Two recent studies have received a lot of attention for showing the significant role that diet can play in treating depression - the SMILES trial and the HELFIMED study.
No one seems satisfied with the state of mental health treatment. People battling depression and other conditions often find only partial relief, or may continue to decline despite trying every available treatment. Similarly, providers often bemoan their lack of effective options in helping patients find relief.
The numbers tell a rather dismal tale: Rates of depression have continued to rise even as the percentage of those taking psychiatric medication has skyrocketed. One in six adults in the US filled a psychiatric prescription in the past year, about one in eight for depression medication. Clearly we need better options than are currently available.
As a therapist I'm always looking for effective treatment approaches, and I've become more interested in nutritional approaches to mental health. Two recent studies got a lot of attention for showing the significant role that diet can play in treating depression—the SMILES trial and the HELFIMED study.
But I have to be honest: I'm sometimes hesitant to propose them to the people I work with. I anticipate a skeptical response like, "I'm battling Major Depression and you're suggesting I eat better and take a multi?"
I recently spoke with a leading researcher on nutrition and mental health, psychologist Julia Rucklidge. I was interested to learn that Rucklidge came to this area as a skeptic herself, and maintains a scientific objectivity about psychiatric research on diet and supplements. And yet she noted that the data are telling a compelling story about the role of nutrition in treating mental illness.
One of the dramatic demonstrations of the role of nutrition in mental health came from studies Rucklidge and colleagues did following two earthquakes in Christchurch, New Zealand, in 2010 and 2011. Participants who received high doses of micronutrients reported significantly lower levels of anxiety, depression, and posttraumatic stress symptoms. The benefits were sustained at a one-year follow-up. Similar results were found by Rucklidge's colleague, Dr. Bonnie Kaplan, following a flood in Calgary in 2013.
How could such a simple and inexpensive treatment make a substantial difference in mental health outcomes in the face of trauma? There are many hypotheses about how micronutrients have their effect. Rucklidge pointed out that people tend to be displaced following natural disasters and nutritious food may not be as readily available, so micronutrient supplements may be especially needed at these times.
She also suggested that extreme stress and being constantly on guard create an ongoing fight-or-flight stress response that further depletes the body of essential nutrients. "You're depleting, depleting, depleting, and so you have nothing left to feed your brain," she said, "and to ensure that other functions are well supplied with nutrients. Your body is making sure that survival is addressed first, and that's compromising the availability of what your body needs for everything else. And the research very much shows that adding nutrients when you're under a high amount of stress is a very good thing to do."
Other possible ways that nutrients help include the possibility that nutrients may affect gene expression - an "epigenetic" effect - turning some geneson and others off, according to the needs of the body and brain. Rucklidge and her team are also exploring the effects of micronutrients on the microbiome - the collection of bacteria that populate the gut. She also noted the possible effects on inflammation, given the established links between inflammation and depression. Much additional research is needed to determine which of these mechanisms are involved.
Despite the evidence that the way we fuel our bodies and brains can have significant effects on our psychological health, many people express doubts about the findings. Rucklidge noted the difficulties she has had along the way - getting approval from ethics committees, securing funding, even getting her studies published. She noted that she has never been supported by the government funding agency in New Zealand, and tends to rely instead on funding from foundations and individual donors.
It's easy to understand naysaying from drug manufacturers and others with a vested interest in seeing prescription medication as the only "real" mental health treatment. But how can we make sense of often vigorous pushback - at times bordering on anger - from those with no obvious stake in the debate? I asked Rucklidge what she thinks might drive some of these highly energized reactions.
"Sometimes I think it's just that it doesn't fit into their worldview," she told me. The scientifically discredited but still widely believed "chemical imbalance" myth likely plays a role. Rucklidge noted her own initial skepticism about using micronutrients to treat psychiatric conditions, while emphasizing that she and other scientists have a responsibility to "explore ideas that might contravene current ways of understanding mental illness."
It also seems hard for supplements to shed the taint of quackery, and of being somehow a fringe alternative treatment—no matter what the state of the science is. People may believe that if micronutrients were important for mental health, they would already know about it. Rucklidge also pointed out that disappointing results from single-nutrient studies may have biased some to reject newer findings with broad spectrum nutrient approaches.