Depression and DietDepression and Diet

Presented by: Christina M. ZarzaPresented by: Christina M. Zarza

December 6, 2005December 6, 2005

Prevalence of DepressionPrevalence of Depression

Depression is among the top five Depression is among the top five leading causes of disability and leading causes of disability and disease burden throughout the worlddisease burden throughout the world

In the US: 8.7 % of the general In the US: 8.7 % of the general population suffers from depressionpopulation suffers from depression

28 % of the US adult population 28 % of the US adult population meets full criteria for a psychiatric meets full criteria for a psychiatric diagnosisdiagnosis

Economic BurdenEconomic Burden

Treatment rate increased by over Treatment rate increased by over 50% between 1990 and 200050% between 1990 and 2000

19.9 billion in 188019.9 billion in 1880 26.1 billion in 200026.1 billion in 2000

What is depression?What is depression?

DSM-IV Types:DSM-IV Types:• Major Depressive Disorder (MDD)Major Depressive Disorder (MDD)• Dysthymic DisorderDysthymic Disorder• Others (including Adjustment Disorder Others (including Adjustment Disorder

with Depressed Mood, or Adjusted with Depressed Mood, or Adjusted Disorder with Mixed Anxiety or Disorder with Mixed Anxiety or Depressed Mood )Depressed Mood )

Others: Seasonal Affective Disorder, Post Others: Seasonal Affective Disorder, Post Partum Depression, Bipolar DisorderPartum Depression, Bipolar Disorder

Symptoms of MDDSymptoms of MDD

depressed mooddepressed mood AnhedoniaAnhedonia Weight changesWeight changes Disrupted sleepDisrupted sleep FatigueFatigue feelings of worthlessness or excessive guiltfeelings of worthlessness or excessive guilt cognitive dysfunctioncognitive dysfunction recurrent thoughts of death recurrent thoughts of death

Effectiveness of TreatmentEffectiveness of Treatment

Around 80% of patients respond to TxAround 80% of patients respond to Tx Of Those, 50% achieve complete Of Those, 50% achieve complete

remissionremission Of those who recover, 50 % experience Of those who recover, 50 % experience

a relapse within 2 yearsa relapse within 2 years Over 20 years, 20 % continue free Over 20 years, 20 % continue free

of illnessof illness Over 25 years, 11 % Over 25 years, 11 %

Current TreatmentsCurrent Treatments

Monoamineoxidase inhibitorsMonoamineoxidase inhibitors Specific Serotonin Reuptake Specific Serotonin Reuptake

inhiborsinhibors Electroconvulsive TherapyElectroconvulsive Therapy LithiumLithium

Depression and DietDepression and Diet

Essential Fatty Essential Fatty AcidsAcids

Folic AcidFolic Acid Simple Simple

CarbohydratesCarbohydrates

Essential Fatty AcidsEssential Fatty Acids Changes in fatty acid consumption over Changes in fatty acid consumption over

evolutionary time:evolutionary time:• Current O-6/0-3 ratio is 15:1 to 20:1Current O-6/0-3 ratio is 15:1 to 20:1• Paleolithic ratio was 1:1 or lessPaleolithic ratio was 1:1 or less

Countries with high rates of fish oil Countries with high rates of fish oil consumption have low rates of depression consumption have low rates of depression (Hibbeln and Salem 1995)(Hibbeln and Salem 1995)

Evidence for decreased levels of omega-3 Evidence for decreased levels of omega-3 fatty acid levels in severely depressed pts. fatty acid levels in severely depressed pts. (Maes et al. 1996)(Maes et al. 1996)

EFA Treatment Ameliorates EFA Treatment Ameliorates Depressive Symptoms (Nemets Depressive Symptoms (Nemets

2002)2002)

Subjects: ages 18-75, diagnosed with Subjects: ages 18-75, diagnosed with major depressive disorder (DSM-IV)major depressive disorder (DSM-IV)

Method: subjects received either E-Method: subjects received either E-EPA or a Placebo daily over 4-weeks EPA or a Placebo daily over 4-weeks (double-blind)(double-blind)

Results: E-EPA subjects showed Results: E-EPA subjects showed significantly lower Hamilton significantly lower Hamilton Depression Rating scoresDepression Rating scores

Our Favorite Fatty AcidsOur Favorite Fatty Acids

Role of EFAs in the Central Role of EFAs in the Central Nervous SystemNervous System

The dry weight of the adult brain is The dry weight of the adult brain is 50% to 60% lipid, 20% of this lipid 50% to 60% lipid, 20% of this lipid content is composed of EFAscontent is composed of EFAs

EFAs can influence membrane EFAs can influence membrane fluidity and synaptic activityfluidity and synaptic activity

EFAs can also influence the EFAs can also influence the cytokine responsecytokine response

Folic Acid (Folate)Folic Acid (Folate)

Common Food Sources: green vegetables, Common Food Sources: green vegetables, yeast, liver, kidney, egg yolkyeast, liver, kidney, egg yolk

Functions in metabolic processesFunctions in metabolic processes Concentration of folic acid in the CNS is Concentration of folic acid in the CNS is

three times that of its concentration in the three times that of its concentration in the serumserum

Decreased levels of folic acid have been Decreased levels of folic acid have been measured in depressed patients (Lerner et measured in depressed patients (Lerner et al. 2005)al. 2005)

Folic Acid StructureFolic Acid Structure

www.bioscience.org/ 2004/v9/af/1431/fig1.jpg

www.fda.gov/fdac/graphics/ 1999graphics/folate.jpg

Amelioration of Depressive Amelioration of Depressive Symptoms with Folic Acid Symptoms with Folic Acid

(Guaraldi et al. 1993)(Guaraldi et al. 1993) Subjects: 20 drug free patientsSubjects: 20 drug free patients Method: pts. Given either placebo Method: pts. Given either placebo

or 50 mg methyltetrahydrofolate or 50 mg methyltetrahydrofolate daily for 6 weeks (double blind)daily for 6 weeks (double blind)

Results: showed significant Results: showed significant improvement in symptoms on improvement in symptoms on Hamilton Depression Rating Scale Hamilton Depression Rating Scale (81% responders)(81% responders)

Sites of ActionSites of Action

Functions in methylation reactions: Functions in methylation reactions: SAM pathwaySAM pathway

http://www.bioscience.org/2004/v9/af/1431/figures.htm

Other Good ThingsOther Good Things

Promotes synthesis of tetrahydro Promotes synthesis of tetrahydro biopterin (BH4)biopterin (BH4)• Which plays a role in the synthesis of Which plays a role in the synthesis of

dopamine, norepinephrine, and dopamine, norepinephrine, and serotoninserotonin

Yeah FDA!Yeah FDA!

FDA enacted legislation in 1996 FDA enacted legislation in 1996 requiring the fortification of foods requiring the fortification of foods with folic acidwith folic acid

Folate levels in baked goods, Folate levels in baked goods,

cereal grains, and pasta cereal grains, and pasta

doubled or tripled after doubled or tripled after

the regulations were the regulations were

implementedimplemented

Simple CarbohydratesSimple Carbohydrates

Found in a favorite foods, e.g. Found in a favorite foods, e.g. anything with refined sugarsanything with refined sugars

Mmm…chocolate, cake, cookies, Mmm…chocolate, cake, cookies, sweet breadssweet breads

Provide quick sources of Provide quick sources of

energy energy

Effects in DepressionEffects in Depression

Depressed persons crave simple Depressed persons crave simple carbohydratescarbohydrates

May be a form of self-medicationMay be a form of self-medication May be associated with the fatigue aspect May be associated with the fatigue aspect

of depressionof depression A recent cross-national study showed a A recent cross-national study showed a

highly significant correlation between highly significant correlation between sugar consumption and annual rate of sugar consumption and annual rate of depression (Westover and Marangell 2002)depression (Westover and Marangell 2002)

Mood and Carbohydrate Mood and Carbohydrate Cravings (Christensen et al. Cravings (Christensen et al.

2001)2001)

Subjects: 113 male and 138 female Subjects: 113 male and 138 female college studentscollege students

Method: students completed a Method: students completed a craving questionare and several craving questionare and several mood inventories (depression/vitality)mood inventories (depression/vitality)

Results: Significant positive Results: Significant positive correlation between carb craving correlation between carb craving intensity and moodintensity and mood

ConclusionsConclusions

Eat more like a paleolithic man and Eat more like a paleolithic man and you will be happieryou will be happier

What can you do?What can you do?

Enact change, follow the example of Enact change, follow the example of Artemis Simopoulos 2001Artemis Simopoulos 2001

““n-3 Fatty Acidsn-3 Fatty Acids

and Human and Human

Health: Health:

Defining Defining

Strategies for Strategies for

Public Policy”Public Policy”

For ReferencesFor References

E-mail: E-mail: christina.zarza@colorado.educhristina.zarza@colorado.edu

Phone: 303-807-4399Phone: 303-807-4399 You can also find me on FacebookYou can also find me on Facebook