Mood Disorders: Depression & Anxiety PDF

MOOD DISORDERS: DEPRESSION & ANXIETY AUTHOR: D R. M A R YA M YA VA R I , M D , P H. D. , N D NMT150 2023 LEARNING OBJECTIVES Considerations for providing nutritional guidance as it relates to this week’s case presentation: Diet, spices, microbiome SAM-E Omega 3 FA 5 HTP...

MOOD DISORDERS: DEPRESSION & ANXIETY AUTHOR: D R. M A R YA M YA VA R I , M D , P H. D. , N D NMT150 2023 LEARNING OBJECTIVES Considerations for providing nutritional guidance as it relates to this week’s case presentation: Diet, spices, microbiome SAM-E Omega 3 FA 5 HTP B vitamins Magnesium Vitamin D TREATMENT GOALS Address presenting symptoms and improve patient comfort Support full and speedy recovery to return to regular activities Patient education Monitor and Prevent sequelae DIET & MOOD REGULATION Blood sugar balance Weight management DIET & MOOD REGULATION Stimulants Food sensitivities  ANTIOXIDANTS Wang et al, meta-analysis: Intake of antioxidant supplements is associated with improved depression and anxiety states, further affirms the therapeutic potential of antioxidant supplements as adjunctive therapy to conventional antidepressants. Wang H, Jin M, Xie M, Yang Y, Xue F, Li W, Zhang M, Li Z, Li X, Jia N, Liu Y. Protective role of antioxidant supplementation for depression and anxiety: A meta-analysis of randomized clinical trials. Journal of Affective Disorders. 2022 Nov 25.  SPICES Saffron: similar effectiveness to antidepressant medication in reducing depressive symptoms in one review. Turmeric: one RCT found daily supplementation of curcumin for 8 weeks resulted in significantly lower anxiety scores compared to a placebo. Dai L, Chen L, Wang W. Safety and efficacy of saffron (Crocus sativus L.) for treating mild to moderate depression: a systematic review and meta-analysis. The Journal of nervous and mental disease. 2020 Apr 1;208(4):269-76. Asadi S, Gholami MS, Siassi F, Qorbani M, Sotoudeh G. Beneficial effects of nano‐curcumin supplement on depression and anxiety in diabetic patients with peripheral neuropathy: A randomized, double‐blind, placebo‐controlled clinical trial. Phytotherapy Research. 2020 Apr;34(4):896-903.  MEDITERRANEAN DIET Lassale C et al analyzed 41 studies on the topic and found a link between people’s diet and their chances of developing depression. People who followed a strict Mediterranean diet had a 33% lower risk of being diagnosed with depression compared to people who were least likely to follow these eating habits.. Lassale C, Batty GD, Baghdadli A, Jacka F, Sánchez-Villegas A, Kivimäki M, Akbaraly T. Healthy dietary indices and risk of depressive outcomes: a systematic review and meta-analysis of observational studies. Molecular psychiatry. 2019 Jul;24(7):965- 86.  MICROBIOME Microbiome-derived compounds (short-chain fatty acids, tryptophan catabolites, microbial pattern recognition) and vagal nerve activity and fecal microbiota transplants) may play a role in mental health. Yang et al: more than half of the studies showed it was positive to treat anxiety symptoms by regulation of intestinal microbiota. There are two kinds of interventions (probiotic and non-probiotic interventions), and the non-probiotic interventions were more effective than the probiotic interventions. Peirce JM, Alviña K. The role of inflammation and the gut microbiome in depression and anxiety. Journal of neuroscience research. 2019 Oct;97(10):1223-41. 1;29(6):629-43. Winter G, Hart RA, Charlesworth RP, Sharpley CF. Gut microbiome and depression: what we know and what we need to know. Reviews in the Neurosciences. 2018 Aug Yang B, Wei J, Ju P, Chen J. Effects of regulating intestinal microbiota on anxiety symptoms: a systematic review. General psychiatry. 2019;32(2).  OMEGA-3 FATTY ACIDS Liao et al in a meta-analysis showed omega-3 PUFAs with EPA ≥ 60% at a dosage of ≤1 g/d would have beneficial effects on depression. Liao Y, Xie B, Zhang H, He Q, Guo L, Subramanieapillai M, Fan B, Lu C, McIntyre RS. Efficacy of omega-3 PUFAs in depression: a meta-analysis. Translational psychiatry. 2019 Aug 5;9(1):190. 5 HTP Current studies are relatively weak Tryptophan can be found in turkey, chicken, milk, potatoes, pumpkin, sunflower seeds, turnip and collard greens, and seaweed.  SAM E Cuomu A et al systematic review: The existing trials of SAMe, used as monotherapy or add on to another antidepressants, have shown encouraging and generally positive results. Cuomo A, Beccarini Crescenzi B, Bolognesi S, Goracci A, Koukouna D, Rossi R, Fagiolini A. S-Adenosylmethionine (SAMe) in major depressive disorder (MDD): a clinician-oriented systematic review. Annals of general psychiatry. 2020 Dec;19(1):1-7.  B VITAMINS B vitamins play an important role in anabolic and catabolic cellular processes that are essential for brain function. B vitamin supplementation may reduce anxiety and depression and benefit at-risk populations for stress. Young LM, Pipingas A, White DJ, Gauci S, Scholey A. A systematic review and meta-analysis of B vitamin supplementation on depressive symptoms, anxiety, and stress: Effects on healthy and ‘at-risk’individuals. Nutrients. 2019 Sep 16;11(9):2232.  MAGNESIUM Magnesium dietary supplementation may have several health benefits including lowering blood pressure, reducing insulin resistance, and improving symptoms of depression, anxiety, and migraine. Magnesium deficiency is common among people with depression, and Mg supplementation may reduce depressive symptoms. Wang J, Um P, Dickerman BA, Liu J. Zinc, magnesium, selenium and depression: a review of the evidence, potential mechanisms and implications. Nutrients. 2018 May 9;10(5):584.  VITAMIN D Vitamin D may reduce the risk of depression by reducing inflammation, regulating mood, and protecting against neurocognitive dysfunction. Serum vitamin D levels inversely correlate with clinical depression, but the evidence is not strong enough to recommend universal supplementation in depression. Menon V, Kar SK, Suthar N, Nebhinani N. Vitamin D and Depression: A Critical Appraisal of the Evidence and Future Directions. Indian J Psychol Med. 2020 Jan 6;42(1):11-21 SUPPLEMENTS SAMe: 200 mg twice a day up to 400 mg three times a day; ramp up slowly. Omega 3 FA: 1-4 gram EPA+DHA /day 5 HTP: 200-400 mg/day B vitamins Magnesium: 200-600 mg/day Vitamin D: 1000- 2500 IU/day  QUESTION Sarah is a 25-year-old CCNM student. She is concerned about fatigue and low mood. She does not have the motivation for daily tasks and feels hopeless. Sarah is following a healthy vegan diet for the last 7 years but is not receiving any supplements. She wants to know if there is a supplement that you recommend she take to help with her depression and fatigue. You decide to run a lab test and based on the result you consider this supplement:… Vitamin B12 Vitamin D Iron All options are correct REFERENCES CDC: https://www.cdc.gov/ Online source Center for Disease Control and Prevention Updates 2022 Prousky J. Textbook of Integrative Clinical Nutrition. CCNM Press Inc.; 2012. Katz D. Nutrition in Clinical Practice. 2nd Edition. Lippincott Williams & Wilkins; 2008. Katsilambros N. Clinical Nutrition in Practice. WileyBlackwell; 2010. Pizzorno J and Katzinger J. Clinical Pathophysiology. Mind Publishing; 2012. Marz RB. Medical Nutrition from Marz. 2nd edition. Quiet Lion Press; 1999. Murray MT. Encyclopedia of Nutritional Supplements. Prima Health; 1996. Gropper S, Smith J. Advanced Nutrition and Human Metabolism. 7th Ed. Cengage Learning; 2018. Gaby A. Nutritional Medicine.; Perlberg Publishing 2011. Hoffer A, Prousky J. Naturopathic Nutrition: A Guide to Nutrient-Rich Food & Nutritional Supplements for Optimal Health. CCNM Press; 2006. REFERENCES Lopresti AL, Drummond PD. Saffron (Crocus sativus) for depression: a systematic review of clinical studies and examination of underlying antidepressant mechanisms of action. Human Psychopharmacology: Clinical and Experimental. 2014 Nov;29(6):517-27. Ng QX, Koh SS, Chan HW, Ho CY. Clinical use of curcumin in depression: a meta-analysis. Journal of the American Medical Directors Association. 2017 Jun 1;18(6):503-8. Pannu A, Sharma PC, Thakur VK, Goyal RK. Emerging role of flavonoids as the treatment of depression. Biomolecules. 2021 Dec 3;11(12):1825. Bloch MH, Hannestad J. Omega-3 fatty acids for the treatment of depression: systematic review and meta-analysis. Molecular psychiatry. 2012 Dec;17(12):1272-82. Sun C, Wang R, Li Z, Zhang D. Dietary magnesium intake and risk of depression. Journal of affective disorders. 2019 Mar 1;246:627-32. GJ. Life in a post-pandemic world: What to expect of anxiety-related conditions and their treatment. Journal of anxiety disorders. 2020 May;72:102231. REFERENCES Sun C, Wang R, Li Z, Zhang D. Dietary magnesium intake and risk of depression. Journal of affective disorders. 2019 Mar 1;246:627-32. Hidese S, Nogawa S, Saito K, Kunugi H. Food allergy is associated with depression and psychological distress: A web-based study in 11,876 Japanese. Journal of affective disorders. 2019 Feb 15;245:213-8. Yin W, Löf M, Chen R, Hultman CM, Fang F, Sandin S. Mediterranean diet and depression: a population-based cohort study. International Journal of Behavioral Nutrition and Physical Activity. 2021 Dec;18:1-0. Gibson-Smith D, Bot M, Brouwer IA, Visser M, Giltay EJ, Penninx BW. Association of food groups with depression and anxiety disorders. European journal of nutrition. 2020 Mar;59:767-78. Taylor S, Asmundson GJ. Life in a post-pandemic world: What to expect of anxiety-related conditions and their treatment. Journal of anxiety disorders. 2020 May;72:102231. Jackson SE, Smith L, Firth J, Grabovac I, Soysal P, Koyanagi A, Hu L, Stubbs B, Demurtas J, Veronese N, Zhu X. Is there a relationship between chocolate consumption and symptoms of depression? A cross‐sectional survey of 13,626 US adults. Depression and anxiety. 2019 Oct;36(10):987-95. THANK YOU!