According to WHO, or the World Health Organization, major depression affects 350 million people worldwide and as stated in this study, by the year 2020, depression will be the second leading cause of disease burden after heart disease in the world.
A study published by Current Pharmacology in NIH says depression is associated with a significant burden and affects about 16 % of the population in the US in a lifetime, with costs estimated to about 83 billion per year.
According to that study, of those treated, only about a third achieve remission.
The worst part of this is that chances of remission decrease with each consecutive medication trial. Depression is difficult to treat. Why is that?
It is thought that the complex nature of the disease-causing factors may have to do with the difficulty of treatment because there are many causes associated with depression, and depression may develop due to psychosocial issues, environmental, biological and genetic factors.
Depression is one of the most misunderstood diseases and especially perhaps by those who have never suffered its debilitation of darkness and gloom, its gripping hopelessness, sadness, and the hopelessness that is so difficult to explain.
Depression is a debilitating illness that impacts all aspects of one’s life. People with depression may report feeling like they are walking in a fog, or as if their bodies are made of lead a heaviness of body and mind.
They may feel lethargic, fatigue and the list of signs and symptoms can be lengthy. Take a look at these signs and symptoms of depression from the National Institute of Mental Health (NIH).
Signs and symptoms include the following:
• Persistent sad, anxious, or “empty” mood
• Feelings of hopelessness or pessimism
• Feelings of guilt, worthlessness, or helplessness
• Loss of interest or pleasure in hobbies or activities
• Decreased energy, fatigue, or being “slowed down”
• Difficulty concentrating, remembering, or making decisions
• Difficulty sleeping, early-morning awakening, or oversleeping
• Appetite and/or weight changes
• Thoughts of death or suicide or suicide attempts
• Restlessness or irritability
• Aches or pains, headaches, cramps, or digestive problems without a clear physical cause and/or that do not ease even with treatment.
If a person is experiencing these symptoms, its no wonder they act different, as every aspect of their life is affected.
So be kind and remember that those suffering from this disease are not just malingering or putting on act, and cannot just get over it.
While a person may not suffer all these symptoms, and indeed different people may experience different symptoms, any of these is bad enough.
After all, we all want to feel alive and vibrant.
If your loved one is affected you generally want to look for anything and everything that can help.
In many cases, medications don’t work or only cause slight improvement, and in many cases cause terrible side effects.
But first what causes depression?
There are many causes of depression both genetic and environmental factors, and depression can be triggered by trauma, or major stress if someone is predisposed to depression.
So what can be done?
Depression is typically treated using a multidimensional approach including medications and counseling. Research is now, however, looking at various causes of depression and perhaps a new approach of supplementing traditional treatment. And to that end, Science is looking to nutrition.
A whole new field of science is emerging aiming to shed light on the connection between nutrition and mental health, namely nutritional neuroscience, according to an article in Indian Journal of Psychiatry published in NIH website.
Research continues to show that poor quality diets tend to be associated with depression while wholesome diets -those composed of fruits and vegetables, fish and whole grains, such as the Mediterranean diet show a decreased incidence of depression.
We all know that a healthy diet protects people from diseases such heart disease, and diabetes, and now it turns out, even depression and Alzheimers.
There is increasing research that is making the case for nutrition in mental health in general and depression in particular.
So can diet influence depression?
Can diet cause depression, or does the debility of being depressed lead one into poor food choices and then depression?
And most importantly, can you eat your way to happiness?
It is likely.
No, I don’t mean you eat all the comfort food in the world.
I know, sometimes nothing but chocolate ice cream will do, or a good helping of your mama’s macaroni and cheese.
But think about all the advice you hear about eating nutritious food for your health.
Many people only think of diabetes, heart disease, and obesity, but never mental health.
When you stop to think about it, you realize that we feed the body, and we know that food, nutritious food, is required for our body to work at optimal levels. Why not the brain? The brain is part of the body.
Indeed it is a very important part of the body. This study of middle-aged women shows that eating a whole food diet as compared to processed food decreased the incidence of depression, which according to the study was likely due to the higher levels of protective antioxidants which have been shown to lower depression rates, or perhaps due to the folate found in legumes and cruciferous vegetables as some studies have shown.
Several research studies show that there is a relationship between low levels of vitamin B12, folate, and depression as in this 2012 study published in Health promotion perspective.
Folate is needed for myelin formation, cell membrane phospholipids, and neurotransmitters.
Also, the low incidence of depression in those who ate whole food diet may come from fish and N-3 Omega fatty acids which are major components of neuron membranes and with vascular and anti-inflammatory effects.
Studies have shown an inverse relationship between blood levels of omega 3s and depression.
Now going way back to high school science when we learned about Mitochondria-the energy centers of each cell -and remember you have a lot of cells and the brain has a lot of cells too, and therefore a lot of mitochondria, right? Mitochondria need the right nutrient to work, and since mitochondria contribute a lot to mental and brain function, if they are not functioning well that can lead to mental disorders.
Certain foods are pro-inflammatory.
These include processed foods which are for the most part high in simple sugars and saturated fats. Not good for the brain.
When the inflammation is turned on and never turned off it leads to cell damage causing many health problems such as cardiac disease, Alzheimers, cancer, and even, yes, depression.
Research is proving that there is a correlation between depression and nutrition. So if you have been feeling blue, sad and nothing is bringing the joy back, or are experiencing some of the signs mentioned above, or know someone who is, you may want to examine if there is a diet connection.
Please note I am not advocating that anyone stop taking their meds or seeing their mental health specialist.
Also always check with your provider before beginning any type of health regiment.
Always seek your medical professional’s advice in your therapies.
So what should you be eating to avoid or to alleviate depression?
A healthy diet rich in vitamins and minerals and healthy fats may go a long way to making you feel better in the long run, as opposed to the immediate feel-good effect after a serving of buttery mashed potatoes, or a soothing serving of ice cream.
Here is a list of nutrients and foods to consider including in your diet:
B Vitamins: These are B1, B3, B6, B12, and Folate
The B vitamins are found in meat, green leafy vegetables, eggs, legumes, and whole grains.
Vitamin B1 or Thiamine
Thiamin is important in the function of your cells and a deficiency can lead to cell dysfunction and oxidative stress.
Also, the most active form of thiamine is involved in glucose metabolism, changing carbohydrates into energy.
The brain and nervous system require a lot of energy. This is important in serotonin synthesis and also plays an important role in nerve conduction.
Therefore, if you are not having enough thiamine, you are likely to be feeling down in the dumps.
You know that when your sugar is low you feel lethargic. So apparently glucose does not just float into the cells. There is a complex process before you can get its benefits, vitamin B 1 helps in that process.
Deficiency in thiamine can cause fatigue and weakness, psychosis, and nerve damage, according to Medline Plus.
So, what foods can you eat to get the benefits of thiamine for your brain health and general health?
Thiamin is found in nuts and legumes, in whole grains, eggs, trout, beef, and pork.
B12 and folic acid
Folic and vitamin B12 work together to ensure proper functioning of your cells, especially brain cells, and are involved in the formation of neurotransmitters such as serotonin. The two vitamins are also required in the production of phospholipids, important components of neuronal myelin sheaths. (myelin sheaths enclose and offer protection for nerve cells) and cell receptors.
Deficiency in folic or vitamin B12 leads to accumulation of a substance called homocysteine-which leads to oxidative stress and is not good for the brain cells. One of the most debilitating diseases, MS, is related to deterioration and break down of the myelin sheaths.
Ultimately deficiency in B12 or folic (they work together) leads to neural toxicity and development of various disorders such as depression.
This may be due to the accumulation of homocysteine, which fails to be recycled into methionine.
You can read more on the connection between vitamin B12, folic and depression in this post.
Unfortunately, a condition caused by a gene defect called MTHFR can lead to an inability to synthesize folic and vitamin B12 leading to depression and many other health problems.
Related post: 20 Powerful Superfoods for Brain Health
Research has shown that in China where people consume diets rich in folate and B12, depression rates are low.
Studies also show that many people with depression are likely to have a deficiency in B12 or folate or both according to this study published in Pub Med. The study asserts that deficiency in folic B12, and B6 and unsaturated omega3 fatty acids affect the biochemical processes in the brain.
Deficiency in B12 and folic lead to impaired metabolism of neurotransmitters, phospholipids, myelin and receptors and oxidative stress leading to the development of various disorders including depression according to the same study.
Also, deficiency in either is related to resistance to antidepression medications, research shows.
Supplementing b6, b12 and folate have proven to be three times as effective in lowering homocysteine than folate alone according to research published in Radcliffe Medical Press which advice checking homocysteine levels and claims its a better indicator of deficiency in vitamin B12, and folate.
The article also states that some people with mental illness such as depression or schizophrenia have a deficiency in these vitamins, even when they don’t show signs of anemia because those with a fault in a methylating ( a process that leads to production of serotonin, the feel-good hormones) gene, need much higher levels in B12 and folate.
As referenced here in regard to homocysteine.
Vitamin B3 is niacin; Deficiency in this vitamin is rare. But when present deficiency causes a skin condition called pellagra, and skin looks as if it’s sunburnt, with scales.
Severe deficiency causes the 4 Ds of dermatitis, diarrhea, delirium/ dementia, and death. A vitamin deficiency can do all that? Well, Yes. Vitamins play a crucial role in many metabolic processes. This article gives more information
Zinc and Brain Health
According to an article in Biological Psychiatry, zinc is essential for many physiological functions, and plays a major role in cell growth, cell death, (old cells have to die to make room for new one), and also regulates endocrine, immune and neuronal functions that may have to do with the pathophysiology of development of depression.
Zinc deficiency may be caused by many things including, aging, medical illness, alcoholism, hormones, medications such as antiretroviral, anti-inflammatories, cardiovascular medications, and anti-inflammatory medications according to (Petrilli, M., et al. 2017).
Per said study, zinc plays a key role in over 300 biological processes and is required for cellular functions, DNA replication, and transcription, protein synthesis, maintenance of cell membranes, cellular transport, endocrine, immune and neuronal functions.
The study further states that dysregulation of zinc is associated with reduced immunological functioning, stunted tissue regeneration, growth retardation, gi problems, visual and other sensory disturbances. Insufficiency is also associated with neuropsychiatry manifestations of altered behavior and cognition with reduced ability to learn and, yes, depression.
Zinc is essential for all physiological systems including neuron functioning and studies are continuing to show an association between deficiency in zinc and clinical depression and psychosis.
Research has found that those who suffered from depression were more likely to show a low level of peripheral blood zinc. And this study found that zinc deficiency can influence mood leading to depression-like symptoms and that zinc supplementation may also enhance the treatment of depression as well as to have anti-depressant effects by itself, (Mlyniec, K. 2015).
Several foods are rich in zinc such as eggs, poultry, nuts, legumes, meat, fish, and seeds.
Magnesium is involved in over 300 biochemical processes in the body affecting various systems including the brain.
Read this article to see the amazing wonder that is the power of magnesium.
And according to this article, magnesium influences several neural transmission pathways associated with the development of depression leading to personality changes such as delirium, apathy, depression, agitation, and confusion. Furthermore, the article states that magnesium also improves the efficacy of conventional antidepression medications.
Apart from regulating muscle and blood sugar, magnesium also regulates DNA and nerve function, so you can imagine what happens when you are deficient.
With low magnesium you are bound to feel low and depressed if you walking around with a body that is struggling with suboptimal blood sugar, of a body, struggling to maintain functions such manufacture new cells or maintain blood pressure levels.
And what about that nerve function?
Well, you can’t sleep well for one and that is bound to influence your mood will make you depressed.
According to a 2010 study published in Pub Med, low calcium and low magnesium levels were associated with depressive mood and its progression.
There are many foods rich in magnesium including the following:
- Dark chocolate.
It is amazing to think that your gut can have an influence on your brain. Well, research shows it does. Apparently, according to this study, the bacteria in your gut does some signaling stuff to your brain.
There are some horrible things that cause inflammation called interleukin 1-B and Interleukin 1-8 -are pro-inflammatory cytokines that cause neuroinflammation and neurodegeneration. If a person does not have the right gut microbes, and a person eats too many things high in simple sugars and saturated fats, inflammatory bacteria flourish causing these bad inflammation substances mentioned here.
Amazingly, “The gut microbiota brain axis is a complex multiorgan bidirectional signaling system between the microbiota and the brain that plays a fundamental role in host physiology, homeostasis, development, and metabolism.” Wong et al, (2016).
That means the gut and the brain are involved in this two-way communication sending signals back and forth that influences behavior. So yes, your gut may call the sots sometimes.
Research is increasingly showing the role of gut microbes in modulating behavior.
So now you can blame your choices and behavior on the bacteria in your gut.
You may also want to consider the food choices you make because that determines the bacteria in your gut, and likely, your mood, behavior and other choices you make.
According to a 2016 study in Molecular Psychiatry, mice showed depressive and anxiety symptoms when their gut microbiome was altered, showing bacteria can cause one to behave in a certain way, even influence what you eat.
An article in Translation Psychiatry, published in NIH, shows there is accumulating evidence that there is a correlation between our guts and our brain health.
Per this research, ” the gut microbiota–brain axis plays a role in the pathogenesis of depression, and contributes to the antidepressant actions of certain compounds.” Chun Yang, et al (2017).
So grab some buttermilk, some kombucha, or some provider recommended probiotic. Your gut and your brain will thank you.
Omega3 Fatty Acids
While research is still on-going, mixed and not quite conclusive, it shows that in many cases omega 3 unsaturated fatty acids-when low affect the brain dopamine levels.
It is also known that N-3 fatty acids are building blocks to healthy brain development and function.
Research has shown that a number of psych disorders like Parkinson’s, schizophrenia, attention deficit disorders and to some extent depression involve dysregulation of dopamine, although it is important to note that the etiology (disease development) in these illnesses is multifactorial with both genetic and environmental factors.
Other research also shows that persons with depression are more likely to have low levels of Omega 3, and deficiency is also associated with personality and cognitive reactivity, such as high levels of hopelessness and suicidality as seen in this study.
According to research, it is thought that there is a relationship between the increased incidence of depression and a diet lacking in PUFAs.
PUFAs (polyunsaturated fatty acids) have been shown to be important in cell membrane structure, and functions, cell communication, inflammatory process, and neurotransmitters activities.
Deficiency has been shown to be associated with personality and cognitive changes, and personality reactivity with high hopelessness and suicidality.
Various research studies have shown that there is a correlation in depression incidence and low levels of N-3 fatty acids as shown in this 2018 study published in Pub Med
Foods rich in omega 3s include:
- flax seeds
Iron is essential for oxygenation and energy. It is needed in the cells, and especially in the brain. Iron carries oxygen to the cells, and oxygen is needed for synthesis of neurotransmitters and myelin.
Research shows that twice many women as men have depression with the gender differences starting in adolescence and more marked among childbearing women according to this article.
The deficiency in iron is likely implicated. Anemia causes fatigue, apathy, and depression.
A study in Bio Med Central Psychiatry published in NIH found that iron deficiency in early life increases the likelihood of psychiatric illnesses, including unipolar depression, bipolar depression, anxiety disorder, ADHD and even mental retardation.
According to the study, neuroimaging studies have found that brain development is a continuous process from infancy to late adolescence and early adulthood.
The study also states that since iron is a vital element in relation to cognition and social-emotional development and functioning, a deficiency is likely to impair proper brain development.
The study further states that children with iron deficiency anemia tended to have unipolar depression after adolescence and that iron deficiency had the immediate and chronic effect on brain development and, these children showed increased delayed development and various cognitive and emotional problems in adolescence.
This study in the Journal Of Nutrition shows that iron deficiency can affect dopamine biology and thus impaired dopamine function. Dopamine is one of the neurotransmitters needed for optimal brain function.
Here are some foods rich in Iron:
Spinach, red meat, organ meats such as liver, Mushrooms, beans, eggs, Tofu, lentils dark chocolate, oysters.
Aah, the Sunshine vitamin! If it were so simple as to just get outside and get some sunshine! But it’s not.
Due to our modern lifestyles, many cities stay indoors, some up to 24 hours a day.
Some parts of the world don’t see much sun for a good chunk of the year.
Many people these days are deficient in vitamin D.
Everyone should have their levels checked.
Deficiency in this vitamin is sometimes associated with depression.
Research is ongoing and although not quite conclusive, most point to a relationship between depression and vitamin D deficiency as in this study, which showed a relationship between bone loss and depression in postmenopausal women.
Many more studies show an association between Vitamin D levels and depression.
But the research is not quite conclusive.
A study in the PLOS journal found a strong link between vitamin D deficiency and depression.
The research study aimed to find the relationship between vitamin D, and the severity and dimensions of symptoms in patients hospitalized with depression.
And according to an article in the International Journal of Molecular Science, vitamin D deficiency is at epidemic levels worldwide with insufficiency affecting 50% of the world population and 1 billion people in the world showing a deficiency.
The insufficiency/deficiency of vitamin D raises public health concern since it has been shown to be independently associated with a higher risk of all-cause mortality.
In fact, hypovitaminosis D has long been known to increase the risk for osteoporosis and rickets, and only in the last decades it has been linked with various chronic pathological conditions, i.e., cancer, coronary heart disease (CHD), non-insulin dependent diabetes, neurological disorders, as well as autoimmune and inflammatory diseases research shows, according to this article in NIH.
So I think even if not for depression, everyone should optimize their vitamin D levels for their overall health.
Have your doctor check to see if you are deficient especially if suffering from any chronic illness, have immune health problems, or are overweight, as research is finding a correlation between vitamin D deficiency and these conditions.
If you have a deficiency, you can start taking vitamin D supplements. You need to have recommendations from your doctor first. Here are the vitamin D supplements I take as I have a chronic vitamin D deficiency.
Only recently have I heard of this one –what is it?
Anyway just get yourself some.
This is an essential mineral and it is, according to studies associated with mood improvement.
Selenium is considered a protective agent against free radicals.
According to research, in Bio Med Central published in NIH, an inverse relationship existed between selenium levels and depression.
Now you know oxidative stress is not good for the cells and therefore cannot be any good for brain cells to be oxidized.
Selenium can be found in cod, walnuts, brazil nuts, and poultry and mushrooms
In a study published in the International Journal of Neuropsychopharmacology patients with refractory mood disorders who were treated with chromium showed dramatic improvement.
Researchers attributed this to the fact that chromium improves insulin sensitivity and therefore better glucose control and also increased tryptophan availability, and increased norepinephrine release.
Chromium is found in many foods in small amounts so eat a variety of foods such as broccoli, green beans, eggs, sweet potatoes, black pepper, barley, and beef. This one can be found in almost any healthy diet.
Yes, this one is not a mineral or vitamin but I found it interesting that it had the same effect on depression as SSRIs, antidepressant medications.
This yellow exotic spice has been shown to significantly decrease depression in randomized controlled studies.
So a good reason to get cracking making that aromatic saffron rice.
A meta-analysis of several randomized controlled studies found that saffron supplementation improved depression significantly compared to placebo.
According to this study, although it was not clear the mechanism of action, saffron was thought to have a modulating effect on certain mood-enhancing brain chemicals such as serotonin.
This may be due to saffron preventing the reuptake of serotonin in neurotransmitter synapses researchers thought, thereby increasing serotonin, a mood-enhancing substance in the brain.
There is perhaps a good reason that studies are showing there is an increase in depression worldwide as people are eating a more and more unhealthy diet.
So as you can see a good healthy diet may do much more than making your body healthy.
It may help your brain function better too.
Sometimes though even in our best efforts we are not able to get enough of the nutrition we need from our foods, and supplements may be needed.
I do still encourage you to visit a farmers market and get healthy in body and brain.
Do you know of any other trace minerals, phyoto nutrients that can help improve depression? Let me know in comments.
Akbaraly, T. N., Brunner, E. J., Ferrie, J. E., Marmot, M. G., Kivimaki, M., & Singh-Manoux, A. (2009). Dietary pattern and depressive symptoms in middle age. The British Journal of Psychiatry, 195(5), 408–413. http://doi.org/10.1192/bjp.bp.108.058925
Agra Araújo D3, Flamínio Abrunhosa S4, Nunes Rocha A5, Freitas Amaral T6. UNDERNUTRITION, SERUM VITAMIN B12, FOLIC ACID AND DEPRESSIVE SYMPTOMS IN OLDER ADULTS 2015 Jul 1;32(1):354-61. doi: 10.3305/nh.2015.32.1.8880.
Caccamo, D., Ricca, S., Currò, M., & Ientile, R. (2018). Health Risks of Hypovitaminosis D: A Review of New Molecular Insights. International Journal of Molecular Sciences, 19(3), 892. http://doi.org/10.3390/ijms19030892
Chen, M.-H., Su, T.-P., Chen, Y.-S., Hsu, J.-W., Huang, K.-L., Chang, W.-H., … Bai, Y.-M. (2013). Association between psychiatric disorders and iron deficiency anemia among children and adolescents: a nationwide population-based study. BMC Psychiatry, 13, 161. http://doi.org/10.1186/1471-244X-13-161
Gao, S., Jin, Y., Unverzagt, F. W., Liang, C., Hall, K. S., Cao, J., … Hendrie, H. C. (2012). Selenium level and depressive symptoms in a rural elderly Chinese cohort. BMC Psychiatry, 12, 72. http://doi.org/10.1186/1471-244X-12-72
Hausenblas, H. A., Saha, D., Dubyak, P. J., & Anton, S. D. (2013). Saffron (Crocus sativus L.) and major depressive disorder: a meta-analysis of randomized clinical trials. Journal of Integrative Medicine, 11(6), 377–383. http://doi.org/10.3736/jintegrmed2013056
Jung, K.I., Ock, S.M., Chung, J.H. et al. Biol Trace Elem Res (2010) 133: 153. https://doi.org/10.1007/s12011-009-8421-y
Karakula H, Medical University of Lublin, The Department of Psychiatry, Poland.
Lozoff, B. (2011). Early Iron Deficiency Has Brain and Behavior Effects Consistent with Dopaminergic Dysfunction. The Journal of Nutrition, 141(4), 740S–746S. http://doi.org/10.3945/jn.110.131169
Imai CM1, Halldorsson TI, Aspelund T, Eiriksdottir G, Launer LJ, Thorsdottir I, Harris TB, Gudnason V, Brouwer IA, Gunnarsdottir I. J Nutr Health Aging. 2018;22(3):354-360. doi: 10.1007/s12603-017-0929-9.
Malcolm N. McLeod, Robert N. Golden; Chromium treatment of depression, International Journal of Neuropsychopharmacology, Volume 3, Issue 4, 1 December 2000, Pages 311–314, https://doi.org/10.1017/S146114570000208X
Młyniec, K. (2015). Zinc in the Glutamatergic Theory of Depression. Current Neuropharmacology, 13(4), 505–513. http://doi.org/10.2174/1570159X13666150115220617
Mollard, E., Bilek, L., & Waltman, N. (2018). Emerging evidence on the link between depressive symptoms and bone loss in postmenopausal women. International Journal of Women’s Health, 10, 1–9. http://doi.org/10.2147/IJWH.S147006
Patrick Holford BSc(Psych)DipION FounderoftheInstituteforOptimumNutrition,DirectoroftheMentalHealthProject, ClinicalDirectoroftheBrainBioCentre,London,UK
Pitche PT.Sante. 2005 Jul-Sep;15(3):205-8. Review. French.PMID:16207585 https://www.ncbi.nlm.nih.gov/pubmed/16207585
PLoS ONE,10(9), e0138550. http://doi.org/10.1371/journal.pone.0138550
Pourghassem Gargari, B., Saboktakin, M., Mahboob, S., & Pourafkari, N. (2012). Nutritional Status in Patients with Major Depressive Disorders: A Pilot Study in Tabriz, Iran. Health Promotion Perspectives, 2(2), 145–152. http://doi.org/10.5681/hpp.2012.017
Rao, T. S. S., Asha, M. R., Ramesh, B. N., & Rao, K. S. J. (2008). Understanding nutrition, depression, and mental illnesses. Indian Journal of Psychiatry, 50(2), 77–82. http://doi.org/10.4103/0019-5545.42391
Von Känel, R., Fardad, N., Steurer, N., Horak, N., Hindermann, E., Fischer, F., & Gessler, K. (2015). Vitamin D Deficiency and Depressive Symptomatology in Psychiatric Patients Hospitalized with a Current Depressive Episode: A Factor Analytic Study
Wong, M.-L., Inserra, A., Lewis, M. D., Mastronardi, C. A., Leong, L., Choo, J., … Licinio, J. (2016). Inflammasome signaling affects anxiety- and depressive-like behavior and gut microbiome composition. Molecular Psychiatry, 21(6), 797–805. http://doi.org/10.1038/mp.2016.46
Krista, (2005). Zinc in Depression: A Meta-Analysis. Sante.Jul-Sep;15(3):205-8. Review. French.
Pourghassem Gargari, B., Saboktakin, M., Mahboob, S., & Pourafkari, N. (2012). Nutritional Status in Patients with Major Depressive Disorders: A Pilot Study in Tabriz, Iran. Health Promotion Perspectives, 2(2), 145–152. http://doi.org/10.5681/hpp.2012.017
Rao,T. S. S., Asha, M. R., Ramesh, B. N., & Rao, K. S. J. (2008). Understanding nutrition, depression, and mental illnesses. Indian Journal of Psychiatry, 50(2), 77–82. http://doi.org/10.4103/0019-5545.42391
http://www.nimh.nih.gov U.S. Department of Health and Human Services
National Institutes of Health
NIH Publication No. TR 16-3561