Diet and depression

Monique Tello, MD, MPH

Contributing Editor

Just this week, I have seen three patients with depression requiring treatment. Treatment options include medications, therapy, and self-care. Self-care includes things like sleep, physical activity, and diet, and is just as important as meds and therapy — sometimes more so.

In counseling my patients about self-care, I always feel like we don’t have enough time to get into diet. I am passionate about diet and lifestyle measures for good health, because there is overwhelming evidence supporting the benefits of a healthy diet and lifestyle for, oh, just about everything: preventing cardiovascular disease, cancer, dementia, and mental health disorders, including depression.

Diet and emotional well-being

Diet is such an important component of mental health that it has inspired an entire field of medicine called nutritional psychiatry. Mind-body medicine specialist Eva Selhub, MD has written a superb summary of what nutritional psychiatry is and what it means for you right here on this blog, and it’s worth reading.

What it boils down to is that what we eat matters for every aspect of our health, but especially our mental health. Several recent research analyses looking at multiple studies support that there is a link between what one eats and our risk of depression, specifically. One analysis concluded:

“A dietary pattern characterized by a high intake of fruit, vegetables, whole grain, fish, olive oil, low-fat dairy and antioxidants and low intakes of animal foods was apparently associated with a decreased risk of depression. A dietary pattern characterized by a high consumption of red and/or processed meat, refined grains, sweets, high-fat dairy products, butter, potatoes and high-fat gravy, and low intakes of fruits and vegetables is associated with an increased risk of depression.”

Which comes first? Poor diet or depression?

One could argue that, well, being depressed makes us more likely to eat unhealthy foods. This is true, so we should ask what came first, the diet or the depression? Researchers have addressed this question, thankfully. Another large analysis looked only at prospective studies, meaning, they looked at baseline diet and then calculated the risk of study volunteers going on to develop depression. Researchers found that a healthy diet (the Mediterranean diet as an example) was associated with a significantly lower risk of developing depressive symptoms.

So, how should I counsel my patients on diet? There are several healthy options that can be used as a guide. One that comes up again and again is the Mediterranean diet. Another wonderful resource for folks is the Harvard T.H. Chan School of Public Health website with an introductory guide to healthy diet.

The bottom line

The gist of it is, eat plants, and lots of them, including fruits and veggies, whole grains (in unprocessed form, ideally), seeds and nuts, with some lean proteins like fish and yogurt. Avoid things made with added sugars or flours (like breads, baked goods, cereals, and pastas), and minimize animal fats, processed meats (sorry, bacon), and butter. Occasional intake of these “bad” foods is probably fine; remember, everything in moderation. And, for those who are trying to lose weight, you can’t go wrong with colorful fruits and veggies. No one got fat eating berries or broccoli. Quality matters over quantity. And when it comes to what we eat, quality really, really matters.

Resources

Dietary patterns and depression risk: A meta-analysis. Psychiatry Research, July 2017.

Diet quality and depression risk: A systematic review and dose-response meta-analysis of prospective studies. Journal of Affective Disorders, January 15, 2018.

Related Information: Understanding Depression

Comments:

  1. Mike

    Thank you for this post. I know many of us have struggled with poor diet and depression and it certainly can be a downward spiral without a correction. Good healthy eating and learning to love yourself is a smart start. I will be looking into the Mediterranean diet as it is new to me. Itt does look like a focus on natural things instead of processed “junk” based on my quick read from your link above. I think it will be good to investigate. Thanks again.
    Mike

  2. Laura McCall, CNE

    Doctor Tello – thank you for this article. As more medical doctors such as yourself acknowledge the tie between what we eat and how our bodies and brains function, I believe many patients will be helped and healed. My own history with depression has led me to a career in nutrition. I now help others using food as my Rx. Again, grateful to see this concept disseminated among doctors too.

  3. kari

    I beg Harvard to change their diet recommendation to exclude “whole grain” and “low-fat”. It seems the research is available to conclude there are healthy fats and certainly other plants to substitute for “whole grains”.

    • Monique Tello, MD, MPH
      Monique Tello, MD, MPH

      I agree that there are healthy fats: avocado, nuts, seeds, and olive oil contain healthy fats, which are dense in calories and should be taken in moderate amounts for that reason. In the article I do talk about limiting animal fats, like butter and bacon, because that is what the research covered in this article shows is associated with a higher risk of depression.

  4. Penny

    “The gist of it is, eat plants, and lots of them, including fruits and veggies, whole grains (in unprocessed form, ideally), seeds and nuts, with some lean proteins like fish and yogurt. Avoid things made with added sugars or flours (like breads, baked goods, cereals, and pastas), and minimize animal fats, processed meats (sorry, bacon), and butter. “

    I have found this precise lifestyle to truly be the miracle cure for anxiety and depression. I have exercised at a pretty high intensity all of my life and always avoided junk and fake food but my mood improved significantly and stayed that way for a few years now that I avoid processed grains ie breads, pasta and refined sugar. I was raised in an Italian family on big bowls of pasta and bread and never would have thought I could stop but almost all cravings for those foods disappeared. Can’t recommend it enough.

  5. Edythe McKee

    I have been able to stay off psych meds because my depression went away on a ketogenic diet. It is probably due to the lack of added sugars. It would be nice if there could be a study of the ketogenic diet on depression patients. The trouble is virtually all my depressed friends are sugar addicts and can’t get close to a keto diet.

    • Monique Tello, MD, MPH
      Monique Tello, MD, MPH

      Avoiding added sugars is consistently shown to help with weight loss, and in this case, mood. Sure, there can be more studies of the ketogenic diet specifically, but the bottom line is, there’s already plenty of research to support a plant-based diet, and the ketogenic diet is a difficult diet to maintain long-term. Great that it’s worked for you, however, and thank you for reading and sharing.

      • Suzanne

        Any diet is difficult to maintain long term. The problem with restriction is that it makes you crave what you’ve restricted.

        With the ketogenic way of eating, a lot of people find it actually minimises their cravings and naturally reduces caloric intake. I don’t know where this myth comes from that keto in particular is hard to maintain. It’s no harder than any other WoE, except that you have to trust that everything you were brought up believing about food is wrong, turn it on its head, and commit.

  6. Deirdre Kennedy

    I gave up gluten because of a thyroid problem and three days later I woke up to a different world. The major depression that I had suffered with my whole life was lifted…. It is amazing to me how a thing like gluten could cause such a change….I had spent a fortune on physiatrists and psychologists and was way overmedicated to the point where I was shaking. Also I dropped 25 lbs so quickly that I thought there was something wrong with me…. They have improved the quality of gluten free food since I quit so I have gained some of that weight back but now I work out so it is not an issue. I am just happy to not be fighting depression every day. I gave up gluten and have not looked back since…

    • Monique Tello, MD, MPH
      Monique Tello, MD, MPH

      I’m so glad that you feel better off of medications and using dietary changes alone! Refined grains of all kinds are what seemed to be associated with a higher risk of depression in these studies.

  7. Jl in Jersey

    Glad to see this topic getting the attention it deserves. Keep up the good work. We discovered the diet mental health connection some years ago. The elimination of gluten made an enormous night and day difference for the better. While celiac was in the immediate family, without the classic symptoms we never made the connection to mental health, anxiety and ability to focus. Hope more research is done in this area.

  8. Thomas Braun RPh

    Depression is the result of a deficiency in key brain nutrients.
    Poor diet and stress are the root causes. Key nutrients that need to be boosted are Vitamin D, Folate (l-methylfolate) B6 and B12.
    Also, boosting Omega-3 and rejecting Omega-6 food sources is essential. The medical research has been done, we just have to connect the dots.

  9. Judith Brown

    I eat the diet you are suggesting and have been a healthy eater for decades. But,I am still in treatment for depression/dysthymia.

    • Monique Tello, MD, MPH
      Monique Tello, MD, MPH

      Diet is often only part of the solution. Treatment options for depression include medications, therapy, and self-care. Self-care includes things like sleep, physical activity, and diet, and is just as important as meds and therapy.

  10. USMacScientist

    The body is a complex machine. Diet and exercise are important, but genetics is too. In the case of depression, MTHFR mutations play a significant role as they impact the methylation cycle, that produces many neuro-transmitters. By supplementing you can optimize this cycle and compensate for faulty genetics. Genetics also conditions how fast you metabolize fat, carbs, caffeine… So adapting your diet to your genetics is extremely important. We are also discovering the role of microbes and their interactions with our body. Diet definitely impacts those microbes. We need a holistic and personalized approach to health.

    • Monique Tello, MD, MPH
      Monique Tello, MD, MPH

      The evidence-based jury is still out on MTHFR gene mutations and links to any diagnosis or treatment. Just now checking out the literature on this in the US National Library of Medicine National Institutes of Health (i.e. Pubmed), and recent reviews call for more and higher-quality research before an association can be suggested. Meantime, most folic acid supplements are relatively harmless, if they come from a reliable source.

  11. sana guher

    Don’t comprehend what sort of eating regimen you are on. Yet, practice is incredible for my winter dejection. What has at long last worked this previous year for weight reduction has been two things. One is work out. It’s an awesome bootcamp home video that works. Those have kept me off sugar, being fulfilled when I eat just 50% of what’s on my plate, longing for bunches of water and needing to work out. They are incredible and truly take a shot at your intuitive. I simply hear them out when I get into overnight boardinghouse nod off tuning in to them…and regardless they work.

  12. Kaiyum Hossain

    Definitely following a Mediterranean diet is good choice for future health. But I can’t agree with the fact that eating processed meat, refined grains, sweets, high fat dairy products in short following a bad diet increase the risk of depression. We should more focus on living an active life and spend more time on exercise rather than only focusing on diet. Exercise is more effective than diet when it comes to depression and anxiety. We should focus on both following a healthy diet and exercise.

    • Monique Tello, MD, MPH
      Monique Tello, MD, MPH

      Diet is only part of it, I agree. Treatment options for depression include medications, therapy, and self-care. Self-care includes things like sleep, physical activity, and diet, and is just as important as meds and therapy.

  13. azure

    Been eating a “mediterranean diet” in most respects (I make my own bread & bagels so I eat some “flours”) for years. Buy as much organic produce, or at least “no spray” local produce, as I can. Walk/hike an hour/day about 5-6 days/week.

    Diagnosed dysthymic w/some anxiety & tendency to slide into depression at times, years ago. Not much has changed since.

    Maybe I’m an outlier but you couldn’t prove by me that diet makes much of a difference.

    • Brenda M. Weiner, MPH

      Azure: IMHO, from what you write, I don’t think you’re an extreme outlier. Some thoughts:

      – You say you eat a Med. Diet in “most respects”. People are extremely unique and we all need to discover which foods are best for each of us. Sometimes removing a food to which you’ve had even a mild allergic reaction, can make a difference in mood and behavior. Small changes matter! Maybe try some? I discovered removing gluten from my diet lifted my mood substantially and reduced bread/sugar cravings. You admit you eat many flours (even if home-made). Perhaps look into trying gluten free to see if it makes a difference?

      -It’s EXCELLENT that you walk/hike an hour a day 5-6 days a week, but how do you spend the OTHER 24 hours in your day? if you’re not very active the rest of the day, just being upright and vertical more often can make a positive impact on mood, mind and body. Also, specifically for anxiety, yoga and meditation are really helpful. You may want to try them out in addition to walking/hiking.

      -the author, Dr. Monique Tello,never says to just focus on diet as you suggest. She opens with the fact that “self care” (sleep, physical activity and diet) are at LEAST as important as meds and therapy in her opening paragraph.

      Optimal health is a puzzle we each must put together based on our individual genetics, medical history, somatotypes, personalities, environments and health literacy. If we have a deficit in one of those areas, there are many things we can do to bridge the gap. It starts with a desire to know and following through to gain the resources necessary, along with the discipline to continue working on our personal health.
      The payoff is golden.

    • Bea

      Following an entirely plant-based, at least from time to time, has helped me. I’ll have a lot of berries and other fruits, lettuces and other greens, preferably raw, in addition to some cooked vegetables and whole grains. I don’t do this all the time, but when I do it does help.

    • Monique Tello, MD, MPH
      Monique Tello, MD, MPH

      Treatment options for depression include medications, therapy, and self-care. Self-care includes things like sleep, physical activity, and diet, and is just as important as meds and therapy. I.E., diet is only part of this equation.

  14. Bill Bradley, R.D.

    As a dietitian who had suffered from depression, I can tell you that the Mediterranean Diet changed my life. I feel a significant difference in how I feel mentally eating Mediterranean. The food is delicious, I eat it with abandon (and lost 40 pounds), and I celebrate what I eat. It is truly a life changer.

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