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Effect of a dietary intervention based on the Mediterranean diet on the quality of life of patients recovered from depression: Analysis of the PREDIDEP randomized trial.
Cabrera-Suárez, BM, Lahortiga-Ramos, F, Sayon-Orea, C, Hernández-Fleta, JL, González-Pinto, A, Molero, P, Vega-Pérez, R, Sánchez-Villegas, A
Experimental gerontology. 2023;175:112149
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Unipolar depression is a prevalent and disabling condition that negatively influences quality of life. Patients with depression are more vulnerable to have a poorer health-related quality of life (HRQoL). The aim of this study was to assess the effect of 2-year intervention with Mediterranean Diet enriched with extra virgin olive oil on HRQoL. This study is a multicentre, randomised, controlled, single-blind trial. The study included 52 men and 144 women aged between 18 and 86 years who had suffered at least one depression episode and who were in a stage of clinical remission. The participants were randomly assigned to the intervention or control group. Results show that a Mediterranean diet–based nutritional intervention enriched with extra virgin olive oil compared with usual care, resulted in a significantly greater increase in HRQoL in recovered depressed patients. This association was greater for the mental dimensions rather than the physical dimensions. Furthermore, this association was also observed for participants aged 60 or more. Authors conclude that since depression is an important condition for its high prevalence, economic cost and personal suffering, it is important to evaluate cost-effective, safe, and inexpensive interventions, such as Mediterranean Diet nutritional interventions.
Abstract
INTRODUCTION There is substantial evidence supporting that improving diet quality leads to improved health-related quality of life (HRQoL). Our major aim was to assess the effectiveness of a Mediterranean diet-based nutritional intervention to improve HRQoL in the context of a secondary prevention trial of depression. Secondarily to assess its effectiveness among adults aged 60 or more years. METHODS The PREDIDEP study is a 2-year multicentre, randomized, single-blinded nutritional trial. At baseline and at 1-year and 2-year follow-up, SF-36 health survey questionnaire was collected to evaluate participants' HRQoL (total and specific range for each of the 8 dimensions: 0 to 100 points). Mixed effect linear models were used to assess changes in HRQoL according to adherence to the Mediterranean diet. The trial was registered at ClinicalTrials.govNCT03081065. RESULTS After 2 years of intervention, the Mediterranean Diet intervention group compared to control group (without nutritional intervention, only usual clinical care) showed an improvement in some dimensions of HRQoL such as Mental Health (7.22; 95 % CI = 2.22-12.22) (between-group difference: 6.79; 95 % CI -0.14-13.73, p = 0.055); Vitality (9.51; 95 % CI = 4.00-15.03) (between-group difference: 9.00; 95 % CI 1.75-16.25, p = 0.020); Mental Summary Component (2.83; 95 % CI = 0.55-5.11) (between-group difference: 1.17; 95 % CI = -1.96-4.30, p = 0.462); and General Health (10.70; 95 % CI = 5.58-15.81) (between-group difference: 6.20; 95 % CI = -0.89-13.28, p = 0.086). Similar results were observed for participants aged 60 or more years. CONCLUSION The intervention based on Mediterranean diet in patients with previous depression seems to be effective in improving HRQoL, especially the mental dimensions. This effect is also observed among participants aged 60 or more years.
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Effect of vitamin D supplementation on depression in older Australian adults.
Rahman, ST, Waterhouse, M, Romero, BD, Baxter, C, English, DR, Almeida, OP, Berk, M, Ebeling, PR, Armstrong, BK, McLeod, DSA, et al
International journal of geriatric psychiatry. 2023;38(1):e5847
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Depression can considerably impair daily function. However, although medications and psychological therapy can be effective in treating depression, non‐compliance with and/or side effects of antidepressants are common. Thus, identifying alternative or adjunctive therapies to prevent or treat depression may help to overcome some limitations of current management strategies. The aim of this study was to examine whether supplementing older Australians with monthly doses of 60,000 IU of vitamin D3 for 5 years would reduce depressive symptoms or incidence of antidepressant use, as a surrogate for a formal diagnosis of depression. This study used data from the D‐Health Trial, a large population‐based randomised controlled trial. Authors randomly selected potential participants aged between 60 and 79 years from the Australian Commonwealth Electoral Roll. The participants who accepted the invitation were randomly allocated to either 60,000 IU of cholecalciferol (vitamin D3) or placebo in a 1:1 ratio. Results show that there wasn’t an overall benefit of monthly supplementation with 60,000 IU of vitamin D for up to 5 years on measures of depression. However, pre‐specified subgroup analyses suggested a potential beneficial effect of vitamin D supplementation in people taking antidepressants at baseline or with lower predicted baseline vitamin D3 concentration. However there was an unfavourable effect in participants with a body mass index <25 kg/m2 or those with higher predicted baseline vitamin D3 concentration. Authors conclude that routine supplementation with vitamin D in populations with a low prevalence of vitamin D deficiency is unlikely to be of benefit for depression and may cause harm in people with low body mass index or normal vitamin D status.
Abstract
OBJECTIVES To investigate whether vitamin D supplementation reduces depressive symptoms and incidence of antidepressant use. METHODS We used data from the D-Health Trial (N = 21,315), a randomized double-blind placebo-controlled trial of monthly vitamin D3 for the prevention of all-cause mortality. Participants were Australians aged 60-84 years. Participants completed the Patient Health Questionnaire (PHQ-9) at 1, 2 and 5 years after randomization to measure depressive symptoms; national prescribing records were used to capture antidepressant use. We used mixed models and survival models. RESULTS Analyses of PHQ-9 scores included 20,487 participants (mean age 69·3 years, 46% women); the mean difference (MD) in PHQ-9 score (vitamin D vs. placebo) was 0·02 (95% CI -0·06, 0·11). There was negligible difference in the prevalence of clinically relevant depression (PHQ-9 score ≥10) (odds ratio 0·99; 95% CI 0·90, 1·08). We included 16,670 participants in the analyses of incident antidepressant use (mean age 69·4 years, 43% women). Incidence of antidepressant use was similar between the groups (hazard ratio [HR] 1·04; 95% CI 0·96, 1·12). In subgroup analyses, vitamin D improved PHQ-9 scores in those taking antidepressants at baseline (MD -0·25; 95% CI -0·49, -0·01; p-interaction = 0·02). It decreased risk of antidepressant use in participants with predicted 25(OH)D concentration <50 nmol/L (HR 0·88; 95% CI 0·75, 1·02; p-interaction = 0·01) and increased risk in those with predicted 25(OH)D ≥ 50 nmol/L (HR 1·10; 95% CI 1·01, 1·20). CONCLUSION Monthly supplementation with high-dose vitamin D3 was not of benefit for measures of depression overall, but there was some evidence of benefit in subgroup analyses. CLINICAL TRIAL REGISTRATION The trial is registered on the Australian New Zealand Clinical Trials Registry: ACTRN12613000743763. https://www.anzctr.org.au/.
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Plant-based dietary quality and depressive symptoms in Australian vegans and vegetarians: a cross-sectional study.
Lee, MF, Eather, R, Best, T
BMJ nutrition, prevention & health. 2021;4(2):479-486
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Poor diet and mood disorders are known leading causes of morbidity and mortality. Some studies suggest that plant-based diets are associated with improved mood and mental health. The aim of this study was to explore the association between vegan and vegetarian dietary patterns and depressive symptoms in adults by exploring the overall dietary quality of these patterns. This study is an online cross-sectional study which invited vegan and vegetarian adults aged between 18 and 44 years who live in Australia to complete an online survey through social media platforms. Results show that high plant-based diets quality was associated with decreased risk of depressive symptoms. However, this study also shows that following a plant-based diet does not necessarily mean the individual consumes a ‘healthy’ dietary pattern. Authors conclude that further studies are needed which should focus on the specific quality of vegan and vegetarian diets in relation to depression and mental well-being.
Abstract
Plant-based dietary patterns (vegan and vegetarian) are often considered 'healthy' and have been associated with broad health benefits, including decreased risk of obesity and ill health (cardiovascular disease, blood glucose and type II diabetes). However, the association between plant-based diets and mood disorders such as depression remains largely equivocal. This cross-sectional study of 219 adults aged 18-44 (M=31.22, SD=7.40) explored the associations between an estimate of overall plant-based diet quality and depression in vegans (n=165) and vegetarians (n=54). Overall plant-based diet quality was associated with depressive symptoms in vegans and vegetarians F(1, 215)=13.71, p<0.001 accounting for 6% of the variation in depressive symptoms. For those without depression, higher diet quality was protective against depressive symptoms F(1, 125)=6.49, p=0.012. Conversely, for those with depression no association with diet quality was found F(1, 89)=0.01, p=0.963. These findings suggest that a high-quality plant-based diet may be protective against depressive symptoms in vegans and vegetarians. In line with emerging research between food and mental health, higher-quality dietary patterns are associated with a reduced risk of depressive symptoms. Given the rapidly increasing rate of vegan and vegetarian food products within Australia, understanding the potential mechanisms of effects through which a plant-based diet may influence depressive symptoms is required.
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The Role of Diet, Eating Behavior, and Nutrition Intervention in Seasonal Affective Disorder: A Systematic Review.
Yang, Y, Zhang, S, Zhang, X, Xu, Y, Cheng, J, Yang, X
Frontiers in psychology. 2020;11:1451
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Seasonal affective disorder (SAD) is a mood disorder characterised by annual depression or bipolar disorder in a seasonal pattern. Recent evidence suggests dietary intervention and nutrition status can affect the symptoms in depressed patients, but none have specifically considered depression among SAD patients. The aim of this review was to assess the associations between diet, eating behaviour and nutrition intervention in SAD patients. Eleven studies were included and found vegetarian diet patterns and alcoholism to be associated with higher SAD prevalence. Additionally, SAD patients tend to consume larger dinners, more snacks, and show more cravings for starch-rich foods. Despite these patterns, dietary supplementation or nutrition intervention did not show benefit for SAD symptoms. Overall, the authors conclude there is a lack of evidence to draw conclusions on dietary pattern and nutritional interventions for preventing and managing SAD. The authors suggest further evidence is needed from larger controlled trials and encourage investigation of the role of the B vitamin group, rather than an isolated B12 supplementation.
Abstract
Background: Seasonal affective disorder (SAD) is a biological and mood disorder with a seasonal pattern. Dietary intervention and nutritional status have been reported to affect SAD severity. The objective of this study was to systematically review the evidence of associations between SAD and diet, eating behavior, and nutrition intervention. Methods: We performed a comprehensive search of MEDLINE, EMBASE, Web of Science, and Google Scholar from inception up to July 1, 2019. Studies that examined diet and eating behaviors in SAD patients and tests of nutrition interventions for SAD were included. Two independent investigators extracted data based on study designs, participants, outcomes, exposures, and association measures. Results: Eleven studies were included: six studies examined distinctive dietary patterns and eating behaviors in SAD patients and five studies explored the efficacy of nutrition interventions for SAD. Vegetarianism and alcoholism were associated with higher SAD prevalence, but normal alcohol intake was not correlated with SAD severity. Compared with non-clinical subjects, SAD patients tended to consume significantly larger dinners and more evening snacks during weekdays and weekends and exhibit a higher frequency of binge eating, external eating, and emotional eating. Additionally, compared to healthy controls, SAD patients presented more cravings for starch-rich food and food with high fiber. However, neither the ingestion of carbohydrate-loaded meals nor Vitamin D/B12 supplementation showed benefit for SAD. Conclusion: Studies suggest that SAD patients may exhibit distinctive diet preferences and eating behaviors, but no current nutrition intervention has demonstrated efficacy for ameliorating SAD symptoms. Further evidence is needed from randomized controlled trials with larger sample sizes and longer durations.
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Current Perspectives on Gut Microbiome Dysbiosis and Depression.
Capuco, A, Urits, I, Hasoon, J, Chun, R, Gerald, B, Wang, JK, Kassem, H, Ngo, AL, Abd-Elsayed, A, Simopoulos, T, et al
Advances in therapy. 2020;37(4):1328-1346
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The gut microbiome has been implicated in several neurological disorders; however exact mechanisms are still not fully understood. This review of recent studies, aimed to investigate the relationship between an imbalanced gut microbiome and depression. The authors first looked at the epidemiology of disease, concluding that significant burden needs to be assessed through improved preventative measures. This will depend upon the correct identification of risk factors, and the study focused on the role of the gut microbiome in this through animal and human studies. Imbalances in inflammation through altered gut microbiota, depleted biodiversity and stress induced microbiome changes were all implicated in the development of depression. It was concluded that studies on the role of microbiota in depression remain promising but are small and follow many different methodologies. This study could be used by healthcare professionals to better understand the role of gut microbiota in the development of depression and that ensuring a healthy gut may improve symptoms.
Abstract
The human gut microbiome partakes in a bidirectional communication pathway with the central nervous system (CNS), named the microbiota-gut-brain axis. The microbiota-gut-brain axis is believed to modulate various central processes through the vagus nerve as well as production of microbial metabolites and immune mediators which trigger changes in neurotransmission, neuroinflammation, and behavior. Little is understood about the utilization of microbiome manipulation to treat disease. Though studies exploring the role of the microbiome in various disease processes have shown promise, mechanisms remain unclear and evidence-based treatments for most illnesses have not yet been developed. The animal studies reviewed here offer an excellent array of basic science research that continues to clarify mechanisms by which the microbiome may affect mental health. More evidence is needed, particularly as it relates to translating this work to human subjects. The studies presented in this paper largely demonstrate encouraging results in the treatment of depression. Limitations include small sample sizes and heterogeneous methodology. The exact mechanism by which the gut microbiota causes or alters neuropsychiatric disease states is not fully understood. In this review, we focus on recent studies investigating the relationship between gut microbiome dysbiosis and the pathogenesis of depression. This article is based on previously conducted studies and does not contain any studies with human participants or animals performed by any of the authors.
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PROVIT: Supplementary Probiotic Treatment and Vitamin B7 in Depression-A Randomized Controlled Trial.
Reininghaus, EZ, Platzer, M, Kohlhammer-Dohr, A, Hamm, C, Mörkl, S, Bengesser, SA, Fellendorf, FT, Lahousen-Luxenberger, T, Leitner-Afschar, B, Schöggl, H, et al
Nutrients. 2020;12(11)
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Depression is one of the most common mental disorders which may result in significant disabilities in affected patients. Inflammation is a major pathophysiological pathway associated with affective disorders. The aim of this study was to analyse and compare the effects on clinical parameters and intestinal microbiota between the two arms of the study. This study is a double-blind, placebo-controlled, randomized study in individuals with depressive symptoms receiving either (a) the multi-strain probiotic “Omnibiotic Stress Repair®” plus biotin or [n=42] (b) a placebo plus biotin over 28 days in addition to standard anti-depressive treatment [n=40]. Results indicate that: - both groups improved significantly over time in psychiatric symptoms. - Zonulin did not significantly change over time. - the intake of probiotic supplements in addition to standard therapy might help to balance microbiota composition in individuals with depressive disorders already early in the treatment period. Authors conclude that probiotic intervention compared to placebo only differed in microbial diversity profile, but not in clinical outcome measures.
Abstract
Gut microbiota are suspected to affect brain functions and behavior as well as lowering inflammation status. Therefore, an effect on depression has already been suggested by recent research. The aim of this randomized double-blind controlled trial was to evaluate the effect of probiotic treatment in depressed individuals. Within inpatient care, 82 currently depressed individuals were randomly assigned to either receive a multistrain probiotic plus biotin treatment or biotin plus placebo for 28 days. Clinical symptoms as well as gut microbiome were analyzed at the begin of the study, after one and after four weeks. After 16S rRNA analysis, microbiome samples were bioinformatically explored using QIIME, SPSS, R and Piphillin. Both groups improved significantly regarding psychiatric symptoms. Ruminococcus gauvreauii and Coprococcus 3 were more abundant and β-diversity was higher in the probiotics group after 28 days. KEGG-analysis showed elevated inflammation-regulatory and metabolic pathways in the intervention group. The elevated abundance of potentially beneficial bacteria after probiotic treatment allows speculations on the functionality of probiotic treatment in depressed individuals. Furthermore, the finding of upregulated vitamin B6 and B7 synthesis underlines the connection between the quality of diet, gut microbiota and mental health through the regulation of metabolic functions, anti-inflammatory and anti-apoptotic properties. Concluding, four-week probiotic plus biotin supplementation, in inpatient individuals with a major depressive disorder diagnosis, showed an overall beneficial effect of clinical treatment. However, probiotic intervention compared to placebo only differed in microbial diversity profile, not in clinical outcome measures.
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The Impact of Nutrition and Intestinal Microbiome on Elderly Depression-A Systematic Review.
Klimova, B, Novotny, M, Valis, M
Nutrients. 2020;12(3)
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Depression is a common condition in the ageing population; however, it is underdiagnosed due to the high occurrence of other diseases in this group of people. When it is diagnosed, treatment with antidepressants can be unsuccessful and research is being undertaken to determine why. Non-pharmacological treatments such as diet and lifestyle modifications have been indicated to play a part in the treatment of depression, possibly due to its influence over the gut microbiota and in turn, its impact on the brain. The aim of this systematic review of six randomised control trials and cross-sectional studies was to determine whether nutrition has a positive effect on the prevention or reduction of symptoms among elderly people. The results showed that there is an association between nutrient intake and symptoms of depression amongst the elderly. There was evidence of an association between vitamin B intake and an increase in the prevalence of depressive symptoms. The influence of the gut microbiome was discussed in this association, however no analysis was made on this. It was concluded that there is an association between nutrient intake and depressive symptoms amongst the elderly population, however it was noted that it is important to study dietary intake as a whole and not just individual nutrients. This study would be of benefit to healthcare professionals to recommend a healthy diet with a high vitamin B content to improve symptoms of depression.
Abstract
The aim of this review is to systematically review the evidence whether proper nutrition has a positive impact on the prevention or decline of depressive symptoms among elderly people. In addition, possible connections between nutrition, microbiome, and serotonin molecules and its tryptophan precursor are discussed. The methodology follows the PRISMA guidelines, including the PRISMA flow chart. The authors systematically reviewed peer-review, English-written articles published in Web of Science and PubMed between 2013 and 2018. The findings of six original articles, detected on the set inclusion and exclusion criteria, indicate that there is an association between nutrition and depressive symptoms in the target group, i.e., that proper nutrition has a positive impact on the prevention or reduction of depressive symptoms among elderly people. The findings also reveal that there is a considerable correlation between the intakes of vitamin B and a decrease in the prevalence of depressive symptoms. Furthermore, sufficient nutrient intake of tryptophan appears to be an important factor in terms of nutrition and serotonin levels in the body. The authors consider it important to explore associations between the overall dietary intake and depression since diets are not consumed as individual nutrients. Returning to preventive approaches seems to be a rational way to promote the mental health of seniors. Future studies thus need to include interdisciplinary collaboration: from a good diagnosis of the disease by a psychiatrist, through an analysis of the need for nutrient metabolism by a biochemist to the development of a nutritional plan by a nutritional therapist. The limitations of this review consist in a relatively small number of the studies on this topic, including just few randomized controlled trials, which are a guarantee of efficacy and objectivity in comparison with cross-sectional studies.
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Mechanisms Underlying the Anti-Depressive Effects of Regular Tea Consumption.
Rothenberg, DO, Zhang, L
Nutrients. 2019;11(6)
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Previous research suggests that tea consumption is linked to a lower risk of depression, but it is not understood why. This meta-analysis and literature review looked at previous human, animal and laboratory studies that might give an indication of the mechanisms by which drinking tea can lead to a reduced depression risk. Tea contains many different active compounds such as L-theanine, various polyphenols and polyphenol metabolites that have effects on the immune system, stress response, brain neurotransmitters such as serotonin and dopamine, and gut bacteria. Different types of tea such as black, green or oolong tea contain different amounts of active compounds. The authors found that these compounds are capable of functioning through multiple pathways simultaneously that together reduce the risk of depression. The authors concluded that daily consumption of moderate amounts of different types of tea may offer significant potential benefit in the risk reduction of depression.
Abstract
This article is a comprehensive review of the literature pertaining to the antidepressant effects and mechanisms of regular tea consumption. Meta-data supplemented with recent observational studies were first analyzed to assess the association between tea consumption and depression risk. The literature reported risk ratios (RR) were 0.69 with 95% confidence intervals of 0.62-0.77. Next, we thoroughly reviewed human trials, mouse models, and in vitro experiments to determine the predominant mechanisms underlying the observed linear relationship between tea consumption and reduced risk of depression. Current theories on the neurobiology of depression were utilized to map tea-mediated mechanisms of antidepressant activity onto an integrated framework of depression pathology. The major nodes within the network framework of depression included hypothalamic-pituitary-adrenal (HPA) axis hyperactivity, inflammation, weakened monoaminergic systems, reduced neurogenesis/neuroplasticity, and poor microbiome diversity affecting the gut-brain axis. We detailed how each node has subsystems within them, including signaling pathways, specific target proteins, or transporters that interface with compounds in tea, mediating their antidepressant effects. A major pathway was found to be the ERK/CREB/BDNF signaling pathway, up-regulated by a number of compounds in tea including teasaponin, L-theanine, EGCG and combinations of tea catechins and their metabolites. Black tea theaflavins and EGCG are potent anti-inflammatory agents via down-regulation of NF-κB signaling. Multiple compounds in tea are effective modulators of dopaminergic activity and the gut-brain axis. Taken together, our findings show that constituents found in all major tea types, predominantly L-theanine, polyphenols and polyphenol metabolites, are capable of functioning through multiple pathways simultaneously to collectively reduce the risk of depression.
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Gut feeling: randomized controlled trials of probiotics for the treatment of clinical depression: Systematic review and meta-analysis.
Nikolova, V, Zaidi, SY, Young, AH, Cleare, AJ, Stone, JM
Therapeutic advances in psychopharmacology. 2019;9:2045125319859963
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Major depression is a common and complex illness that significantly diminishes quality of life. Currently, most pharmacological treatments target neurotransmitter activity in the brain and are known to have a delayed onset of effect as well as a range of side-effects. The aim of this study was to identify and synthesize all published data from randomized controlled trials (RCTs) on the efficacy of probiotics as treatment for depression in clinically depressed patients. This study is a systematic review of three studies. Within the three included RCTs, a total of 229 clinically depressed patients were randomized, with an average age of 36 years and a gender distribution of 76% female. Results indicate a non-significant difference in depressive symptoms between the probiotic and placebo groups post-intervention. Authors conclude that further larger studies in well-defined clinical populations are needed, both to determine the clinical utility of this novel treatment approach, and to investigate potential underlying mechanisms.
Abstract
BACKGROUND Recently the gut microbiota has attracted significant interest in psychiatric research due to the observed bidirectional gut-brain communication. A growing body of evidence from preclinical work has suggested that probiotics may be effective in reducing stress and anxiety and alleviating low mood. It is unclear to what extent these effects are seen in clinical populations. We aimed to identify all published evidence on the efficacy of probiotics as treatment for depression in clinically depressed populations. METHODS Randomized controlled trials of patients with depression where probiotics were used as supplementary or standalone treatment were considered eligible. A literature search with the terms (probiotic* OR bacteria OR Lactobacillus OR Bifidobacterium) AND depress* was performed in PubMed and Web of Science. Data on study population characteristics, treatment effectiveness, tolerability and risk of bias were extracted from eligible studies. A random effects model was used for meta-analyses. RESULTS Only three studies met inclusion criteria (229 individuals randomized), two of which administered probiotics as a supplementary treatment to antidepressants and one as a standalone treatment. Upon removal of the latter study from the meta-analysis due to clinical heterogeneity, there was an overall positive effect of probiotics on depressive symptoms (standardized mean difference = 1.371, 95% confidence interval 0.130-2.613). CONCLUSIONS There is limited evidence for the efficacy of probiotics in depression at present, although there may be a beneficial effect of probiotics on depressive symptoms when administered in addition to antidepressants. Further studies are required to investigate this and explore potential mechanisms.