Nutrition and Mental health Flashcards
How is Major Depressive Disorder diagnosed?
The DSM-5 has a list of symptoms:
* Depressed mood
* Lack of interest
* Sleep problems
* Appetite/weight changes
* Low energy
* Concentration problems
* Psychomotor retardation or agitation
* Guilt or worthlessness
* Suicidal ideation
In order to be diagnosed with major depressive disorder, a patient should have a minimum of 5 symptoms (but must have depressed mood and lack of interest) present for at least 2 weeks.
Name risk factors of major depressive disorder.
- Genetics
- Psychosocial factors (personality, life events)
- Behavioral factors (smoking, alcohol, nutrition)
- Somatic health factors (CVD, diabetes, pain)
- Biological factors (inflammation, cortisol)
Name reasons why nutrition could be important for the cause (and also the treatment) of depression.
- Obesity: unhealthy diet is a risk factor for obesity and people with obesity are at increased risk for depression.
- One of the symptoms of depression is the change of appetite/weight, so nutrition is already in the definition of depression.
- Gut-brain axis
What are omega-3 poly unsaturated fatty acids (PUFAs)?
Fatty acids that contain >1 double bond (poly unsaturated) and where the first double bond is located at the third carbon atom counting from the methyl end of the fatty acid. Fish is a large source of these kind of fatty acids.
What is the association between fish and risk of depression?
High intake of fish is related to a reduced risk of depression.
What is the relation between depression and diabetes?
Rates of depression are doubled in patients with diabetes. On top of this, appr. 50% is still depressed after treatment, highlighting that there is still much to discover and to improved (could nutrition be a key factor in this?)
An RCT was developed to find out whether EPA (type of PUFA) on top of antidepressants was effective in treatment of depression. Summarize the findings of this study.
- Patients that used EPA was increasingly found in red blood cell membranes over time.
- However, while minor improvements regarding depression severity were found for the EPA group, these effects were too small to be significantly different from the control group.
Although the RCT on EPA supplementation was not found to be singificant, a review of meta-analysis of RCTs for the treatment of depression using EPA’s found some interesting things. What?
Small-to-moderate positive effects from high-EPA formulas in clinical depression generally, as well as an adhunctive to SSRIs in major depressive disorder.
Summary of omega-3 PUFAs for the treatment of depression.
Meta-analyses of observational studies:
* Lower fish intake and omega-3 intake related to depression
* Lower blood levels of omega-3 PUFAs related to depression
Meta-analysis of intervention studies:
* Small-to-moderate positive effects of omega-3 PUFAs on depression compared to placebo
* Heterogeneity
* Omega-3 PUFAs more effective in clinically diagnosed depression, and EPA dose appears to be the driving force
What other nutrients were (not) found to have an effect on major depressive disorder?
- Folate supplementation was found to significantly reduce symptoms of major depressive disorder and negative symptoms of schizophrenia (but low review quality scores).
- Zinc and magnesium: lack of compelling evidence
- Vit. D supplementation also not found to have significant effects on major depressive disorder.
What is the meaning of the following terms in regard to how e.g. diet quality is assessed:
* a priori
* a posteriori
- a priori: adherence to dietary guidelines.
- a posteriori: data driven techniques (to establish whether or not a specific diet is good for a patient)
Complete the sentences.
- A high-quality diet is associated with a decreased odds on …
- (High) intake of fish and vegetables is associated with ….
- A low-quality diet is associated with …
- A high-quality diet is associated with a decreased odds on incident depression.
- (High) intake of fish and vegetables is associated with lower depression incidence
- A low-quality diet is associated with no higher depression incidence.
What are difficulties/challenges that are associated with studies on diet quality and depression?
- Heterogeneous definition of healthy diets and depression
- Measurement uncertainty -> are multiple measurements needed for accurate measurement of diet and depression?
- Use of observational studies, establishing causality is difficult and such studies are often confounded by other lifestyle factors or SES.
How could we prevent the difficulties in studies on diet quality and depression in the future?
- Study its mechanisms
- Control for relevant confounders
- Randomized controlled prevention trials
The MoodFood study:
* RQ: What is the effect of 2 nutritional strategies (multinutrient supplementation, food-related behavioral activation (FBA) therapy) and their combination on prevention of a new MDD episode in overweight adults with subsyndromal depressive symptoms?
* 2x2 factorial RCT -> multinutrient supplementation x food-related behavioral activation.
* Inclusion: 18-75 yrs, BMI 25-40 kg/m2, depressive symptoms.
* Exclusion: current depressive disorder, other psychiatric disorders, already taking supplements.
* Measurements: baseline and follow-up at 3, 6, and 12 months.
Summarize the findings of the MoodFood study.
- No effect of supplements, FBA or combination of both on the onset of major depressive disorder.
- Supplements had a higher overall follow-up depression an anxiety scores.
- FBA had lower anxiety scores after 12 months.
- FBA increased vegetable, fruit, legumes and whole grain intake and decreased intake of sweets.
- FBA improved two unhealthy eating styles (emotional and uncontrolled eating).
- Interventions had no effect on bodyweight.
Note: even though this study did not identify significant findings, the study was still published in the JAMA journal. Think of reasons why this study was still published, despite insignificant findings.
