Depression

Depression is a highly prevalent mental health disorder in the US. Both diet and lifestyle changes are now being recognised as effective treatment options for depression, backed by science. In the last 3 years 2,145 scientific papers have been published looking at diet and depression, compared to only 649 studies in the early 2000s.  

Cases per year

21 million1

General frequency

8.4% of adults1

Risk

Depression can affect anyone, and certain factors elevate your risk including family history of depression, a significant life event, poor social support, low socioeconomic status, insomnia, certain medications or medical conditions, and certain diet and lifestyle choices.

Treating depression with a whole-food plant-based diet and lifestyle medicine

Studies show us that various lifestyle factors are associated with depression, and so by changing these, such as moving towards a plant-rich diet that supports the gut-brain axis, patients are better able to manage their symptoms.

Dr Laurie Marbas

Podcasts

Here are some top scientific studies that support the results our clinicians have seen first-hand:

Meta-analysis of 41 studies shows plant-prominent diets reduce the risk of having depressive symptoms

Healthy dietary indices and risk of depressive outcomes: a systematic review and meta-analysis of observational studies

A systematic review and meta-analysis of 41 separate studies was carried out to determine the link between healthy dietary patterns and developing depressive symptoms. The authors found the strongest association between a Mediterranean diet (centered around unprocessed plant-based food) and depressive symptoms. Analysis of the data found that the key components of a plant-based diet (fruits, vegetables, legumes/pulses, and cereals/wholegrains) reduce the risk of developing depressive symptoms whereas meat and dairy both increase the risk of experiencing depression. The authors conclude that an anti-inflammatory diet is protective against depression 2.

A workplace intervention trial shows a plant-based diet actively reduces symptoms of depression, anxiety, and well-being within 18 weeks

A Multicenter Randomized Controlled Trial of a Nutrition Intervention Program in a Multiethnic Adult Population in the Corporate Setting Reduces Depression and Anxiety and Improves Quality of Life: The GEICO Study

A plant-based nutrition program was delivered to 292 participants, for 18 weeks, across 10 corporate sites of a U.S. company. Depression and anxiety, and work productivity were measured before and after the 18 weeks using the Short Form-36 questionnaire and Work Productivity and Activity Impairment questionnaire, respectively. The trial saw significant improvements in depression for the people who followed a plant-based diet, as well as anxiety, fatigue, general health, and well-being, which often go hand-in-hand with depressive symptoms 3.

Whole-food plant-based diet and lifestyle changes improves severe depression in 12 weeks

Diet and lifestyle intervention on chronic moderate to severe depression and anxiety and other chronic conditions

This study involved 500 men and women with chronic moderate to severe depression and anxiety. The intervention was a whole-food plant-based diet plus exercise, mindfulness and environmental changes. This significantly improved self-reported depressive symptoms at the end of the 12 weeks and after a 6 month follow up. This shows a lifestyle medicine prescription can improve people’s depressive symptoms even in cases of severe depression, and it can be maintained beyond the initial 12 weeks 4.

Individuals with major depression reduced depression severity in just 12 weeks by switching to a plant-predominant diet

A randomized controlled trial of dietary improvement for adults with major depression (the ‘SMILES’ trial)

Known as the The SMILES trial, this intervention aimed to improve the diets of 67 people with a depressive disorder, who at the time consumed unhealthy diets. They were given a diet similar to a Mediterranean diet, high in unprocessed plant-based food, and supported by clinicians across seven individual nutritional consulting sessions. After 12 weeks, this led to a significant reduction in scores on the Montgomery-Åsberg Depression Rating Scale, compared with controls who did not change their diet 5.

Below you will find more general information about depression

What is depression?

Depression is one of the most common mental health disorders in the United States. 

Characterized by persistent sadness and lack of interest in previously rewarding or enjoyable activities, it can destroy an individual's quality of life and make daily life incredibly difficult. 

The causes and pathophysiology of depression are not fully understood, current evidence suggests it’s brought on by a mix of genetic, biological, and environmental factors that involve several mechanisms. Whilst genetics are not modifiable, other factors such as diet, lifestyle, and social support contribute to the disease and represent ways it can be prevented, managed, and even treated 6.

Depression can often be triggered by a significant life event, such as the unexpected passing of a loved one or because of an experienced trauma. It often co-occurs with other illnesses and medical conditions, such as cancer, stroke, and heart disease which can also be managed with a diet and lifestyle medicine approach 7

There are many different types of depression including Major Depressive Disorder, Dysthymia, Perinatal Depression, Premenstrual Dysphoric Disorder, Seasonal Depression and Situational Depression. The symptoms of each depressive disorder overlap, because symptoms depend on the individual, not the depressive disorder itself. 

Symptoms

The symptoms of depression can vary widely depending on the individual. Sometimes the symptoms are more obvious, such as feelings of sadness, hopelessness, an inability to feel joy, crying easily, irritability, and loss or interest or pleasure in life 2 6. Other times, symptoms of depression may be harder to recognise, such as a loss of appetite, constant fatigue, headaches, lack of focus, and abdominal pain. 

These symptoms may occur by themselves or in combination, and they can sometimes take a while to identify as depression especially when they don’t consist of the more obvious, emotion-related symptoms. 

These symptoms can cause a range of further struggles for the individual. It can make the individual's ability to cope with work much worse, and destroy daily life skills. At the more severe end, depression can eventually lead to disability or premature death 8

Diagnosis

There are no specific lab tests designed to diagnose depression. Healthcare professionals instead use evidence-based assessments to diagnose an individual who may be suffering from depression. Assessments most frequently used are the Patient Health Questionnaire (PHQ)-2 and PHQ-9. 

Treatment 

The role that diet and lifestyle play in depression, especially via modulating gut health and inflammation, are becoming increasingly recognised as important tools for treating depression.  These approaches aim to heal people by fixing the root cause of depression, not just controlling the symptoms. For example, exercise and improved gut health naturally boost serotonin and dopamine levels in the brain. A recent paper discovered gut bacteria produce neurotransmitters, such as dopamine and serotonin, that are connected to the brain via the vagus nerve, immune system, and other pathways, and can influence our mood and behavior 9. Diet and lifestyle changes also aim to reduce inflammation in the body, as people with depression have been shown to have higher levels of inflammatory biomarkers 10

Therapy and improved social connections are often key in the treatment of depression. There are a number of different types of therapy available, including talking therapy, behavioral therapy, behavioral couples therapy, group therapy, art therapy, ecotherapy, and psychodynamic psychotherapy. Adjunctive therapies such as mindfulness and yoga can also improve the symptoms of depressive disorders 11

Diagram showing how our diet can impact our brain health directly via anti-inflammatory foods, and changes to the gut microbiome which in turn affect dopamine and seretonin levels in the brain
What we eat affects our brain health directly and through changes to the gut microbiome

Plant-based lifestyle medicine also improves overall physical health and risk of comorbidities such as heart disease, and certain cancers, which helps to improve symptoms of depression. 

All of these practices are encouraged by our Physicians within the Mora Medical treatment plan, allowing you to take control of your own health without needing unnecessary medications.  

Useful links

Think you may be suffering with this and need help? Join us today to make a change. 

References 

1. Major Depression. National Institute of Mental Health (NIMH)

2. Lassale, C. et al. Healthy dietary indices and risk of depressive outcomes: a systematic review and meta-analysis of observational studies. Mol. Psychiatry 24, 965–986 (2019).

3. Agarwal, U. et al. A Multicenter Randomized Controlled Trial of a Nutrition Intervention Program in a Multiethnic Adult Population in the Corporate Setting Reduces Depression and Anxiety and Improves Quality of Life: The GEICO Study. Am. J. Health Promot. 29, 245–254 (2015).

4. Null, G. & Pennesi, L. Diet and lifestyle intervention on chronic moderate to severe depression and anxiety and other chronic conditions. Complement. Ther. Clin. Pract. 29, 189–193 (2017).

5. Jacka, F. N. et al. A randomised controlled trial of dietary improvement for adults with major depression (the ‘SMILES’ trial). BMC Med. 15, 23 (2017).

6. Xu, Y. et al. Role of dietary factors in the prevention and treatment for depression: an umbrella review of meta-analyses of prospective studies. Transl. Psychiatry 11, 478 (2021).

7. Depression Statistics. Depression and Bipolar Support Alliance

8. Orsolini, L. et al. Understanding the Complex of Suicide in Depression: from Research to Clinics. Psychiatry Investig. 17, 207–221 (2020).

9. Valles-Colomer, M. et al. The neuroactive potential of the human gut microbiota in quality of life and depression. Nat. Microbiol. 4, 623–632 (2019).

10. Wium-Andersen, M. K., Ørsted, D. D., Nielsen, S. F. & Nordestgaard, B. G. Elevated C-Reactive Protein Levels, Psychological Distress, and Depression in 73 131 Individuals. JAMA Psychiatry 70, 176 (2013).

11. Saeed, S. A., Cunningham, K. & Bloch, R. M. Depression and Anxiety Disorders: Benefits of Exercise, Yoga, and Meditation. Am. Fam. Physician 99, 620–627 (2019).

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