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9 Nutrients To Consider When Taking Antidepressants

28/11/2023

It's tempting to believe that depression is all about a lack of connection.
Or trauma.
Or inflammation.

(If you're an integrative health practitioner like me, inflammation seems to be the scapegoat for everything these days!)

But depression isn't about any one of these things. Depression is the final common pathway of many biological, psychological, interpersonal and social problems.

Not all depression is the same. There are many different types of depression, many causes of depression, and many reasons why someone might decide to start taking antidepressants.

And many of us have decided to support ourselves this way. With 1 in 8 Australians on antidepressants, these medications continue to be prescribed at an increasing rate, especially among young people (1). In 2018, over 3 million Australians were prescribed an antidepressant, mainly Selective Serotonin Reuptake Inhibitors (SSRIs) for depression or anxiety (2).

As a dietitian and naturopath I work with many clients who have taken these medications for years, yet unfortunately have no idea that the chronic use of certain antidepressants can induce subclinical and clinical micronutrient deficiencies.

Over time (months to years), these deficiencies can cause additional symptoms and increase the side effects of the medication.

What are these side effects? In a 2016 study of 180 long-term users of antidepressants (3–15 years of use), common side effects included:

withdrawal effects (73.5%)
sexual problems (71.8%)
weight gain (65.3%)
feeling emotionally numb (64.5%)
feeling addicted (43%)
feeling moderate-to-severe depression despite being on antidepressants (30%) (3).

To some extent, in some individuals, these side effects will be driven by nutrient deficiencies.

There are two ways that certain vital nutrients and antidepressant medications can form a vicious cycle of deficiency:

1. Nutrient deficiencies can drive depression and anxiety

Interestingly, nutrient deficiencies can be one of the causes of depression and anxiety, two of the most common symptoms these medications are prescribed to treat.

Being deficient in vitamin D, B vitamins (such as B2, B12 and folate) and calcium can make you more prone to depression and anxiety (4). Inadequate levels of these simple, powerful nutrients can be a huge driving factor behind a person's mood disorder. This is why anyone presenting to their health care practitioner with these issues should really be assessed for nutritional deficiencies.

Unfortunately, a thorough nutritional assessment does not always happen.

To add insult to injury, having preexisting low stores of some nutrients (e.g. folate) drastically reduces the efficacy of antidepressants like SSRIs. Nutrient deficiencies can increase the time taken to respond to medication, decrease overall response rate, and increase relapse rate.

2. Antidepressants can further deplete nutrient stores

Antidepressant medications can then further deplete certain vitamins, minerals and hormones from your body. This can lead to more symptoms down the road, such as a return of the depression plus additional side effects like increased anxiety, struggle with focus, and feeling detached emotionally.

Before you accuse me of being a big pharma hating hippie, this article is not a vendetta against these medications. Au contraire. Time and time again I've seen these medications save lives and bring people back from a very deep, dark abyss without which they would have struggled immensely - or simply not made it out.

This article is not a plea for my many wonderful clients and loved ones taking these medications to discontinue their antidepressants. Not only is this out of my scope, but it's a decision that can only be instigated by the person taking the medication and the practitioner (a GP or psychiatrist) who prescribes their medication.

Antidepressant medications have a place and serve an extremely important purpose. I have no doubt about that.

And before any of you hippies accuse me of being a big pharma shill*, I fully support those clients who decide they're dissatisfied with the side effects of antidepressants and wish to reduce their dose or wean off them entirely.

The purpose of this article is to help those taking antidepressants

to be aware of the potential nutrient deficiencies that can initiate depression and/or come with long term use, and
to know how to detect, prevent and mitigate these deficiencies in the case that you want or need to keep taking your medication.

Knowledge is power, and in knowing more about this topic you can:

improve the efficacy and safety of your antidepressant medication/s
reduce the dose of antidepressants you require for mood stabilisation (always under the supervision of your GP)
if you choose to, work collaboratively with your GP, psychiatrist and/or nutrition professional (e.g. dietitian, naturopath, nutritionist) to slowly wean off of antidepressants with minimal withdrawal symptoms.

If any of that sounds good to you, or you're a health practitioner who wishes to support those of your clients who are taking antidepressants, I invite you to read on!

Foundations of eating for mental health

7/11/2023

Did you know that depression and anxiety are the most common mental health conditions worldwide? Perhaps. But even if you don't have an official diagnosis, subclinical symptoms of depression and anxiety also heavily impact the wellbeing and functioning of many people (1). If this is you, read on.

We know there's a huge connection between how you eat and your mental health, with studies showing that dietary improvement is one of the most effective and accessible treatment strategies for managing depression (2). Wild-caught salmon, matcha, blackberries, cacao, probiotic foods, and turmeric are the mental health superfoods du jour. And "cutting out sugar and anything processed!" is a catch cry in the wellness worlds I inhabit.

But the thing is, SO many people I see in clinic are under eating or cutting out foods unnecessarily. It's this that's leaving them in a worse state of mental health, rather than not eating aaaallll the superfoods.

When it comes to mood support, rather than ask yourself, "What should I be taking away?", consider, "What can I add to my diet?"

Here are the four big basics of eating to support mental health that need to be in place before things like matcha and curcumin can actually be of benefit:

1. Regular eating

Your brain needs fuel every few hours to keep it functioning and to keep your mood at an even keel throughout your day. Eating breakfast and eating every 3-5 hours after that are super important.

For some people, skipping meals temporarily provides a surge of energy and sharper focus. This "energy boost" is really just the up-regulation of stress hormones (adrenaline and cortisol) by your body in response to perceived famine. Your body is screaming at you to go and find food, and the energy and hyper-focus that follows prolonged fasting are meant to help you to go hunting and/or foraging so that you can feed your body! Not to push a little harder at work or in the gym. Besides the stress hormone injection, the effects of an irregular dietary pattern on glycaemia (blood glucose regulation), immune activation, and the gut microbiome likely disrupt mood (2).

So whether I'm working with a client in recovery from a severe eating disorder, or with someone who skips breakfast and is experiencing mood crashes later in the day, addressing meal regularity is usually the first place I start.

2. Adequate dietary fat

Fat can be scary for many of my clients, but eating what's considered a low-fat diet (less than 45g of fat each day) can worsen your mental health. We need at least 65g of fat daily, from sources like olive oil, butter, avocados, and nut butters. To achieve this, aim to include a source of added fat at least twice a day. Luckily, fat is naturally found in many foods that also contain proteins or carbohydrates, for example dairy products. Fat maintains the cell structure of the brain's communication network, so we need it for brain function!

3. Adequate carbohydrates

The scapegoat macro of the day! Your brain can't store glucose so it needs a constant supply. The type of carbohydrates youn get from grains, starchy vegetables, legumes, fruit, and dairy supply glucose which can be used right away for energy by your brain, muscles, and nervous system.

Low-carb intake contributes to brain fog, depression, fatigue, crappy sleep, and muscle breakdown. I see inadvertent carb-phobia in so many of my female clients (especially physically active women and newly postpartum mums), it's almost surprising when someone is eating enough low GI, slow-burning carbohydrate! For best functioning, your body needs ~50% of your daily intake as carbs. I know, I know... that's a lot more than your average paleo or keto coach suggests. But it's what I've seen work best in female clients, especially busy, active, pre-menopausal women. Do your body, brain and moods a favour and carb up.

4. Adequate protein

Protein is made up of amino acids = the building blocks of neurotransmitters, the chemicals that allow your cells to communicate messages about sleep, appetite, and mood. Beans and legumes, nuts and seeds, meat and poultry, fish, eggs, and dairy products are all great sources!

Protein should be between 15-20% of your total daily intake. I frequently see clients consuming well over this, sometimes eating two or three times their actual requirements! When you're eating this much protein, it is likely to be displacing carbohydrate and fat in the diet. Because it's been near-eroticised in fitness culture protein is the sexy macro, and many of my clients have a "more is better" attitude - often at the detriment of their sleep, mood and - ironically - performance in the gym. My challenge to these folks is to up their carbs and fat and watch their mental health improve!

Once these fundamental pieces of the puzzle are in place, then sure let's get excited about wild-caught salmon, probiotics, and turmeric! But unless we're already eating regular meals with adequate calories and macronutrients, adding superfoods to improve your mental health symptoms is a mere drop of matcha tea in the ocean.

Benefits of adequate eating for mental health

As a naturopath and dietitian I have seen, time and time again, the incredible power of nutrition and herbal medicine in helping clients to:

Alleviate anxiety
Reduce severity of depressive episodes
Improve sleep
Support more stable moods
Recover from eating disorders
Reduce the risk of nutrient and antioxidant deficiencies when taking mood-altering medications like SSRIs and anti-psychotics
Improve focus and reduce limiting behaviours (including in ADHD and other forms of neurodivergence)
Replete nutrients in alcohol and drug addiction recovery
Support mental health during hormonal transitions such as PMS, postpartum and peri-menopause

If you're looking for guidance on how to support your mental health, I'm offering 20% off all naturopathic appointments for the rest of 2023, limited spaces available (limited because I'm a busy mum and need to look after my own mental health too!)

Here's to calm, stable moods and a well-nourished brain!
Casey

References

Johnson, J., Weissman, M. M., & Klerman, G. L. (1992). Service utilization and social morbidity associated with depressive symptoms in the community. JAMA, 267(11), 1478–1483.
Jacka, F. N., O'Neil, A., Opie, R., Itsiopoulos, C., Cotton, S., Mohebbi, M., Castle, D., Dash, S., Mihalopoulos, C., Chatterton, M. L., Brazionis, L., Dean, O. M., Hodge, A. M., & Berk, M. (2017). A randomised controlled trial of dietary improvement for adults with major depression (the 'SMILES' trial). BMC medicine, 15(1), 23. https://doi.org/10.1186/s12916-017-0791-y

Casey's blog

9 Nutrients To Consider When Taking Antidepressants

Foundations of eating for mental health

1. Regular eating

2. Adequate dietary fat

3. Adequate carbohydrates

4. Adequate protein

Benefits of adequate eating for mental health

References

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