Nutrition and Depression a Review of the Evidence

• Journal List
• Int J Prev Med
• 5.x; 2019
• PMC6484557

Int J Prev Med. 2019; 10: 42.

Nutritional Aspects of Depression in Adolescents - A Systematic Review

Preeti Khanna

Department of Food and Nutrition, Institute of Home Economics, University of Delhi, India

Vijay One thousand. Chattu

Department of Food and Diet, Plant of Home Economics, University of Delhi, Bharat

¹ Kinesthesia of Medical Sciences, The University of the West Indies, St. Augustine, Trinidad and Tobago, Kerala, India

Bani T. Aeri

Department of Food and Nutrition, Institute of Domicile Economics, University of Delhi, Republic of india

Received 2018 Aug 29; Accustomed 2019 Feb 21.

Abstract

Low is defined equally a cluster of specific symptoms with associated damage affecting vii.4% of the adolescents globally. Equally office of the systematic review, around g relevant articles published between January 1978 and December 2017 were identified by systematic online search from 6 electronic databases (PubMed, PsycInfo, Scientific discipline Direct, MEDLINE, Scopus, and Google Scholar) and overall, 56 relevant studies were included in the current review equally per the inclusion criteria. Findings highlight the potential importance of the human relationship between healthy dietary patterns or quality and positive mental health throughout life span. Various nutrition and dietary compounds have been suggested to be involved in the onset maintenance and severity of depressive symptoms and disorders. Nutritional compounds might modulate depression associated biomarkers. In this context, several salubrious foods such as olive oil, fish, nuts, legumes, dairy products, fruits, and vegetables have been inversely associated with the risk of depression and might likewise amend symptoms. In dissimilarity western dietary patterns including the consumption of sweetened beverages, fried foods, processed meats, baked products have been shown to be associated with an increased hazard of low in longitudinal studies. Diet and nutrition offering central modifiable targets for the prevention of mental disorders. Bear witness is steadily growing for the relation between nutrition deficiencies, diet quality and mental health and for the efficacy and utilise of nutritional supplements to accost deficiencies or as augmentation therapies. Nosotros advocate recognition of nutrition and nutrition as crucial factors in prevention and management of mental disorders.

Keywords: Adolescents, depression, diet, mental health, nutritional neuroscience, systematic review

Introduction

Low is defined as a cluster of specific symptoms with associated damage affecting 7.4% of the adolescents (10–14 years) globally.[ane] The clinical and diagnostic features of the disorder are broadly similar in adolescents and adults.[2,3] Enquiry suggests that depression in adolescent is an early-set sub class of the equivalent adult disorder; it has strong linkage with the recurrence later in life. The illness in adolescents and adults has similar clinical features and patterns of neural activity.[4] Due to the associated symptoms such every bit mood reactivity and irritability, depression in adolescents is more oft missed than in adults. Likewise, due to master presenting issues like anxiety, eating disorders, refusal to nourish schoolhouse, decline in academic performance, unexplained physical symptoms or behavioral problems, it remains unnoticed.[v] Furthermore data from findings of recent systematic reviews and meta-analysis concludes a significant evidence of association between unhealthy eating patterns and poor mental wellness amid children and adolescents.[vi] Also high intakes of fruit, vegetables, fish, and whole grains may be associated with a reduced depression risk in adults[7] and adherence to a Mediterranean diet may contribute to the prevention of a series of encephalon diseases.[8] Almost mental disorders begin during youth but are detected for the starting time time in subsequently life. Self-impairment and suicide are the leading cause of decease in young people. Poor mental wellness is associated with overall health and developmental concerns among youth; like educational achievements, reproductive and sexual health, substance abuse and violence. Even in wealthier societies, the needs of mental health care services are unmet, with worse situations in developing countries. Therefore, in that location is a need to empathize the patterns of onset of psychiatric disorders during babyhood and boyhood, transitioning into machismo.[9] Thus it is also important to forbid, recognize and treat this disorder. The electric current systematic review represents an updated comprehensive data nearly low in adolescents, its mechanism and the role of nutrition in prevention and treatment.

Methodology

Literature search

Relevant articles were identified past systematic online search from half-dozen electronic databases, i.e., PubMed, PsycInfo, Scientific discipline Direct, MEDLINE, Scopus, and Google Scholar. The articles and research studies published between January 1978 and December 2017 were selected. Relevant keywords relating to low, in combination with (and/or) mechanisms, psychosocial chance factors, nutritional medicine, food, nutrition, malnutrition, mental health, adolescents and/or clinical trials, interventions, randomized control trials, longitudinal studies, cantankerous-exclusive studies were used to extract articles. Boosted publications were identified from references cited in the original articles.

Inclusion - Exclusion criteria

Studies considered for inclusion in this review

• (1)

  Full-text articles;

• (2)

  Published in English;

• (3)

  Primarily conducted on humans

• (4)

  Studies conducted on children, adolescents and adults;

We excluded studies that:

• (ane)

  Examined affect of medication on mental health;

• (two)

  Used psychological therapies every bit a treatment for psychosocial problems;

• (3)

  Were published in languages other than English

Data extraction

We screened potentially relevant articles for eligibility based on titles and abstracts. If they met the eligibility criteria, the full text publication was retrieved and reviewed. The reference lists of relevant articles were too screened to include boosted studies. Total text articles were retrieved if the citation was considered eligible and was subjected to a second evaluation. Data were extracted from selected studies and details are presented beneath.

Results

Study selection

A flowchart detailing the study option process is shown in Effigy 1. The initial search yielded 1100 citations of which 965 were excluded upon initial screening for non meeting inclusion criteria. Of the remaining 135, 43 were excluded for the post-obit reasons: not a target population, did not include a target outcome, not a relevant intervention, not a target written report design, bereft particular of dietary intervention and not a validated measure of mental health outcomes. 50 studies fulfilled the inclusion criteria and additional 6 studies were screened through the reference list and citations. Overall, 56 studies were included in the review. The nutritional factors which play an important role in the etiology of depression are discussed below.

Flowchart of study option process

Nutrition hazard factors in mental wellness disorders

"Nutritional neuroscience[ten,11] is an emerging research field exploring the nutritional factors linked with man noesis, behavior and emotions."

A robust enquiry evidence suggests that diet is to mental health, beyond the lifespan, although there are particular periods of rapid development. Prenatal and postnatal diet is important to the mental health of the mother[12] just besides has implications for mental development and cognition of her offspring.[13,xiv] This suggests the potential to target the nutritional condition of a woman during pregnancy in society to positively influence future mental health outcomes in children and adolescents.[xv]

Equally in other domains of health, childhood experiences accept an impact on the hereafter wellness of the adolescent.[16] Unfortunately, many studies take reported that young people are eating well below dietary recommendations. They are increasingly reliant on nutrient poor, foods high in sugar and saturated fat acids such as soft drinks, confectionary items, and baked snacks. These dietary patterns are not only significantly related to obesity and not-communicable diseases, only they likewise critically touch on the encephalon development and mental health as well.[17] Consumption of diet and snack like foods has been linked to behavioral and emotional problems in children, which has been linked to mental disorders in adulthood.[xviii]

During adolescence, teenagers have greater independence to food choices and begin to constitute dietary habits that will bear through adulthood.[xix] This menstruum is also critical, as it is typically during this stage that mental disorders emerge for the starting time time.[20] Globally, researchers have consistently demonstrated that diet quality is of import to mental health of immature people transitioning into adulthood.[twenty,21,22] Existing systematic reviews confirm a human relationship between diet quality and mental health in children and adolescence.[23] This research prove suggests the importance of establishing snack like foods with food rich diets that support brain development and lays the foundation for a healthy adulthood.[six]

Low is perceived equally a biochemical based mental wellness disorder, while nutrition can touch its onset, severity and duration. Noticeable nutrient patterns (like poor appetite, skipping meals, and a ascendant want for sweet foods) which precede depression are the aforementioned as those occurring during low.

Enquiry suggests that dietary patterns in Asian and American countries are frequently deficient in nutrients, particularly vitamins, minerals, and omega-3 fatty acids. Also, a similar pattern of dietary intake is observed (diets deficient in vitamins, minerals, and omega-3 fatty acids) among patients with mental disorders. Studies take indicated that daily supplementation of these vital nutrients is often effective in reducing the symptoms of the patients. Amino acids supplements have also been establish to reduce symptoms, equally they are converted to neurotransmitters which in turn convalesce depression and other mental health disorders. On the basis of accumulating research bear witness, diet therapy or modifications in the diet may be appropriate in controlling and preventing low, anxiety, eating disorders, schizophrenia, and addictions.

Discussion

With special relevance to depression, various meaning nutrients are discussed below.

Proteins

Proteins (amino acids) are the building blocks of life. Our trunk manufactures 12 amino acids and the remaining 8 have to be supplied by the nutrition (essential amino acids). High biological value poly peptide foods like meats, eggs, milk and dairy products are rich in skillful quality poly peptide and provide essential amino acids. Establish-based proteins such as peas, beans, and grains are low biological value protein and may lack one or two essential amino acids. Dietary intake of poly peptide (intake of individual amino acids) tin can touch the encephalon functioning and mental wellness. Furthermore, many of the neurotransmitters in the encephalon are made from amino acids. For example, the amino acids tryptophan and tyrosine are precursors of neurotransmitters serotonin and dopamine. Low dietary intake of these amino acids results in reduced synthesis of the corresponding neurotransmitters, which is associated with low mood and aggression in patients.[24]

There are oft two sides of low feeling apathetic and unmotivated and feeling miserable. The most prevalent biochemical theory describing the crusade of these feelings is a brain imbalance in two families of neurotransmitters.[25] There are:

• Serotonin, primarily influences mood

• Dopamine, noradrenaline and adrenaline, primarily influences motivation.

Figure ii shows those nutrients that are essential for the product of serotonin, dopamine, adrenaline, and noradrenaline.

Nutrients that make mood enhancing neurotransmitters. Source: Adjusted from Holford, 2003; Depression: the diet connectedness. Primary Intendance Mental Health ane: ix-16

If a person is suffering from low mood, feels tense and irritable, is tired all the fourth dimension, tends to comfort consume, has sleeping bug, the chances are they are curt on serotonin. Table ane summaries the outcome of deficiency of the neurotransmitters, the foods that will make the deficiency worse and those that will improve the symptoms.

Table 1

Deficiency of neurotransmitter and their relationship with nutrient

Neurotransmitter	Furnishings of deficiency	Foods to avoid	Foods to swallow
Acetylcholine	Deterioration of memory and imagination	Carbohydrate	Organic/free-range eggs
	Fewer dreams	Deep-fried foods	Organic or wild fish - especially salmon, mackerel, sardines and
	Increased confusion, forgetfulness and	Junk foods	fresh tuna
	disorganisation	Refined and processed foods
		Cigarettes
		Alcohol
Serotonin	Low mood	Booze	Fish
	Difficulty sleeping		Fruits
	Feeling "disconnected"		Eggs
	Lacking joy		Avocado
			Wheatgerm
			Low-fat cheese
			Lean, organic poultry
Dopamine	Lacking drive, motivation and/or enthusiasm	Tea and coffee	Regular, balanced meals
	Crave stimulants	Caffeinated drinks and pills	Fruits and vegetables loftier in vitamin C
			Wheatgerm
			Fermented products
Gamma-Amino Butyric Acid (GABA)	Difficult to relax	Sugar	Dark green vegetables
	Broken-hearted about things	Alcohol	Seeds and nuts
	Irritable	Tea and Coffee	Potatoes
	Cocky-disquisitional	Caffeinated drinks	Bananas
			Eggs

Serotonin is fabricated from the amino acid tryptophan, a elective of protein. Dr Philip Cowen and colleagues from the University of Oxford, United kingdom of great britain and northern ireland, conducted a trail on xv volunteers who had history of depression, simply were currently not depressed. They gave these volunteers a nutritionally balanced drink, that excluded tryptophan. Inside seven hours from the consumption of the drink, 10 out of 15 participants noticed a worsening of their mood and started to bear witness signs of depression. On existence given the same drink, simply this time with added tryptophan, their mood improved. The recommended dosage of this amino acrid is 100 mg of 5 Hydroxy Tryptophan (5-HTP), two or three times a twenty-four hour period, for depression. Some supplements also provide vitamins and minerals such equally B12 and folic acid, which may be even more effective because these nutrients help to plow 5-HTP into serotonin.[26]

Another grouping of neurotransmitters associated with lack of motivation and depression are catecholamines—dopamine, noradrenaline and adrenaline. Every bit discussed in Effigy two, both adrenaline and noradrenaline are synthesized from dopamine, which is made from the amino acrid phenylalanine.

A group of researchers from Chicago, screened depressed patients past testing phenylethylamine in the claret; low levels meant, more amounts of phenylethylamine. They supplemented 40 depressed patients with supplements of phenylalanine and 31 of them showed improved symptoms.[27]

Tyrosine as well has been shown to work well in those with dopamine-dependent depression. A pilot study conducted on 12 patients in France concluded that assistants of 3200 mg of tyrosine a day showed pregnant improvement in mood and sleep on the very first 24-hour interval.[28]

Enquiry suggests that all-time results are achieved past supplementing all these amino acids - 5-HTP, phenylalanine and tyrosine - together with the B group vitamins (B6, B12) and folic acid which help turn them into neurotransmitters.

SAMe and TMG: The natural antidepressants

SAMe and TMG represent s-adenosyl methionine and tri-methyl-glycine, respectively. These ii strange sounding nutrients are kind of amino acids. They are methyl grouping donors and can lower homocysteine levels by donating methyl groups.

Same is the most comprehensively studied natural antidepressants. Many placebo-controlled, double-blind studies have shown that SAMe is equal to or superior to antidepressants, works faster (within few days, whereas pharmaceutical antidepressants may have 3–half-dozen weeks to testify effect). The recommended allowance is 200–600 mg a day, simply it is very expensive and unstable. An alternative which is less costly and more stable is TMG. In the trunk information technology turns into Same, only the quantity is iii times i.e., 600–2000 mg a mean solar day, on an empty stomach or with a fruit.[29,thirty,31]

Omega three fat acids

Brain has the highest levels of lipids. These brain lipids (equanimous of fat acids) are structural constituents of membranes. Gray matter in the encephalon contains l% polyunsaturated fatty acids (33% are omega-iii) and are supplied through nutrition. Northward-3 PUFAs modulate the mechanism of encephalon neuron communication. Decosahexanoic Acid (DHA) predominantly constitutes fifteen% of the encephalon, whereas EPA constitutes 0.2%. Therefore, DHA concentration affects the membrane permeability of cells in Central Nervous Organization (CNS) and deficiency of DHA is linked with the dysfunction and impaired transmission neurotransmitters; serotonin, norepinephrine, and dopamine. Phospholipids of neural cell membrane are equanimous of PUFAs. N-iii PUFAs and fish consumption have been connected to the inflammation theory.[32]

Omega - 3 fats accept a directly influence on serotonin status by enhancing its production and reception. According to Dr JR Hibbeln,[33] who discovered that fish eaters are less prone to low, described the process equally "It's like building more serotonin factories, instead of just increasing the efficiency of serotonin you accept."

Research suggests that depletion of n-3 PUFAs can be an etiological factor in several neuropsychiatric disorders including depression. Lower intake or concentrations of n-3 PUFAs is observed in depressed individuals.[34] Fish intake of >150 thou/week is linked to decreased levels of proinflammatory markers like C Reactive Poly peptide (CRP) and cytokines such as interleukin-6. This supports the hypothesis that eating more fish could lead to reduced depressive symptoms through modification of inflammatory process.[35]

Another researcher from London's Hammersmith Hospital, Great britain reported a case report of a 21-year-old student who had been on a variety of antidepressants, but had shown no comeback. He had a very depression sense of esteem, piffling appetite, sleeping problems, found information technology hard to socialize and often thought of killing himself. Subsequently ane calendar month of supplementation with ethyle-EPA (eicosapentaenoic acid), a concentrated course of omega-3, he was no longer having suicidal thoughts and after 9 months of supplementation, no longer had depression.[36]

Bear witness [Table 2] also suggests that, there are a number of associated mechanisms observed in neural systems of individuals with depression and those affected in dietary deficiency of omega 3 PUFAs;

Table 2

Comparing of effects of low and omega 3 PUFA on neural parameters

Mechanism	Low	Deficiency of omega 3 PUFA	Improver of omega 3 PUFA
Neurotransmission	Treatment maintains levels of neurotransmitters	Decreased levels of dopamine and D2 receptor	Increased levels of dopamine and increased binding to D2 receptor
Glucose metabolism in brain	Reduced metabolism.	Increased by handling with lithium.	Reduced uptake of glucose via glucose transporter
AA metabolism in encephalon	Treatment reduces AA turnover and metabolism	Increases AA turnover and metabolism
Proinflammatory cytokine levels	Increased		Reduced
Neuronal cloudburst	Increased		DHA promotes neural prison cell growth and reduces apoptosis
BDNF levels in brain	Decreased (restored by antidepressant treatment)	Decreased by deficiency, diets high in saturated fatty and sucrose and COX inhibitor	Increased past omega 3 PUFA, exercise, vitamin East, and prostaglandins

• Altered levels of neurotransmitters

• Reduce glucose metabolism in brain

• Decreased levels of encephalon derived neurotrophic cistron.

Supplementation trails with omega three PUFAs have shown positive effects in low. In a double blind trial, 20 subjects with major depressive disorders received (randomly) 3.3 g/day of EPA + DHA (fish oil) or placebo for eight weeks in addition to the usual treatment. Patients who received PUFA (EPA + DHA) supplementation had lower scores on the depression scale.[37]

Noaghuil and Hibbeln[38] investigated cantankerous-national prevalence rates of bipolar disorders and ended that there is a stiff relationship betwixt increased sea food consumption and lower prevalence rates. Regular consumption of fish has also been associated with reduced suicidal ideation and better self-reported status of mental health.

B Grouping Vitamins

B grouping vitamins act as co-factors in central enzymes that control the production and balance of neurotransmitters. For example, serotonin (5-HT) is produced from 5-HTP by improver of a methyl group (carboxylase) as is adrenaline from noradrenaline. This process is highly dependent on vitamin B12, B6, and folate. Folate deficiency is extremely common among depressed patients.[39] A study conducted at Depression and Clinical Research Plan at Boston Massachusetts Full general Hospital, USA on 213 depressed patients, reported that people with lower folate levels had more "melancholic" depression.[forty]

Another research on people diagnosed with depression and schizophrenia was conducted at Kings Higher Hospital, London, UK.[41] The researchers constitute that one in three of these patients had deadline or definite folate deficiency. These patients than took part in a supplementation trial, where they took folate for 6 months. Post six months supplementation trail, these patients had significantly improved recovery and the longer they took folate, improve they felt.

Folate

Subsequently conception of the fetus, intake of folate is important for the formation of the neural tube, development of encephalon and nervous system, normal growth, nucleotide synthesis as well as programmed cell death. Research suggests that deficiency of folate may affect one-third of psychiatric patients. This could be due to disturbed ambition, lowered intake, altered absorption or increased requirement.[42] Interestingly, individuals with megaloblastic anemia have been reported to have neuropsychiatric issues, and depression is the most common neuropsychiatric manifestation of folate deficiency.[43] However, folate deficiency and depression are interconnected, information technology is not clear whether depression leads to folate deficiency or primary folate deficiency is a crusade of depression. Deficiency of folate can pb to irregularities in methylation and synthesis of monoamine neurotransmitters. Different forms of folate share an inter conversion potential and are nowadays in the pathways of carbon cycles impacting the synthesis of dopamine, serotonin and norepinephrine.[44]

Folate in the form of methylenetetrahydrofolate (MTHF) is required in the methylation procedure of homocysteine (a sulphureted amino acid) back to methionine. Homocysteine present in meat, fish, cheese, egg and poultry is derived from dietary methionine. Elevated levels of blood homocysteine is a functional marking of folate deficiency and is linked to the prevalence of depression. In addition to this, homocysteine is suggested to have neurotoxic effects.[45] Several other methylation reactions, like the synthesis of S-adenosyl-methionine (Same, the vital methyl donor) require MTHF. Anti-depressant backdrop of Same have also been suggested.[46]

Vitamin B12

Cognitive changes are observed in adolescents with borderline levels of vitamin B12 deficiency. In elderly, supplementation with cobalamin enhances cerebral and cognitive functions, delays onset of dementia and enhances linguistic communication function of people with cognitive disorders.[47]

Minerals

Zinc

Zinc is an important mineral involved in the process of gustation (taste perception). It as well protects the encephalon cells against the potential harm caused by free radicals. In patients with clinical depression, zinc levels are lowered. Intervention research suggest that oral zinc supplementation can influence the effectiveness of antidepressants, such every bit imipramine.[48]

A placebo-controlled, double bullheaded trial of zinc supplementation in antidepressant therapy was conducted in patients who had major (unipolar) low. Patients received zinc supplementation (half-dozen patients; 25 mg of Zn2+ once daily) or placebo (8 patients) and were treated with standard antidepressant therapy (tricyclic antidepressants, selective serotonin reuptake inhibitors). Zinc supplementation significantly reduced scores in both measures after 6- and 12-week supplementation when compared with placebo treatment. This supplementation trail is the beginning demonstration of the benefit of zinc supplementation in antidepressant therapy.[49]

Iron

Atomic number 26 is necessary for the synthesis of neurotransmitters and myelin, product of free energy in the cerebral parenchyma and oxygenation. Iron deficiency anemia is associated depression, apathy and fatigue, affecting boyish girls and women in the child bearing historic period. Fatigue, sluggishness, and depression can all exist symptoms of iron deficiency, which has led to studies investigating the human relationship between circulating levels of iron and depression.[50,51] Fe concentrations in the umbilical artery are of import for the fetal evolution and IQ in children.[52]

Major Depressive Disorder (MDD) in adolescents is often persisting or reappearing in developed life. MDD has likewise been associated with inflammation and changes in iron measures, such as decreased serum transferrin levels.[53] However, these studies are few in number, especially for adolescents.

Iodine

The office of iodine in the encephalon development is well established. Iodine provided by the thyroid hormone regulates the energy metabolism of the cerebral cells. During pregnancy, deficiency of iodine results in Iodine Deficiency Disorders (IDD) which induces cerebral dysfunction, somewhen leading to mental retardation and cretinism.[54]

Conclusions

Micronutrient deficiencies and malnutrition can impact the physical and mental evolution of a child. Given that the average age of onset for anxiety and mood disorders is 6 years and thirteen years, respectively[l] the potential for early intervention using strategies targeted at improving dietary intake at a population level may exist of substantial public health benefit.

Though, depression is considered as a cause of global disability amid adolescents, many cognition and research gaps nonetheless exist. Due to the immense brunt of mental disorders, preventive treatment strategies and modifiable run a risk factors need to be identified. Furthermore, in low and eye income countries, evolution of cost-effective methods for detection, assessment and treatment of depression is required. In-depth research is required in reporting and understanding prevalence, causes and mechanisms underlying depression throughout lifespan.

Diet and diet offering key modifiable targets for the prevention of mental disorders, having a cardinal role in the promotion of mental wellness. The surface area of nutritional neuroscience needs to be promoted for the prevention and direction of low (and other mental disorders) through a healthy nutrition. Farther research is required in this regard because pregnant prove linking diet (quality, eating pattern, and specific nutrients) and mental wellness among children and adolescents is now bachelor.[6,7,45,52,53,54] Inquiry is further required to institute the apply, efficacy and dosage of nutrients (limerick and constituents of a diet) in individuals with and without mental disorders. This further needs to framed into public health policies and programs. Nutritional medicine should at present exist considered as a mainstream element of psychiatric practice, with research, education, policy, and health promotion supporting this new framework.[45]

Financial support and sponsorship

Nil.

Conflicts of interest

In that location are no conflicts of interest.

Acknowledgments

Authors wish to thank all the researchers and authors of the articles that were reviewed for this review.

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