Back when I was doing my psychology training, the major lifestyle factors that were proposed to be related to mental health were exercise and sleep.
Such was the relationship between these lifestyle factors and mental health that in addition to medication or therapy, it was sensible to suggest to someone to look at getting more exercise and better quality sleep. These recommendations remain today.
In the intervening 12 or so years, a third lifestyle pillar has been strongly linked to mental health, namely diet/nutrition. Studies now show that poor diet often accompanies mental ill health, that poor diet/nutrition can be a predictor of mental ill health, and that some mental health conditions can be treated with diet/nutrition. This is particularly the case with depression.
There are two main ways to improve your diet/nutrition.
– One is to modify the foods that you eat. For example, eating more vegetables, more whole grains, less sugary foods/drinks, more fish/less red meat. When I talk to dietitians, this is generally the preferred option, because it is generally whole diet quality that is more important than any single given nutrient. Get your overall diet in shape, rather than focusing on specific nutrients.
– However, the other way to improve diet/nutrition is to supplement with specific nutrients. This can be done to plug gaps in one’s diet, achieve higher doses of nutrients than would be achievable through food sources or to use more bio-available forms. For example, I get regular B12 injections because I don’t seem to absorb B12 particularly well through my diet.
As a culture, I think we have a bit of an over-fascination with supplementation. Just look at the supplement aisle at your local Chemist Warehouse. 40% of Australians take some kind of vitamin, mineral or supplement, despite most of them not having particularly good evidence to support their use. We spend large amounts of money on single nutrient supplements, rather than spending less but making more effort to improve our overall diet.
I also think supplements are marketed in a way that exaggerate and sometimes completely make-up the potential benefits. This is because they aren’t regulated in the same way as pharmaceutical drugs.
Hence it is important to be very mindful about what supplement selections (if any) we should make for our health and wellbeing.
This is where we turn to the published literature. We can often find guidance in the published literature on which supplements are beneficial for which conditions.
So what supplements can help in the treatment of mental health conditions?
That is what Firth et al. (2019) have tried to answer in their “The efficacy and safety of nutrient supplements in the treatment of mental disorders: a meta-review of meta analyses of randomised controlled trials“.
What did they do?
A meta-review is where you collect together other people’s reviews and then review them. It is a way of trying to ensure that you are only accessing the best quality studies when trying to answer a research question. It does however require that a fair bit of research has been done in the area.
Firth et al. were interested in studies that had looked at using nutrient supplements as a treatment (either stand-alone or adjunct to an existing treatment) for mental disorders like depression, anxiety, schizophrenia or ADHD.
They collected together reviews that had studied whether particular supplements (e.g. Vitamin D, omega-3, folate) could lead to physical or mental improvements in individuals with diagnosed mental health conditions/disorders and collated those results.
What did they find?
Only a few supplements have demonstrated significant benefits for specific conditions.
They are as follows:
EPA (eicosapentaenoic acid – Omega-3 fatty acid) for Major Depressive Disorder (MDD), particularly where there are raised inflammatory markers – look for a >50% EPA formula providing 2200mg EPA/day – as an adjunct to existing treatment
Methylfolate for Major Depressive Disorder (MDD) – 15mg per day as an adjunct to existing treatment
Vitamin D and depression – 50,000 IU per week as adjunctive treatment
Possibly also helpful are:
NAC (N-acetylcysteine) for depression – 2000mg day
Methylfolate for schizophrenia – 15mg per day as an adjunct to existing treatment
Probiotics for depression – dose and type currently unknown
What should you do with this information?
If you are currently being treated for depression, that is, taking an anti-depressant and/or receiving psychological therapy for depression, you might want to take this review (accessed via this link) to your GP/psychiatrist and discuss whether supplementation with EPA, Vitamin D, NAC or methylfolate might be helpful in your case.
If you are currently being treated for schizophrenia, you might wish to take this review to your GP/psychiatrist and discuss whether methylfolate supplementation might be helpful in your case.
Do not start supplementing with these before discussing with your doctor, as there may be other reasons not to take them in your unique situation (e.g. interactions with other medications).
Final words
Nutritional supplementation may play a role in the treatment of depression, and there is good/growing evidence of the potential benefits of a few particular nutrients: EPA, Vitamin D, NAC and methyfolate.
In all cases, these should be seen as adjuncts to existing treatments, rather than replacements. Discuss with your GP the idea of trialing these in your situation. Take the review with you if that helps you broach the conversation.
I’d also strongly suggest seeing a dietitian to get your overall diet quality assessed and improved. It is likely that modifications to your overall diet are likely to elicit greater improvements that single supplements alone. For example, this Australian study found large improvements on symptoms of depression, anxiety and stress by getting participants to adopt a more Mediterranean diet.
This adds to a growing body of literature that highlights lifestyle factors as important targets of change in those with mental health conditions.
If you struggle with mental ill health, consider making improvements to the 3 biggest lifestyle factors: sleep, physical activity and diet.
If you’re not sure where to start, talk to your GP.