Can diet help with mental health?

Hippocrates, father of modern medicine, said more than 2,000 years ago: “Let your food be your medicine, and your medicine be your food.” [1]Today, we're discovering more and more evidence that we should take his advice seriously, as the quality of our food can significantly influence our brain health. 

Eating a lot of processed foods, like what's often called the "western diet," is strongly connected to a higher risk of getting depression, problems with thinking, and ADHD.[2][3] Not having enough healthy food to eat, called food insecurity, can also make you more likely to have mood and anxiety issues.[4] On the bright side, eating whole foods, following traditional diets, or sticking to a Mediterranean diet can help protect you from getting depression and other mental health problems.[5][6][7]

Can diet help with mental health?

There is growing evidence shows that the food we choose is strongly connected to our mental health. However in the field of healthcare, there isn't widespread agreement among professionals that diet can be used to treat or help with mental health issues. Doctors might not feel confident talking about diets because they haven't been trained much in it, they're short on time, and they don't get paid well for it. They also get confused because there are so many different diet suggestions and groups in our society.

Nutritional psychiatry, also known as psychonutrition, is a new area of research that explores how diet influences mental health.

The exploration of diet's impact on mental health dates back to the late 1990s, when a cross-national study revealed a link between higher fish consumption in a country and lower annual rates of major depressive disorder (8).

In 2005, M. Ephimia (Ephi) Morphew-Lu introduced the first nutritional psychology course at John F. Kennedy University in Pleasant Hill, California.

Furthermore, in 2015, members of the International Society for Nutritional Psychiatry Research published a significant article titled "Nutritional Medicine as Mainstream in Psychiatry," shedding light on emerging evidence in this field (9).

Since then, researchers have conducted numerous studies revealing that the same foods beneficial for physical health also contribute to positive mental well-being.

In 2019, a groundbreaking meta-analysis [10] was conducted by researchers from various universities in the UK and Australia, marking the first comprehensive proof of diet's efficacy in mental health intervention. This analysis meticulously curated 16 high-quality studies utilizing diet as an intervention method. Among these studies, a randomized controlled clinical trial involving 45,826 participants demonstrated a significant improvement in depressive symptoms through dietary intervention. Additionally, the sole clinical study specifically addressing severe anxiety disorder revealed notable improvements in anxiety symptoms among the participants.

In a study led by psychologist Natalie Parletta, PhD, [11]and her team in South Australia, adults with self-reported depression participated in a randomized controlled trial. The study involved 95 participants who either received 3 months of biweekly cooking classes focused on the Mediterranean diet and 6 months of fish-oil supplements or 3 months of biweekly engaging social groups and an additional 3 months of fish-oil supplements. After 6 months, the moods of all participants improved, but those in the diet group showed greater improvement.

Yes, diet can have a significant impact on mental health. Research has shown that what you eat can influence your mood, cognitive function, and overall mental well-being.

How does diet affect mental health?

The relationship between diet and health is highly intricate, multifaceted, and interactive, extending beyond a single biological pathway. Diet has the potential to impact mental health through numerous diverse biological routes. Emotions were once thought to be a product of the heart, but now it has long been established that they are a problem of the brain. A recent review article, featured in the Molecular Psychiatry journal [12], which summarized 9 possible biological pathways through which diet affects mental health.

1, Inflammation

Around 25% of patients with neuropsychiatric conditions,including mood disorders and schizophrenia, exhibit increased levels of inflammation. [13][14]Stress is a common trigger for inflammation, and various stressors like psychological stress, childhood adversities, as well as physical inactivity and an unhealthy diet, can lead to increased inflammation in the body, potentially contributing to depressive symptoms.[14-a]

A healthy eating pattern also has many anti-inflammatory nutrients. For example, phytonutrients such as polyphenols have strong anti-inflammatory properties and may be beneficial for a variety of neuropsychiatric diseases; the omega-3 fatty acids EPA and DHA also have anti-inflammatory properties and can improve clinical outcomes in depression and delay cytokines Induced depressive episode.

2, Oxidative stress

Oxidative stress (an imbalance of oxidative and antioxidant processes) causes damage to cellular lipids, proteins, and DNA. Sustained oxidative stress is considered a potential mechanistic pathway in depression and other mental health disorders .[15]A meta-analysis of 115 studies reported that patients with depression had elevated levels of oxidative stress markers and reduced levels of antioxidant markers.[16]Apart from causing direct cellular damage, the increased production of reactive oxygen and nitrogen compounds can result in problems with mitochondria, inflammation, and changes in tryptophan metabolism. These factors are all associated with mental health conditions.[15]

Decreased or increased intake of dietary compounds with antioxidant properties in the diet can exacerbate or ameliorate oxidative stress. Animal studies show that a high-fat Western diet increases levels of oxidative stress markers, such as protein oxidation and lipid peroxidation in the brain and periphery. [17] Improving diet quality and enhancing the body’s antioxidant defense may be a feasible intervention.

Changing your diet to include more or fewer foods with antioxidant properties can worsen or alleviate oxidative stress. Research in animals has demonstrated that a high-fat Western-style diet can raise the levels of markers indicating oxidative stress in both the brain and the body, like protein oxidation and lipid peroxidation.[17] Therefore, enhancing the quality of your diet and boosting the body's ability to counteract oxidative stress could be a practical intervention.

3, The gut microbiota

A growing body of research indicates that dietary modifications can result in alterations in gut microbiota, which, in turn, might induce behavioral changes reminiscent of symptoms seen in common mental disorders like anxiety and depression. [18][19] Studies involving animals have revealed that transplanting the gut flora from animals following a high-fat diet into the intestines of those on a different diet can also bring about changes in behavior, impacting factors such as exploration and cognition. [20] Additionally, one study demonstrated that after a year-long intervention with a Mediterranean diet, elderly individuals exhibited an increase in bacterial diversity. This dietary change was accompanied by improvements in cognitive function and reductions in the inflammatory markers C-reactive protein and interleukin-17. [21]

4, The hypothalamic–pituitary–adrenal (HPA) axis

The HPA axis, composed of the hypothalamus, pituitary gland, and adrenal glands, regulates the production of glucocorticoids and is involved in the pathophysiology of neuropsychiatric diseases. More than 60% of patients with depression exhibit cortisol hypersecretion or other HPA axis dysfunction.[22]

Clinical intervention trials employing nutrients like vitamin C have documented a decrease in cortisol reactivity during acute physiological stress in healthy adults;[23] both healthy adults and individuals with depression displayed improvements in cortisol levels after omega-3 fatty acid interventions;[24][25] and similar reductions in cortisol levels were observed in healthy individuals who underwent interventions with polyphenol-rich foods.[26]

[27] For instance, in a recent four-week trial involving healthy subjects, those who consumed dark chocolate rich in flavonoids exhibited lower total daily cortisol levels, with significant reductions in morning cortisol levels. Conversely, a brief three-day study found a slight increase in cortisol secretion associated with a high-glycemic index diet.[26]

Due to the role of the gut-brain axis in mental health, probiotics have also been explored as potential interventions targeting the HPA axis. [28]

5,Adult hippocampal neurogenesis and brain-derived neurotrophic factor (BDNF)

Increased neurogenesis in the hippocampus is associated with improved learning and memory abilities, while decreased neurogenesis is often associated with certain behaviors associated with depression. [29][30] BDNF is a neurotrophin that is highly expressed in the hippocampus Factors involved in key cellular functions such as synaptic plasticity and cell metabolism. Serum BDNF levels are reduced in patients with major depression. [31]

Diet has the capacity to influence BDNF and adult hippocampal neurogenesis. [32] Research with animals has demonstrated that a high-fat, high-sugar Western-style diet can impair neurogenesis, diminish BDNF levels in the hippocampus, and have detrimental effects on cognitive function.[33] Conversely, dietary components like omega-3 fatty acids, probiotics, and vitamins have positive effects.[34][35] Various polyphenolic compounds, such as resveratrol, blueberries, green tea, gingerin, and cocoa, can counteract adverse changes seen in conditions like psychopathology, aging, and disease, and help maintain the integrity of adult hippocampal neurogenesis. [36]

6,Neurotransmitter metabolism

Tryptophan, an essential amino acid that must be supplied in the diet, is an important building block for a number of key neuroactive molecules.[37] In psychiatry, the primary emphasis regarding tryptophan has been on its role in converting into serotonin, which is the main therapeutic target for most antidepressants and anti-anxiety medications.[38] There is an obvious tryptophan metabolism disorder in patients with depression, which can lead to depression.

Understanding tryptophan availability and metabolism is important when addressing the prevention and treatment of mental illness through dietary intervention. Direct tryptophan supplementation has been trialled in patients with depression as a way to improve serotonin signaling.[37]

Nutrients such as curcumin[38-a] and green tea[39], as well as dietary regimens such as the ketogenic diet[40] and fasting[41], can also modulate the activity of the Tryptophan–kynurenine pathway. Dietary regimens (such as caloric restriction) and dietary nutrients (including probiotics, resveratrol, and black tea) may also modulate kynurenine metabolism. For example, in a trial of 60 patients with depression, probiotic intervention significantly reduced kynurenine levels.[42]

7, Mitochondrial dysfunction 

Depression, as well as other mental disorders such as bipolar disorder and schizophrenia, is connected to problems in how our cells generate energy within tiny structures known as mitochondria. [43]Mitochondria - tiny factories in each of our cells that convert the food we eat and the oxygen we breathe into energy.

These energy-related problems can affect the function of both the brain and the rest of the body, result in symptoms of depression, like fatigue and cognitive difficulties . [44]

When the energy production process in mitochondria is disturbed, it can impact the growth and repair of nerve cells in the brain, which are fundamental components of the biology underlying depression.[43]

Substantial preclinical research indicates that an unhealthy diet might play a role in causing problems with mitochondria.[45]Eating a diet rich in fats is linked to irregular mitochondrial production and is also connected to higher levels of free radicals, inflammation, and insulin resistance.[46][47][48]A hyper-caloric high-carbohydrate diet drives similar path-ways [49], as well as a high salt diet.[50]

Calorie restriction shown to have beneficial effects on mitochondrial function.[45]There is also some evidence that quercetin, N-acetylcysteine, and resveratrol, among others, can increase mitochondrial biogenesis.[51][52]

8, Epigenetic Influences, Early-Life Experiences, and the Impact of Maternal and Paternal Dietary Factors

Nutrition is the most studied environmental factor affecting epigenetics. [53][54]Research suggests that increased risk of adult disease due to poor nutrition during early development is associated with epigenetic dysregulation. Certain early life nutritional exposures, such as breastfeeding and maternal obesity, can also influence epigenetic states that may modulate psychopathology in children and adolescents. [55]For example, a nutrition study in Barbados found that adults who had been hospitalized in infancy due to inadequate protein and energy intake exhibited DNA methylation changes in risk genes associated with neuropsychiatric disorders.[56]

Nutrients found in healthy diets, like vitamins such as folate, biotin, B6, and B12, as well as polyphenols like curcumin, resveratrol, and genistein, along with omega-3 fatty acids, have been proven to affect our epigenetic status through various mechanisms. [57][58]

9, Obesity and mood disorders

Meta-analysis data show that obese men and women both have a 55% increased risk of depression, and depression. People with obesity are 58% more likely to develop obesity.[59]Calorie restriction and weight loss diets may be beneficial for overweight individuals a reliable measure of body inflammatory status [60][61] and depressive symptoms. [62]

Summary:

Substantial evidence supports the use of dietary interventions as adjunctive treatments for depression. Diet may affect mental health through a variety of pathways, including inflammation, oxidative stress, gut microbiota, HPA axis, neurogenesis and BDNF, tryptophane-kynuridine metabolism, mitochondrial dysfunction, and epigenetic regulation.

The occurrence of diseases often involves multiple biological pathways, and the development of some drugs is often aimed at a specific pathway, and sometimes relief can be seen quickly, but other pathways are often ignored, so it is difficult to fundamentally solve the problem, resulting in long-term dependence on drugs, and the toxic side effects of various drugs.

The interaction between diet and health is very complex, not limited to any one biological pathway, often multiple pathways work together, diet will not be as quick as drugs to see results, but in the long run, it may be more fundamental to solve the problem.

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[59]Luppino FS, de Wit LM, Bouvy PF, Stijnen T, Cuijpers P, Penninx BW, et al. Overweight, obesity, and depression: a systematic review and meta-analysis of longitudinal studies. Arch Gen Psychiatry. 2010;67:220–9. https://doi.org/10.1001/archgenpsychiatry.2010.2

[60]Fontana L, Meyer TE, Klein S, Holloszy JO. Long-term calorie restriction is highly effective in reducing the risk for atherosclerosis in humans. Proc Natl Acad Sci USA. 2004;101:6659–63.  https://doi.org/10.1073/pnas.0308291101

[61]Rizza W, Veronese N, Fontana L. What are the roles of calorie restriction and diet quality in promoting healthy longevity? Ageing Res Rev. 2014;13:38–45.https://doi.org/10.1016/j.arr.2013.11.002  

[62]Jebeile H, Gow ML, Baur LA, Garnett SP, Paxton SJ, Lister NB. Association of pediatric obesity treatment, including a dietary component, with change in depression and anxiety: a systematic review and meta-analysis. JAMA Pediatr. 2019;173:e192841 https://doi.org/10.1001/jamapediatrics.2019.2841

Can diet and exercise help with your depression and anxiety?

 

Diet and exercise have shown significant benefits in relieving depression and anxiety. My personal recovery experience is proof of this. After medication and psychotherapy failed to help, I turned to a combination of a scientifically tailored diet, regular exercise, and nutritional supplements, and I fully recovered within 8 months. While medication and psychotherapy remain the primary treatments for anxiety disorders, research indicates that nearly half of patients do not respond to these methods. This has led many to seek alternative therapies. Numerous studies have demonstrated that diet and exercise, as key components of alternative treatments, are highly effective in managing emotional disorders.

Firstly, a healthy diet has a highly beneficial impact on depression and anxiety.

Anti-inflammatory Foods:

Research suggests a significant link between chronic inflammation and depression. An anti-inflammatory diet, such as the Mediterranean diet rich in vegetables, fruits, nuts, and healthy fats, can improve emotional well-being by reducing systemic inflammation. A 2019 systematic review conducted by Katie Tolkien and colleagues highlighted that anti-inflammatory foods help alleviate depressive symptoms. The study found a correlation between pro-inflammatory diets and an increased risk of depression. Adopting an anti-inflammatory diet is an effective intervention or preventive measure for reducing the risk and symptoms of depression.


A meta-analysis published in Translational Psychiatry found that Omega-3 fatty acids, particularly EPA (a major component of fish oil), have a significant effect on alleviating depressive symptoms. The study suggests that Omega-3 can reduce brain inflammation and regulate neurotransmitter function, thus helping to relieve depression and anxiety.
Deficiencies in nutrients such as vitamin D, B vitamins, magnesium, and zinc are closely related to depressive symptoms. Vitamin D is not only beneficial for the immune system but also affects areas of the brain responsible for mood regulation. Studies have shown that supplementing with vitamin D can reduce depressive symptoms. Magnesium plays a key role in neurotransmission, and low magnesium levels are linked to mood disorders. A systematic review conducted by Anglin in 2013 found that vitamin D deficiency is strongly associated with depressive symptoms, and supplementing with vitamin D helps improve mood. Research by Tarleton and Littenberg in 2018 indicated that magnesium intake significantly improves symptoms of depression and anxiety, particularly in individuals with magnesium deficiencies, where supplementation effectively stabilizes mood.

Association between physical exercise and mental health in 1·2 million individuals in the USA between 2011 and 2015: a cross-sectional study Chekroud, Sammi R et al. The Lancet Psychiatry, Volume 5, Issue 9, 739 - 746

Katie Tolkien, Steven Bradburn, Chris Murgatroyd, An anti-inflammatory diet as a potential intervention for depressive disorders: A systematic review and meta-analysis, Clinical Nutrition, Volume 38, Issue 5, 2019, Pages 2045-2052, ISSN 0261-5614, https://doi.org/10.1016/j.clnu.2018.11.007.

Gut-Brain Axis Research:

The gut microbiota is closely related to brain function and emotional regulation. By improving the balance of gut microbiota, mental health can be enhanced. Research on the gut-brain axis and mental health is abundant, and a 2019 review published in Annals of Medicine pointed out that the gut microbiota plays a key role in regulating the production of neurotransmitters such as serotonin. By improving diet and supplementing with probiotics, it is possible to reduce gut-related inflammatory responses and improve mood.

Halverson, T., & Alagiakrishnan, K. (2020). Gut microbes in neurocognitive and mental health disorders. Annals of Medicine, 52(8), 423–443. https://doi.org/10.1080/07853890.2020.1808239

Role of Omega-3 Fatty Acids:

A meta-analysis published in Translational Psychiatry  found that Omega-3 fatty acids, particularly EPA (a major component of fish oil), have a significant effect on alleviating depressive symptoms. The study suggests that Omega-3 can reduce brain inflammation and regulate neurotransmitter function, thus helping to relieve depression and anxiety. 

Liao, Y., Xie, B., Zhang, H. et al. Efficacy of omega-3 PUFAs in depression: A meta-analysis. Transl Psychiatry 9, 190 (2019). https://doi.org/10.1038/s41398-019-0515-5

Vitamins and Minerals:

Deficiencies in nutrients such as vitamin D, B vitamins, magnesium, and zinc are closely related to depressive symptoms. Vitamin D is not only beneficial for the immune system but also affects areas of the brain responsible for mood regulation. Studies have shown that supplementing with vitamin D can reduce depressive symptoms. Magnesium plays a key role in neurotransmission, and low magnesium levels are linked to mood disorders. A systematic review conducted by Anglin in 2013 found that vitamin D deficiency is strongly associated with depressive symptoms, and supplementing with vitamin D helps improve mood. Research by Tarleton and Littenberg in 2018 indicated that magnesium intake significantly improves symptoms of depression and anxiety, particularly in individuals with magnesium deficiencies, where supplementation effectively stabilizes mood. 

Anglin, R. E. S., Samaan, Z., Walter, S. D., & McDonald, S. D. (2013). Vitamin D deficiency and depression in adults: Systematic review and meta-analysis. The British Journal of Psychiatry, 202(2), 100-107. doi:10.1192/bjp.bp.111.106666

Tarleton, E. K., & Littenberg, B. (2015). Magnesium intake and depression in adults. Journal of the American Board of Family Medicine, 28(2), 249-256. doi:10.3122/jabfm.2015.02.140176

Exercise also has significant and undeniable effects on depression and anxiety.

Exercise and Depression

A large-scale study published in The Lancet Psychiatry found that regular exercise, especially aerobic exercise, significantly reduces the incidence of depression. The research analyzed data from over 1.2 million people and concluded that even light physical activity can substantially improve mental health.

Promoting Neuronal Growth (Aerobic Exercise and BDNF):

Aerobic exercise can stimulate the hippocampus, a brain region closely associated with memory and emotional regulation, and enhance the secretion of brain-derived neurotrophic factor (BDNF). This, in turn, helps repair damaged neurons and promote the formation of new neural connections. A 2015 study by Kristin L. Szuhany et al. found that regular exercise increases BDNF levels, particularly in the hippocampus, contributing to better mood regulation and neuroplasticity. The study demonstrated that the increase in BDNF is directly associated with improvements in symptoms of depression and anxiety. This supports the idea that exercise can serve as a natural and effective means of enhancing mental health by promoting neural growth.

Kristin L. Szuhany, Matteo Bugatti,and Michael W. Otto (2015). A meta-analytic review of the effects of exercise on brain-derived neurotrophic factor. Journal of Psychiatric Research, 60, 56-64.

.Stress Relief:

Research by Hillman et al. (2008) demonstrated that consistent physical activity results in lower cortisol levels and increased resilience to stress. Participants who engaged in regular aerobic exercise experienced a reduction in stress-induced anxiety and depressive symptoms, further underscoring the role of exercise in managing mental health.

Hillman, C. H., Erickson, K. I., & Kramer, A. F. (2008). Be smart, exercise your heart: Exercise effects on brain and cognition. Nature Reviews Neuroscience, 9(1), 58-65. doi:10.1038/nrn2298

The research highlighted above is just the tip of the iceberg. Compared to traditional drug treatments for anxiety, much of the research on diet and exercise remains in the laboratory and meta-analysis stages, with relatively few clinical trials. However, current findings confirm that exercise and diet have clear benefits for alleviating anxiety. If you are struggling with anxiety, it’s important to take action—adjust your diet and start exercising. For a systematic approach to using nutritional supplementation, dietary adjustments, improved sleep, and increased physical activity as natural therapies, click the link below for more information.

Past trauma may be one of the reasons you have anxiety now – do you have Post-Traumatic Stress Disorder (PTSD)?

In the 1990s, political circumstances in Romania led to a large number of orphans. Due to insufficient staff in orphanages, most orphans were malnourished, lacked proper care, and lived in extremely poor conditions. Scientists studied the brains of these orphans as adults, and the results were shocking.

The study[1] showed that the brain volume of children adopted from Romania was 8.6% smaller than that of British children . The research team also found that the degree of brain volume reduction was related to the length of time spent in Romanian orphanages: for every additional month, the total brain volume would decrease by 3 cubic centimeters. "The poorer they are, the smaller their brains are," the researchers noted. This study shows that childhood trauma can have a profound impact on the structure and function of the brain. Brain imaging studies show that children who suffer extreme neglect have smaller brains. This picture shows the brains of two 3-year-old children. The one on the right is the brain of a neglected child, and it is obvious that his brain is smaller than the brain of a normal child on the left.

This picture comes from a paper[2] by Bruce D. Perry, director of Texas Child Psychiatry. The paper points out that children who are pampered and cared for by their mothers have more fully developed brains, while children who suffer abuse and neglect have shrunken and smaller brains. Perry explained that children and adults who experience emotional neglect find it particularly difficult to establish healthy relationships, and are more likely to have memory and psychological problems in the future.

Additionally, research[3,4] has found that veterans with PTSD have an 8% reduction in the volume of one side of the hippocampus, compared to the control group. But their volume of the amygdala significantly increases.

These studies indicate that various traumatic events can alter brain development, structure, and function. Emotional neglect, physical and mental abuse, domestic violence, car accidents, and combat experiences are deeply imprinted in our brains and bodies, causing changes in the way we think, react, and behave today. Therefore, some people may not have obvious anxiety factors in their current lives, but because of past traumatic experiences, their brains have been altered so that they now have a variety of anxiety symptoms. These symptoms include inexplicable anxiety and various physical reactions.

If you have experienced trauma, could you be suffering from Post-Traumatic Stress Disorder (PTSD)?

The impact of trauma on the brain is mainly concentrated in the amygdala, hippocampus, and prefrontal cortex. Changes in these areas can also lead to anxiety disorders. Let's look at some of the symptoms of PTSD:

•Overactivity of the amygdala: causes hypervigilance and anxiety, manifested as always being very nervous, easily frightened, often fearful and anxious.

•Atrophy of the hippocampus: causes learning and cognitive impairment, manifested as learning difficulties, poor memory and inability to complete simple tasks.

•Dysfunction of the prefrontal cortex: affects decision-making and impulse control, manifested as impulsiveness, having difficulty calming down and controlling oneself.

These are just some of the symptoms of PTSD. If you experience the above, it may be a sign that you have PTSD.

So, what should we do?

Currently, mainstream medicine generally recommends psychological therapy and medication to address PTSD. Among the various existing psychotherapies, Cognitive Behavioral Therapy (CBT) is considered one of the most effective methods for alleviating PTSD symptoms. Research [5] shows that CBT is effective for 60% of veterans with PTSD. However, another study[6] found that up to 50% of PTSD patients do not respond to CBT.

Antidepressants are currently the first choice for treating PTSD, with the most commonly used being selective serotonin reuptake inhibitors (SSRIs). However, although the overall response rate of SSRIs for PTSD patients is about 60%, but only 20% to 30% of patients can achieve complete remission.[7]

In terms of non-pharmacological and non-psychological treatments. Some severe PTSD patients, as well as a significant portion of others, do not respond to psychological therapy and SSRI medication. However, this does not mean they have no chance of recovery. In current research, there are many non-drug treatments that have been shown to be effective. 

As mentioned earlier, traumatic events can alter brain structure and function, leading to PTSD and anxiety. herefore, we need to treat the affected brain cells. Among the methods to promote brain recovery, nutritional supplements and exercise are the most powerful. Because both can repair the brain and promote brain nerve regeneration.

An article[8] published in BioPsychoSocial Medicine in 2011 pointed out that supplementing with omega-3 fatty acids can promote neurogenesis in the hippocampus, thereby clearing fear memories in the hippocampus. The study mentioned that 15 patients who were hospitalized due to accidents were recruited in a hospital in Japan. After taking omega-3 fatty acid capsules every day for 12 consecutive weeks, only one patient developed PTSD and depression symptoms, awhile the others recovered completely . This experiment shows that supplementing with omega-3 after accidental injury may effectively reduce PTSD symptoms. 

Resveratrol is a polyphenol compound widely found in grapes, peanuts and pomegranates. It has antioxidant and anti-inflammatory properties, which can improve depression and anxiety. In some animal experiments, [9] scientists found that resveratrol can increase the level of BDNF (brain-derived neurotrophic factor) in the hippocampus, thereby promoting the recovery of the hippocampus. Another study [10] showed that resveratrol can normalize biosynthesis in the brain and prevent dysfunction of the hypothalamic-pituitary-adrenal axis, thus potentially offering therapeutic effects against PTSD. 

Vitamin C has antioxidant effects. Reports [11]suggest that some symptoms of PTSD, such as memory loss and anxiety, may be related to increased oxidative stress in the hippocampus, eventually leading to neuronal degeneration. One study[12] demonstrated that vitamin C supplementation can successfully reduce oxidative stress in the hippocampus and alleviate memory impairment. 

There is currently a wealth of research proving that exercise can improve mental health. A 2017 study[13] showed that comprehensive exercise in groups can reduce post-traumatic stress disorder symptoms and improve psychological quality of life. A 2014 study[14] showed that aerobic exercise not only fights anxiety but also reduces PTSD symptoms. After two weeks of cycling training among 33 people with PTSD, 89% of the majority of participants experienced a clinically significant reduction in PTSD severity. 

The above studies only cover a portion of the treatment for PTSD. Some non-drug, non-psychological natural therapies are not only effective, but can also fundamentally treat anxiety disorders. Of course, relying on the few supplements mentioned above is far from enough. To achieve a healing effect, a systematic approach, the right dosage and combination must be adopted. 

Four years ago, I suffered from severe anxiety and depression, having experienced many traumas in the past. I believe these traumas contributed significantly to my later development of anxiety. However, those experiences are now behind me, as I have fully recovered. As someone who has overcome these challenges, I feel a responsibility to share my journey with the public, offering hope that others can also find relief from the pain of PTSD and anxiety. My recovery did not involve medication or psychotherapy because I did not respond to those treatments. As a former acupuncturist, I researched numerous medical articles and, through trial and error, developed some effective and safe methods based on my own experience.

Ref: [1]Mackes NK, Golm D, Sarkar S, Kumsta R, Rutter M, Fairchild G, Mehta MA, Sonuga-Barke EJS; ERA Young Adult Follow-up team. Early childhood deprivation is associated with alterations in adult brain structure despite subsequent environmental enrichment. Proc Natl Acad Sci U S A. 2020 Jan 7;117(1):641-649. doi: 10.1073/pnas.1911264116. PMID: 31907309; PMCID: PMC6955353. [2]https://www.researchgate.net/publication/260387981_Altered_Brain_Development_following_Global_Neglect_in_Early_Childhood [3]Bremner D, Randall P, Scott TN, Bronen RA, Seibyl JP, Southwick SM, Delaney RC, McCarty G, Charney DS, Innis RB. MRI-based measurements of hippocampal volume in combat-related posttraumatic stress disorder. Am J Psychiatry. 1995a;152:973–981. [4]Pieper J, Chang DG, Mahasin SZ, Swan AR, Quinto AA, Nichols SL, Diwakar M, Huang C, Swan J, Lee RR, Baker DG, Huang M. Brain Amygdala Volume Increases in Veterans and Active-Duty Military Personnel With Combat-Related Posttraumatic Stress Disorder and Mild Traumatic Brain Injury. J Head Trauma Rehabil. 2020 Jan/Feb;35(1):E1-E9. doi: 10.1097/HTR.0000000000000492. PMID: 31033749; PMCID: PMC6814512. [5]Eftekhari A, Ruzek JI, Crowley JJ, Rosen CS, Greenbaum MA, Karlin BE. Effectiveness of national implementation of prolonged exposure therapy in Veterans Affairs care. JAMA Psychiatry. 2013 Sep;70(9):949-55. doi: 10.1001/jamapsychiatry.2013.36. PMID: 23863892. [6]Schottenbauer MA, Glass CR, Arnkoff DB, Tendick V, Gray SH. Nonresponse and dropout rates in outcome studies on PTSD: review and methodological considerations. Psychiatry. 2008 Summer;71(2):134-68. doi: 10.1521/psyc.2008.71.2.134. PMID: 18573035. [7]Berger W, Mendlowicz MV, Marques-Portella C, Kinrys G, Fontenelle LF, Marmar CR, Figueira I. Pharmacologic alternatives to antidepressants in posttraumatic stress disorder: a systematic review. Prog Neuropsychopharmacol Biol Psychiatry. 2009 Mar 17;33(2):169-80. doi: 10.1016/j.pnpbp.2008.12.004. Epub 2008 Dec 24. PMID: 19141307; PMCID: PMC2720612. [8]Matsuoka Y. Clearance of fear memory from the hippocampus through neurogenesis by omega-3 fatty acids: a novel preventive strategy for posttraumatic stress disorder? Biopsychosoc Med. 2011 Feb 8;5:3. doi: 10.1186/1751-0759-5-3. PMID: 21303552; PMCID: PMC3045887. [9]Ali SH, Madhana RM, K V A, Kasala ER, Bodduluru LN, Pitta S, Mahareddy JR, Lahkar M. Resveratrol ameliorates depressive-like behavior in repeated corticosterone-induced depression in mice. Steroids. 2015 Sep;101:37-42. doi: 10.1016/j.steroids.2015.05.010. Epub 2015 Jun 3. PMID: 26048446. [10]Zhang ZS, Qiu ZK, He JL, Liu X, Chen JS, Wang YL. Resveratrol ameliorated the behavioral deficits in a mouse model of post-traumatic stress disorder. Pharmacol Biochem Behav. 2017 Oct;161:68-76. doi: 10.1016/j.pbb.2017.09.004. Epub 2017 Sep 23. PMID: 28947177. [11]https://www.sciencedirect.com/science/article/pii/S0891061810000852 [12]Alzoubi KH, Shatnawi AF, Al-Qudah MA, Alfaqih MA. Vitamin C attenuates memory loss induced by post-traumatic stress like behavior in a rat model. Behav Brain Res. 2020 Feb 3;379:112350. doi: 10.1016/j.bbr.2019.112350. Epub 2019 Nov 8. PMID: 31711893. [13]Goldstein LA, Mehling WE, Metzler TJ, Cohen BE, Barnes DE, Choucroun GJ, Silver A, Talbot LS, Maguen S, Hlavin JA, Chesney MA, Neylan TC. Veterans Group Exercise: A randomized pilot trial of an Integrative Exercise program for veterans with posttraumatic stress. J Affect Disord. 2018 Feb;227:345-352. doi: 10.1016/j.jad.2017.11.002. Epub 2017 Nov 4. PMID: 29145076. [14]Fetzner MG, Asmundson GJ. Aerobic Exercise Reduces Symptoms of Posttraumatic Stress Disorder: A Randomized Controlled Trial. Cogn Behav Ther. 2015;44(4):301-13. doi: 10.1080/16506073.2014.916745. Epub 2014 Jun 9. PMID: 24911173.

St. John's wort for depression and anxiety

 St. John's wort is a wild plant with five-petaled yellow blooms in clusters. It gets its name from the fact that it blooms around St. John the Baptist's birthday, June 24. For thousands of years, people have utilised the blooms and leaves of this plant to treat many ailments.

St. John's wort benefits

St. John's wort, which functions similarly to an SSRI, also inhibits serotonin reabsorption in the central nervous system, boosting the availability of the brain chemicals serotonin, dopamine, and norepinephrine. These neurotransmitters aid in mood enhancement. Because St. John's wort includes a range of polyphenols, including rutin, it may have more antioxidant and anti-inflammatory properties than pharmaceuticals.

St. John's wort for depression and anxiety

A 2015 meta-analysis research [1], which included 66 prior studies and a total of 15,161 patients, compared the impact of antidepressants with other drugs, including St. John's wort. The researchers determined that St. John's wort showed some impact compared to placebo, but the study data was insufficient to advocate therapeutic usage.

The 2010 American Psychiatric Association medical report [2] said that, while there is no consistent scientific evidence on St. John's wort, more study will be published in the future. St. John's wort may cause mild to moderate illness in certain persons as a treatment options for depression.

In a randomized controlled clinical trial in 2011 [3], whether it was St. John's Wort or the SSRI drug Citalopram (Citalopram), there was no significant difference compared to placebo after 12 weeks of use.

In 2012, a research on major depressive illness [4] discovered that whether it was St. John's wort, the SSRI medicine Sertraline (Sertraline), or placebo, the therapeutic impact was equivalent after 26 weeks of therapy, that is, whether it was St. John's wort or SSRIs have been demonstrated to be more effective than a placebo in clinical trials.

The country that clinically uses St. John's Wort as a treatment for depression, Germany may be regarded as the earliest and most used country. St. John's Wort was prescribed as high as 66 million doses a year! [5] St. John's wort has been shown to work as well as SSRI drugs, but like drugs, it's actually not that different from a placebo. The above studies are all short-term clinical studies, and related meta-analysis, long-term use of St. John's wort, there are two possibilities, one is that, like SSRI drugs, it will cause drug resistance and require higher and higher doses to achieve the effect, It is not sure whether it is safe in the long term; secondly, St. John's wort contains polyphenols such as rutin, which has antioxidant and anti-inflammatory effects that SSRI drugs do not have. Can long-term use be more effective by reducing inflammation? This needs more research to prove. St. John's wort is recommended for short-term use and is a good alternative when not taking prescription drugs.

How long does it take for St. John's wort to work?

You may not feel the full advantages of St. John's wort for two to six weeks, depending on the type you take. Again, there is no evidence that this supplement works, so you may not see any results at all. It is advisable to consult with your healthcare practitioner to determine what is best for you.

Do I need a prescription for St. John's wort?

The Food and Drug Administration (FDA) considers Trusted Source St. John's wort to be a nutritional supplement and does not authorise it for use as a medicine in the United States.

As a result, St. John's wort is available without a prescription in the United States and many other nations. However, in certain countries, like as Ireland, a prescription is required to obtain it.

Safety and Side Effects

St. John's wort is usually safe when taken by mouth in appropriate doses for no longer than 12 weeks. but may cause:

     • Restlessness and anxiety

     • Dizziness

     • Diarrhea, constipation and upset stomach

     • dry mouth

Other side effects may include:

     • Fatigue and insomnia

     • Headache

     • Increased sensitivity to sunlight (photosensitivity)

There isn't enough information about the safety of topical St. John's wort.

Do not use St. John's wort during pregnancy and breastfeeding.

Is there anything I should be concerned about when taking St John's wort?

Many different drugs can be affected by St. John's wort. Many common medicines can create significant and perhaps hazardous interactions with it. St. John's wort may potentially reduce the efficacy of other drugs. These combinations may render your medications ineffective.

Combining St. John's wort with SSRIs may result in a potentially fatal spike in serotonin. This can result in a disease known as serotonin syndrome. The consequences of serotonin syndrome might take minutes or hours to manifest. Among these signs are:

 

     • Rapid heartbeat.

     • High blood pressure.

     • Increased body temperature.

     • Hallucinations.

Ask your doctor before combining St. John's wort with any other medications, especially prescription medications.

REF：

[1]Linde, K., Kriston, L., Rücker, G., Jamil, S., Schumann, I., Meissner, K., Sigterman, K., & Schneider, A. (2015). Efficacy and acceptability of pharmacological treatments for depressive disorders in primary care: systematic review and network meta-analysis. Annals of family medicine, 13(1), 69–79.https://doi.org/10.1370/afm.168

[2]Freeman, M. P., Fava, M., Lake, J., Trivedi, M. H., Wisner, K. L., & Mischoulon, D. (2010). Complementary and alternative medicine in major depressive disorder: the American Psychiatric Association Task Force report. The Journal of clinical psychiatry, 71(6), 669–681.https://doi.org/10.4088/JCP.10c

[3]Rapaport, M. H., Nierenberg, A. A., Howland, R., Dording, C., Schettler, P. J., & Mischoulon, D. (2011). The treatment of minor depression with St. John's Wort or citalopram: failure to show benefit over placebo. Journal of psychiatric research, 45(7), 931–941.https://doi.org/10.1016/j.jpsyc

[4]Sarris, J., Fava, M., Schweitzer, I., & Mischoulon, D. (2012). St John's wort (Hypericum perforatum) versus sertraline and placebo in major depressive disorder: continuation data from a 26-week RCT. Pharmacopsychiatry, 45(7), 275–278.https://doi.org/10.1055/s-0032-

[5]Peter Smet (1996),Letter, St John’s Wort as an antidepressant,BMJ Volume 313 3 Aug 1996 https://doi.org/10.1136/bmj.313.7052.241

Can fish oil help with Anxiety and depression?

 Fish oil is an extract of fish and seafood rich in n-3 omega fatty acids. But fish oil is not equal to omega 3 fatty acids, because the content of ordinary fish oil is about 30% omega 3 fatty acids, and the rest is other fatty acids. 

The human body does not have the ability to synthesize omega 3 fatty acid on its own. Instead, it needs to get these fatty acids from food.

Fish oil contains two essential omega-3 acids for the body: eicosapentenoic acid (EPA) and dihydroxyapatenoic acid (DHA).

Eating more fish has been shown to reduce the risk of developing depression by a factor of 0.58.

According to a study conducted in a Greek island in 2009, eating an additional serving of fish each week was linked to a lower rate of depression.

Hibbeln (1998) found an association between higher fish consumption and lower annual rates of major depressive disorder in many countries around the world. [2]

A 2014 meta-analysis [3] showed that fish oil containing omega 3 can help treat patients with major depressive disorder.

A meta-analysis in 2019 [4] showed that omega 3 fish oil containing more than 60% EPA, with a dose of less than 1g per day, is helpful in treating depression patients.

The effectiveness of fish oil in promoting human health is a subject of ongoing debate. A clinical study conducted in 2016 [5] examined the use of fish oil in the treatment of depression but failed to provide substantial evidence that either EPA (Eicosapentaenoic Acid) or DHA (Docosahexaenoic Acid) alone could deliver significant therapeutic benefits. This lack of efficacy might be attributed to the purity of the fish oil and its EPA content.

In a 2012 meta-analysis, researchers made certain adjustments to an earlier omega-3 fats meta-analysis [6], which included 13 clinical studies conducted by other researchers prior to their own investigation. Notably, this meta-analysis excluded non-clinical definitions of depression.

According to a study carried out in the United States, supplementing omega-3 fats with fish oil indeed has a substantial impact on the treatment of depression.

Furthermore, this study categorized the findings of previous clinical studies and arrived at the conclusion that individuals who consumed fish oil with an EPA content exceeding 60% experienced significantly better results in managing depression compared to those who consumed fish oil with less than 60% EPA content. In the end, the consensus is that both EPA (Eicosapentaenoic Acid) and DHA (Docosahexaenoic Acid) hold equal importance for human health. Nevertheless, when it comes to treating depression, EPA (Eicosapentaenoic Acid) proves to be more effective than DHA (Docosahexaenoic Acid).

In 2014, a meta-analysis, encompassing 19 clinical studies on depression, also arrived at the same verdict [7]. The consensus drawn was that supplementing omega-3 fatty acids proved effective in managing depression. However, the key factor influencing this effectiveness was the EPA content in fish oil. Consequently, among the omega-3 fatty acids, EPA demonstrated greater effectiveness than DHA in treating depression.

In 2015, a significant animal experiment provided answers to most of our inquiries regarding the connection between omega-3 fatty acids and Endotoxin LPS [8]. Endotoxin LPS can induce inflammation in brain and in body. The study's design was remarkably clever, involving the use of genetically modified mice known as "Fat-1 Mice," These unique rodents distinguished themselves from regular mice by their ability to transform n-6 fatty acids (considered bad fat) from their diet, such as corn oil, into n-3 fatty acids(EPA,DHA,ALA)

The researchers then fed both Fat Mouse No. 1 and the control group of ordinary mice a diet rich in n-6 fatty acids. Remarkably, the n-6 fatty acids in the blood of Fat Mouse No. 1 did not see a significant increase because they were efficiently converted into n-3 fatty acids. What's more, the LPS levels in the blood of Fat Mouse No. 1 remained stable, whereas ordinary mice experienced a considerable increase in LPS.

Further analysis of the feces from these two groups of mice revealed that Fat Mouse No. 1 hosted a substantial population of beneficial probiotics, including Bifidobacterium and Lactobacillus, which were notably absent in the regular mice.

The researchers then applied three methods to mice that produced substantial amounts of LPS: broad-spectrum antibiotics, exposing normal mice to the feces of Fat Mouse No. 1, and supplementing with omega-3 fatty acids. All three approaches successfully reduced LPS levels in the blood of regular mice.

This outcome underscores the connection between LPS in the blood and the composition of intestinal flora, as well as the ability of n-3 fatty acids to mitigate LPS production. But the question remained: by what mechanism did this occur? To answer that, the researchers utilized sterile feces from Fat Mouse No. 1 and found that regular mice could also reduce LPS in their blood. This is when the star of the study emerged: IAP (Intestinal alkaline phosphatase). IAP is a protein secreted by intestinal parietal cells, equipped with the capability to combat bacteria and reduce LPS toxins. N-3 fatty acids stimulate the secretion of IAP by intestinal parietal cells, while n-6 fatty acids inhibit it.

Returning to the experiment, the researchers fed regular mice IAP supplements, which also resulted in a reduction of LPS in their blood. Therefore, the balance between n-3 and n-6 fatty acids affects the behavior of intestinal wall cells, influencing the secretion of IAP, modifying the composition of intestinal flora, and concurrently impacting the quantity of LPS in the blood. Regrettably, there is currently no readily available health product for direct IAP supplementation.

Therefore, the most effective steps we can take at present involve supplementing with fish oil rich in n-3 and reducing the consumption of n-6 vegetable oil.

The sole dietary and nutritional supplement capable of simultaneously treating symptoms (reducing inflammation) and tackling the root issue (reducing LPS) is fish oil. It's essential that the fish oil comprises pure omega-3. If the content is only 30%, the remaining 70% might consist of detrimental omega-6 fatty acids. One of the primary goals of using fish oil is to balance the n-3/n-6 ratio. Naturally, the higher the content of n-3 in the fish oil, the more effective it is.

Benefits of Fish Oil for anxiety and depression

Regarding the potential of fish oil to alleviate anxiety and depression, based on the properties of fish oil and existing research, the potential reasons for fish oil's capacity to alleviate anxiety and depression are as follows:

1. Anti-inflammatory effect

Symptoms of depression are associated with the ongoing inflammatory response within the body. The antidepressant properties of Omega-3 are attributed to their role in regulating oxidative reactions in nerve cells and curbing the generation of inflammatory cytokines like TNF-a or IL-6. Omega-3 also binds with the building blocks of these inflammatory cytokines (such as arachidonic acid) to diminish inflammation. Furthermore, EPA hinders the enzyme responsible for arachidonic acid production (A5 unsaturase).[9]

2. Promote the transmission of information in the nerves.

Omega-3 has the potential to influence neurotransmission by altering the flexibility of cell membranes and boosting the transmission of information through G protein and PKC (protein kinase C). This results in heightened sensitivity of serotonin and dopamine receptors. EPA, in particular, has the capability to enhance the transmission of dopamine and serotonin, consequently amplifying neurotransmission associated with feelings of happiness.

In animal experiments, the supplementation of Omega-3 in test mice was shown to increase the brain's dopamine by 40% and elevate the proportion of dopamine receptors binding to it. This, in turn, allows more dopamine, responsible for transmitting joyous information, to reach the brain.[10]

3. Relieve endocrine system disorders

Depression is linked to elevated cortisone levels in the body. This occurs when excessive stress triggers the overactivation of the HPA axis, leading to the excessive secretion of corticotropin-releasing hormone (CRH). CRH plays a pivotal role as the primary switch in the hormonal system for stress regulation, and heightened CRH levels stimulate the amygdala in the brain, resulting in increased feelings of anxiety and fear.

EPA has the capacity to inhibit the excessive activation of the HPA axis and reduce the secretion of CRH. Additionally, it can curb the protein responsible for transporting cortisone, thereby limiting the entry of cortisone into the brain. This helps maintain a balance in cortisone levels within the brain and stabilizes the overexcited endocrine system.[11]

4. Stabilize brain balance

Research has revealed that following the supplementation of EPA, there is an increase in N-acetyl-aspartate in the brain. N-acetyl-aspartate is known for its neuroprotective properties, and this rise can contribute to stabilizing brain nerves. Furthermore, Omega-3 is capable of enhancing the fluidity of brain cell membranes and reinforcing the integrity of the tight junctions within the blood-brain barrier (BBB). Ultimately, Omega-3 can diminish the likelihood of brain atrophy caused by depression by reducing cortisone levels.[12]

Which fish oil to choose for anti-depression and anxiety?

It is recommended to choose "pure EPA" or "EPA-based" fish oil, which will be more effective than DHA-based fish oil. But in fact, compared with DHA, EPA is not concentrated in the brain. EPA is more effective than DHA because EPA can quickly enter the brain as a free fatty acid and has a better anti-inflammatory effect. [13]

We can choose "Concentration", "Ratio", and "Quality" respectively:

► Concentration: In fish oil, the recommended concentration is EPA+DHA>60%, or >80%. In studies that recommend using EPA+DHA more than 80%, it is indicated that >80% content is better than <80%.

► Ratio: EPA and DHA are synergistic. The recommended ratio is EPA/DHA>2.

►Quality: Quality has a great influence on the effect. When selecting fish oil, you need to pay attention to the absorption, extraction method, heavy gold plaque and the content of pollutants.

How much fish oil do you need to eat to effectively fight anxiety and depression?

In recent clinical studies, EPA mostly uses "720-1000mg" per day, which is more effective than DHA-based. And the use of EPA fish oil alone, or with anti-anxiety and depression drugs are effective. If you want to improve your memory at the same time, you can choose 1 or 2g of DHA per day, which is more effective than a high dose of 4g/day.

Ref:

[1]Long-term fish intake is associated with less severe depressive symptoms among elderly men and women: the MEDIS (MEDiterranean ISlands Elderly) epidemiological study Vassiliki Bountziouka, Evangelos Polychronopoulos, Akis Zeimbekis, Eftichia Papavenetiou, Evaggelia Ladoukaki, Natassa Papairakleous, Efthimios Gotsis, George Metallinos, Christos Lionis, Demosthenes Panagiotakos PMID: 19587361 https://doi.org/10.1177/0898264309340693

[2] Fish consumption and major depression Joseph Hibbeln Published:April 18, 1998 https://doi.org/10.1016/S0140-6736(05)79168-6

[3] Grosso, Giuseppe & Pajak, Andrzej & Marventano, Stefano & Castellano, Sabrina & Galvano, Fabio & Bucolo, Claudio & Drago, Filippo & Caraci, Filippo. (2014). Role of Omega-3 Fatty Acids in the Treatment of Depressive Disorders: A Comprehensive Meta-Analysis of Randomized Clinical Trials. PloS one. 9. e96905. 10.1371/journal.pone.0096905. http://dx.doi.org/10.1371/journal.pone.0096905

[4] Liao, Yuhua & Xie, Bo & Zhang, Huimin & He, Qian & Guo, Lan & Subramaniapillai, Mehala & Fan, Beifang & Ciyong, Lu & Mclntyer, R.. (2019). Efficacy of omega-3 PUFAs in depression: A meta-analysis. Translational Psychiatry. 9. 10.1038/s41398-019-0515-5. https://doi.org/10.1038/s41398-019-0515-5

[5] Mischoulon, D., Nierenberg, A. A., Schettler, P. J., Kinkead, B. L., Fehling, K., Martinson, M. A., & Hyman Rapaport, M. (2015). A double-blind, randomized controlled clinical trial comparing eicosapentaenoic acid versus docosahexaenoic acid for depression. The Journal of clinical psychiatry, 76(1), 54–61.https://doi.org/10.4088/jcp.14m08986