Major depressive disorder and nutritional medicine: a review of monotherapies and adjuvant treatments

Abstract

A literature review was conducted to examine the evidence for nutritional interventions in depression. It revealed a number of significant conclusions. Interestingly, more positive clinical trials were found to support adjuvant, rather than monotherapeutic, use of nutrients to treat depression. Much evidence exists in the area of adjuvant application of folic acid, S-adenosyl-methionine, omega-3, and L-tryptophan with antidepressants. Current evidence does not support omega-3 as an effective monotherapy to treat depression. However, this may be due, at least in part, to olive oil being used as the control intervention, some studies using docosahexaenoic acid alone or a higher docosahexaenoic acid to eicosapentaenoic acid ratio, and significant heterogeneity regarding depressive populations. Nevertheless, adjunctive prescription of omega-3 with antidepressants, or in people with dietary deficiency, may be beneficial. Inositol lacks evidence as an effective antidepressant and cannot be currently recommended. Evidence on the use of L-tryptophan for depression is inconclusive, and additional studies utilizing a more robust methodology are required.

Eicosapentaenoic acid as an add-on to antidepressant medication for co-morbid major depression in patients with diabetes mellitus: A randomized, double-blind placebo-controlled study

“…Furthermore, there is some evidence that EPA may be particularly effective as add-on treatment in patients with major depression using antidepressant medication (Pouwer et al, 2005;Sarris et al, 2009). The exact mechanisms of the relationship between depression and ω-3 PUFAs remain to be elucidated, but could include increased membrane fluidity, altered cellular signaling processes, altered neurotransmitter processing, and increased antiinflammatory activity (Parker et al, 2006;Pouwer et al, 2005;Sarris et al, 2009). The efficacy of ω-3 PUFAs on depressive symptoms in patients with diabetes mellitus is unknown.…”

Physical Activity Impairment in Depressed COPD Subjects

“…21 Depression similarly appears to be linked to poor nutritional status, characterized by poor dietary intake and low serum levels of nutrients. 22 Therefore, COPD and depression appear likely to play a complementary role in the reduction of physical activity and in nutritional status impairment. The recognition of this dangerous link may be clinically important as a potential target to improve patients' quality of life.…”

The Future of Mental Health Care Toward an Integrative Paradigm

“…This principle has been demonstrated in many studies showing increased antidepressant efficacy when SAMe, folic acid, L-tryptophan or omega-3 fatty acids are combined with antidepressants in the treatment of depressed patients. (Sarris et al, 2009); and increased efficacy when n-acetyl cysteine, magnesium, folic acid or amino acids are combined with conventional mood stabilizers in bipolar patients (Sarris et al, 2010b). Future studies will examine such synergistic combinations of synthetic drugs and natural products to determine optimal formulas addressing common psychiatric disorders.…”

“…By the year 2050 non-invasive neuroprosthetic devices will be widely used to effectively and safely treat serious psychiatric disorders that are poorly responsive to psychotropic drugs including bipolar disorder, severe depressed mood and dementia. In addition to advances in psychoparmacology, genetics and technology-based therapies, natural product research is yielding significant findings of beneficial effects when a specific vitamin, mineral or herbal is used as a monotherapy to treat a specific psychiatric disorder (Sarris et al, 2009). An important trend that is pushing the evolution of contemporary biomedical psychiatry toward increasing integration with other healing traditions comes from the use of synergistic combinations of synthetic drugs and select natural products (Sarris et al, 2009).…”

“…In addition to advances in psychoparmacology, genetics and technology-based therapies, natural product research is yielding significant findings of beneficial effects when a specific vitamin, mineral or herbal is used as a monotherapy to treat a specific psychiatric disorder (Sarris et al, 2009). An important trend that is pushing the evolution of contemporary biomedical psychiatry toward increasing integration with other healing traditions comes from the use of synergistic combinations of synthetic drugs and select natural products (Sarris et al, 2009). This principle has been demonstrated in many studies showing increased antidepressant efficacy when SAMe, folic acid, L-tryptophan or omega-3 fatty acids are combined with antidepressants in the treatment of depressed patients.…”