1. Depression and Diet Presented by: Christina M. Zarza December 6, 2005

2. Prevalence of Depression b Depression is among the top five leading causes of disability and disease burden throughout the world b In the US: 8.7 % of the general population suffers from depression b 28 % of the US adult population meets full criteria for a psychiatric diagnosis

3. Economic Burden b Treatment rate increased by over 50% between 1990 and 2000 b 19.9 billion in 1880 b 26.1 billion in 2000

4. What is depression? b DSM-IV Types: Major Depressive Disorder (MDD)Major Depressive Disorder (MDD) Dysthymic DisorderDysthymic Disorder Others (including Adjustment Disorder with Depressed Mood, or Adjusted Disorder with Mixed Anxiety or Depressed Mood )Others (including Adjustment Disorder with Depressed Mood, or Adjusted Disorder with Mixed Anxiety or Depressed Mood ) Others: Seasonal Affective Disorder, Post Partum Depression, Bipolar Disorder

5. Symptoms of MDD b depressed mood b Anhedonia b Weight changes b Disrupted sleep b Fatigue b feelings of worthlessness or excessive guilt b cognitive dysfunction b recurrent thoughts of death

6. Effectiveness of Treatment b Around 80% of patients respond to Tx b Of Those, 50% achieve complete remission b Of those who recover, 50 % experience a relapse within 2 years b Over 20 years, 20 % continue free of illness b Over 25 years, 11 %

7. Current Treatments b Monoamineoxidase inhibitors b Specific Serotonin Reuptake inhibors b Electroconvulsive Therapy b Lithium

8. Depression and Diet b Essential Fatty Acids b Folic Acid b Simple Carbohydrates

9. Essential Fatty Acids b Changes in fatty acid consumption over evolutionary time: Current O-6/0-3 ratio is 15:1 to 20:1Current O-6/0-3 ratio is 15:1 to 20:1 Paleolithic ratio was 1:1 or lessPaleolithic ratio was 1:1 or less b Countries with high rates of fish oil consumption have low rates of depression (Hibbeln and Salem 1995) b Evidence for decreased levels of omega-3 fatty acid levels in severely depressed pts. (Maes et al. 1996)

10. EFA Treatment Ameliorates Depressive Symptoms (Nemets 2002) b Subjects: ages 18-75, diagnosed with major depressive disorder (DSM-IV) b Method: subjects received either E-EPA or a Placebo daily over 4-weeks (double-blind) b Results: E-EPA subjects showed significantly lower Hamilton Depression Rating scores

11. Our Favorite Fatty Acids

12. Role of EFAs in the Central Nervous System b The dry weight of the adult brain is 50% to 60% lipid, 20% of this lipid content is composed of EFAs b EFAs can influence membrane fluidity and synaptic activity b EFAs can also influence the cytokine response

13. Folic Acid (Folate) b Common Food Sources: green vegetables, yeast, liver, kidney, egg yolk b Functions in metabolic processes b Concentration of folic acid in the CNS is three times that of its concentration in the serum b Decreased levels of folic acid have been measured in depressed patients (Lerner et al. 2005)

14. b Folic Acid Structure www.bioscience.org/ 2004/v9/af/1431/fig1.jpg www.fda.gov/fdac/graphics/ 1999graphics/folate.jpg

15. Amelioration of Depressive Symptoms with Folic Acid (Guaraldi et al. 1993) b Subjects: 20 drug free patients b Method: pts. Given either placebo or 50 mg methyltetrahydrofolate daily for 6 weeks (double blind) b Results: showed significant improvement in symptoms on Hamilton Depression Rating Scale (81% responders)

16. Sites of Action b Functions in methylation reactions: SAM pathway http://www.bioscience.org/20 04/v9/af/1431/figures.htm

17. Other Good Things b Promotes synthesis of tetrahydro biopterin (BH4) Which plays a role in the synthesis of dopamine, norepinephrine, and serotoninWhich plays a role in the synthesis of dopamine, norepinephrine, and serotonin

18. Yeah FDA! b FDA enacted legislation in 1996 requiring the fortification of foods with folic acid b Folate levels in baked goods, cereal grains, and pasta doubled or tripled after the regulations were implemented

19. Simple Carbohydrates b Found in a favorite foods, e.g. anything with refined sugars b Mmm…chocolate, cake, cookies, sweet breads b Provide quick sources of energy

20. Effects in Depression b Depressed persons crave simple carbohydrates b May be a form of self-medication b May be associated with the fatigue aspect of depression b A recent cross-national study showed a highly significant correlation between sugar consumption and annual rate of depression (Westover and Marangell 2002)

21. Mood and Carbohydrate Cravings (Christensen et al. 2001) b Subjects: 113 male and 138 female college students b Method: students completed a craving questionare and several mood inventories (depression/vitality) b Results: Significant positive correlation between carb craving intensity and mood

22. Conclusions Conclusions b Eat more like a paleolithic man and you will be happier

23. What can you do? b Enact change, follow the example of Artemis Simopoulos 2001 “n-3 Fatty Acids and Human and HumanHealth:Defining Strategies for Public Policy”

24. For References b E-mail: christina.zarza@colorado.edu christina.zarza@colorado.edu b Phone: 303-807-4399 b You can also find me on Facebook