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Simone O'Neill
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O'neill, S.; Minehan, M.; Knight-Agarwal, C.; Turner, M. Dietary Interventions in Adults with Depression. Encyclopedia. Available online: https://encyclopedia.pub/entry/23466 (accessed on 09 July 2024).
O'neill S, Minehan M, Knight-Agarwal C, Turner M. Dietary Interventions in Adults with Depression. Encyclopedia. Available at: https://encyclopedia.pub/entry/23466. Accessed July 09, 2024.
O'neill, Simone, Michelle Minehan, Catherine Knight-Agarwal, Murray Turner. "Dietary Interventions in Adults with Depression" Encyclopedia, https://encyclopedia.pub/entry/23466 (accessed July 09, 2024).
O'neill, S., Minehan, M., Knight-Agarwal, C., & Turner, M. (2022, May 27). Dietary Interventions in Adults with Depression. In Encyclopedia. https://encyclopedia.pub/entry/23466
O'neill, Simone, et al. "Dietary Interventions in Adults with Depression." Encyclopedia. Web. 27 May, 2022.
Dietary Interventions in Adults with Depression
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This entry is adapted from the peer-reviewed paper 10.3390/nu14071398

Dietary interventions may reduce depression levels with positive outcomes. There is a positive result for diets that promote an increased intake of fresh produce, wholegrains, low-fat dairy and lean protein sources, while also decreasing the intake of processed and high-fat foods.

dietary intervention whole diet whole food depression

1. Introduction

Depression, a principal basis of global disability, is a key factor in the burden of worldwide disease with an estimated 264 million individuals suffering worldwide [1]. Economically this impacts governments through increased social security payments and higher demands on healthcare systems, whilst also decreasing income through taxes [2]. Depression has consequences at the individual and community levels, such as reduced employment, the breakdown of relationships and potentially suicide [3][4]. Additionally, depression is known to have detrimental effects on physical health, further compounding the potential issues that arise from a depressive episode [1].
The pathophysiology of depression is not completely understood, but biological and psychosocial factors influence the development of depression with interactions between genetics and the environment possibly involved [5]. Currently, depression is treated using a combination of pharmacological and psychotherapy methods [5] with varying degrees of effectiveness, particularly in regard to chronic depression [6][7][8]. Dietary modification may offer a possible alternative or concurrent treatment for depression, but there is a need for clarity regarding the efficacy of dietary intervention [9].
In a number of meta-analyses of epidemiological studies, diet quality has been found to be inversely related to depression [10][11]. Lassale et al. [10] concluded that the intake of a Mediterranean diet led to a lower incidence of depression. Further support for links between decreased depression levels and high-quality diets is provided by Molendijk et al. [11] and Wu et al. [12]. Lassale et al. [10] also found a low inflammatory diet decreased the incidence of depression in women. This suggests that diet should be considered as a modifiable risk factor for depression [10].
Currently there are a number of hypothesised mechanisms for the role of diet in depression. Increased inflammation levels are thought to influence various physiological functions that are related to depressive disorders [13]. Elevated levels of oxidative stress markers have also been associated with increased levels of depression [13]. Consumption of a high-quality diet with anti-inflammatory properties and an increased supply of antioxidants may reduce systemic inflammation and oxidative stress, thereby potentially decreasing depressive symptomology. Studies have also found the gut microbiome may be implicated in increasing the risk of depression through increased inflammatory cytokines and other metabolites that are released by the microbiota [14]. Therefore, diets high in fibre and probiotics that support healthy microbiota may reduce the incidence of depression. Other physiological effects of depression include an increase in cortisol production, leading to the disruption of the hypothalamic-pituitary-adrenal (HPA) axis, decreased levels of brain-derived neurotrophic factor (BDNF) and impaired mitochondrial ATP production, possibly causing diminished neurogenesis and dysfunctional neuronal plasticity [13]. Studies have found that diets rich in vitamins, polyphenol compounds and omega-3 fatty acids support these physiological pathways and functions [13]. For a more in-depth discussion of these mechanisms refer to Marx et al. [13] and Jang et al. [14].
As humans do not consume micronutrients in isolation, it is more meaningful to consider the effects of whole foods and whole dietary patterns in relation to depression [15]. A small number of literatures adopting a whole food/whole diet lens have concluded that dietary interventions offer a potential treatment for depression [10][16][17].

2. Dietary Interventions in Adults with Depression

Most studies showed a reduction in depression measures from baseline to conclusion. The study undertaken by Lindseth et al. [18] provides additional evidence that consuming a diet low in tryptophan may potentially increase depression symptomology. Previous examination of tryptophan intake and urinary outputs from the kynurenine metabolic pathway in an elderly cohort found depression was linked with a decreased intake of tryptophan and an increased output of metabolites associated with the kynurenine metabolic pathway [19]. Study [18] had a clearly defined intervention where the adjustment of dietary tryptophan was based on 5 mg/kg body weight for the low level intervention and 10 mg/kg body weight at the high level intervention. The participants were provided all food required to ensure dietary compliance. However, a major drawback in the study was the short time frame, 2 weeks, for both interventions. The two studies [20][21] that assessed foods high in polyphenols and flavonoids provide further support to previous epidemiological evidence that intake of these phytochemicals can alleviate symptoms of depression through a proposed mechanism relating to the antioxidant and anti-inflammatory nature of these phytochemicals [22][23]. A limitation of these studies is that it is difficult to ensure the consistency of the phytochemical provided in food as these vary due to factors such as growing climate, ripeness at harvesting and food processing [24]. This also has implications for implementation as a potential treatment option in the future. Each of the phytochemicals discussed here are found abundantly within a Mediterranean diet, as is tryptophan [22][23][25]. This provides additional support for the examination of this diet model and similar models in the remaining three studies [26][27][28] that showed positive outcomes. Furthermore, the literature reports a strong correlation between adherence to a Mediterranean diet or a similar style of eating and decreased risk of depression [10].

3. Future Research

Firstly, the selection of participants needs to consider current dietary intake, providing a clear starting point. Alternatively, the use of a ‘washout’ period prior to commencement of the intervention as undertaken by Kontogianni et al. [20] also provided a clear baseline.
There are a number of considerations regarding study interventions. Firstly, interventions should be delivered by qualified professionals to maximise potential outcomes [29][30]. Appropriate professionals are highly encouraged. However, further consideration needs to be given to intervention duration. Current recommendations for pharmacological and psychotherapy interventions are that they continue for a period of three to four months [7]. Therefore, in future, dietary interventions to manage depression should have a minimum duration of three months. A clear measure of any dietary change is vital to attribute any effects to an intervention. Therefore, the recommendation is that protocols include measures of dietary compliance. A variety of compliance measures including 24-h dietary recalls, food frequency questionnaires, food diaries and diet-specific questionnaires are utilised. The most stringent control possible involves providing all food and drink for participants [18]. Additional confirmation of dietary compliance can be obtained through biochemical markers [31]. Only one utilised biochemical markers [27] and, where possible, the inclusion of validated biomarkers is recommended to strengthen the quality of future research. Furthermore, consideration needs to be given to the bidirectional influences between nutrition and mental health.
Finally, the choice of a relevant depression scale from the plethora available needs to be undertaken with care.

References

  1. Fact Sheet: Depression. Available online: https://www.who.int/news-room/fact-sheets/detail/depression (accessed on 16 August 2021).
  2. Schofield, D.; Cunich, M.; Shrestha, R.; Tanton, R.; Veerman, L.; Kelly, S.; Passey, M. Indirect costs of depression and other mental and behavioural disorders for Australia from 2015 to 2030. BJPsych Open 2019, 5, 1–7.
  3. National Mental Health Reform 2011–12: The Challenges. Available online: https://www1.health.gov.au/internet/publications/publishing.nsf/Content/nmhr11–12~nmhr11–12-challenges (accessed on 16 August 2021).
  4. Depression: Impact. Available online: https://www.who.int/health-topics/depression#tab=tab_2 (accessed on 16 August 2021).
  5. Gin, S.M.; Mann, J.J. Depression. Lancet 2018, 392, 2299.
  6. Low Dog, T. The role of nutrition in mental health. Altern. Ther. Health Med. 2010, 16, 42–46.
  7. Casacalenda, N.; Perry, J.C.; Looper, K. Remission in Major Depressive Disorder: A Comparison of Pharmacotherapy, Psychotherapy, and Control Conditions. Am. J. Psychiatry 2002, 159, 1354–1360.
  8. Machmutow, K.; Meister, R.; Jansen, A.; Kriston, L.; Watzke, B.; Härter, M.C.; Liebherz, S.; Liebherz, S. Comparative effectiveness of continuation and maintenance treatments for persistent depressive disorder in adults. Cochrane Libr. 2019, 2019, CD012855.
  9. Adan, R.A.H.; van der Beek, E.M.; Buitelaar, J.K.; Cryan, J.F.; Hebebrand, J.; Higgs, S.; Schellekens, H.; Dickson, S.L. Nutritional psychiatry: Towards improving mental health by what you eat. Eur. Neuropsychopharmacol. 2019, 29, 1321–1332.
  10. Lassale, C.; Batty, G.D.; Baghdadli, A.; Jacka, F.; Sánchez-Villegas, A.; Kivimäki, M.; Akbaraly, T. Healthy dietary indices and risk of depressive outcomes: A systematic review and meta-analysis of observational studies. Mol. Psychiatry 2018, 24, 965–986.
  11. Molendijk, M.; Molero, P.; Ortuño Sánchez-Pedreño, F.; Van der Does, W.; Angel Martínez-González, M. Diet quality and depression risk: A systematic review and dose-response meta-analysis of prospective studies. J. Affect. Disord. 2018, 226, 346–354.
  12. Wu, P.-Y.; Lin, M.-Y.; Tsai, P.-S. Alternate healthy eating index and risk of depression: A meta-analysis and systemematic review. Nutr. Neurosci. 2020, 23, 101–109.
  13. Marx, W.; Lane, M.; Hockey, M.; Aslam, H.; Berk, M.; Walder, K.; Borsini, A.; Firth, J.; Pariante, C.M.; Berding, K.; et al. Diet and depression: Exploring the biological mechanisms of action. Mol. Psychiatry 2021, 26, 134–150.
  14. Jang, S.-H.; Woo, Y.S.; Lee, S.-Y.; Bahk, W.-M. The Brain-Gut-Microbiome Axis in Psychiatry. Int. J. Mol. Sci. 2020, 21, 7122.
  15. Jacka, F.N. Nutritional Psychiatry: Where to Next? EBioMedicine 2017, 17, 24–29.
  16. Lai, J.S.; Hiles, S.; Bisquera, A.; Hure, A.J.; McEvoy, M.; Attia, J. A systematic review and meta-analysis of dietary patterns and depression in community-dwelling adults. Am. J. Clin. Nutr. 2014, 99, 181–197.
  17. Psaltopoulou, T.; Sergentanis, T.N.; Panagiotakos, D.B.; Sergentanis, I.N.; Kosti, R.; Scarmeas, N. Mediterranean diet, stroke, cognitive impairment, and depression: A meta-analysis. Ann. Neurol. 2013, 74, 580–591.
  18. Lindseth, G.; Helland, B.; Caspers, J. The Effects of Dietary Tryptophan on Affective Disorders. Arch. Psychiatr. Nurs. 2015, 29, 102–107.
  19. Cezary, C.; Tomasz, P.; Jan, C.; Michał, F.; Paulina, K.; Janusz, B. Tryptophan Intake and Metabolism in Older Adults with Mood Disorders. Nutrients 2020, 12, 3183.
  20. Kontogianni, M.D.; Vijayakumar, A.; Rooney, C.; Noad, R.L.; Appleton, K.M.; McCarthy, D.; Donnelly, M.; Young, I.S.; McKinley, M.C.; McKeown, P.P.; et al. A High Polyphenol Diet Improves Psychological Well-Being: The Polyphenol Intervention Trial (PPhIT). Nutrients 2020, 12, 2445.
  21. Park, M.; Choi, J.; Lee, H.-J. Flavonoid-Rich Orange Juice Intake and Altered Gut Microbiome in Young Adults with Depressive Symptom: A Randomized Controlled Study. Nutrients 2020, 12, 1815.
  22. Bayes, J.; Schloss, J.; Sibbritt, D. Effects of Polyphenols in a Mediterranean Diet on Symptoms of Depression: A Systematic Literature Review. Adv. Nutr. 2020, 11, 602–615.
  23. Godos, J.; Castellano, S.; Ray, S.; Grosso, G.; Galvano, F. Dietary Polyphenol Intake and Depression: Results from the Mediterranean Healthy Eating, Lifestyle and Aging (MEAL) Study. Molecules 2018, 23, 999.
  24. Tiwari, U.; Cummins, E. Factors influencing levels of phytochemicals in selected fruit and vegetables during pre- and post-harvest food processing operations. Food Res. Int. 2013, 50, 497–506.
  25. Hoffman, R.; Gerber, M. Constituents and physiological effects of Mediterranean plant foods. In The Mediterranean Diet: Health and Science, 1st ed.; Wiley-Blackwell: Chichester, UK, 2012; Chapter 2.
  26. Assaf, A.R.P.; Beresford, S.A.A.P.; Risica, P.M.D.R.D.; Aragaki, A.; Brunner, R.L.P.; Bowen, D.J.P.; Naughton, M.P.; Rosal, M.C.P.; Snetselaar, L.P.; Wenger, N.M.D. Low-Fat Dietary Pattern Intervention and Health-Related Quality of Life: The Women’s Health Initiative Randomized Controlled Dietary Modification Trial. J. Acad. Nutr. Diet. 2016, 116, 259–271.
  27. Francis, H.M.; Stevenson, R.J.; Chambers, J.R.; Gupta, D.; Newey, B.; Lim, C.K. A brief diet intervention can reduce symptoms of depression in young adults – A randomised controlled trial. PLoS ONE 2019, 14, e0222768.
  28. Jacka, F.N.; O’Neil, A.; Opie, R.; Itsiopoulos, C.; Cotton, S.; Mohebbi, M.; Castle, D.; Dash, S.; Mihalopoulos, C.; Chatterton, M.L.; et al. A randomised controlled trial of dietary improvement for adults with major depression (the ‘SMILES’ trial). BMC Med. 2017, 15, 23.
  29. Saffel-Shrier, S.; Johnson, M.A.; Francis, S.L. Position of the Academy of Nutrition and Dietetics and the Society for Nutrition Education and Behavior: Food and Nutrition Programs for Community-Residing Older Adults. J. Acad. Nutr. Diet. 2019, 119, 1188–1204.
  30. Holmes, A.L.; Sanderson, B.; Maisiak, R.; Brown, A.; Bittner, V. Dietitian Services Are Associated with Improved Patient Outcomes and the MEDFICTS Dietary Assessment Questionnaire Is a Suitable Outcome Measure in Cardiac Rehabilitation. J. Am. Diet. Assoc. 2005, 105, 1533–1540.
  31. Barnaba, L.; Intorre, F.; Azzini, E.; Ciarapica, D.; Venneria, E.; Foddai, M.S.; Maiani, F.; Raguzzini, A.; Polito, A. Evaluation of adherence to Mediterranean diet and association with clinical and biological markers in an Italian population. Nutrition 2020, 77, 110813.
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Simone O'Neill
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Michelle Minehan
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Murray Turner
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Update Date: 27 May 2022
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