Depression, traditionally thought of as a mental disorder, has its roots in biology with the psychological symptoms being a result of tangibly altered physiology. As research emerges, an expanded understanding of the pathogenesis of depression is starting to come to the forefront - with a focus on nutrient deficiencies. There is strong evidence that correcting nutrient deficiencies and addressing the why of the initial deficiency can lead to a decrease in symptoms and improved long-term outcomes. The key nutrients that should be assessed in every individual with depression are protein, omega 3’s, folate, zinc and magnesium.
Nutrition and Depression
Nutritional neuroscience is an emerging field which looks at how nutrients act on the brain and on the pathways that heavily influence neuronal activity. It shows that the components of food are intertwined with human emotion and clinically it’s seen that nutritional status plays a substantial role in the onset, severity and duration of depression.
In depression, nutritional interventions are centered around optimizing micro and macro nutrient intake while increasing the absorption and assimilation of nutrients necessary for brain health.The evidence is clear that neurotrophic factors as well as neurotransmitter synthesis rely on sufficient supply of nutrients and that the structure and function of the brain depends on adequate nutrients.
When it comes to successful management of depression, several facets need to be addressed to form complete protocols. These include blood sugar regulation, macronutrient composition, gut health, food sensitivities, inflammatory load and phytochemical content. In addition, using targeted nutrient support can help to understand the individual root cause and physiology and provide relief.
Nutrients in Depression
Assessing protein status is important in the dietary management of depression. Individual amino acids such as tyrosine, tryptophan and methionine play critical roles in neurotransmitter synthesis and SAMe production. Above this, plasma levels of amino acids, such as carnitine are shown to be chronically low in those with depression. Clinical research shows that increasing bioavailable protein in the diet is correlated with a decrease in depressive symptoms.
Note: protein bioavailability and quality in addition to grams needs to be assessed.
Cell membrane fluidity, which is largely determined by the content of fatty acids in the lipid bilayer, influences the correct firing of neurotransmitters. The omega 3, DHA is concentrated in the brain, and it’s associated with neuronal membrane structure and the functionality of dopamine and serotonin.
EPA, while it does not concentrate within the brain, is able permeate the blood brain barrier and exert anti-inflammatory effects. It is thought to inhibit the neuronal proinflammatory cascade that accompanies the pathophysiology of depression.
Due to these supported mechanisms of action, as well as many proposed pathways, supplementation with EPA and DHA has been shown to be therapeutic in depression and provides an overall increase in mood with adequate dosing.
A deficiency in folate increases levels of homocysteine, which subsequently decreases levels of SAMe - both which are risk factors for depression. Folate deficiency can be indicative of a reduced methylation capacity which has been correlated to altered neurotransmitter synthesis.
Individuals with depression often present with low levels of folate. Assessing folate levels is always important, however the research shows those with treatment resistant depression are often lower in folate and there's increased therapeutic value in this population.
Correcting folate levels has been shown to improve the efficacy of antidepressants and in some cases, restoring folate levels has symptomatic reduction similar to certain antidepressants.
Remember that unnecessary folate supplementation can be harmful - always test levels first.
Levels of zinc are required for maintaining homeostasis in the hippocampus, amygdala and the cerebral cortex, which are all structures involved in the pathophysiology of depression. Lower levels of zinc are correlated to decreased mood, while deficiency, which is common in the developed world, can induce depressive behaviors. Zinc has been used successfully to manage depression. Like folate, zinc potentiates the effect of antidepressants and is something to consider in treatment resistant depression as a potential contributor to pathogenesis.
The molecular mechanism at play circles back to its role in regulating both neurotransmitters and the antioxidant systems that govern the body as well promoting the healthy expression of neurotrophic factors.
Magnesium deficiency can both mimic depressive symptoms and contribute to already existing depression. Magnesium influences the fluidity of the neuronal membrane and participates in several biochemical pathways in the nervous system. Restoring levels of magnesium in the body is a foundational part of any mental illness protocol. On its own, unlike other nutrients, is not comparable to traditional antidepressants but it potentiates and sets the foundation for the whole protocol.
We’ll be exploring depression further, and diving into proposed pathogenic mechanisms including methylation dysfunction, insulin resistance, BDNF levels and neuroinflammation providing clinicians with several avenues to take for management. Stay tuned, and if there are any specific questions you have, please reach out to us @ firstname.lastname@example.org
NOTE: This is not medical advice and is intended to broaden the knowledge base of practitioners in order to create more comprehensive protocols that address depression from all angles and is not intended for self diagnosis or use by the general public
Author: Lisa Kowalyk, Co-Founder Fiore Health