As technology in food preparation and processing has advanced, so
has society's food consumption pattern. Greater emphasis is placed
on foods that complement the busy lifestyle of many people. This
has resulted in the increasing popularity of energy-dense and nutrient-poor
diets. In combination with a lack of physical activity, this has
caused a vast increase in cardiovascular disease (CVD), such as
coronary (or ischemic) heart disease (heart attack), cerebrovascular
disease (stroke), hypertension (high blood pressure), heart failure,
and rheumatic heart disease (WHO 2003).
Chronic noncommunicable diseases such as CVD, diabetes, obesity,
cancers and respiratory disease account for 59% of the 57 million
deaths annually and 46% of the global burden of disease. Risk factors
for the diseases, including high blood pressure, high cholesterol,
obesity, physical inactivity, and insufficient consumption of fruits
and vegetables, are related to diet and physical activity (WHO,
2003). Thus, the growing importance of nutrition and physical health
is a key determinant to one's well-being.
These alterations in food consumption and diet have not only influenced
chronic physical conditions, but also have had an impact on cognitive
and emotional well-being. There is a strong link between what one
consumes and one's feelings. Inadequate eating habits can aggravate
mental illness and prevent general good mental and emotional health
The brain is one of the most metabolically active organs in the
body. It requires essential nutrients, vitamins, minerals, and essential
fatty acids as cofactors for maintenance. Without the adequate intake
of all these nutrients, the brain cannot function optimally (Horrobin
Through research, the scope of treatment options, including that
of vitamins, minerals, and various nutrients, has increased. This
article presents a brief overview of some recent studies involved
in mental health and nutrition, particularly as it relates to depression.
A specific dietary supplement, which has been the focus of much
research for its nutritional benefits, is omega-3 fatty acid. This
fatty acid will be discussed in more depth later in this article,
as an example of a treatment for mental disorders.
Depression is characterized by feelings of sadness that last two
weeks or longer. Depressed individuals tend to feel helpless and
hopeless and to blame themselves for having these feelings. People
who are depressed may become overwhelmed and exhausted and may stop
participating in their routine activities. They may withdraw from
family and friends. Some may even have thoughts of death or suicide
(Strock 1994). Within the US, as many as 18.8 million adults, or
9.5% of the entire population, suffer from depression (APA 2005).
Many theories have emerged for the treatment of depression. Here
we will focus on the use of tryptophan in relation to the monoamine
theory; SAMe, folate, and B12 from the methylation process; and,
finally, the usage of minerals.
A fundamental theory in understanding depression is the monoamine
hypothesis. It is based on the presumption that essential amino
acid supplementation will increase neurotransmitter levels and improve
brain functioning. The essential amino acid tryptophan is obtained
from diet and converted to 5-hydroxytryptophan (5-HTP), which is
converted to serotonin, a neurotransmitter required for mood and
psychological health, and thus used to treat depression. It has
also been useful in treating fibromyalgia, binge eating, chronic
headaches, obesity, and insomnia (Shannon 2001).
The benefits of tryptophan were demonstrated in a randomized, double-blind,
placebo-controlled trial. Patients had met the criteria for nonpsychotic
major depressive disorder based on the DSM-IV. All subjects were
given 20 mg of fluoxetine every morning for eight weeks and assigned
to one of two protocols: either 4 g of tryptophan or placebo 20
to 40 minutes before bedtime. Depression levels were assessed using
the Hamilton Depression Rating Scale (HDRS) and the Beck Depression
Inventory (BDI). Sleep study assessments were done at weeks 4 and
8 using electrophysiological recordings. It was hypothesized that
individuals receiving the tryptophan and fluoxetine would have greater
improvements in mood than the placebo and fluoxetine group. It was
also believed that tryptophan might provide an antidepressant effect
with the fluoxetine. Finally, it was also thought that tryptophan
would improve sleep measures (Levitan, Shen, Jundal, Driver, Kennedy,
and Shapiro 2000).
It was found that those in the fluoxetine plus tryptophan group
showed a significant decrease in depression scores (BDI) compared
to those using the fluoxetine and placebo, in the first week of
treatment. Those in the tryptophan-fluoxetine group had greater
improvements in mood than those receiving placebo (as shown by HDRS
scores). Tryptophan also appeared to lessen the impact of fluoxetine-induced
decrements in slow-wave sleep, resulting in better sleep (Levitan,
Shen, Jundal, Driver, Kennedy, and Shapiro 2000).
Other nutritional supplements, such as S-adenosyl-methionine (SAMe),
have been used to treat depression, dementia, and other neurological
disorders. SAMe is "a modified amino acid ubiquitous throughout
the body, manufactured by cells using methionine. It is an essential
amino acid found in high-protein foods like meat and fish."
(Shannon 2001). SAMe has the ability to limit the accumulation of
homocysteine, which can lead to increased arterial plaque formation;
blood clotting; and elevated risk of heart disease, stroke, female
reproductive cancers, colon cancer, Alzheimer's disease, fibromyalgia,
and depression. SAMe is required in methylation, where a methyl
group is transferred from one molecule to another. SAMe donates
methyl groups in 35 different reactions to DNA, proteins, lipids,
and hormones. It is believed that depression may be related to a
weakening methylation (Shannon, 2001).
A recent open trial was conducted to examine the use of SAMe as
an adjunctive treatment for major depression. Outpatients met DSM-IV
criteria for current major depressive disorder and were on medication
to treat their mental illness. Subjects were started on 400 mg b.i.d.
of SAMe tosylate and increased to 800 mg b.i.d. after two weeks.
The study was conducted for a total of six weeks. The patients were
assessed using the Hamilton Depression Rating Scale (HAM-D-17),
the Montgomery Asberg Depression Rating Scale (MADRS), BDI, the
CGI – Severity and Improvement scales, the Kellner Symptom
Questionnaire (SQ), and the Massachusetts General Hospital Sexual
Function Questionnaire. Pre- and posttreatment serum homocysteine
levels were measured. Also, baselines for B12, homocysteine, serum,
and red blood cell folate were determined (Alpert et al. 2004).
The study showed that there was a small but significant decrease
in pretreatment to posttreatment homocysteine levels. The Massachusetts
General Hospital Sexual Function Questionnaire scores also indicated
improvement. There was also a significant reduction in depression
severity from baseline to endpoint, as measured by the MADRS, HAM-D-17,
and BDI. There was also a significant decrease in scores for the
CGI-S scores. There was no statistical significance with the SQ
scores. Folate, B12, and homocysteine levels were not associated
with positive clinical response to SAMe augmentation. These improvements
in depression suggest that there is a beneficial relationship with
SAMe augmentation (Alpert et al. 2004).
B12, Folate and Folinic
Other critical methyl donor groups, besides SAMe, include vitamin
B12 (cyanocobalamin and folate [folic acid]). Often patients with
major depressive disorder are also low in plasma and red cell folate
levels, which causes them to respond less well to antidepressants
(Shannon 2001). A study completed by Coppen and Bailey (2000) examined
this hypothesis through the benefits of folic acid when augmented
with the antidepressant fluoxetine. A randomized, double-blind,
placebo-controlled study was completed in a multicenter general
practice setting. Subjects were enrolled in the study and diagnosed
with depression, according to the DSM-III-R. Each was prescribed
20 mg/day of fluoxetine. Subjects were assigned either 500 µg
of folic acid or matching placebo, in addition to their medication,
for ten weeks. Hamilton Rating Scale (HRSD) and laboratory tests
measuring vitamin B12, homocysteine, and plasma folate levels were
The results showed that the folic acid group had a significantly
better response at week ten than the patients in the placebo group.
However, this applied only to the women subjects. The patients in
the folic acid group had significantly increased plasma folic acid
concentration at 10 weeks. There was a significant decrease in homocysteine
levels in the women only (21.0%) (Coppen and Bailey 2000).
This study suggested that only in female depressed patients did
the augmentation of folic acid significantly improve the response
to fluoxetine. Improvements were related to plasma homocysteine
levels and not plasma folate. The smaller increase in plasma folate
in men, which did not change the plasma homocysteine levels, may
indicate their lack of clinical response. It was assumed that analyzing
the results with a higher dosage of folic acid in men may be useful
in future studies (Coppen and Bailey 2000).
Moreover, Alpert, Mischoulon, Rubenstein, Bottonari, Nierenberg,
and Fava (2002) examined whether folinic acid, which is metabolized
to methylfolate, the major physiological form of folate, could enhance
selective serotonin reuptake inhibitor (SSRI) response among depressed
normfolatemic adults with major depressive disorder with an inadequate
response to SSRIs. Patients who met DSM-IV criteria for major depressive
disorder, and had shown a partial or no response to SSRIs or venlafaxine
after at least four weeks of treatment, were enrolled in an eight-week
open trial. Folinic acid (leucovorin) was given as 15 mg/day for
two weeks, followed by 30 mg/day for 6 weeks. Leucovorin was added
to a stable SSRI regimen of adequate dosage (e.g., fluoxetine 20
mg/day, sertraline 50mg/day). Response to treatment was determined
using the HAM-D-17 and the CGI.
Those who completed the study had a decreased mean HAM-D-17 and
CGI score from the baseline visit. At screening, all subjects had
folate levels greater in the moderate to high range, which rose
significantly at the end of the trial. Thus, adjunctive folinic
acid may represent a desirable approach to refractory/recurrent
depression in some depressed patients with normal or high folate
levels (Alpert et al. 2002).
Minerals are also important in treating depression. One, zinc, is
an important bioelement in the immune and nervous systems; and imbalances
may accompany mood disturbances. Nowak, Siwek, Dudek, Zieba, and
Pilc (2003) examined the effect of zinc supplementation on antidepressant
therapy in unipolar depression. Patients meeting DSM-IV criteria
for depression participated in a randomized, double-blind, placebo-controlled
trial. Subjects received antidepressant medication and were randomly
assigned to either zinc supplements (25mg Zn2+) or placebo for 12
weeks. Patients' psychological status was assessed using the HDRS
and the BDI.
Initially, after the second week, the antidepressant therapy reduced
the HDRS score in both groups. However, the zinc supplementation
significantly reduced the HDRS scores at the sixth and twelfth week
of treatment, when compared to the placebo group. The zinc group
had also significantly reduced the BDI scores at the twelfth week
of treatment, when compared to the placebo supplementation. There
is a delay in the effect of zinc co-treatment; however, the results
do indicate it to be beneficial in treating unipolar depression
(Nowak et al. 2003).
Bipolar disorder, also known as manic-depressive disorder, is related
to depression, and thus similar treatment modalities have been used
to treat patients with this illness. This disorder causes unusual
shifts in a person's mood, energy, and ability to function. Different
from the normal ups and downs that everyone goes through, the symptoms
of bipolar disorder are severe. They can result in damaged relationships,
poor job or school performance, and even suicide.
One study used a combination of vitamins and minerals adjunctively
with current medication to treat bipolar disorder. Kaplan, Simpson,
Ferre, Gorman, McMullen, and Crawford (2001) examined the therapeutic
effects of 36 ingredients, primarily chelated minerals. Subjects
who had met the DSM-IV criteria for bipolar I, bipolar II, or bipolar
disorder not otherwise specified (NOS) participated in an open-label
trial. Subjects were administered 32 capsules consisting of a mineral
and vitamin formulation, which were distributed 4 times throughout
the day, in addition to their psychotropic medications. Patients
were assessed by their own psychiatrists for 6 months using various
measures such as, HAM-D, Young Mania Rating Scale (YMRS), and the
Brief Psychiatric Rating Scale (BPRS).
Among the intention-to-treat (ITT) subjects (those who entered the
study), there was a 55% symptom reduction in the HAM-D, 60% reduction
on the BPRS, and 66% reduction on the YMRS. For those who completed
the study, psychotropic medication was reduced by more than 50%
after they began taking the supplement. These preliminary data indicate
that nutritional supplements have a beneficial psychotropic effect
(Kaplan et al. 2001).
These studies indicated the importance of proper food and nutrition
in the diet, particularly for those who suffer from mental illness.
Further, it appears that nutrition is a key determinant in the outcome
and prevalence of various mental disorders.
Fatty acids play a dominant role in the formation of a cell membrane's
phospholipid bilayer. Each phospholipid molecule is made up of a
3-carbon glycerol backbone. At the Sn3 position are a phosphorus
atom and a head group. The properties of the phospholipid depend
on the nature of the head group and the fatty acids attached at
the Sn1 and Sn2 positions. The membrane varies in physical properties
according to the wide variety of saturated and unsaturated fatty
acids that attach to the Sn1 and Sn2 positions. Altering the phospholipid
environment affects the functional activity of the neurotransmitter
receptors and other proteins embedded inside the protein (Peet 2002).
Fatty acids can be subdivided into saturated, monounsaturated, and
polyunsaturated. There are two main types of polyunsaturated fatty
acids, omega-6 and omega-3. Arachidonic(AA) and docosahexaenoic
(DHA) are the most abundant fatty acids in the brain. AA, dihomogamma-linolenic
acid, and eicosapentaenoic acid (EPA) are also important cell-signaling
and enzyme-regulating molecules. The parent precursors to these
acids, linolenic (omega-6) and a-linolenic (omega-3), are known
as "essential" fatty acids because they cannot be created
by humans. The omega-3 fatty acids are primarily obtained from marine
and vegetable sources and the omega-6 fatty acids from animal and
plant sources (Peet 2002).
In the past, humans consumed a low-fat diet containing a large amount
of omega-3 fatty acids and much less omega-6. Currently, the fatty
acid consumption is generally reversed, whereby a disproportionately
high amount of omega-6 fatty acids is consumed. This imbalance is
associated with a greater increase in some major mental illnesses
With a firm understanding of the background and purpose of essential
polyunsaturated fatty acids, the next step is to be able to use
them in treatment. In the case of depression, it is evident that
omega-3 deficiency plays a major role in its prevalence. Various
studies have been conducted to analyze omega-3 benefits when used
in a clinical setting. Marangell, Martinez, Zboyan, Kertz, Kim,
and Puryear (2002) conducted a randomized, double-blind, placebo-controlled
trial of the omega-3 fatty acid DHA in treating patients with major
depression. The patients were assigned either 2 g/day DHA or placebo
for 6 weeks. Subjects were assessed using the MADRS, the HDRS, and
the Global Assessment of Functioning Scale.
There was no significant difference between the DHA and the placebo
group. The results suggest, that while omega-3 has proven effective
in treating depression, it is not DHA fatty acid that is beneficial;
thus EPA must be further examined. A variety of other studies have
closely studied the influence of EPA in treating depression (Marangell
et al. 2002).
Peet and Horrobin (2002) conducted a randomized, double-blind study
using a mixture of doses of ethyl-EPA in patients with chronic depression
despite ongoing treatment with an adequate dose of a standard antidepressant.
Subjects were randomized to placebo, 1 g/day, 2 g/day, or 4 g/day
of ethyl-EPA for 12 weeks. Subjects were assessed using the MADRS,
the HDRS, and the BDI. Two populations were assessed: the ITT, which
included all those who were randomized, and the per-protocol (PP),
which included the patients who had completed the 12 weeks of treatment.
The results demonstrated over 90% compliance in all treatment conditions.
The majority of the adverse events recorded were due to gastrointestinal
events, which affected 4 of the 18 in the placebo group and 20 of
the 52 in the ethyl-EPA groups. These events were attributable to
the intake of 4 g/day of an oily substance. The 1 g/day group showed
a significant improvement in scores on the MADRS, HDRS, and the
BDI when compared to the placebo. In the 2 g/day group, none of
the measures approached significance. In the 4 g/day group, the
comparisons approached significance in the PP population but not
the ITT population. Thus, the study suggests that 1g/day of ethyl-EPA
is an effective dosage to treat for the symptoms of depression (Peet
and Horrobin 2002).
Peet, Brind, Ramchand, Shah, and Vankar (2001) had conducted a series
of trials to investigate this fatty acid influence. The first was
an open-label study investigating the influence of fish oil in treating
schizophrenia in patients who were symptomatic despite using antipsychotic
medication. Patients were given 10 g/day of concentrated fish oil
(containing 1.1g DHA and 1.7g EPA) for 6 weeks. Outcome measures
consisted of the Positive and Negative Syndrome Scale (PANSS) and
the Abnormal Involuntary Movement Scale (AIMS). By the end of 6
weeks, patients had shown significant improvement in their symptoms,
as indicated by their scores on the PANSS and AIMS. From these results,
the next step was to conduct a pilot double-blind trial to compare
EPA and DHA with a placebo.
For the second trial, again, patients diagnosed with schizophrenia
and on a stable dosage of medication were selected. They were also
symptomatic despite medical treatment with antipsychotics. Patients
continued taking their medication while being randomly allocated
to treatment of 2g EPA, 2g DHA, or equivalent corn oil placebo.
Patients were rated on the PANSS scale at the beginning and end
of the three-month treatment (Peet et al. 2001).
After treatment, the PANSS scores were significantly lower in the
EPA group than in the other groups. This indicated that subjects
in this group were less symptomatic after the three months. There
was a significant treatment effect favoring EPA over DHA on the
positive PANSS score but not for the negative symptoms. Further,
those with higher baseline EPA levels had the most improvement on
the PANSS scores. The study authors assumed that those with particularly
low levels of polyunsaturated fatty acid levels, which responded
less well to EPA treatment, perhaps had a more serious underlying
metabolic abnormality that cannot be treated through EPA administration.
The next step was to determine whether EPA alone was sufficient
in treating schizophrenia (Peet et al. 2001).
Patients diagnosed with schizophrenia, on no medication, and presented
as either new or relapsed cases were randomly assigned to either
2g/day EPA or equivalent placebo for three months. The purpose of
this study was to use EPA as the sole treatment, if possible, but
antipsychotics were permitted if clinically necessary (Peet et al.
In the placebo group, every subject required conventional antipsychotic
medication by the end of the trial period. However, six patients
on EPA were not taking antipsychotic medication at the end of the
study. Four of the six went through the entire period without antipsychotic
medication, one received medication for the first week only, and
one received a single dose of depot antipsychotic medication at
the start of the trial. Furthermore, the EPA group had a significantly
lower PANSS scores by the end of the study compared to the placebo
group. Again, this difference applied predominantly to the positive
symptom subscale (Peet et al. 2001). The results of this study suggest
that the application of EPA in the treatment of schizophrenia presents
To further the development of combination supplements in treating
schizophrenia, Arvindakshan, Ghate, Ranjekar, Evans, and Mahadik
(2003) examined vitamins E and C with omega-3 to use adjunctively
with medication. Outpatients diagnosed with schizophrenia according
to DSM-IV criteria were tested and compared with normal, healthy
controls. Pretreatment, posttreatment, and four-month posttreatment
washout assessments included the PANSS, BPRS, Heinrichs Quality
of Life (QOL), and the General Psychiatry Cluster Score (GTOT).
Treatment for the schizophrenia group involved a mixture of EPA/DHA
(180:120 mg), and a mixture of antioxidants (400 IU Bio E:500 mg
Celin) for four months. Blood levels were drawn at posttreatment
and at the four-month washout.
Blood samples confirmed that EPA and DHA levels were lower in the
pretreatment schizophrenic patients when compared to the normal
controls. However, the levels had significantly increased posttreatment.
The psychological assessments showed an improvement in the schizophrenic
patients' scores from the posttreatment and washout scores when
compared to pretreatment scores. This was the first study to show
that combination supplementation was effective in improving psychopathology
with a concomitant increase in both DHA and EPA. These improvements
were evident after the washout period as well. This study presents
promising results using a combination of fatty acids and nutrients
to treat schizophrenia.
Stoll, Severus, Freeman, Rueter, Zboyan, Diamond, Cress, and Marangell
(2003) studied the use of omega-3 in the treatment of bipolar disorder,
by conducting a double-blind, placebo-controlled trial. It was hypothesized
that omega-3 fatty acids would be an effective mood stabilizer in
bipolar disorder. Patients with bipolar disorder on constant medication
were randomized to receive either omega-3 fatty acid (7 capsules,
2 times/day with each capsule containing 6.2 g EPA and 3.4 g DHA)
or an olive oil placebo for 16 weeks. At baseline, a psychiatric
and medical history was obtained. The following rating scales were
performed at this time: Structured Clinical Interview for DSM-IV
screening for current mania and depression, Young Mania Scale, HDRS,
investigator- and patient-rated CGI scale, the Global Assessment
Scale, and adverse-effects scale. The main outcome measure of the
study was the duration of time to exit the treatment because of
bipolar disorder symptoms becoming severe enough to cause a change
Stoll et al. (1999) noted that the patients in the omega-3 trial
remained in the study longer than the placebo group. A post hoc
analysis was conducted on a subgroup of eight subjects who did not
receive any mood-stabilizing drugs upon entering the study. Those
in the omega-3 group remained in remission significantly longer
than the subjects who received the placebo monotherapy. According
to the secondary measures, the omega-3 group performed much better
than the placebo group. This showed that omega-3 fatty acids used
as an adjunctive treatment in bipolar disorder resulted in a significant
symptom reduction and a better outcome compared with placebo.
Borderline personality disorder (BPD) is a serious mental illness
characterized by pervasive instability in moods, interpersonal relationships,
self-image, and behavior. This instability often disrupts family
and work life, long-term planning, and the individual's sense of
self-identity. Originally thought to be at the "borderline"
of psychosis, people with BPD suffer from a disorder of emotion
regulation. There is a high rate of self-injury without suicide
intent, as well as a significant rate of suicide attempts and completed
suicide in severe cases (NIMH 2001).
Zanarini and Frankenburg (2003) examined the influence of ethyl-EPA
as monotherapy in a double-blind, placebo-controlled pilot study
of female patients with borderline personality disorder. Subjects
were given either 500 mg ethyl-EPA or an equivalent placebo for
8 weeks. They were assessed on the MDRS and the Modified Overt Aggression
The ethyl-EPA treatment group showed a significantly greater decrease
in psychological assessment scores than the placebo group. This
indicated an improvement in their condition. Thus, the results show
that ethyl-EPA may be a safe and efficacious monotherapy for moderately
disturbed women with borderline personality disorder (Zanarini and
The trend surrounding the lack of omega-3 consumption and rates
of illness can be seen occurring internationally. The relevance
of polyunsaturated fatty acids for their effects on mental disorders
has been emphasized through national epidemiological studies. Noaghiul
and Hibbeln (2003) conducted an epidemiological study examining
the relationship of lifetime prevalence of bipolar disorder in various
countries to differing rates of seafood consumption. Prevalence
rates of schizophrenia were used as a control measure. The Cross-National
Collaborative Group epidemiological study of ten countries, and
other studies identified through MEDLINE and Psychinfo were analyzed
for rates of bipolar disorder and schizophrenia. National seafood
consumption rates were obtained from National Marine Fisheries Service
and the Food and Agriculture Organization of the United Nations.
The results showed that higher national seafood consumption predicted
lower prevalence rates of bipolar spectrum disorder, bipolar I disorder,
and bipolar II disorder. The greatest rise in prevalence rates for
bipolar disorder generally occurs in countries having a seafood
consumption of less than 50 lb. per person annually. These results
assume that an insufficient dietary intake of omega-3 essential
fatty acids increases the risk of affective disorders (Noaghiul
and Hibbeln 2003).
Dietary practices taken in relation to schizophrenia and depression
were assessed by Peet (2004). He rationalized that physical illness,
particularly diabetes and coronary heart disease, was occurring
with increased frequency in patients with major mental illness,
such as schizophrenia and depression. Therefore, he performed an
ecological analysis of international variations of food supply in
relation to epidemiological data on the outcome of schizophrenia
and on the prevalence of depression.
A robust relationship was found between the high dietary consumption
of seafood and reduced prevalence of depression, and less strongly
with the intake of starchy roots. The seafood consumption provided
the strongest independent predictor of depression prevalence. The
data indicated that greater consumption of refined sugar was associated
with a worse outcome of schizophrenia and a greater prevalence of
depression. Thus, the study determined that dietary patterns that
influence insulin resistance and result in diseases associated with
metabolic disturbances are reflected by the dietary patterns of
those with the mental illness (Peet 2004).
These results suggest a wide potential for using omega-3 fatty acids
either adjunctively or independently in treatment approaches to
various mental illnesses. It also appears that the increase in mental
disorders reflects the changes in international food consumption
habits. Thus, the importance of a diet containing all essential
antioxidants and fatty acids is essential to consider when planning
treatment for mental disorders.
When considering treatment options for mental illnesses, it is important
to include the influence of diet. For instance, with depression,
tryptophan was found to be an important regulator of serotonin;
SAMe, folic (or folinic) acid; vitamin B12 and key nutrients regulate
the methylation cycle; and the use of zinc or chelated minerals
to regulate symptoms. Omega-3 presented the value of particular
nutritional supplements showing promise in treating many different
mental disorders, such as depression, schizophrenia, bipolar disorder,
and borderline personality disorder, either adjunctively or as a
This article has presented highlights on some recent studies being
conducted in nutrition and mental health. These studies show much
promise for the management of mental illness, and future researchers
can consider this food for thought when studying nutritional supplements
as adjunctive treatment.
Kaur Khamba Grewal, BSc, MPH, ND (Cand.)
7180 Lilford Gate
Mississauga, Ontario L5N 7S7
Baljit earned her honors degree in psychology
at York University. It was here that she completed her thesis project
on the 'Influence of IAPS pictorial stimuli on inductive and
deductive syllogistic reasoning.' She then pursued a career
as a research analyst in the Clinical Neuroscience Department at
the Centre for Addiction and Mental Health, in Toronto. Under the
supervision of Martin Zack, PhD, Baljit tested participants and
analyzed alcohol and its effects on anxiety. She then continued
her studies at Lakehead University, earning a master's degree
in Public Health. Baljit's project at Lakehead was on treating
mental illnesses using complementary and alternative medicine. She
then continued her studies and love of the healing arts in Toronto,
where she is currently a fourth-year student at the Canadian College
of Natuorpathic Medicine. Baljit is also registered as a member
of the Ontario Association of Naturopathic Doctors.
Alpert JE, Mischoulon D, Rubenstein GEF, Bottonari K., Nierenberg
AA, Fava M. Folinic acid (leucovorin) as an adjunctive treatment
for SSRI-refractory depression. Ann Clin
Alpert JE, Papakostas G, Mischoulon D et al. S-Adenosyl-L-Methinine
(SAMe) as an adjunct for resistant major depressive disorder.
J Clin Psychopharmacol. 2004;24(6):661-664
American Psychiatric Association. Depression and How Psychotherapy
and Other Treatments Can Help People Recover [Web page]. 2005. (http://www.apa.org/pubinfo/depression.html).
Accessed Dec. 17, 2008.
Arvindakshan M., Ghate M, Ranjekar PK, Evans DR, Mahadik SP. Supplementation
with a combination of omega-3 fatty acids and antioxidants (vitamins
E and C) improves the outcome of schizophrenia. Schizophr
Coppen A, Bailey J. Enhancement of the antidepressant action of
fluoxetine by folic acid: a randomised, placebo controlled trial.
J Affect Disord. 2000;60:121-130.
Horrobin DF. Food, micronutrients, and psychiatry. Int
Kaplan BJ, Simpson SA, Ferre RC, Gorman CP, McMullen MD, Crawford
SG. Effective mood stabilization with a chelated mineral supplement:
an open-label trial in bipolar disorder. J
Clin Psychol. 2001;62(12):936-944.
Levitan RD, Shen J, Jindal R, Driver HS, Kennedy SH, Shapiro CM.
Preliminary randomized double-blind placebo-controlled trial of
tryptophan combined with fluoxetine to treat major depressive disorder:
antidepressant and hypnotic effects. J
Psychiatry Neurosci. 2000;25(4):337-346.
Noaghiul S, Hibbeln JR. Cross-national comparisons of seafood consumption
and rates of bipolar disorders. Am J Psychiatry.
Marangell LB, Martinez JM, Zboyan HA, Kertz B, Kim HFS, Puryear
LJ. A double-blind placebo-controlled study of the omega-3 acid
decosahaexanoic acid in the treatment of major depression. Am
J Psychiatry. 2003;160(160):996-998.
National Institute of Mental Health. Borderline personality disorder:
raising questions, finding answers [Web page]. 2001. http://www.nimh.nih.gov/publicat/bpd.cfm.
Accessed Dec. 17, 2008.
Nowak G, Siwek M, Dudek D, Zieba A, Pilc A. Effect of zinc supplementation
on antidepressant therapy in unipolar depression: a preliminary
placebo-controlled study. Pol J Pharmacol.
Peet M. Essential fatty acids: theoretical aspects and treatment
implications for schizophrenia and depression. Advances
in Psychiatric Treatment. 2002;8:223-229.
Peet M. International variations in the outcome of schizophrenia
and the prevalence of depression in relation to national dietary
practices: an ecological analysis. Br J
Peet M, Brind J, Ramchand CN, Shah S, Vankar GK. Two double-blind
placebo-controlled studies of eicosapentaenoic acid in the treatment
of schizophrenia. Schizophr Res.
Peet M, Horrobin DF. A dose-ranging study of the effects of ethyl-eicosapentaenoate
in patients with ongoing depression despite apparently adequate
treatment with standard drugs. Arch Gen
Shannon S. Handbook of Complementary and
Alternative Therapies in Mental Health. San Diego, CA: Academic
Somer, E. Food and Mood. New York:
Henry Holt and Company; 1999.
Spearing, M. (2008). Bipolar Disorder [Web page]. National Institute
of Mental Health http://www.nimh.nih.gov/health/publications/bipolar-disorder/nimhbipolar.pdf
Stoll A, Severus WE, Freeman MP et al. Omega-3 fatty acids in bipolar
disorder: a preliminary double-blind, placebo-controlled trial.
Arch Gen Psychiatry. 1999;56:407-412.
Strock, M. (1994). Plain Talk about Depression [Web page]. National
Institute of Mental Health. (http://www.nimh.nih.gov/publicat/depression.cfm#ptdep1).
World Health Organization. The global strategy on diet, physical
activity, and health [Web page]. 2003. http://www.who.int/dietphysicalactivity/media/en/gsfs_general.pdf.
Accessed Dec. 17, 2008.
Zanarini MC, Frankenburg FR. Omega-3 fatty acid treatment of women
with borderline personality disorder: a double-blind, placebo-controlled
pilot study. Am J Psychiatry. 2003;160:167-169.