Integrating Nutrient Profiling in Depression Management

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What do oysters and watercress have in common? Both may be loaded with antidepressant nutrients according to a new study published in the World Journal of Psychiatry by psychiatrists Laura LaChance and Drew Ramsey (LaChance and Ramsey). The evidence presented offers a novel profiling system that ranks foods based on their antidepressant potential. The idea of food as medicine is nothing new, but how might we translate this storied adage into practice?

LaChance and Ramsey introduce an antidepressant food score based on a systematic review of several studies dating back to the 1940s that examines a correlation between specific nutrients and depressive symptoms. Twelve nutrients emerged after rigorous analyses as carrying the highest antidepressant potential: folate, iron, long-chain omega-3 fatty acids, magnesium, potassium, selenium, thiamine, vitamin A, vitamin B6, vitamin B12, vitamin C, and zinc. Oysters, watercress, spinach, kale, and several organ meats were considered antidepressant nutrient-dense.

This research is fascinating for a number of reasons, but, understandably, the findings (and even the study itself) may evoke mixed emotions. I like this study, and after discussing it with colleagues over the past week, I have received both bright-eyed engagement and the flippant eye-roll. I am, however, encouraged that thoughtful conversations about mental health care have invariably ensued. Hey, if we are willing to talk productively about psychiatry and how to make it better—and a study spearheads this process—then I am all for it.

What I like about this study is that it offers an alternative route from the traditional medication versus psychotherapy dyad that often limits treatment options. It also steers us away from vague recommendations like “eat healthier for a better mood” to targeting what exactly we might eat to best support depression prevention and treatment—a dietary prescription, if you will. I don't view the study findings as hard dietary recommendations just yet, and I doubt this was the authors' intention, either; rather, the results provide a good foundation of ideas on which to build upon.

When the authors categorized foods, vegetables as a food group had the highest mean antidepressant food score. This is significant, considering that according to the Centers for Disease Control (CDC) only 1 in 10 adults eat enough fruits or vegetables per day. This research offers another good reason to pile up on the green stuff. Oysters sit atop the non-veggie antidepressant foods.

As the authors duly point out, depressive disorders are among the leading causes of disability worldwide. The CDC recently brought to our attention an increasing suicide rate that rose 30 percent between 2000 and 2016. Despite the emergence of selective serotonin reuptake inhibitors (SSRIs) and the development of several new antidepressants during that timeframe, the troublesome statistics remain. I will always advocate for judicious medication management, because psychiatric medications continue to help millions of people around the world. I see firsthand the positive impact psychiatric medications have in my clinical work on a daily basis.

However, as we trend away from psychotherapy and towards a biomedical model of depression, I cannot help but wonder if this approach might be contributing to undesirable outcomes. There remains a hearty cohort of scientists who are focused on finding the perfect pill that will shift neurotransmitters in just the right way and eradicate depression completely as a biochemical illness. I applaud them, and I hope they find this pill. I would happily prescribe it. But, we cannot ignore that recent evidence suggests that up to 45,000 Americans alone (many whom are already taking antidepressants) are victims of suicide on an annual basis. Please take a pause to think about this. These victims are our coworkers, our neighbors, our friends, and our family members.

Suicide is a preventable cause of mortality, and this is why the work continues. If addressing nutrition in our discussions with patients can place even a marginal dent in suicide statistics, then these studies are well worth it, and let us encourage more of them.

I recently spoke with Max Elliott, co-founder and executive director of Urban Roots, a farm-based youth leadership organization here in Austin for my podcast, “This is Mental Health.” Although our discussion did not focus primarily on the potential for food to target depressive symptoms from a nutritional standpoint, he addressed the idea of food and farming as a way to build a sense of community, to bring people together. The bottom line here is that we should not underestimate the healing potential of food.

I advocate passionately for Green Psychiatry, which offers a patient-centered evidence-based approach to health and wellness that utilizes standard-of-care treatments alongside complementary and alternative treatments, including nutrition. Nutritional psychiatry is growing in popularity, and as LaChance and Ramsey point out, has been recommended as a standard approach to treating depression by an international panel of mental health researchers. It is my view that nutrition, along with encouraging physical activity, should at the very least be addressed in every psychiatric encounter, because we know that these habits contribute to overall health, including mental health.

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LaChance and Ramsey suggest that future studies that extend from the antidepressant food score concept may provide more substantial evidence supporting specific dietary modifications for improved mood. The study presented here is an overture to a broader discussion on standardizing a method of including nutritional modifications in a comprehensive depression treatment plan. Is this the future of psychiatry? I certainly hope so.