Nutritional Testing for Mood Disorders

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Mood disorders are a group of psychological conditions in which a disturbance in a person’s mood is considered to be the main underlying feature. Specifically, loss of interest or pleasure in normally enjoyable activities and decreased functional capacity are underlying presentations of depressive disorder across the entire depressive continuum.

In addition to quality-of-life and medical costs, lost productivity is estimated to cost U.S. employers over $44 billion annually, 81% due to poorer on-the-job performance,1 or “presenteeism” (present but less effective).2

To complicate the picture, more than half of the people with depression also have anxiety as a simultaneous condition.3 Anxiety and depressive disorders comprise major mental health concerns in U.S. adults, with 28.8% and 20.8%, respectively, experiencing these disorders during their lifetime.4

Mood disorders are diagnosed conventionally by a thorough physical and psychological evaluation.

Conventional treatment of mood disorders is based primarily on pharmacotherapy or psychotherapy, or (ideally6) a combination of both. Focusing on a deregulation of neurotransmitter signaling as the major cause of depression has been the foundation for the use of antidepressant drugs for the last 60 years.7 Some studies have found that the benefits of antidepressants, while helpful for a set of patients with more severe symptoms, may be minimal or nonexistent for patients with milder or more moderate symptoms.8,9 In addition, medication side effects are frequent, with almost 40% reporting one or more side effects from the commonly prescribed serotonergic medications; sexual dysfunction, sleepiness, and weight gain are the top three complaints.10

Given concerns related to such pharmaceutical side effects, many patients have sought alternatives to pharmacological treatments. [Freeman MP, Mischoulon D, Tedeschini E, et al. Complementary and alternative medicine for major depressive disorder: a meta-analysis of patient characteristics, placebo-response rates, and treatment outcomes relative to standard antidepressants. J Clin Psychiatry. 2010 Jun;71(6):682-8.]

The etiology of mood disorders is multifaceted and includes biological, psychosocial, environmental, and lifestyle factors. Nutritional status is one of the key factors in proper brain development and normal cognitive function.11 Diet quality has been associated with common mental disorders, including depression and anxiety,12-16 and certain nutrients have been found to be particularly important. For instance:

  • Sufficient levels of specific amino acids, or substrates, such as phenylalanine, tyrosine, and tryptophan, are required for the production of mood-regulating neurotransmitters.17
  • Adequate levels of relevant vitamin (Vitamin B6, B12 and Folate) and mineral (Magnesium and Zinc) cofactors are required for critical enzyme function in neurotransmitter pathways:
    • Several members of the B-complex vitamin family are intimately involved in brain function. Vitamin B6 is a cofactor for over 100 enzyme-catalyzed reactions, including many reactions involved in the synthesis or catabolism of neurotransmitters.18
    • Inadequate Vitamin B12 and Folate can contribute to mood instability;19,20 one study found that more than a quarter of depressed elderly women were deficient in B12.21
    • Magnesium levels are related to risk of depression and anxiety.22-24
    • Zinc status is also associated with mood disorders. Several studies have shown that Zinc levels are lower in those with clinical depression.25-27
  • Many individual nutrients, such as Vitamin D, have also been found to be associated with depression and mood disorders. Research has repeatedly found that low Vitamin D levels correlate with a greater risk of depression.28-31

Comprehensive nutritional testing can ensure a solid foundation, identifying nutrients needed to support critical enzyme function in neurotransmitter pathways that may support optimal mood. The level of functional performance of these critical enzymes can be reliably estimated by assessing the “upstream” building blocks and “downstream”metabolites in these relevant pathways:

  • ”Upstream” nutrient building blocks, such as amino acids used in the production of mood-regulating neurotransmitters.
  • “Downstream” metabolites, such as neurotransmitter breakdown products that can identify need for nutrient co-factors, such as Vitamin B12 or Magnesium.

Identifying and supplementing a patient’s targeted needs helps to personalize treatments that may alleviate symptoms associated with underlying nutritional imbalance.

Our comprehensive NutrEval® profile provides an insightful tool for clinicians managing the care of patients who are seeking individualized nutritional support for optimizing mood.

*For NY clients, please order the ION profile that can also provide valuable nutritional insights related to supporting patients with mood disorders.

1. Stewart WF, Ricci JA, Chee E, Hahn SR, Morganstein D. Cost of lost productive work time among US workers with depression. JAMA : the journal of the American Medical Association. Jun 18 2003;289(23):3135-3144.

2. Kessler RC, Akiskal HS, Ames M, et al. Prevalence and effects of mood disorders on work performance in a nationally representative sample of U.S. workers. The American journal of psychiatry. Sep 2006;163(9):1561-1568.

3. Griffin M. Depression: Coping with Anxiety Symptoms. 2010. Accessed February 19, 2015.

4. Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of general psychiatry. Jun 2005;62(6):593-602.

5. DSM. 2014; Accessed February 17, 2015.

6. Khan A, Faucett J, Lichtenberg P, Kirsch I, Brown WA. A systematic review of comparative efficacy of treatments and controls for depression. PLoS One. 2012;7(7):e41778.

7. Tartakovsky M. Depression: New Medications On The Horizon. 2013. Accessed February 20, 2015.

8. Fournier JC, DeRubeis RJ, Hollon SD, et al. Antidepressant drug effects and depression severity: a patient-level meta-analysis. JAMA : the journal of the American Medical Association. Jan 6 2010;303(1):47-53.

9. Kirsch I, Deacon BJ, Huedo-Medina TB, Scoboria A, Moore TJ, Johnson BT. Initial severity and antidepressant benefits: a meta-analysis of data submitted to the Food and Drug Administration. PLoS medicine. Feb 2008;5(2):e45.

10. Cascade E, Kalali AH, Kennedy SH. Real-World Data on SSRI Antidepressant Side Effects. Psychiatry (Edgmont (Pa. : Township)). Feb 2009;6(2):16-18. [Freeman MP, Mischoulon D, Tedeschini E, et al. Complementary and alternative medicine for major depressive disorder: a meta-analysis of patient characteristics, placebo-response rates, and treatment outcomes relative to standard antidepressants. J Clin Psychiatry. 2010 Jun;71(6):682-8.]

11. Katz DL, Friedman RSC. Diet and Cognitive function. Nutriton in Clinical practice: a comprehensive, evidence-based manual for the practitioner. Philadelphia: Lippincott Williams & Wilkins; 2008.

12. Jacka FN, Mykletun A, Berk M, Bjelland I, Tell GS. The association between habitual diet quality and the common mental disorders in community-dwelling adults: the Hordaland Health study. Psychosom Med. Jul-Aug 2011;73(6):483-490.

13. Nanri A, Kimura Y, Matsushita Y, et al. Dietary patterns and depressive symptoms among Japanese men and women. European journal of clinical nutrition. Aug 2010;64(8):832-839.

14. Jacka FN, Pasco JA, Mykletun A, et al. Association of Western and traditional diets with depression and anxiety in women. The American journal of psychiatry. Mar 2010;167(3):305-311.

15. Sanchez-Villegas A, Delgado-Rodriguez M, Alonso A, et al. Association of the Mediterranean dietary pattern with the incidence of depression: the Seguimiento Universidad de Navarra/University of Navarra follow-up (SUN) cohort. Archives of general psychiatry. Oct 2009;66(10):1090-1098.

16. Akbaraly TN, Brunner EJ, Ferrie JE, Marmot MG, Kivimaki M, Singh-Manoux A. Dietary pattern and depressive symptoms in middle age. The British journal of psychiatry : the journal of mental science. Nov 2009;195(5):408-413.

17. Nutritional Biochemistry and Metabolism. 2nd ed. Connecticut: Appleton & Lange; 1991.

18. Clayton PT. B6-responsive disorders: a model of vitamin dependency. Journal of inherited metabolic disease. Apr-Jun 2006;29(2-3):317-326.

19. Coppen A, Bolander-Gouaille C. Treatment of depression: time to consider folic acid and vitamin B12. Journal of psychopharmacology (Oxford, England). Jan 2005;19(1):59-65.

20. Young SN. Folate and depression--a neglected problem. Journal of psychiatry & neuroscience : JPN. Mar 2007;32(2):80-82.

21. Hanna S, Lachover L, Rajarethinam RP. Vitamin b(1)(2) deficiency and depression in the elderly: review and case report. Primary care companion to the Journal of clinical psychiatry. 2009;11(5):269-270.

22. Mlyniec K, Davies CL, de Aguero Sanchez IG, Pytka K, Budziszewska B, Nowak G. Essential elements in depression and anxiety. Part I. Pharmacological reports : PR. Aug 2014;66(4):534-544.

23. Jacka FN, Overland S, Stewart R, Tell GS, Bjelland I, Mykletun A. Association between magnesium intake and depression and anxiety in community-dwelling adults: the Hordaland Health Study. The Australian and New Zealand journal of psychiatry. Jan 2009;43(1):45-52.

24. Serefko A, Szopa A, Wlaz P, et al. Magnesium in depression. Pharmacological reports : PR. 2013;65(3):547-554.

25. Levenson CW. Zinc: the new antidepressant? Nutrition reviews. Jan 2006;64(1):39-42.

26. Rao TS, Asha MR, Ramesh BN, Rao KS. Understanding nutrition, depression and mental illnesses. Indian journal of psychiatry. Apr 2008;50(2):77-82.

27. Nowak G, Szewczyk B, Pilc A. Zinc and depression. An update. Pharmacological reports : PR. Nov-Dec 2005;57(6):713-718.

28. Spedding S. Vitamin D and depression: a systematic review and meta-analysis comparing studies with and without biological flaws. Nutrients. 2014 Apr 11;6(4):1501-18.

29. Liu JJ, Galfalvy HC, Cooper TB, Oquendo MA, Grunebaum MF, Mann JJ, Sublette ME. Omega-3 polyunsaturated fatty acid (PUFA) status in major depressive disorder with comorbid anxiety disorders. J Clin Psychiatry. 2013 Jul;74(7):732-8.

30. Anglin RE, Samaan Z, Walter SD, McDonald SD. Vitamin D deficiency and depression in adults: systematic review and meta-analysis. Br J Psychiatry. 2013 Feb;202:100-7.

31. Kerr DC, Zava DT, Piper WT, Saturn SR, Frei B, Gombart AF.Associations between vitamin D levels and depressive symptoms in healthy young adult women. Psychiatry Res. 2015 Mar 5.

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