From Nutrition to Neighborhoods, Many Roads Lead to Mental Health

Robert McNamara, PhD

Robert McNamara, PhD, discusses the link between nutrition and depression. Photos by Cindy Starr.

Effective treatment of depression can involve far more than popping a pill. That was the take-home message for a hundred physicians, nurses and mental health professionals who attended the UC Mood Disorders Center’s 4th annual symposium April 5 at the Daniel Drake Center for Post-Acute Care. Experts with a broad range of clinical and research interests presented evidence of how depression can be impacted by nutrition, parenting skills, behavior therapy, mindfulness and even the depolarizing of brain cells with an electromagnetic field.

Robert McNamara, PhD, a mood disorders researcher and Associate Professor in UC’s Department of Psychiatry and Behavioral Neuroscience, presented studies that showed the relationship between diet and mental health. In particular, he highlighted the importance of vitamin D, folic acid, and fish consumption in reducing the risk of developing depression. A review of 21 studies found that high intakes of fruit, vegetables, fish and whole grains may be associated with a reduced risk of depression, he said.

Conversely, mood disorders can be linked to fast food, commercial baked good consumption and sugar consumption. “These foods that we hold dear turn out to be bad for us,” he said. The typical Western diet, he said, is deficient in omega-3 fatty acids, which are found in fish. The Western diet also has nutrient excesses in processed sugar, gluten, and saturated fats, as well as omega-6 fatty acids found in vegetable oils.

He pointed to a Rhode Island study that found that 35 percent of adolescents eat fish fewer than three times a year. “Three or less times per year is insufficient to maintain liver and brain omega-3 levels, and it is putting youth at increased risk for developing mood symptoms,” he said.

A study of children with depression found that children who were treated with fish oil were more likely to experience remission over a period of 16 weeks than children treated with a placebo.

Meanwhile, baby rats with dietary-induced omega-3 deficiencies experience elevated inflammation, reduced volume of the hippocampus, changes in multiple neurotransmitter systems, and behavioral depression in young adulthood.

Vitamin D3 deficiency in baby rats also leads to long-term changes in brain structure.

A 2013 study found that active-duty military service members with low vitamin D levels had a higher risk of suicide.

Pointing to Hippocrates, who said in 420 BC, “Leave your drugs in the chemist’s pot if you can heal the patient with food,” Dr. McNamara issued a challenge to his audience: “If you gave the Hippocratic oath, as a physician you are compelled – obligated – to heed Hippocrates’s words and start asking your patients about their diet.”

Additional Highlights

Ernest Pedapati, MD, MS, above, a fifth-year resident at Cincinnati Children’s Hospital Medical Center, is eyeing a new model of treating adolescent depression – “from neurons to neighborhoods” — with a focus not only on the brain, but also on the environment. An understanding of interactions between genes and the environment, he said, can lead to novel interventions.

A child who has a genetic risk of depression (because of a short allele on the serotonin transporter gene) and who is maltreated, has a 30 times greater risk of depression than a maltreated child who has no genetic risk of depression (long allele), he said. An at-risk environment includes one in which the child fails to develop a secure attachment with the primary caregiver. This can occur if the mother is depressed, and studies have shown that only 20 percent of infants born to depressed mothers develop secure attachment.

When depressed mothers were coached in how to respond to their infants in a 2006 randomized prevention study, however, attachment was greater between the infants and depressed mothers than between infants and the mothers who were not depressed. Cheryl McCullumsmith, MD, PhD

Associate Professor Cheryl McCullumsmith, MD, PhD, left, whose research focuses on suicide and clinical outcomes after psychiatric crisis, spoke of the promise of the investigational drug ketamine for the treatment of acute suicidal thoughts in the emergency department setting.

Ketamine as a treatment for acute depression is off-label and is being studied in numerous clinical trials. Dr. McCullumsmith studied ketamine at the University of Alabama at Birmingham (UAB) before coming to UC in 2013.

Suicide is the No. 10 cause of death overall in the United States and the third leading cause of death for people aged 15 to 24. Physicians face difficult choices when suicidal patients are admitted to the emergency department, Dr. McCullumsmith said. “We don’t know how to assess suicide risk or how to treat it,” she said.

Meanwhile, because current medications for depression and suicidal thoughts can take weeks to take effect, patients are discharged before their medications have begun to help. The promise of ketamine, a fast-acting anti-depressant, is that it can reduce depression and suicidal thinking within 15 minutes.

John Hawkins, MD

John Hawkins, MD, above, Chief of Psychiatry and Deputy Chief of Research at the Lindner Center of HOPE, said that transcranial magnetic stimulation (rTMS) is producing “robust improvements” in Lindner Center patients who have not responded to medication.

The FDA-approved technology involves a machine that uses pulsating magnetic fields to produce an electrical current that depolarizes neurons in the left prefrontal cortex. Benefits for patients typically occur after six weeks. Cost has been a deterrent, he said, as at least one major insurer will pay for treatment only in patients diagnosed with major depressive disorder.

Scott Ries, MSW, LISW-S, a clinician at the UC Mood Disorders Center, said he uses “behavioral activation” as the first phase of treatment. Depression often starts when an individual withdraws from an environment perceived as dangerous, he said. The result is social withdrawal, which in turn eliminates the possibility of positive feedback.

“We all need positive feedback,” Mr. Ries said. “We all thrive on this. This makes a difference in people’s lives. Avoidance of normal activities increases our experience of failure and uselessness. The lack of energy is self-perpetuating. We get less energetic sitting on the couch.”

Using behavioral therapy, Mr. Ries shapes treatment by getting patients to define and recommit to important life goals. “If you didn’t care about your job but parenting is important, that’s where we start,” he said. “We’re not digging back in a person’s history. We look at what’s important to them now. We want to get them to act according to a goal instead of to a feeling.”

Sian Cotton, PhDSian Cotton, PhD, right, Director of Integrative Health and Wellness at UC Health, spoke of mindfulness as an experiential treatment for depression. Mindfulness, she said, means that instead of banishing feelings of anxiety or distress, one accepts them and pays attention to them. “In this approach, we are noticing how the anxiety is functioning rather than trying to change it. It is a second-order process rather than first-order process.”

Mindfulness is a learned ability, she said. “The goal is to loosen the association between dysphoria (an intense feeling of discontent) and automatic thoughts. It involves stepping back and changing the relationship between thoughts and emotions.”

Course Co-Directors of the symposium were Caleb Adler, MD, and Melissa DelBello, MD, MS, Co-Directors of the UC Mood Disorders Center, and Stephen Benoit, PhD. The event was underwritten by the UC Department of Psychiatry and Behavioral Neuroscience, the UC Gardner Neuroscience Institute, the National Network of Depression Centers, Cindy and Bill Starr, and Gina Weitzel.

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