Stress Management: Feeding the Brain
Our society is overburdened with stressors of all kinds: tense work places, long commutes, family/relationship troubles, financial difficulties, too much caffeine, too little sleep, and not enough leisure time. The offshoot of chronic stress results in depression, anxiety, and insomnia. While we ought to change our stressful situations as much as possible and work on our coping methods, we need to optimize our physical health status to help our bodies manage the effects of chronic stress. Providing the body with key nutrients that have been shown to improve neurological and mental function goes a long way in helping manage ongoing stress. This article will discuss the effects of vitamin D, fish oil, B vitamins, and lavender on mental health.
Vitamin D is a steroid hormone with activity in the brain, and is called a “neurosteroid” by some. The vitamin D receptor (VDR) is widely distributed throughout the human brain, including the limbic system and prefrontal cortex, which are involved in regulation of mood and affect. One of the mechanisms of depression is thought to involve inflammatory processes in the brain and, interestingly, vitamin D is also known to have anti-inflammatory effects. Animal studies suggest that vitamin D may have a role in the production or maintenance of dopamine and serotonin levels in the brain. Finally, vitamin D has also been shown to influence the hypothalamic-pituitary-adrenal (HPA) axis, which is the primary system responsible for adaptation to stress. Although the role of vitamin D on adrenal function is not well-known, one study found that prenatal vitamin D deficiency leads to an increase in maternal corticosterone hormone.
Clinical trials indicate that vitamin D supplementation is effective in treating depression and anxiety. A 2016 study of 158 girls with PMS‑related mood symptoms and vitamin D deficiency found that a supplementation of this vitamin was associated with significantly decreased anxiety score and irritability score, as well as with a decrease in symptoms of crying easily and sadness. Another randomized study in 40 patients with major depressive disorder (MDD) found that vitamin D supplementation (50 000 IU per week for eight weeks) improved symptoms of depression on the Beck Depression Inventory (BDI), compared to placebo.
Another study evaluated the effect of vitamin D when added to the antidepressant fluoxetine. A total of 42 patients with a diagnosis of major depressive disorder were randomized to receive daily either 1500 IU vitamin D3 plus 20 mg fluoxetine, or fluoxetine alone, for eight weeks. Researchers found that depression severity decreased significantly after intervention, with the vitamin D–plus-fluoxetine combination being significantly better than fluoxetine alone from the fourth week of treatment.
Fish-derived omega-3 fatty acids include eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). EPA exerts well-documented anti-inflammatory effects: It competitively inhibits the production of proinflammatory cytokines such as prostaglandin E2 (PGE2) from arachidonic acid (AA), and leads to the production of anti-inflammatory cytokines by the cyclooxygenase (COX) enzymes. EPA may also influence cell signaling and neurotransmitter production in the brain. It has also been shown to lower cortisol levels in patients with major depression, equally to antidepressants (fluoxetine).
An extensive body of research indicates that EPA exerts powerful antidepressant and mood-stabilizing effects. Data from many randomized trials and several meta-analyses show that EPA improves mood in patients with depression and bipolar disorder, as well as in patients with depressive symptoms but not necessarily meeting the criteria for major depression. Notably, a meta-analysis by Sublette et al found that supplements with EPA content greater than or equal to 60% showed benefit on standardized mean depression scores, with an effect size of approximately 50%, while supplements with less EPA were ineffective.
EPA has also been shown to improve the effectiveness of antidepressants. In one study, 42 subjects were randomized to receive 1800 mg EPA and 400 mg DHA in addition to citalopram (antidepressant), compared to citalopram. After nine weeks, patients receiving both citalopram plus EPA demonstrated significantly greater improvement in Hamilton Depression Rating scale scores over time, starting at four weeks.
Another study examined the effects of EPA alone (1000 mg), fluoxetine alone (20 mg), or both combined for eight weeks on patients with major depression. This study showed that EPA alone and fluoxetine alone were equally effective in managing the symptoms of depression; however, their combination resulted in the best improvement. The EPA-plus-fluoxetine combination was significantly better than fluoxetine or EPA alone from the fourth week of treatment. Response rates, defined as a 50% or greater decrease in baseline depression score, were 50%, 56%, and 81% in the fluoxetine, EPA, and combination groups, respectively.
The family of B vitamins is important in the synthesis and metabolism of neurotransmitters and hormones such as estrogen. In addition, according to the homocysteine hypothesis of depression, elevations of the molecule homocysteine are implicated in the pathogenesis of depression.
Homocysteine is an intermediate metabolite of methionine metabolism circulating in the bloodstream. If there are adequate levels of folate, vitamin B6, and vitamin B12 available, homocysteine is metabolized to cysteine, a harmless end-product. In the event of a deficiency of these compounds, homocysteine accumulates in the bloodstream and has been associated with increased risk of stroke and, hypothetically, depression.
One study evaluated supplementation with one capsule of activated B vitamins among 330 patients with genetic polymorphisms of folic-acid metabolism and major depressive disorder (MDD). After eight weeks, 82.4% of patients showed a mean 25% reduction in homocysteine, while on average patients receiving placebo showed a small elevation in homocysteine. Patients receiving B vitamins also showed an average 12-point reduction in depression symptoms by week eight, while 42% achieved full remission.
Numerous studies show that supplementation with various B vitamins—including thiamin, folic acid, and vitamin B12—improve symptoms in patients with depression and in patients on antidepressant medications and not.
Finally, although not a nutrient, lavender is an herbal medicine with a high level of scientific evidence supporting its effectiveness in the treatment of anxiety and comorbid depression. In Germany, an oral lavender preparation is approved for the treatment of anxiety. Studies show that it is equal to common anxiolytic medications such as paroxetine (Paxil) and lorazepam (Ativan) in the treatment of anxiety.
In a study of 318 adults with mixed anxiety and depressive disorder (MADD) and at least moderately severe anxious and depressed mood, treatment with 80 mg of lavender daily for 70 days improved symptoms significantly better than placebo. Patients taking lavender also showed more pronounced improvements of impaired daily-living skills and health-related quality of life. A similar study found improvements in sleep quality and anxiety ratings among patients with restlessness, insomnia, and anxiety.
Natural health products have a role in supporting mood and stress management. Agents such as vitamin D, B vitamins, eicosapentaenoic acid, and lavender help provide fuel for optimal brain function, and show few side effects in comparison with some of the commonly available prescription medications.
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