A Systematic Review to Propose an Evidence-based Nutrition Protocol in Depression

Background: Rates of depression have been rising steadily over the last several decades with more than 264 million people affected, making it one of the top three burdens globally. The pandemic has brought on a greater risk of depression. Forty-two percent of individuals surveyed in December 2020 by the US Census Bureau reported depressive symptoms. Many factors, including poor diet quality, play a role in the development of depression during traumatic events like the pandemic. A low-quality dietary pattern has been associated with obesity, low-grade chronic inflammation, dysbiosis, increased cortisol levels and monoamine neurotransmitter deficiency. Among others, these factors have been correlated with an increased risk of depression. Additionally, antidepressants have been shown to be ineffective in up to 40% of individuals. Therefore, the potential of a nutrition-focused approach could be helpful. Purpose/Objectives: A systematic review was conducted to determine if an evidence-based, targeted nutrition protocol could be developed for the prevention or treatment of depressive symptoms. Methods: The systematic review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines and PICOS framework. An extensive PubMed search was conducted in June 2021. Randomized control trials or observational studies published in 2005 or later with human adults 18 or older that consisted of a dietary pattern or nutrition intervention, depression outcome measured and similar group treatment were reviewed for inclusion. Results: The Mediterranean-style and anti-inflammatory dietary patterns were associated with the greatest improvements by potentially mitigating oxidative stress and systemic inflammation associated with depression. Supplementation of certain nutrients including B vitamins, vitamin D, omega-3 fatty acids, zinc, or magnesium were associated with a decrease in depressive symptoms. Conclusions: The results of nearly 100 studies strongly indicate certain nutrients and dietary patterns have the potential to reduce depressive symptoms. A proposed nutrition protocol was developed as a result of this unique review. Interprofessional Implications: Proper nutrition has a significant impact on overall health and reduced risk of disease, likely from the potential to modulate pathophysiological factors in depression. The use of a targeted nutrition-focused protocol could be useful in the prevention or treatment of mental illness. Abstract References: Adaa.org. Accessed June 1, 2021. https://adaa.org/understanding-anxiety/depression
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