Feelings of sadness, changes in appetite, changes in sleep patterns, low energy, fatigue, general feelings of malaise and lack of motivation – many of these symptoms can be traced to biological components. When symptoms become prolonged – it can become extremely challenging to find relief.
Even without meeting criteria for an official diagnosis, depression symptoms can quickly impact daily functioning and overall well-being. Depression, like anxiety, is very common throughout the world and there remains a need for effective and efficient treatments. While science has made leaps and bounds in recent years on identifying biological components to depression, helping to reduce the stigma surrounding it in many ways, there remains a lot to learn. While antidepressants and psychotherapy benefit many, there remains a large sect of people who continue to suffer.
Appetite changes that frequently occur with depression may play a role in the nutritional aspect related to the following research. Again, and this cannot be stressed enough, correlation does not equal causation. Relationships between vitamin deficiencies and depression symptoms have been found but this does not mean that one causes the other; there may be an alternative explanation that has not been identified.
That said, the appetite changes that frequently occur with depression can include overeating or undereating. Some will find themselves snacking all day or binge eating, commonly referred to as “emotional eating”, typically sweet or salty foods (which boost dopamine resulting in small bursts of feeling relief). Others may find it overwhelming to even consider eating, let alone think about cooking an actual meal. In either case, nutritional recommendations are frequently disobeyed.
The lack of consistent research into using supplements during treatment is lacking. There seems to be little attention paid to how treating vitamin deficiencies may improve mood symptoms. More experimental research is definitely warranted.
For the purpose of this post, meta-analysis and literature review articles were focused on. Meta-analysis involves looking at research that is currently available and conducting statistical analysis of the results. Literature reviews peruse available information and present findings, typically to call for additional research and identify gaps or similar findings.
So, without further ado:
There is a lot of anecdotal evidence about treating Seasonal Affective Disorder (SAD) with Vitamin D supplements – the following studies did not particularly look at mood changes related to seasonal changes and this will be delved into further on another post. SAD is theorized to be caused from changes in light patterns due to changing seasons, with depression symptoms occurring because of not enough sunlight being available. Vitamin D is absorbed through our skin via sun exposure and SAD tends to occur more frequently in areas with harsh winters.
The research evidence on Vitamin D and depression symptoms tends to be conflicting, including whether there is even a relationship between Vitamin D and depression.
For example, while Bicikova and colleagues (2015) found lower levels of the Vitamin D precursor, called calcidiol, Karanova and his colleagues (2015) found no similar correlation between Vitamin D deficiency and depression symptoms; however, they did find a correlation between depression and age.
Black and colleagues (2013) found a correlation between depression and Vitamin D levels in a sample of males; however, Alatram (2015) found no similar correlation in his sample of 43 males.
Studies concerning the use of Vitamin D supplements for the treatment of depression do not appear to be as promising as one may think. One study found that Vitamin D supplements produced only a moderate effect for those with significant depressive symptoms and minor effect for those with less severe symptoms (Shaffer et al 2015). A meta-analysis found no reduction in depression symptoms after Vitamin D supplementation (Gowda et al 2015).
Again, none of these studies discussed SAD specifically.
B vitamins are another supplement for which anecdotal evidence is common, and two studies showed some benefit to their use.
A study on “Max Stress B”, a Vitamin B supplement, showed significant improvements in depression symptoms when compared to a placebo (Lewis et al 2013).
Stough and colleagues (2011) were interested in reducing workplace stress and improving mood ratings of employees. They found that after taking a B supplement for 3 months, participants reported less workplace stress and strain when compared to those assigned to the placebo group.
The most research found pertained to the use of Folate as a supplemental treatment to augment antidepressant medications. Adding folate to a traditional depression treatment was found to reduce Hamilton Depression Rating Scale (HDRS) scores in a review of three randomized trials (247 total participants). The review also found reduction in HDRS scores with folate use alone, and no significant difference between using folate or trazodone; however, the research is unclear whether participants were folate deficient or not and the number of participants for each study is fairly small (Taylor et al 2004).
Coppen and Bolander-Gouaille (2005) found through a literature review of current research a correlation between low folate and recurrent mood disorders, as well as a link between poor antidepressant treatment outcomes and low folate levels. They suggest, based on their review, that oral supplements of folic acid and vitamin B12 be used in addition to antidepressants for those who continue to experience depression symptoms.
In another literature review, short term use of folate and Vitamin B12 symptoms did not improve depression symptoms in adults with major depression who were already being treated with an antidepressant medication. However, prolonged consumption of the supplements may decrease relapse of symptoms for people at risk of recurrence (Almeida et al 2015). This may further support the use of these supplements as an addition to medication treatment, rather than a replacement.
Omega 3 Fatty Acids
Bloch and Hannestad (2012) conducted a meta-analysis of 13 randomized trials (731 participants total) and found there to be no significant benefit of Omega-3 fatty acid treatment compared to a placebo. They further suggested that studies demonstrating any benefits were biased, poorly designed experiments or comprised of participants with greater baseline symptoms.
In critique of this meta-analysis, Martins and colleagues (2012) conducted their own meta-analysis and suggested that EPA (eicosapentaenoic acid), a component of omega-3 fatty acid supplements, is really the key to treatment. They found that regimes with lower than 60% EPA content had no effect; however, supplements with 60% or greater content did demonstrate improvements with depression symptoms. They criticized Bloch and Hannestad for suggesting that all Omega-3 treatments are the same and called for further research to focus on dosages of supplements.
Another meta-analysis of 13 studies found that omega-3 may be a potential depression treatment but not for mania (Kraguljac et al 2009).
Swardfager et al (2013) found in a meta-analysis of 17 studies that depression is associated with lower levels of zinc. However, this analysis did not include using zinc as a potential treatment protocol.
Further research, particularly strong experimental designs with large sample sizes, are needed to help identify the link and role of vitamin deficiencies and depression symptoms. The more biological components to mental health symptoms are studied, the more understanding is gained and the more effective treatment can be.
- I am not a medical doctor or a nutritionist. This information is only being presented as a broad overview based off of previous academic studies. I encourage you to read the studies for yourself and discuss with your physician before taking ANY supplements. Many supplements can be toxic at the wrong dose or potentially worsen symptoms
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- Alatram, A. (2015). The Relationship Between Vitamin D Deficiency, Anxiety, and Depression. The FASEB Journal, 29(1 Supplement), LB310.
- Akbaraly, T., Brunner, E., Ferrie, J., Marmot, M., Kivimaki, M., & Singh-Manoux, A. 2009. Dietary Pattern and Depressive Symptoms in Middle Age. The British Journal of Psychiatry, 195 (5) 408-413; DOI: 10.1192/bjp.bp.108.058925
- Almeida, O. P., Ford, A. H., & Flicker, L. (2015). Systematic review and meta-analysis of randomized placebo-controlled trials of folate and vitamin B12 for depression. International psychogeriatrics, 27(5), 727-737.
- Bicíková, M., Dusková, M., Vítku, J., Kalvachová, B., Rípová, D., Mohr, P., & Stárka, L. (2015). Vitamin D in anxiety and affective disorders. Physiological Research, 64, S101-S103.
- Black, L. J., Jacoby, P., Allen, K. L., Mori, T. A., Beilin, L. J., Adams, L. A., & Oddy, W. H. (2013). Low vitamin D levels are associated with symptoms of depression, anxiety and stress in young adult males. The FASEB Journal, 27(1 Supplement), lb264-lb264.
- Bloch, M. H., & Hannestad, J. (2012). Omega-3 fatty acids for the treatment of depression: systematic review and meta-analysis. Molecular psychiatry, 17(12), 1272.
- Coppen, A., & Bolander-Gouaille, C. (2005). Treatment of depression: time to consider folic acid and vitamin B12. Journal of Psychopharmacology, 19(1), 59-65.
- Gowda, U., Mutowo, M. P., Smith, B. J., Wluka, A. E., & Renzaho, A. M. (2015). Vitamin D supplementation to reduce depression in adults: meta-analysis of randomized controlled trials. Nutrition, 31(3), 421-429.
- Karonova, T. L., Andreeva, A. T., Belyaeva, O. D., Bazhenova, E. A., Globa, P. Y., Vasil’eva, E. Y., & Grineva, E. N. (2015). Anxiety/depressive disorders and vitamin D status. Zhurnal nevrologii i psikhiatrii imeni SS Korsakova, 115(10 Pt 2), 55-58.
- Kraguljac, N. V., Montori, V. M., Pavuluri, M., Chai, H. S., Wilson, B. S., & Unal, S. S. (2009). Efficacy of omega-3 fatty acids in mood disorders-a systematic review and metaanalysis. Psychopharmacology bulletin, 42(3), 39-54.
- Lewis, J. E., Tiozzo, E., Melillo, A. B., Leonard, S., Chen, L., Mendez, A., … & Konefal, J. (2013). The effect of methylated vitamin B complex on depressive and anxiety symptoms and quality of life in adults with depression. ISRN psychiatry, 2013.
- Martins, J. G., Bentsen, H., & Puri, B. K. (2012). Eicosapentaenoic acid appears to be the key omega-3 fatty acid component associated with efficacy in major depressive disorder: a critique of Bloch and Hannestad and updated meta-analysis. Molecular psychiatry, 17(12), 1144.
- Melanson, K. J. (2007). Nutrition review: relationships of nutrition with depression and anxiety. American Journal of Lifestyle Medicine, 1(3), 171-174.
- Shaffer, J. A., Edmondson, D., Wasson, L. T., Falzon, L., Homma, K., Ezeokoli, N., … & Davidson, K. W. (2014). Vitamin D supplementation for depressive symptoms: a systematic review and meta-analysis of randomized controlled trials. Psychosomatic medicine, 76(3), 190.
- Stough, C., Scholey, A., Lloyd, J., Spong, J., Myers, S., & Downey, L. A. (2011). The effect of 90 day administration of a high dose vitamin B‐complex on work stress. Human Psychopharmacology: Clinical and Experimental, 26(7), 470-476.
- Swardfager, W., Herrmann, N., Mazereeuw, G., Goldberger, K., Harimoto, T., & Lanctôt, K. L. (2013). Zinc in depression: a meta-analysis. Biological psychiatry, 74(12), 872-878.
- Taylor, M. J., Carney, S. M., Goodwin, G. M., & Geddes, J. R. (2004). Folate for depressive disorders: systematic review and meta-analysis of randomized controlled trials. Journal of Psychopharmacology, 18(2), 251-256.