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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
... An interaction between air pollution and plant-based dietary patterns on cognitive function among older adults was also found [13]. Regarding depression, the founding of the International Society for Nutritional Psychiatry Research provides a promising focal point [14]. Recently, the Mediterranean-DASH intervention for neurodegenerative delay (MIND) diet has received considerable attention from the field of psychiatry due to its emphasis on unprocessed foods that are rich in antioxidant nutrients that reduce oxidative stress and inflammation and its ease of adherence [15]. ...
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This study aims to explore the interaction between a Chinese version of the Mediterranean–DASH intervention for neurodegenerative delay (cMIND) diet and indoor air pollution and its effect on depression among older adults. This cohort study used 2011–2018 data from the Chinese Longitudinal Healthy Longevity Survey. Participants included 2724 adults aged 65 and older without depression. The Chinese version of the Mediterranean–DASH intervention for neurodegenerative delay (cMIND) diet scores ranged from 0 to 12 based on validated food frequency questionnaire responses. Depression was measured using the Phenotypes and eXposures Toolkit. Cox proportional hazards regression models were used to explore the associations, and the analysis was stratified using the cMIND diet scores. A total of 2724 participants (54.3% males and 45.9% 80 years and older) at baseline were included. Living with severe indoor pollution was associated with a 40% increase in the risk of depression (HR: 1.40, 95% CI: 1.07, 1.82) compared to living without indoor pollution. Indoor air pollution exposure was significantly associated with cMIND diet scores. Participants with a lower cMIND diet score (HR: 1.72, 95% CI: 1.24, 2.38) had a greater association with severe pollution than those with a higher cMIND diet score. The cMIND diet may alleviate depression caused by indoor pollution among older adults.
... Although medication and psychological interventions are the first-line therapies for depression, lifestyle intervention (including diet and physical activity) is mutable, safe and low-cost, and may provide the basis of practical interventions to manage depression. Among the lifestyle factors, the diet has been considered as the central determinant of mental health [9]. The relationship between depression and diet has been verified both in prospective and cross-sectional studies. ...
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This study examined the association between the energy-adjusted Dietary Inflammatory Index (E-DII)-based dietary inflammatory potential and depressive symptoms (DepS) among patients with breast cancer and explores whether systemic inflammation mediates this association. We assessed dietary intake and DepS in 220 breast cancer patients by three 24 h dietary recalls and the Center for Epidemiological Studies Depression Scale (CES-D), respectively, and determined plasma levels of C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), and interleukin (IL)-1β, IL-4, and IL-6 in 123 blood samples. We found that each one-point increase of E-DII was related to a 53% elevated risk of DepS. Patients with the most pro-inflammatory diets had a 5.13 times higher risk of DepS than those with the most anti-inflammatory diets. Among the E-DII components, vitamin B2, zinc, and iron were inversely associated with DepS risk. Furthermore, E-DII scores were positively associated with CRP and TNF-α. Higher levels of TNF-α and IL-6 were associated with higher DepS risk. A significant mediating effect of TNF-α was revealed between E-DII and DepS. Our findings suggest that a pro-inflammatory diet is positively associated with breast cancer-related DepS, which may be mediated by TNF-α.
... Over the past three decades, the influence of nutrition and nutrients, such as vitamin D, vitamin B12, folate, and zinc, on mental health has received growing attention through epidemiological and experimental findings [59], but the mechanism through which specific nutrients and depression are correlated is not clear. Our present data provided a novel possibility that couples specific nutrients to depression, that is, stress impairs the absorption or metabolism of nutrients, followed by the disruption of physiological function, which supports the nutrition psychiatry hypothesis [61]. For the limitation of detection sensitivity, the content of plasma ascorbic acid was not tested in this study. ...
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Vitamin C, a key antioxidant in the central nervous system, cycles between ascorbic acid and dehydroascorbic acid under pathophysiological conditions. Clinical evidence supports that the absence of vitamin C may be linked to depressive symptoms, but much less is known about the mechanism. Herein, we show that chronic stress disrupts the expression of ascorbic acid transporter, sodium-dependent vitamin C transport 2, and induces a deficiency in endogenous ascorbic acid in the medial prefrontal cortex, leading to depressive-like behaviors by disturbing redox-dependent DNA methylation reprogramming. Attractively, ascorbic acid (100 mg/kg-1000 mg/kg, intraperitoneal injection, as bioequivalent of an intravenous drip dose of 0.48 g–4.8 g ascorbic acid per day in humans) produces rapid-acting antidepressant effects via triggering DNA demethylation catalyzed by ten-eleven translocation dioxygenases. In particular, the mechanistic studies by both transcriptome sequencing and methylation sequencing have shown that S100 calcium binding protein A4, a potentially protective factor against oxidative stress and brain injury, mediates the antidepressant activity of ascorbic acid via activating erb-b2 receptor tyrosine kinase 4 (ErbB4)-brain derived neurotrophic factor (BDNF) signaling pathway. Overall, our findings reveal a novel nutritional mechanism that couples stress to aberrant DNA methylation underlying depressive-like behaviors. Therefore, application of vitamin C may be a potential strategy for the treatment of depression.
... Public Health 2022, 19, 14437 2 of 10 A complex interplay of genetic, biological, psychological, behavioral, and environmental determinants for depression has been proposed [6][7][8]. In particular, the role of diet in the etiology and course of depression has received more attention in recent years as a modifiable lifestyle factor that could contribute to the treatment of this mental disorder [9,10]. The pathways through which diet influences depression could be related to inflammation, oxidative stress, hypothalamic-pituitary-adrenal axis function, tryptophan-kynurenine metabolism, neurogenesis and brain-derived neurotrophic factor, epigenetics, mitochondrial function, and the gut microbiota [11]. ...
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The associations between Mediterranean diet (MD) adherence and depression levels have been synthesized from observational studies. However, a systematic review with meta-analysis including randomized controlled trials (RCTs) on this relationship in adults with depressive disorders remains lacking. This protocol was conducted according to the Preferred Reporting Items for Systematic Review and Meta-Analysis for Protocols statement. MEDLINE (PubMed), Cochrane CENTRAL, PsycINFO, Scopus, and Web of Science databases will be systematically searched to identify studies published from database inception up to 30 September 2022. The inclusion criteria will comprise RCTs reporting pre-post changes in depression status (symptoms or remission) after a MD intervention compared to a control condition in adults over 18 years with depressive disorders. Pooled effect sizes and 95% confidence intervals will be calculated using the DerSimonian random-effects model. This study protocol determines the methodological approach for the systematic review and meta-analysis that will summarize the available evidence on the efficacy of MD interventions on depressive symptoms in adults with depressive disorders. The findings from this review may have implications for public mental health programs. The results will be disseminated through peer-reviewed publication, conference presentation, and infographics. No ethical approval will be required since only published data will be used. PROSPERO registration number: CRD42022341895.
... Evidence suggests that inflammatory processes contribute to depression through different pathways, such as exposure to psychosocial stress or a processed-food diet, increasing the activation of proinflammatory cytokines or inflammasomes that drive inflammatory responses relevant to depression [9]. Accordingly, nutrition has received more attention in the last decade as a modifiable lifestyle risk factor for depression [10], with a particular focus on the consumption of specific foods that might modulate inflammatory factors [11,12]. ...
Background & aims Only a few studies have assessed the association between a proinflammatory diet and the risk of depression in older adults, and they have rendered weak results. The present study analysed the association between the Dietary Inflammatory Index (DII) and incident self-reported diagnosis or symptoms of depression in two cohorts of community-dwelling older adults in Spain. Methods We used data from the Seniors-ENRICA-I (SE-I) and Seniors-ENRICA-II (SE-II) cohorts. In both cohorts, the baseline DII was calculated from habitual food consumption estimated with a validated computer-based diet history. The incidence of both physician self-reported diagnosis of depression and mild-to-major depressive symptoms (≥3 on the 10-item Geriatric Depression Scale) was analysed. Logistic regression models were adjusted for the main potential confounders, such as sociodemographics, lifestyles, and comorbidities. The results of both cohorts were pooled using a random effects model. Results Among the 1627 participants in SE-I (mean age 71.5 ± 5.5 y, 53.1% women) and the 1579 in SE-II (mean age 71.4 ± 4.2, 46.7% women), 86 (5.3%) and 140 (8.9%) incident cases of depression were identified after a mean 3.2-y and 2.3-y follow-up, respectively. The fully adjusted odds ratio (95% confidence interval) of incident depression for the highest (the highest proinflammatory diet) versus the lowest quartile of DII was 2.76 (1.25–6.08, p-for-trend = 0.005) in the SE-I, 1.90 (1.04–3.40, p-for-trend = 0.005) in the SE-II and 2.07 (1.01–3.13) in the pooled cohorts. The results were consistent across strata defined by sex, age, physical activity, loneliness/poor social network, and morbidity. Conclusions A proinflammatory dietary pattern is associated with depression risk in older adults. Future research should evaluate whether reducing the inflammatory component of diet leads to reduced depression symptoms in this population.
Les patients atteints de schizophrénie (SZ) présentent un risque de morbi-mortalité cardiovasculaire élevé en lien notamment avec une capacité cardiorespiratoire (CCR) réduite et un mode de vie sédentaire. Par ailleurs, bien que les antipsychotiques puissent réduire les symptômes positifs, leur efficacité sur les symptômes négatifs reste limitée et ils sont bien souvent associés à des effets indésirables cardiométaboliques. L’activité physique (AP) a démontré des effets bénéfiques à la fois sur la santé physique et mentale chez les SZ comme présenté dans notre revue de la littérature. Cependant, certains programmes d’AP classiques en face-à-face se heurtent à des taux d’abandon élevés ou à une accessibilité réduite. Ainsi, les objectifs de cette thèse étaient d’évaluer la faisabilité, l’acceptabilité et les bénéfices d’un programme d’AP adaptée à distance utilisant la visioconférence (e-APA) comparativement à un programme d’éducation à la santé (e-ES) sur la condition physique, le niveau d’AP et de comportement sédentaire, les variables physiologiques, biologiques et cliniques chez des SZ et des témoins volontaires sains (TVS) dont le protocole d’étude a fait l’objet d’une publication. Nous avons mis en évidence que l’e-APA est faisable et acceptable chez les SZ avec un faible taux d’abandon et un taux de participation élevé. Notre résultat principal montre une amélioration de la CCR chez les SZ recevant l’e-APA comparativement à ceux du groupe éducation à la santé ainsi qu’une réduction des comportements sédentaires et du LDL-cholestérol. Enfin, l’e-APA réduit la symptomatologie psychotique et les symptômes négatifs, en particulier la dimension avolition-apathie. Pour conclure, ces résultats soulignent que l’e-APA représente une stratégie thérapeutique adjuvante novatrice, originale, sûre et efficace chez les SZ, laquelle nécessite des explorations supplémentaires pour son application en pratique clinique.
Background: During the COVID-19 pandemic, all health workforces, including nursing students, were mobilized to prevent the spread of the disease. The physical and mental health of frontline healthcare workers has been shown to have several adverse effects during the COVID-19 outbreak. However, few studies analyzed the mental health of nursing students participating in COVID-19 prevention, especially in Vietnam. Objective: The study was to identify and analyze the mental health of students and its related factors during the fourth wave of COVID-19 in Vietnam. Methods: A cross-sectional survey was conducted among 672 nursing students participating in COVID-19 in Ho Chi Minh City, Vietnam, from September to October 2021. Self-administered and online-based surveys were used to collect data using Generalized Anxiety Disorder (GAD-7), Patient Health Questionnaire (PHQ-9),and the Insomnia Severity Index. Descriptive statistics and logistic regression were done for data analysis using R 3.6.0 software. Results: Among our participants, the proportion of depression symptoms, anxiety symptoms, and insomnia were 2.88%, 5.1%, and 4.33%, respectively. Students who had physical activity habits before involvement in COVID-19 and maintained physical activity while participating in the epidemic had lower symptoms of anxiety, depression, and the risk of sleep disturbances. Furthermore, students with healthy diet status had fewer negative consequences on their mental health. Conclusions: Our findings provided evidence for organizations strategizing to preserve the emotional health of nursing students while engaging in the COVID-19 campaign.
Lipids as a large heterogeneous group of hydrophobic or amphipathic organic molecules constituted by hydrocarbons with the presence of other associated functional groups are involved in a plethora of biological processes. Extensive research into the potential bioactivity of lipids in a variety of disease conditions has been conducted over the years, resulting in a paradigm shift for the pharmaceutical, cosmetic, and food industries. Indeed, historically, lipids were previously used as excipients and/or for their nutritional value in these industries; however, with the introduction of the bioactive lipids concept, these molecules began to be used as the main bioactive ingredients in formulations. Regarding this, the present chapter provides an overview of the paradigm shift occurring in the pharmaceutical, cosmetic, and food industries and includes a critical review of each individual perspective of these industries.
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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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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.
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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.
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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.
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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.