A Dietary Treatment for Depression

wikimedia commons
Source: wikimedia commons

A randomized controlled trial shows the right diet can improve depression.

For the past seven years, I’ve been writing articles about food and mood, exploring how different diets and types of foods might create or help mental healthproblems. Despite a great amount of interest in this topic spawning dozens of popular books from Grain Brain to Eat Complete, the data we had was always limited. The vast majority of studies about food and mental health are observational, meaning some form of asking people what they eat and then tracking mental health variables. These data are limited by different types of bias, food studies being particularly prone to bias, as they are often done with “food frequency questionnaires” or FFQs asking about how many hamburgers or vegetables you eat. Even one of the most validated FFQs in the world, the one used for the Nurses’ Health study, has severe limitations. People who lied more about hamburger intake were healthier than those who didn’t, for example. With observational data, you usually find that healthy people who care about their health and listen to health messaging are healthier. Large observational studies are mostly interesting if they have findings that are opposite what is expected (for example, coffee drinkers, despite smoking more and drinking more alcohol, score higher on several measures of good health).

The real meat of science is in the randomized controlled trial. That means taking two groups of people, putting one through an experiment and one through a control, and seeing if there is a difference in outcomes between the groups. When it comes to mental illness, we did have some data for the use of randomized controlled trials of certain diets and some mood outcomes. All of these studies had depression as one of the measured endpoints, but none of these were in a group of depressed people trying different diets to feel better. The measures of depression were just collected along the way of a trial looking at something else (such as heart disease). In these trials, changing diet to various options (such as Mediterranean or lower cholesterol) didn’t worsen symptoms of depressed mood, but only diet trials that didn’t restrict red meat or weren’t described as “low cholesterol” diets were effective in lowering measures of depression by the end of the study. Another randomized therapy trial for early depression in the elderly used a nutritional instruction arm as the control (thinking that food instruction was neutral and wouldn’t help mental health), finding it equal to a type of community-based psychotherapy in preventing worsening of depression.

This year, finally, we have the SMILES trial, the very first dietary trial to look specifically at a dietary treatment in a depressed population in a mental health setting. Participants met criteria for depression and many were already being treated with standard therapy, meds, or both. The designers of this trial took the preponderance of observational and controlled data we already have for general and mental health and decided to train people using dietary advice, nutritional counseling, and motivational interviewing directed at eating a “modified Mediterranean diet” that combined the Australian Dietary Guidelines and the Dietary Guidelines for Adults in Greece. They recommended eating whole grains, vegetables, fruit, legumes, unsweetened dairy, raw nuts, fish, chicken, eggs, red meat (up to three servings per week), and olive oil. Everyone in the study met criteria for a depressive disorder…

more…

https://www.psychologytoday.com/blog/evolutionary-psychiatry/201703/dietary-treatment-depression

WIKK WEB GURU
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