Linking What We Eat to Our Mood: A Review of Diet, Dietary Antioxidants, and Depression

1. Introduction

The World Health Report published by the World Health Organization (WHO) in 2017 identified that the global incidence of depression was over 18% between 2005 and 2015 [1]. Depression has now become the fourth major disease in the world [2], and is predicted to become the world’s second major contributor to the global burden of disease, only less than ischemic heart disease, by 2020 [3]. Patients of depression are suffering from decreased productivity, poor psychosocial status, and decreased quality of life and well-being [4].

The Global Burden of Disease (GBD) 2017 study indicated that mental and behavioral disorders accounted for 22.6% of all years lived with disability (YLDs) [1]. The major category was depressive disorders, with major depressive disorder (MDD) causing 63 million YLDs, and dysthymia causing 11 million YLDs; together accounting for 9.6% of all YLDs [1]. In modern society where fierce competition often occurs, depression has become a social problem that cannot be ignored. Research conducted in young subjects indicated that an increasing prevalence of adolescent or teenage depression may deteriorate this situation even further in the near future. According to a recent study, the cumulative incidence of pubertal depression has increased from 5% to 20% [5,6]. Related studies have shown that the eating habits formed at this stage can also affect teenagers’ emotions and affect their mental health in further years [7].

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In the Practice Guideline for the Patients with MDD released by American Psychiatric Association (APA), pharmacotherapy, psychotherapy, or combined therapies are recommended. However, medication and/or psychotherapy have limitations. Besides the financial burden, side effects of antidepressant medications also cause severe problems. Common side effects of antidepressant medicines include nausea, increased appetite and weight gain, sexual problems such as erectile dysfunction and decreased orgasm, fatigue and drowsiness, and insomnia, to name a few. Moreover, emerging data also indicate that antidepressants may promote suicide [8]. As such, people are now thinking of using alternative methods for MDD prevention and treatment. One of the most attractive ideas is the consumption of a suitable diet as an alternative. Furthermore, a well-designed diet may help to stop obsessing ones’ bad days, therefore lowering the risks of falling in illness or delaying disease progress.

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Balanced nutrition plays an important role in our model of thinking and our behavior, as the intake of foods affects our cognition, memory capacity, and emotions. Besides a balanced diet, isolated nutrients are another element when adopting nutritional strategies to fight MDD. Neurotransmitters are the major subjects, where activated substances in different areas of the brain actively participate in the creation of nerve impulses, thereby regulating our mental abilities and emotions. The interactions between different foods and these neurotransmitters cause different emotions [9]. Researches showed that the foods we eat might affect the chemical composition of our brain, thus changing our mood. For example, ginseng extract G115 and some probiotics, bifidobacterium adolescentis NK98 and Lactobacillus reuteri NK33, have been shown to attenuate depressional behavior by increasing brain-derived neurotrophic factor (BDNF) contents [10,11]. Vitamin D and its metabolite calcitriol could protect our brain from depletion of dopamine and serotonin, thus contributing to brain health [12,13]. MDD is also accompanied with oxidative stress, therefore antioxidants might contribute to protecting us from MDD [14]. Research into the possible role of dietary factors in depressive symptoms is a common problem in public health [4]. In addition, a project named Multi-country cOllaborative project on the role of Diet, Food-related behavior, and Obesity in the prevention of Depression (MooDFOOD), involving 13 organizations in eight European countries, uses a unique integrative approach to explore the prevention of depression through nutritional strategies. This approach combines expertise in nutrition, consumer behavior, psychiatry, and preventive health psychology. The project has been granted nearly nine million Euros to investigate food intake, nutritional status/intake, food-related behavior, and causality between obesity and depression over a five-year period. The relevant results have been used to develop multinational randomized controlled trials. MooDFOOD will be the first multinational project to implement a feasible and effective nutrition strategy to prevent depression, which will help improve the diets of all European Union (EU) citizens in a sustainable manner, and prevent depression [15]. It can be seen that the world has been appreciating the importance of the relationships between depression and diets or nutrition in recent years.

In brief, MDD poses heavy health and economic burdens, thus it must be treated as a global public health priority. Although there is significant research covering topics in eating and moods, the present narrative review will take a glimpse into the relationships between diet patterns, certain food and nutrients including dietary antioxidants, and depression so as to provide a potential preventive and therapeutic approach for the adjuvant treatment of depression.

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