Running Head: DEPRESSION AND NUTRITION 1

Depression and Nutrition

BIO-234-01

Annie Heyen

Marywood University

4/14/19
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Depression and Nutrition

I. The Illness: Depression

Depression is a mental illness that can be “characterized by a cycle that includes low
rank, feelings of being defeated and trapped, feelings of aloneness or disconnectedness, and
the expression of depression” (Gilbert, 2017). Depression is more than just “sadness”.
General sadness comes generally in waves, is able to be controlled/maintained, and does not
cause a loss of interest in enjoyable activities for very long (Parekh, 2017). Depression, on
the other hand, is a constant deep sadness, that is out of one’s control (until they go through
treatment and learn how to work with it), and causes a distance from others and activities
once enjoyed (Parekh, 2017).

It can be caused by a variety of factors, including, but not limited to, environmental
impacts, personality traits, genetics, and brain chemistry (Parekh, 2017). One analysis of
studies found that depression is being increasingly linked to emotional dysfunction
(Rottenberg, 2017). People with depression are greatly impacted by internal let downs as
well as external let downs (Gilbert, 2017).

Depression affects 1 in 15 adults currently and that rate is currently on the rise (Parekh,
2017). According to an article in the Journal of Child Psychology (2017), “over 300 million
people in the world are estimated to live with depression.” Women are more likely to
experience depression than men (Parekh, 2017). One in six people will experience depression
in their lifetime (Parekh, 2017), which also means almost everyone will be in contact
with/experience someone else with depression in their lifetime.

Everyone experiences depression differently (Stringaris, 2017). The term depression can
be broken down into different subcategories, but major depressive disorder (MDD) is the
most common of depressive disorders and is the most common of all mental health problems
and conditions (Rottenberg, 2017). In order for someone to be diagnosed MDD according to
the Diagnostic and Statistical Manual of Mental Disorders 5th edition (DSM-5), they must
have at least 5 of 9 of the following symptoms for at least two weeks (Parekh, 2017):

1. Feeling sad or having a depressed mood

2. Loss of interest or pleasure in activities once enjoyed
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3. Changes in appetite — weight loss or gain unrelated to dieting

4. Trouble sleeping or sleeping too much
5. Loss of energy or increased fatigue
6. Increase in purposeless physical activity (e.g., hand-wringing or pacing) or
slowed movements and speech (actions observable by others)
7. Feeling worthless or guilty
8. Difficulty thinking, concentrating or making decisions
9. Thoughts of death or suicide

(available in depth in Appendix A)

Even though major depressive disorder is the most common mental health condition, it is
also among the most treatable as well (Parekh, 2017). 80-90% of those that receive treatment
respond well to treatment (Parekh, 2017). Different treatment options include medication,
psychotherapy and electroconvulsive therapy (Parekh, 2017). Because of how individualized
each case of depression is to each individual, it’s important to keep in mind that not all of
these treatments work for every individual. For example, minor cases of depression might
just need psychotherapy while some more severe cases might need a combination of
psychotherapy and medication. The treatment must be individualized as well.

II. Genetic Component of Depression

Research in the genetics of depression is still in the early stages. Depression is not a
single gene disease and it has so many other factors besides gene expression. This makes it
difficult to pinpoint one single area of gene mutation that increases risk for depression. This
being said, studies do suggest that many gene variations, each with small effects, can
combine to increase one’s risk to developing MDD (NIH, 2019).

One gene that may be involved in risk for depression is the corticotropin-releasing
hormone receptor 1 (CRHR1) gene. According to a study done in 2006 by Z. Liu and
colleagues, “three SNPs were identified in CRHR1 gene and genotyped in the samples of
patients diagnosed with major depression and matched controls. We observed significant
allele (P = 0.0008) and genotype (P = 0.0002) association with rs242939, and the haplotype
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defined by alleles G-G-T for the represent rs1876828, rs242939 and rs242941 was
significantly over-represented in major depression patients compared to controls.” Those
three SNPS could be responsible for increasing genetic risk for developing depression or
giving people more genetic vulnerability for developing major depression.

Another gene found that may be involved in depressional risk is the colony stimulating
factor 2 receptor (CSF2RB) gene. In the 2011 study of the Han Chinese Population, Chen
Peng and colleagues found three SNPs before this gene that were linked with major
depressive disorder. These SNPs also had a correlation with schizophrenia. This relationship
between mental disorders could suggest that risks for different mental illnesses have similar
or the same genetic differences.

A third gene that may be involved in one’s risk for experiencing depression is the period
circadian regulator 2 (PER2) gene. This gene regulates sleep rhythms in the body. According
to the 2009 study done by Lavebratt and colleagues, any genetic variation in the core of the
circadian genes have been associated with genetic vulnerability for depression. This
vulnerability does not require an exposure to any sleep disturbance factors, just on the
mutation alone.

A person whose parent had depression is two to three times more likely of developing
depression in the future, showing another genetic link of depression (NIH, 2019). “If
identical twin has depression, the other has a 70 percent chance of having the illness
sometime in life” (Parekh, 2017). Though there are not any clear results yet of genetic
variations that increase the risk of the depression, it is clear that genetics does play a role in
one’s development of depression.

III. Nutritional Component of Depression

Vitamin deficiencies can sometimes mimic symptoms of depression, which can make
diagnosing difficult (Parekh, 2017). Also because of this, there is a strong link between
malnourished or deficient diets and depression. Some of those deficiencies are in B vitamins,
and vitamin D. A decrease in fruit and vegetable consumption and an increase in refined
sugar consumption have also been linked to increased risk of depression.
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Vitamin B deficiencies have been linked with depression because the B vitamins are
essential in cognitive functioning as well as energy metabolism (Mikkelsen et al, 2016).
Specifically, folate (B9) deficiencies have been found to increase risk for depression because
adequate levels of folate are crucial for brain functioning and overall body functioning
(Mischoulon and Raab, 2007). Vitamin B12 also is involved in brain functioning and that is
why folate and vitamin B12 have been used in experiments in combatting depression. In a
long-term treatment of those with severe treatment, supplementing with folate and vitamin
B12 found extreme success rates (Almeida et al, 2015).

Vitamin D deficiencies have also been found to increase depressional risk. The
phenotypic stability hypothesis states that vitamin D has a role as a buffer to maintain
calcium ion levels in their redox reactions (Berridge, 2017). According to this theory, vitamin
D works to reduce levels of calcium ions in neurons which can drive up depression
(Berridge, 2017). Vitamin D plays a role in controlling the expression of calcium ion pumps,
and a deficiency of vitamin D can leave unregulated calcium ion pumps which has a
connection to depressional risk (Berridge, 2017). This theory was proven in one study by
Jhee and colleagues (2017) where a vitamin D deficiency was significantly associated with
depression in chronic kidney disease patients.

Fruit and vegetable consumption has been linked with a decreased risk of depression.
Increasing fruit and vegetable consumption has been found to have an inverse relationship
with the risk of depression (Liu et al, 2016). It has also been found that already depressed
individuals “consumed significantly lower amounts of legumes, fruit, and vegetables” in
Grases’s 2019 study.

In that same study, depressed individuals were found to be consuming higher amounts of
sweets and refined sugars (Grases, 2019). This is found consistent with the 2015 study which
found that high glycemic index foods, which are foods high in refined sugars, are also linked
with increased risks of depression (Ganwisch et al, 2015). These foods are also associated
with spikes in blood sugar level which can cause mood swings (Ganwisch et al, 2015).

Overall because food consumption is so associated with mood, overall diet can be linked
with depressional risk. Khalid and colleagues, in their 2016 study, found that there is a strong
association between unhealthy dietary patterns and worsening mental health in adults. Some
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of these unhealthy dietary patterns included things previously mentioned such as less fruit
and vegetable consumption, and increased consumption of refined sugars (Khalid et al,
2016).

IV. Personalized Diet for a Fictitious Patient

There would be many nutritional goals set in place for a fictitious client with major
depressive disorder. The first goal would to increase B vitamin consumption, or at least make
sure they are receiving adequate amounts. These vitamins are crucial for energy metabolism and
brain functioning. For a client who is suffering from MDD, it is even more important to make
sure their brain is properly functioning and their body is moving at the proper speed, because
slowed down mental functioning can lead to more fatigue which can escalate depressive
symptoms. As mentioned earlier, folate and vitamin B12 are extremely crucial in this role.
Examples of foods high in folate that can be suggested are legumes, eggs, citrus fruits, and leafy
greens. Examples of foods high in B12 that can be suggested are meat, eggs, fish, and milk.

A secondary goal would be to increase vitamin D intake. Although some vitamin D can be
absorbed through the sun, I would assume that a client with depression doesn’t spend much time
outside. This goal could be accomplished through increased food consumption of foods high in
vitamin D as well as more time outside. Foods high in vitamin D that could be suggested are
fatty fish, such as salmon or tuna, eggs, and fortified foods/drinks such as milk or orange juice.

A third goal would be to increase fruit and vegetable consumption because of its inverse
relationship with depressional risk. Fruit consumption can help decrease sugar cravings and
therefore decreased refined sugar consumption. Vegetable consumption of dark leafy greens can
also increase intake of B vitamins. Fruit and vegetables are also part of a balanced varied diet,
which can help with mental health stability.

A fourth goal would be to increase exercise. Physical activity releases endorphins which can
improve mood, and increase motivation. For a client with depression, they are very likely to
spend a lot of their time in bed, or in their house, not engaging in any sort of energy-inducing
activity. If the client were able to go on a walk outside for even 30 minutes a day, they would
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have accomplished getting out of bed that day, they would be absorbing vitamin D, and they
would have released endorphins to have an overall better mood.

The fifth and final goal would be to encourage the client to seek out psychotherapy if they
aren’t already. Not only is this a treatment option, but it is another way to get the client out of
their house and make them feel accomplished. Sometimes switching between medications can be
a stressful and depression increasing time while trying to find the right one to work for the
individual. Psychotherapy is a treatment option that is already very individualized and can be
very beneficial in allowing an individual to communicate how they are really feeling.

Some foods would be highly recommended in accomplishing these nutritional goals because
they play multiple needed roles. Fortified milk is a good source of vitamin D, as well as these B
vitamins; thiamin, riboflavin, and B12. Dark leafy greens, such as broccoli or kale, would be
suggested because they are a good source of folate and other B vitamins. Citrus fruits would be
recommended because these are high in B vitamins and as a fruit could decrease sugar cravings.
Whole grains would also be recommended because they are a good source of B vitamins and
they also suppress the need for refined sugars.

V. Conclusion

Depression is a real mental illness that affects a large percentage of the population. Almost
everyone in their lifetime will experience or know someone that experiences depression.
Depression is more than just a general sadness and has a specific criterion to meet, as seen in
Appendix A. Recovery is very possible and treatment options have a very high success rate.

Although research in genetic links to depression is still recent, there is still evidence that a
person’s genetics plays a role in one’s risk for developing depression, but is not the entire
picture. The environment one was raised in, personality traits, and nutrition are all other factors
that can play a role in the likelihood of one developing depression.

There’s no surprise that nutrition absolutely affects MDD because food is so psychological
and constantly affects people’s moods. The more balanced a diet, the less likely it is for one to
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develop depression. Vitamin deficiencies can even have an effect that mimics depressive
symptoms, making it very important to have adequate intake of one’s vitamins and minerals.

In summary, the five nutritional goals I would set for a fictious client with depression is (1)
increasing intake of B vitamins, (2) increasing vitamin D levels, (3) increasing fruit and
vegetable intake, (4) increasing physical activity and (5) encouraging them to seek help through
psychotherapy. Because depression is so individualized it is very important, to work one on one
with the client to see what is working and what is not.
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References

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High glycemic index diet as a risk factor for depression: analyses from the Women’s
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Gilbert, P. (2017). Depression: The Evolution of Powerlessness. Routledge Mental Health.

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Jhee JH, Kim H, Park S, Yun H-R, Jung S-Y, Kee YK, et al. (2017) Vitamin D deficiency is

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Appendix A