For more than 50 years psychiatrists have been researching nutritional treatments to treat psychological problems, often with impressive results. The body of research is overwhelmingly clear that diet not only affects mood, but that inadequate nutrition and vitamin deficiency may be the cause of some people’s depression.

Some people have a metabolic condition that causes difficulties absorbing certain vitamins from food and they can require much higher doses in order to get adequate vitamin levels in their blood. This means that some people can be experiencing vitamin deficiencies even though they are eating a healthy diet and must take supplements. It is therefore a good idea to get your blood tested to see if you are deficient in any vitamins, especially folate, niacin, B12 and D.

Trying to eat better

Social support is important in trying to change your diet. As you will read below, many common foods (such as sugar and dairy) have drug effects and can be very difficult to give up. If you are having difficulty changing your diet, you might want to try attending Overeaters Anonymous.

I believe the most evidence-based diet for optimal health to be Dr. Joel Fuhrman’s Eat to Live program. He advocates maxmizing nutrient density, meaning the amount of nutrition per calorie. Please review his website for specific dietary recommendations.

Imporant Foods and Supplements for Depression

The information below is not meant to constitute a recommended diet. It is a list of foods that have been shown to have a negative correlation with depression.

Green leafy vegetables!
- These are by far the most nutritious foods, including spinach, kale, collards, chard and lettuce. They are an excellent source of folate and stimulate the body to produce its own powerful antioxidents. Try to have at least one bunch of greens or one head of lettuce each day. This is much more than most Americans eat, but it may dramatically improve your health and mood.
Omega-3 fats.
- These fats play an important role in your brain and their positive effect on mood has been well established. If you are depressed, you can get a therapeutic dose of Omega-3′s by taking 3 grams of high quality fish oil each day. Other sources include fresh wild salmon, algae-based DHA, ground flax seeds and walnuts. Click here for more information about Omega-3′s.
Beans especially chickpeas and blackeyed peas.
- They are the best diatary source of folate. Try to have at least one serving each day.
Fruits.
- Fruits such as pomegranate and blueberries are good sources of antioxidents. Like green vegetables, the more fresh fruit you have, the better.
Starchy roots such as potatoes, parsnips and carrots.
- Countries with high intake of these foods have a much lower incidence of depression.
Vitamin D.
- It can be difficult to get enough vitamin D from the sun, especially if you live somewhere that is not sunny year round. You may want to take a supplement, in which case you should know that the most absorbable form of vitamin D is cholecalciferol.
B Vitamins including Folate.
- It is a good idea to take a B12 supplement. Other vitamins can interfere with absorbtion of B12, so you should take it on its own. It also needs to mix with saliva in order to be metabolized, so the ideal form is a small pill called a ‘sublingual’ that you just hold under your tongue until it dissolves.
- MTHF is the most absorbable form of folate.

Foods to Avoid

Sugar.
Caffeine.
Alcohol.
Dairy.
Fried foods.
Food high in cholesterol.
Processed foods in general.

Research

Sugar and Caffeine

Peet, M. International variations in the outcome of schizophrenia and the prevalence of depression in relation to national dietary practices: an ecological analysis. The British Journal of Psychiatry (2004) 184: 404-408

The diets in New Zealand, Canada, Germany, France, USA, USSR, Taiwan and Japan were correlated with their rates of depression. The most consistent finding was that a greater consumption of refined sugar is associated with a greater prevalence of depression. Conversely, high intake of starchy roots was associated with a reduced prevalence of depression.

Carlo Colantuoni, Pedro Rada, Joseph McCarthy, Caroline Patten, Nicole M. Avena, Andrew Chadeayne,and Bartley G. Hoebel. Evidence That Intermittent, Excessive Sugar Intake Causes Endogenous Opioid Dependence Obes Res. 2002;10:478–488.

Intermittant excessive intake of sugar led to physical addtion in rats, marked by strong withdrawal symptoms. Withdrawal symptoms could be triggered after high sugar doses by either fasting or an opiod blocker, Naloxone.

Lenoir, M. et al. Intense Sweetness Surpasses Cocaine Reward. PLoS ONE 2(8): e698. doi:10.1371/journal.pone.0000698

When rats were allowed to choose mutually-exclusively between water sweetened with saccharin–an intense calorie-free sweetener–and intravenous cocaine–a highly addictive and harmful substance–the large majority of animals (94%) preferred the sweet taste of saccharin. The preference for saccharin was not attributable to its unnatural ability to induce sweetness without calories because the same preference was also observed with sucrose, a natural sugar. Finally, the preference for saccharin was not surmountable by increasing doses of cocaine and was observed despite either cocaine intoxication, sensitization or intake escalation–the latter being a hallmark of drug addiction.

Lee MA, Flegel P, Greden JF, Cameron OG. Anxiogenic effects of caffeine on panic and depressed patients. Am J Psychiatry. 1988 May;145(5):632-5.

Found that people who have been diagnosed with depression report that caffeine makes them feel anxious at a level higher than people who are not feeling depressed.

Dairy

The diets in New Zealand, Canada, Germany, France, USA, USSR, Taiwan and Japan were correlated with their rates of depression. It was found that a high intake of dairy products was associated with an increased prevalence of depression.

Alcohol

Brown SA, Schuckit MA. Changes in depression among abstinent alcoholics. J
Stud Alcohol 1988; 49: 412-417.

Heavy drinkers experienced a dramatic decrease in depressive symptoms upon abstaining from alcohol.

Worthington J, Fava M, Agustin C, Alpert J, Nierenberg AA, Pava JA, Rosenbaum JF. Consumption of alcohol, nicotine, and caffeine among depressed outpatients. Relationship with response to treatment. Psychosomatics. 1996 Nov-Dec;37(6):518-22.

Found that even moderate levels of alcohol consumptions interferred with depression treatment.

S . Gilman. A longitudinal study of the order of onset of alcohol dependence and major depression. Drug and Alcohol Dependence , Volume 63 , Issue 3 , Pages 277 – 286

This study followed more than 14,000 consumers of community mental health services and found that when someone begins to drink heavily, they are likely to meet criteria for Major Depression within the next year. The converse is also true.

Jürgen Rehm, Robin Room, Kathryn Graham, Maristela Monteiro, Gerhard Gmel & Christopher T. Sempos. The relationship of average volume of alcohol consumption and patterns of drinking to burden of disease: an overview. Addiction. Volume 98 Issue 9, Pages 1209 – 1228

Found that alcohol consumption correlated to several serious health problems from Major Depression to various forms of cancer.

David W. Oslin, M.D., Ira R. Katz, M.D., Ph.D., William S. Edell, Ph.D., and Thomas R. Ten Have, Ph.D. Effects of Alcohol Consumption on the Treatment of Depression Among Elderly Patients. Am J Geriatr Psychiatry 8:215-220, August 2000

Found that decreasing alcohol use, even for moderate drinkers, lead to an improvement for elderly people with depression.

Davidson KM. Diagnosis of depression in alcohol dependence: changes in
prevalence with drinking status. Br J Psychiatry 1995; 166: 199-204.

82 alcohol-dependent in-patients were tested and during the episode of drinking which led to admission, a diagnosis of major depression was found in the majority of patients (67%). Once detoxification from alcohol took place, only the minority (13%) met criteria for major depression. This shows that alcohol use can cause depression that remits upon abstinence.

Cholesterol

Weidner, G. et al. Improvements in hostility and depression in relation to dietary change and cholesterol lowering. The Family Heart Study. Ann-Intern-Med. 1992 Nov 15; 117(10): 820-3.

Those who consumed a low-fat, high complex-carbohydrate diet at the end of the study showed significantly greater improvements in depression (P = 0.044; difference in improvement, 2.9 points) and aggressive hostility (P = 0.035; difference in improvement, 3.3 points) as well as a reduction in their plasma cholesterol levels (P = 0.024; difference in improvement, 2.7%) compared with those who ate a high-fat “American diet.”

Eating to cope with negative feelings

Musante, G. Costanzo, P. Friedman, K. The comorbidity of depression and eating dysregulation processes in a diet-seeking obese population: A matter of gender specificity. International Journal of Eating Disorders. (1998). Volume 23 Issue 1, Pages 65 – 75.

This sample consisted of 1,184 self-admitted patients enrolled in a residential weight loss program between 1990 and 1995. Subjects were administered several questionnaires including (a) the Beck Depression Inventory, (b) 5-point scales of eating-related foci, and (c) 7-point scales of subject’s confidence in their eating control under various circumstances. For obese females, negative-emotion disrupted eating and binge-purge behaviors were prominent predictors of depression. For males, eating induced by experiences of social or physical inadequacy and fasting relating to eating behaviors were the depression-relevant variables.

Omega 3 Fats

The diets in New Zealand, Canada, Germany, France, USA, USSR, Taiwan and Japan were correlated with their rates of depression. With regard to depression, the strongest association was between a high dietary intake of fish and seafood and reduced prevalence of depression.

Mamalakis G, Tornaritis M, Kafatos A. Depression and adipose essential polyunsaturated fatty acids. Prostaglandins Leukot Essent Fatty Acids. 2002;67(5):311-8.

Depressed people have lower levels of the Omega-3 fat DHA in their fatty tissues compared to others.

Peet M, Stokes C. Omega-3 fatty acids in the treatment of psychiatric disorders. Drugs. 2005;65(8):1051-9.

EPA is more effective than DHA for treating depression.

Maesa, M. Smithd, R. Christophee, A. Cosynsc, P. Desnydera, R. Meltzerb, H. Fatty acid composition in major depression: decreased ω3 fractions in cholesteryl esters and increased C20:4ω6/C20:5ω3 ratio in cholesteryl esters and phospholipids. Journal of Affective Disorders. Volume 38, Issue 1, 26 April 1996, Pages 35-46

Major depressed subjects had significantly higher C20:4ω6/C20:5ω3 ratio in both serum cholesteryl esters and phospholipids and a significantly increased ω6/ω3 ratio in cholesteryl ester fraction than healthy volunteers and minor depressed subjects. Major depressed subjects had significantly lower C18:3ω3 in cholesteryl esters than normal controls. Major depressed subjects showed significantly lower total ω3 polyunsaturated fatty acids in cholesteryl esters and significantly lower C20:5ω3 in serum cholesteryl esters and phospholipids than minor depressed subjects and healthy controls. These findings suggest an abnormal intake or metabolism of essential fatty acids in conjunction with decreased formation of cholesteryl esters in major depression.

Vitamin D

Gloth FM 3rd, Alam W, Hollis B.Vitamin D vs broad spectrum phototherapy in the treatment of seasonal affective disorder. J Nutr Health Aging. 1999;3(1):5-7.

All subjects receiving vitamin D improved in all outcome measures. Subjects receiving vitamin D improved more than those receiving phototherapy.

Folate, Niacin and other B Vitamins

Bolander-Gouaille, C. Treatment of depression: time to consider folic acid and vitamin B12. Journal of Psychopharmacology, Vol. 19, No. 1, 59-65 (2005)

Both low folate and low vitamin B12 status have been found in studies of depressive patients, and an association between depression and low levels of the two vitamins is found in studies of the general population. There is now substantial evidence of a common decrease in serum/red blood cell folate, serum vitamin B12 and an increase in plasma homocysteine in depression. On the basis of current data, we suggest that oral doses of both folic acid (800 µg daily) and vitamin B12 (1 mg daily) should be tried to improve treatment outcome in depression.

Raymond T. P. Paul, Anne P. McDonnell, Dr Christopher B. Kelly. Folic acid: neurochemistry, metabolism and relationship to depression. Human Psychopharmacology: Clinical and Experimental. Volume 19 Issue 7, Pages 477 – 488

A recently discovered genetic variant (5,10 MTHFR) leading to altered folic acid metabolism may explain why some individuals are vulnerable to the effects of folic acid deficiency, despite adequate intake.

Tommi Tolmunena, Jukka Hintikkaa, Anu Ruusunenb, Sari Voutilainenb, Antti Tanskanena, Veli-Pekka Valkonenb, Heimo Viinamäkia, George A. Kaplane, Jukka T. Salonenb. Dietary Folate and the Risk of Depression in Finnish Middle-Aged Men: A Prospective Follow-Up Study. Psychother Psychosom 2004;73:334-339

Studied the association between dietary folate and cobalamin and receiving a discharge diagnosis of depression in a prospective follow-up setting. The cohort was recruited between 1984 and 1989 and followed until the end of 2000, and it consisted of 2,313 men aged between 42 and 60 years from eastern Finland. Results: The mean intake of folate in the whole cohort was 256 µg/day (SD = 76). Those below the median of energy-adjusted folate intake had higher risk of getting discharge diagnosis of depression (RR 3.04, 95% CI: 1.58, 5.86) during the follow-up period than those who had a folate intake above the median.

Alpert JE, Fava M. Nutrition and depression: the role of folate. Nutr Rev. 1997 May;55(5):145-9.

Depressive symptoms are the most common neuropsychiatric manifestation of folate deficiency. Conversely, borderline low or deficient serum or red blood cell folate levels have been detected in 15-38% of adults diagnosed with depressive disorders.

Martha S. Morris, Maurizio Fava, Paul F. Jacques, Jacob Selhub, Irwin H. Rosenberg. Depression and Folate Status in the US Population. Psychother Psychosom 2003;72:80-87

Healthy subjects whose red blood cell (RBC) folate concentrations had been measured were determined to have no depression (n = 2,526), major depression (n = 301 ), or dysthymia (n = 121) using a diagnostic interview schedule. Low folate status was detectable in depressed members of the general US population.

Young, S. The use of diet and dietary components in the study of factors controlling affect in humans: a review. J Psychiatry Neurosci. 1993 November; 18(5): 235–244.

Reviews the effects of diet on depression, especially folate and complex carbohydrates.

Antioxidents and Vitamin E

Tsuboi H, Shimoi K, Kinae N, Oguni I, Hori R, Kobayashi F. Depressive symptoms are independently correlated with lipid peroxidation in a female population: comparison with vitamins and carotenoids. J Psychosom Res. 2004; 56(1): 53-8

Oxidated fats, such as any fat or oil that has been used for cooking, increases chances for depression. Antioxidents neutralize these oxidated fats.

Maes, M. Lower serum vitamin E concentrations in major depression Another marker of lowered antioxidant defenses in that illness. Journal of Affective Disorders , Volume 58 , Issue 3 , Pages 241 – 246.

Major depression is associated with defective antioxidant defenses. Vitamin E is the major fat soluble antioxidant in the body. Patients with major depression had significantly lower serum vitamin E concentrations than healthy controls.

Food and Nutritional Treatments for Depression