Should the FDA Approve the Mediterranean Diet for Depression?

Drew Ramsey, MD


February 22, 2018

Should the US Food and Drug Administration approve the Mediterranean diet for the treatment of clinical depression? I am Dr Drew Ramsey, assistant clinical professor of psychiatry at Columbia University in New York City. This is the Brain Food blog, for Medscape Psychiatry.

This was a big year for brain food. On January 31, 2017, Felice Jacka and colleagues[1] published the SMILES study, which showed that the Mediterranean diet had a significant and positive effect for individuals with moderate to severe depression. One year later, Natalie Parletta and colleagues[2] at the Center for Population Research in South Australia have published a similar study with striking findings. Dr Parletta and her group followed 152 individuals with depression who were randomly assigned to a control group, which participated in a very active support group, or a group that received the Mediterranean diet.

As the authors note, we live in an "obesogenic environment," and therefore changing eating behaviors is quite challenging. To mitigate those challenges, every 2 weeks, the intervention group received a food hamper containing some essential ingredients for a recipe that they would learn, along with staples such as canned tuna or salmon, olive oil, and whole grains and legumes, the basic staples of the Mediterranean diet. Along with the food hamper, they participated in a cooking class. That would certainly make me feel less depressed—to receive free food and a nice Mediterranean diet–style cooking class every couple of weeks!

The researchers followed these participants at 3 and 6 months. What did they find? They found that individuals in the Mediterranean diet intervention group significantly changed their diets. They ate more fish, they ate more plants, and they ate less red meat and fewer confections or processed foods. Investigators also found that participants in the Mediterranean diet group had a significant reduction in their depression scores, with a roughly 45% improvement in their rating scales compared with about a 27% improvement in the control group.

The researchers also gave everyone in the intervention group a fish oil pill or omega-3 supplements to total about 900 mg of DHA and 200 mg of EPA. Of note, that is the opposite ratio that we typically recommend. We usually recommend more EPA and less DHA. This supplement had a nice effect, because getting people to eat more fish certainly is an effort to get them to increase the long-chain omega-3 fats in their diet, and adding the supplement was a way to ensure that this happened. The researchers also did a nice job of reporting erythrocyte omega-3 values of the different polyunsaturated fats, or PUFAs, and then correlating some of those changes with changes in the rating scales in terms of mood and negative emotions.

If you are interested in this type of research, I encourage you to take a look. It is the HELFIMED study by Natalie Parletta and her group. The results of these studies lead to a reasonable question for us. If we are clinicians whose practices are evidence-based and now we see a significant data signal that the Mediterranean or healthy traditional diets can prevent and also treat depression, are we doing a good enough job teaching the next generation of psychiatrists how to assess diet? And are we changing our clinical practices to reflect the evidence?

I will look forward to your comments to let me know how a study like this influences how you practice. I am Dr Drew Ramsey for Medscape Psychiatry.


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