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From the Townsend Letter
October 2016

Anti-Aging Medicine
An Anti-Aging Approach to Depression
by Ronald Klatz, MD, DO, and Robert Goldman, MD, PhD, DO, FAASP
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Depression is one of the most common mood disorders in the US. Current research proposes that it is caused by a combination of genetic, environmental, biological, and psychological factors. It can have an effect on many aspects of day-to-day life, including sleep, diet, relationships, and work habits. Middle-aged or older adults frequently experience depression in conjunction with other illnesses, such as diabetes, heart disease, cancer, and Parkinson's disease. Additionally, the medications prescribed for these conditions can cause side effects that exacerbate depression. Even for those who are physically fit, it can be daunting to face the challenges of aging, and sometimes this in itself may lead to depression.
In this column, we review lifestyle changes that can assist in warding off and decreasing the risk of depression.
Pitch the Pastries
Consumption of carbohydrates increases blood sugar levels to varying degrees, depending on the type of food ingested. The more highly refined the carbohydrate, the higher its score on the glycemic index (GI) scale. James E. Gangwisch, from Columbia University (New York, US), and colleagues analyzed the dietary glycemic index, glycemic load, types of carbohydrates consumed, and depression for 69.954 postmenopausal women enrolled in the Women's Health Initiative Observational Study between 1994 and 1998. The team found that progressively higher dietary GI scores and consumption of added sugars and refined grains were associated with increased risk of new-onset depression. In contrast, greater consumption of dietary fiber, whole grains, vegetables, and nonjuice fruits were associated with decreased risk. The study authors write: "The results from this study suggest that high-[glycemic index] diets could be a risk factor for depression in postmenopausal women. Randomized trials should be undertaken to examine the question of whether diets rich in low-[glycemic index] foods could serve as treatments and primary preventive measures for depression in postmenopausal women."

Gangwisch JE, Hale L, Garcia L, et al. High glycemic index diet as a risk factor for depression: analyses from the Women's Health Initiative. Am J Clin Nutr. 2015 Aug;102(2):454–463.
More Fruit Lessens Depression Risk
A number of previous studies report a link between dietary factors and depression. Gita Mishra and colleagues from University of Queensland (Australia) studied data collected on 6271 women, mean age 55 years, enrolled in the Australian Longitudinal Study in Women's Health. The data revealed that women who ate at least 2 servings of fruit a day were less likely to suffer from depression than women who ate fewer servings, after adjusting for confounding factors. As well, the team observed that 2 or more servings of fruit daily exerted a protective effect against future development of depression. The study authors report: "Increasing fruit consumption may be one important factor for reducing both the prevalence and incidence of depressive symptoms in mid-age women."

Mihrshahi S, Dobson AJ, Mishra GD. Fruit and vegetable consumption and prevalence and incidence of depressive symptoms in mid-age women: results from the Australian longitudinal study on women's health. Eur J Clin Nutr. 2014 Oct 29.
'B'eat Depression
Essential for mental and emotional well-being, B-complex vitamins must be replenished to the body on a daily basis. Osvaldo Almeida and colleagues from the University of Western Australia (Australia) enrolled 153 adult residents of Perth, aged 50 years and older, who were experiencing a major depressive episode, to receive an antidepressant medication together with 0.5 mg of vitamin B12, 2 mg of folic acid, and 25 mg of vitamin B6 for 52 weeks. Symptom changes were assessed via standardized rating scales. Remission of symptoms was achieved by 78.1% and 79.4% of participants treated with placebo and vitamins by week 12, by 76.5 and 85.3% at week 26, and 75.8 and 85.5% at week 52. Further, the risk of relapse was significantly reduced among participants who took the B vitamins. The study authors conclude: "B vitamins did not increase the 12-week efficacy of antidepressant treatment, but enhanced and sustained antidepressant response over 1 year."

Almeida OP, Ford AH, Hirani V, Singh V, vanBockxmeer FM, McCaul K, Flicker L. B vitamins to enhance treatment response to antidepressants in middle-aged and older adults: results from the B-VITAGE randomised, double-blind, placebo-controlled trial. Br J Psychiatry. 2014 Sep 25. pii:bjp.bp.114.145177.
Root for Depression
A common yet debilitating psychiatric condition, depression is a disorder for which many patients do not respond adequately to drug therapy. Jun J. Mao and colleagues from the University of Pennsylvania (Pennsylvania, US) completed a randomized, double-blind, placebo-controlled, comparison trial of oral Rhodiola rosea (roseroot) extract versus conventional antidepressant for mild to moderate major depressive disorder. All of the study's 57 adult participants were diagnosed with major depressive disorder as defined by the DSM-IV. Subjects received 12 weeks of standardized R. rosea extract, a prescription drug (sertraline), or placebo. The researchers monitored changes in depression symptoms over time via standardized assessment scales. While the subjects taking the prescription drug were somewhat more likely to report improvement in their symptoms by week 12 of treatment (as compared with those taking R. rosea), the participants who took R. rosea had 1.4 times the odds of improvement without experiencing side effects (such as nausea and sexual dysfunction, experienced by the subjects taking the medication). Observing that: "Although [Rhodiola] rosea produced less antidepressant effect versus [medication], it also resulted in significantly fewer adverse events and was better tolerated," the study authors submit: "[Rhodiola] rosea … may possess a more favorable risk to benefit ratio for individuals with mild to moderate depression."

Mao JJ, Xie SX, Zee J, et al. Rhodiola rosea versus sertraline for major depressive disorder: A randomized placebo-controlled trial. Phytomedicine. March 15, 2015;22 (3):394–399.
Nature Walks Nurture Well-Being
As an inexpensive, accessible form of exercise, walking – when done in as a group activity and in a nature setting – may be an underrecognized approach to revitalize mental health. Melissa R. Marselle and colleagues from Edge Hill University (UK) assessed 1991 participants in the Walking for Health program in England, which helps facilitate nearly 3000 weekly walks and draws more than 70,000 regular walkers a year. Group nature walks were shown to significantly lower depression, lessen perceived stress, and enhance mental health and well-being. In particular, people who had recently experienced stressful life events such as a serious illness, death of a loved one, marital separation, or unemployment especially saw a mood boost after outdoor group walks. The study authors submit: "Nature-based group walks appear to mitigate the effects of stressful life events on perceived stress and negative affect while synergizing with physical activity to improve positive affect and mental well-being."

Marselle MR, Irvine KN, Warber SL. Examining group walks in nature and multiple aspects of well-being: a large-scale study. Ecopsychology. September 2014:134–147.
Computer Games Combat Depression
Brain-boosting computer games may be as effective as drugs in treating severe depression in older men and women with treatment-resistant depression. Sarah Morimoto and colleagues from Weill Cornell Medical College (New York) enrolled 11 men and women, aged 60 to 89 years, in a 4-week long program of playing computer games that had been developed to promote memory and decision-making skills. As compared with antidepressant medication given to a comparably aged group, the computer exercises were just as effective at reducing symptoms of depression – but did so in 4 weeks instead of 12; and 72% of the group who played computer games experienced full remission of depression. The study authors write: "We conclude that [neuroplasticity-based computerized cognitive remediation-geriatric depression treatment] may be equally effective as [prescription medication] in treating [geriatric depression]. In addition, [neuroplasticity-based computerized cognitive remediation-geriatric depression treatment] participants showed greater improvement in executive functions than historical controls treated with [prescription medication]."

Morimoto SS, Wexler BE, Liu J, Hu W, Seirup J, Alexopoulos GS. Neuroplasticity-based computerized cognitive remediation for treatment-resistant geriatric depression. Nat Commun. 2014 Aug 5;5:4579.
Low Vitamin D Correlates to Risk of Depression
Previously, studies have reported a link between vitamin D status and symptoms of depression. Jane Maddock and colleagues from University College London (UK) analyzed data collected on 7401 subjects involved in the 1958 British birth cohort. Questionnaires were employed to ascertain behaviors at 45 years of age, and measured mental health issues including depression, anxiety, panic, and phobia utilizing standardized assessment scales. The researchers found that, at age 45 years, higher levels of vitamin D were associated with lower risks of depression and panic. Specifically, the data suggested that people with vitamin D levels of at least 75 nmol/L were at 43% lower risk of depression, as compared with people who had vitamin D levels lower than 25 nmol/L. The study authors conclude: "This study provides support for an association of low [circulating vitamin D] concentrations with current and subsequent risk of depression in mid-adulthood."

Maddock J, Berry DJ, Geoffroy MC, Power C, Hypponen E. Vitamin D and common mental disorders in mid-life: cross-sectional and prospective findings. Clin Nutr. 2013 Jan 21.
To stay updated on the latest breakthroughs in natural approaches that may help you to reduce your risks of depression, visit the World Health Network (, the official educational website of the A4M and your one-stop resource for authoritative anti-aging information. Be sure to sign up for the free Longevity Magazine e-journal, your weekly health newsletter featuring wellness, prevention, and biotech advancements in longevity.

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