| Introduction |
The connection between nutrition and depression remains largely unrecognised, despite widespread understanding of nutritional links to physical ailments. Depression is frequently viewed through strictly biochemical or emotional lenses. However, dietary factors significantly influence the onset, severity, and duration of depression. Observable food patterns preceding and during depression often include poor appetite, skipped meals, and intense cravings for sweet foods. Nutritional neuroscience is an expanding field illuminating the intricate relationship between nutritional elements, human cognition, behaviour, and emotions. Common mental disorders globally include depression, bipolar disorder, schizophrenia, and obsessive-compulsive disorder (OCD). Dietary patterns in many regions reveal prevalent deficiencies in essential vitamins, minerals, and omega-3 fatty acids, with these deficiencies being particularly severe in individuals with mental disorders. Scientific evidence indicates that daily supplements of vital nutrients can effectively reduce patient symptoms. Amino acid supplements, which convert into neurotransmitters, also alleviate depression and other mental health challenges. This accumulating evidence supports nutritional supplementation as an effective therapeutic intervention for controlling and potentially preventing a range of conditions, including depression, bipolar disorder, schizophrenia, eating disorders, anxiety disorders, ADD/ADHD, autism, and addiction. In contrast to many prescription drugs, such as common antidepressants, which often cause side effects leading to patient noncompliance and increased risks such as suicide or institutionalisation, nutritional therapies offer an alternative. Psychiatrists can leverage these complementary nutritional approaches, recommending dietary supplement doses based on existing efficacious studies and adjusting them through careful patient observation. A closer examination of depressed individuals' diets reveals inadequate nutrition and food choices that may exacerbate their condition. Low serotonin levels, a key neurotransmitter, are linked to an insensitivity to future consequences, leading to risky, impulsive, and aggressive behaviours, potentially culminating in suicide. Depression manifests with symptoms such as increased sadness, anxiety, appetite loss, depressed mood, and reduced interest in pleasurable activities. Untreated, it can have severe consequences, with depressed patients showing higher suicidal tendencies, often managed with antidepressants and/or psychotherapy. Deficiencies in neurotransmitters such as serotonin, dopamine, noradrenaline, and γ-aminobutyric acid (GABA) are frequently associated with depression. Amino acids such as tryptophan, tyrosine, phenylalanine, and methionine aid in treating mood disorders, including depression. Tryptophan, a serotonin precursor, converts to serotonin when consumed on an empty stomach, promoting sleep and tranquillity, thereby reducing depression stemming from serotonin deficiencies. Tyrosine and phenylalanine convert into dopamine and norepinephrine, enhancing alertness and arousal. Methionine, when combined with adenosine triphosphate (ATP), forms S-adenosylmethionine (SAM), which assists neurotransmitter production in the brain. Further studies are needed to determine optimal daily supplemental doses for these neurochemicals to achieve antidepressant effects. A decline in omega-3 fatty acid consumption is linked to a rise in major depression incidence. Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), found in fish oil, demonstrate antidepressant effects, possibly through neurotransmitter-related mechanisms or by influencing neuronal signal transduction. Epidemiological and clinical studies confirm omega-3 fatty acids' effectiveness in treating depression, with daily supplements of 1.5-2 g of EPA improving mood in depressed patients. Doses exceeding 3 g, however, do not offer additional benefits and may be contraindicated for individuals on anticlotting medications. Beyond omega-3s, deficiencies in B vitamins (e.g., folate) and magnesium are associated with depression. Controlled trials indicate that daily folic acid (0.8 mg) or vitamin B12 (0.4 mg) supplementation reduces depression symptoms. Case studies show rapid recovery from major depression within seven days for most patients treated with 125-300 mg of magnesium (as glycinate or taurinate) per meal and at bedtime. Research highlights common nutritional deficiencies in mental disorder patients, including omega-3 fatty acids, B vitamins, minerals, and amino acid precursors to neurotransmitters. Demographic studies suggest a correlation between high fish consumption and lower rates of mental disorders, attributed to omega-3 intake. While 1-2 g of omega-3 fatty acids daily is a general recommendation for healthy individuals, up to 9.6 g has been safely and effectively used for mental disorder patients. Asian diets often lack fruits and vegetables, leading to further mineral and vitamin deficiencies. Carbohydrates, essential polysaccharides, influence mood and behaviour by triggering insulin release, which facilitates tryptophan entry into the brain, thereby affecting neurotransmitter levels. Low-carbohydrate diets can precipitate depression by reducing serotonin and tryptophan production. Low glycaemic index foods offer sustained effects on brain chemistry and mood, unlike high glycaemic index foods that provide temporary relief. Proteins, composed of amino acids, are vital building blocks. Essential amino acids must be obtained through diet. High-quality protein sources include meats, dairy, and eggs, while plant proteins may lack certain essential amino acids. Protein intake impacts brain function and mental health, as many neurotransmitters derive from amino acids; dopamine from tyrosine and serotonin from tryptophan. Deficiencies in these amino acids can lead to low mood and aggression, while excessive buildup, such as phenylalanine in phenylketonuria, can cause brain damage. The brain, a lipid-rich organ, relies heavily on essential fatty acids, particularly omega-3s (alpha-linolenic acid, ALA), as structural components of membranes. Studies indicate that lowering plasma cholesterol through diet and medication can increase depression, possibly due to imbalances in omega-6 and omega-3 polyunsaturated fatty acids (PUFA). Sufficient long-chain PUFAs, especially DHA, may mitigate depression development. DHA and arachidonic acid (AA), crucial for neural function, cannot be synthesised de novo and must be obtained from diet. Adequate PUFA supply, particularly DHA, is critical for neurodevelopment during gestation and early postnatal periods. Imbalances or deficiencies in omega-3 fatty acids may account for heightened depressive symptoms associated with low plasma cholesterol and mood alterations linked to dieting behaviours. Omega-3 fatty acids also play a role in preventing disorders such as depression and can prevent cerebral aging by supporting membrane renewal. Their role in dyslexia and autism is also suggested. Early experimental work demonstrated omega-3 fatty acids' profound effect on brain structure and function, influencing visual, cerebral, and intellectual abilities in infants. B-complex vitamins are undeniably linked to nutrition and depression. Supplementation of nine vitamins, at ten times the recommended dietary allowance (RDA) for a year, improved mood in men and women, particularly associated with improved vitamin B2 and B6 status. Baseline vitamin B1 status in women correlated with poor mood, improving with supplementation. Thiamine modulates cognitive performance, especially in the elderly. Vitamin B12 (Cyanocobalamin) supplementation, when timed correctly, delays dementia signs and enhances cerebral and cognitive functions in the elderly, improving frontal lobe and language functions. Adolescents with borderline B12 deficiency show cognitive changes. Depressed patients exhibit, on average, 25% lower blood folate levels than healthy controls. Low folate is a strong predictor of poor antidepressant therapy outcomes, with folic acid enhancing antidepressant effectiveness. Folate's critical role in brain metabolic pathways is well-established, with depressive symptoms being a common neuropsychiatric manifestation of folate deficiency. The causal direction (poor nutrition causing folate deficiency or vice versa) remains unclear. Selective serotonin uptake inhibitors (SSRIs) can inhibit calcium absorption into bones and lower blood pressure, increasing fracture risk, especially in ageing patients on multiple medications. Chromium is a micronutrient significant for mental health, with studies showing its association with human depression. Iodine is crucial for mental health, with thyroid hormone-supplied iodine ensuring cerebral cell energy metabolism. Dietary iodine reduction during pregnancy can lead to severe cerebral dysfunction and cretinism. Iron is vital for cerebral oxygenation, energy production, neurotransmitter synthesis, and myelin formation. Iron deficiency is seen in children with attention-deficit/hyperactivity disorder and impacts fetal development and childhood IQ. Infantile anaemia linked to iron deficiency affects cognitive development. Higher rates of clinical depression in women, particularly those of childbearing age, suggest iron's importance, as its deficiency causes fatigue and depression. Iron deficiency anaemia is associated with apathy, depression, and rapid fatigue during exercise. Lithium, a monovalent cation, is a well-established mood stabiliser used for bipolar disorder, depression augmentation, schizoaffective disorder, aggression, impulse control disorder, eating disorders, ADDs, and certain types of alcoholism. Careful monitoring for toxicity is essential, especially in vulnerable populations. Low selenium intake is associated with lower mood status, and selenium supplementation can improve mood and reduce anxiety. Zinc participates in taste perception, and clinical depression often correlates with lower zinc levels. Oral zinc can enhance antidepressant therapy and protects brain cells from free radical damage. Micronutrient deficiencies, even subclinical, can compromise a child's full genetic potential for physical and mental development, though dietary measures can offer some correction. Diet composition and meal patterns can have beneficial or adverse, immediate or long-term effects. Deficiencies in antioxidants and nutrients during aging may precipitate brain diseases, possibly due to impaired protective mechanisms against free radicals. Physiological and psychosocial factors also influence diet and depression. Old age increases vulnerability to unintentional weight loss, linked to increased morbidity and premature death. Anorexia of ageing, influenced by reduced sensory perception, poor dentition, polypharmacy, and depression, contributes to reduced food intake. Malnutrition in the elderly, both institutionalised and community-dwelling, stems from physiological changes, mental disorders, and medical, social, and environmental factors. Complementary and alternative medicine (CAM) interventions are increasingly utilised for depression. Mental health professionals should acknowledge that many bipolar disorder patients use CAM, which some clinicians view as attractive and safe alternatives or adjuncts to conventional psychotropic medications. Current research in psychoneuroimmunology and brain biochemistry highlights communication pathways that enhance understanding of nutritional intake, the central nervous system, and immune function's influence on psychological health. These findings can foster greater acceptance of dietary intervention's therapeutic value among healthcare providers addressing depression and other psychological disorders. |
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