Scopus) were searched to October 2020 for cost-analysis studies of interventions aiming to improve dietary intake in people with mental disorders. No restriction was placed on participant age, mental disorder type or intervention design. Results are presented narratively. Results Of 2753 articles identified, 13 articles reporting on eight studies were included. Studies were RCTs (n = 5), cluster RCT (n = 1), cluster preference RCT (n = 1), and pre-post test (n = 1). Seven studies were in community settings (eg, outpatient clinics), and one study in the community housing setting. All studies were in adults, seven included male and female participants, and one included only females. Defined mental disorder diagnoses included serious/severe mental disorders (n = 3), major depression (n = 2), schizophrenia, schizoaffective disorder or first-episode psychosis (n = 1), any mental disorder (n = 1), and bulimia nervosa (n = 1). Five interventions were multi-behaviour, two were diet only and one was eating disorder treatment. Cost analyses included cost-utility (n = 3), cost-effectiveness (n = 1), cost-utility and cost-effectiveness (n = 3), and a costing study (n = 1). Two studies (25%) reported positive results in favour of cost effectiveness, and four studies reported a mix of positive and neutral results. Conclusions There is limited evidence evaluating the cost effectiveness of dietary interventions in individuals with mental disorders. Additional studies in various settings are needed to confirm cost effectiveness of different interventions.
Suicide is a multifaceted phenomenon, related to an everlasting interconnection between biological, psychosocial, sociological, philosophical, and cultural aspects of human life. Immune system, which is constantly responding to changing environments and changing in response to them, seems to play a major role in this interaction. Multiple studies have reported increased risk of suicidal behaviours after or during inflammatory conditions. Individuals that engage in suicidal behaviours also have increased concentrations of inflammatory markers, such as interleukins 1β and 6, tumour necrosis factor α, and C-reactive protein, both in blood and the central nervous system (CNS). Stress, which is frequently mentioned among the major risk factors for suicidal behaviours, is also associated with a wide immune system dysregulation, entailing glucocorticoid system disruption and a low-grade inflammation. Mechanisms connecting systemic inflammation and CNS changes include damage to blood-brain barrier and interoceptive alterations, both resulting in changes in the communication between the periphery and the brain. Meanwhile, in CNS, pro-inflammatory cytokines may activate microglia causing a shift in tryptophan metabolism, preferentially generating cellular energy and toxic by-products of kynurenine pathway rather than serotonin. These changes in brain homeostasis lead to anatomical and functional brain alterations, most notably prefrontal cortex and insula, engendering maladaptive behavioural phenotypes, such as anhedonia and impulsivity that may mediate the association between inflammation and suicide. This chapter will provide a condensed overview of this complex association between inflammation and suicidal behaviours, presenting major findings in this area and explaining key pathways linking them.
Full-text available
Accumulating evidence suggests that inflammation plays an important role in the pathophysiology and therapeutic mechanism across major psychiatric disorders. “Inflammation theory” might not be the full answer for the big picture of mental disorders, but it might explain the high occurrence of somatic symptoms and comorbidity of physical illness in certain subtypes of the heterogeneous groups. Nutritional psychiatric research has been expanding in the past two decades. Epidemiological studies showed that nutritional deficiency has been associated with an increased prevalence of psychiatric disorders, while nutritional supplementation has been shown to reduce or even play a role in the prevention of psychiatric disorders. Moreover, inflammatory regulation has been suggested to be the possible link between nutritional supplementation and psychiatric disorders. Thus, the aim of this chapter is to discuss the role of nutritional supplementations, including omega-3 polyunsaturated fatty acids (n-3 PUFAs) and prebiotics/probiotics, in two commonly seen psychiatric disorders, major depressive disorder (MDD) and attention deficit hyperactivity disorder (ADHD), with inflammatory regulation as the shared mechanism.
Full-text available
Diet has long been the focus of attention as a leading risk factor for non-communicable diseases. As such, a better understanding of it is crucial to establish priorities for dietary guidelines and to inform, design, and implement strategies for preventing, helping manage, and stopping the progression of sleep and mental health-related symptoms/disorders. The aim of the current study is to conduct the largest investigation of diet, sleep, and mental health to date by utilizing the UK Biobank (UKB) dataset to identify the associations between diet and (i) sleep quality/health, and (ii) mental health symptomatology. This cross-sectional population-based study involved 502,494 middle-aged adults. UKB food frequency, sleep, and psychological factors and mental health questionnaires at baseline were used. Scores were also calculated for healthy diet, healthy sleep, mental health symptomatology, partial fibre intake, and milk intake. We observed positive associations with healthy diet and sleep and mental health, especially benefits of high intakes of vegetable, fruit, fish, water, and fibre. However, processed meat and milk intake were adversely associated with sleep and mental health. These findings make clear that there are health and wellbeing benefits and drawbacks of different diets, but do not, at this stage, demonstrate the clear causal relationships, which would support dietary interventions that might play a role in the treatment and also self-management of sleep and mental health disorders/symptoms. Further research is required to understand mechanisms of actions of which diet acts on to modulate sleep and mental health, while taking comorbidity of sleep and mental health disorders/symptoms into consideration.
Full-text available
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.
Full-text available
We systematically reviewed 12 epidemiological studies to determine whether an association exists between diet quality and patterns and mental health in children and adolescents; 9 explored the relationship using diet as the exposure, and 3 used mental health as the exposure. We found evidence of a significant, cross-sectional relationship between unhealthy dietary patterns and poorer mental health in children and adolescents. We observed a consistent trend for the relationship between good-quality diet and better mental health and some evidence for the reverse. When including only the 7 studies deemed to be of high methodological quality, all but 1 of these trends remained. Findings highlight the potential importance of the relationship between dietary patterns or quality and mental health early in the life span.
Full-text available
Ingesting minerals and vitamins in combination makes physiological sense, and research on the use of broad-spectrum formulations for psychiatric symptoms is increasing rapidly. This review covers formulas consisting of at least four vitamins and/or minerals and includes four experimental designs: randomized controlled trials, open-label trials, case-control studies and case studies with within-subject crossovers. Nevertheless, there is evidence for the efficacy of micronutrients in the treatment of stress and antisocial behaviors as well as depressed mood in nonclinical and elderly populations. Many reports studied mood changes in healthy populations, making it difficult to generalize to clinical samples. There is also preliminary support for the treatment of autism with micronutrients. However, despite positive preliminary findings, there are less data available to support efficacy of micronutrient formulas in treating bipolar disorder, attention deficit-hyperactivity disorder and substance abuse/dependence and no clinical trials have been done with clinically depressed or anxious patient samples, psychosis or eating disorders.
Full-text available
Studies of diet and depression have focused primarily on individual nutrients. To examine the association between dietary patterns and depression using an overall diet approach. Analyses were carried on data from 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' (heavily loaded by vegetables, fruits and fish) and 'processed food' (heavily loaded by sweetened desserts, fried food, processed meat, refined grains and high-fat dairy products). Self-reported depression was assessed 5 years later using the Center for Epidemiologic Studies - Depression (CES-D) scale. After adjusting for potential confounders, participants in the highest tertile of the whole food pattern had lower odds of CES-D depression (OR = 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 (OR = 1.58, 95% CI 1.11-2.23). In middle-aged participants, a processed food dietary pattern is a risk factor for CES-D depression 5 years later, whereas a whole food pattern is protective.
Full-text available
Adherence to the Mediterranean dietary pattern (MDP) is thought to reduce inflammatory, vascular, and metabolic processes that may be involved in the risk of clinical depression. To assess the association between adherence to the MDP and the incidence of clinical depression. Prospective study that uses a validated 136-item food frequency questionnaire to assess adherence to the MDP. The MDP score positively weighted the consumption of vegetables, fruit and nuts, cereal, legumes, and fish; the monounsaturated- to saturated-fatty-acids ratio; and moderate alcohol consumption, whereas meat or meat products and whole-fat dairy were negatively weighted. A dynamic cohort of university graduates (Seguimiento Universidad de Navarra/University of Navarra Follow-up [SUN] Project). A total of 10 094 initially healthy Spanish participants from the SUN Project participated in the study. Recruitment began on December 21, 1999, and is ongoing. Participants were classified as having incident depression if they were free of depression and antidepressant medication at baseline and reported a physician-made diagnosis of clinical depression and/or antidepressant medication use during follow-up. After a median follow-up of 4.4 years, 480 new cases of depression were identified. The multiple adjusted hazard ratios (95% confidence intervals) of depression for the 4 upper successive categories of adherence to the MDP (taking the category of lowest adherence as reference) were 0.74 (0.57-0.98), 0.66 (0.50-0.86), 0.49 (0.36-0.67), and 0.58 (0.44-0.77) (P for trend <.001). Inverse dose-response relationships were found for fruit and nuts, the monounsaturated- to saturated-fatty-acids ratio, and legumes. Our results suggest a potential protective role of the MDP with regard to the prevention of depressive disorders; additional longitudinal studies and trials are needed to confirm these findings.
Studies of single nutrients on depression have produced inconsistent results, and they have failed to consider the complex interactions between nutrients. An increasing number of studies in recent years are investigating the association of overall dietary patterns and depression. This study aimed to systematically review current literature and conduct meta-analyses of studies addressing the association between dietary patterns and depression. Six electronic databases were searched for articles published up to August 2013 that examined the association of total diet and depression among adults. Only studies considered methodologically rigorous were included. Two independent reviewers completed study selection, quality rating, and data extraction. Effect sizes of eligible studies were pooled by using random-effects models. A summary of the findings was presented for studies that could not be meta-analyzed. A total of 21 studies were identified. Results from 13 observational studies were pooled. Two dietary patterns were identified. The healthy diet pattern was significantly associated with a reduced odds of depression (OR: 0.84; 95% CI: 0.76, 0.92; P < 0.001). No statistically significant association was observed between the Western diet and depression (OR: 1.17; 95% CI: 0.97, 1.68; P = 0.094); however, the studies were too few for a precise estimate of this effect. The results suggest that high intakes of fruit, vegetables, fish, and whole grains may be associated with a reduced depression risk. However, more high-quality randomized controlled trials and cohort studies are needed to confirm this finding, specifically the temporal sequence of this association.
Diet quality is related to the risk for depression and anxiety in adults and adolescents; however, the possible impact of maternal and early postnatal nutritional exposures on children's subsequent mental health is unexplored. The large prospective Norwegian Mother and Child Cohort Study recruited pregnant women between 1999 and 2008. Data were collected from mothers during pregnancy and when children were 6 months and 1.5, 3, and 5 years of age. Latent growth curve models were used to model linear development in children's internalizing and externalizing problems from 1.5 to 5 years of age as a function of diet quality during pregnancy and at 1.5 and 3 years. Diet quality was evaluated by dietary pattern extraction and characterized as "healthy" or "unhealthy." The sample comprised 23,020 eligible women and their children. Adjustments were made for variables including sex of the child, maternal depression, maternal and paternal age, maternal educational attainment, household income, maternal smoking before and during pregnancy, mothers' parental locus of control, and marital status. Higher intakes of unhealthy foods during pregnancy predicted externalizing problems among children, independently of other potential confounding factors and childhood diet. Children with a high level of unhealthy diet postnatally had higher levels of both internalizing and externalizing problems. Moreover, children with a low level of postnatal healthy diet also had higher levels of both internalizing and externalizing problems. Among this large cohort of mothers and children, early nutritional exposures were independently related to the risk for behavioral and emotional problems in children.
Key biological factors that influence the development of depression are modified by diet. This study examined the extent to which the high-prevalence mental disorders are related to habitual diet in 1,046 women ages 20-93 years randomly selected from the population. A diet quality score was derived from answers to a food frequency questionnaire, and a factor analysis identified habitual dietary patterns. The 12-item General Health Questionnaire (GHQ-12) was used to measure psychological symptoms, and a structured clinical interview was used to assess current depressive and anxiety disorders. After adjustments for age, socioeconomic status, education, and health behaviors, a "traditional" dietary pattern characterized by vegetables, fruit, meat, fish, and whole grains was associated with lower odds for major depression or dysthymia and for anxiety disorders. A "western" diet of processed or fried foods, refined grains, sugary products, and beer was associated with a higher GHQ-12 score. There was also an inverse association between diet quality score and GHQ-12 score that was not confounded by age, socioeconomic status, education, or other health behaviors. These results demonstrate an association between habitual diet quality and the high-prevalence mental disorders, although reverse causality and confounding cannot be ruled out as explanations. Further prospective studies are warranted.
Adjuvant use of nutritional and herbal medicines has potential to increase the efficacy of synthetic pharmaceuticals, and perhaps also decrease their side-effects by allowing lower doses to be prescribed. We evaluated current evidence for adjuvant use of nutritional and herbal medicines with antidepressants, mood stabilizers and benzodiazepines; and explored novel future areas of research. The paper also critiques current evidence for co-administration of St. John's wort with synthetic antidepressants. We performed a systematic search of MEDLINE, CINAHL, PsycINFO, The Cochrane database, China National Knowledge Infrastructure and the Chinese Science Citation Database. Search results were supplemented by a review of reference lists and a forward search using the Web of Science. Where possible we calculated effect sizes. Encouraging evidence exists for the use of omega-3 fatty acids, SAMe, folic acid and l-tryptophan adjuvantly with antidepressants to enhance response and improve efficacy. Various nutrients also have emerging evidence as effective adjuncts with antipsychotics and mood stabilizers. While some evidence supports nutritional adjuvancy with various psychopharmacotherapies, adjuvant use of herbal therapies has not been sufficiently studied to warrant standard clinical application. This remains a promising area of research via robust, safety-conscious studies.