SUMMARY
Depression is a mood disorder that develops after hereditary, environmental or hormonal disorders. The basis of depression is the reluctance and inability to enjoy life in daily activities that were previously performed voluntarily and fondly. In the treatment of depression, it is important to apply personalized nutrition therapy that supports these treatments, as well as psychotherapy and medication. Situations such as appetite changes and related body weight changes, constipation, dehydration and changes in serum vitamin levels observed in the clinical picture of depressed individuals are among the important points to be considered in the nutritional treatment of the individual. In these patients, particular attention should be paid to omega-3, vitamin B-12, magnesium and folate intake. Foods that affect the levels of the serotonin hormone, which is closely related to depression, are also important for the person. While preparing the nutrition program, foods that trigger and positively affect depression should be carefully considered. In addition, some changes can be made in the individual's daily nutrition program depending on the side effects of the antidepressant drugs used. Special nutrition programs are applied to depressed individuals, especially those treated with monoamine oxidase inhibitor (MAOI) derivatives. MAOI-derived drugs increase the effects of simple phenylethylamines (tyramine and dopamine) and cause many side effects such as hypertension. Foods rich in tyramine should be excluded from the nutrition programs of these individuals. This review article on depression and nutrition treatment will discuss the relationship between depression and nutrients and the nutritional programs that should be implemented.
Keywords:depression, nutrition, mood disorders
ABSTRACT
Depression is the emotional state that develops after hereditary, environmental or hormonal disturbances. On the basis of depression, there is reluctance to enjoy everyday activities that you have been willing and loving before and you can not enjoy life. Depression is a common disease, but the promising side is that it can be treated. Besides psychotherapy and drug treatment in the treatment of depression, it is also important to apply the special nutritional therapy that supports these treatments. Ch. Anges in appetite in the clinical table of depressed individuals and related body weight changes, constipation, dehydration, changes in serum vitamin levels are important points in the nutritional treatment of the individual. Especially the amount of omega-3, vitamin B-12, magnesium, folate should be taken into consideration in these patients. Nutrients that affect serotonin hormone levels, which are closely related to depression, are also important for the individual. When preparing a nutritional program, the nutrients that trigger the depressive condition and affect it positively must be carefully considered. Depending on the side effects of the antidepressant drugs used, some changes can also be made in the individual's daily nutritional program. Special nutritional programs are also applied to depressed individuals who are treated with drugs with monoamine oxidase inhibitor (MAOI) derivatives. MAOI derivative drugs increase the effect of simple phenylethylamines (thyramines and dopamine) and cause many side effects such as hypertension. Nutrients that are rich in thyramines should be removed from these individuals' nutrition programs. This review article on depression and nutritional therapy will discuss the relationship between depression and nutrients and the nutritional programs that should be applied.
Keywords: depression, nutrition, disorder disabilities
INTRODUCTION
Human beings are living things in nature. It is a being with the most intense and lively emotional reactions and the ability to experience it in many different ways. The affective state in which a person remains relatively constant for a certain period of time is called mood. This emotional state is not immutable. It may fluctuate depending on different factors in a person's life. However, in cases where these fluctuations sometimes reach extreme levels and continue for a long time, the person now has an "affective disorder" (1).
Depression, one of the affective disorders, includes helplessness, decreased self-esteem, pessimism, and self-contempt. feelings of guilt, thoughts of death and suicide, memory, attention and concentration disorders, lack of energy, fatigue, appetite changes, weight loss (rarely weight gain), sleep disorders, sexual interest and activity. e decrease, constipation, social sense; It is a syndrome that includes symptoms such as withdrawal from society and loss of interest in social-professional functions. In the pathophysiology of depression, a decrease in NE, (norepinephrine), DA (dopamine) and 5HT2 (serotonin) levels and an increase in mania (overactivity) are generally mentioned (2). Depressive disorders are generally classified as major depressive disorder, dysthymic disorder and depressive disorders not otherwise specified (DTA) (3).
Nutrition; It is the consumption of nutrients for growth and development, maintenance of life, protection and improvement of health. Healthy eating; It is the provision of all the nutrients needed by the individual in sufficient quantities, taking into account his/her age, gender and physiological state (4). One of the most important factors affecting nutrition is the changes in emotional states. Among these mood changes, the most common change in food orientation in the case of depression shows that there is a serious relationship between the two.
The Role of Nutrition in the Etiology of Depression
strong>There are many notable views on the role of nutrition in the etiology of mood disorders. However, since very few of these ideas can work on humans, the mechanisms of most of them are not fully understood (5). Adequate nutrition is required for the continuity of brain functions. Poor diet quality may be a risk factor for depression (6).
The level of serotonin 5-hydroxytryptamine (5-HT) in the brain has an effect on mood and decreases in serotonin levels may cause depression in some cases. It is known to contribute to the etiology of depression in individuals. The use of low doses of 5-HT or drugs that increase the release of this neurotransmitter reduces carbohydrate intake more than protein and fat. After consuming a carbohydrate-rich meal, blood glucose, insulin, leptin and corticosterone levels increase, and 5-HT release in the medial hypothalamus also increases. This increase in 5-HT level suppresses carbohydrate intake with a negative feedback mechanism (7).
Leptin is secreted mainly from white and brown adipose tissue cells. It is a hormone that regulates food intake and energy consumption by transferring information about the amount of body fat to the hypothalamus (8). It is known that leptin exerts its effects on mood through corticotropin-releasing hormone and neuropeptide Y. In prospective studies conducted on this subject, a group of bipolar depressive disorder patients were evaluated for leptin, triglyceride, total cholesterol, low-density lipoprotein-cholesterol (LDL-C) and high-density lipoprotein-cholesterol (HDL-C) levels in the authymic period after 30 days of treatment. The results found that leptin reduces intracellular lipid concentration by decreasing fatty acid and triglyceride synthesis and increasing fat oxidation, and this situation causes low cholesterol levels and is closely related to depression (9).
>Another hormone thought to be closely related to mood disorders is neuropeptide Y, which is responsible for functions such as nutrition and stress responses. It has been found that individuals with low NPY plasma levels or low NPY expression have reduced stress resilience and increased susceptibility to stress-related disorders (10). Although many opinions have been put forward regarding the relationship between NPY and psychiatric diseases, debates continue.
To date, Studies have shown that low plasma and erythrocyte folate levels, a folate-poor diet and high serum homocysteine levels increase the risk of Alzheimer's, Parkinson's, bipolar disorders and depression. Folate is also used in the synthesis of methionine and S-adenosyl methionine (SAM). Due to the known antidepressant properties of SAM, it can be said that the underlying reason for the relationship between folate deficiency and depression is low cellular SAM concentration and inhibition of the SAM-dependent methylation reaction in the central nervous system (11). Folate deficiency reduces the individual's response to antidepressants.
B12 (cobalamin), like folate, is a vitamin thought to be closely related to depression. The incidence of low serum cobalamin (vitamin B12) concentration is quite common in patients with depression. The relationship between vitamin B12 and depression is the direct effects of these vitamins on monoamine metabolism in the central nervous system. It is explained with. Low vitamin B12 levels lead to hyperhomocysteinemia, which is associated with neuropsychiatric disorders such as Alzheimer's disease. For this reason, it is thought that hyperhomocysteinemia may cause or aggravate depression (12). In studies on the effect of folate and vitamin B12 on the etiology of depression, the effect of lithium on these vitamins was investigated. It has been reported that lithium prophylaxis does not affect serum or erythrocyte folic acid levels and causes a decrease in vitamin B12 levels. However, most studies on this subject have reported that long-term lithium use may reduce folic acid levels and that folic acid supplementation would be beneficial to increase the therapeutic effectiveness of lithium (13).
N-3 fatty acids are important in the etiology of depression. It is thought to play a very important role. If the diet is insufficient in terms of n-3 fatty acids, it increases the risk of depression. n-3 fatty acids, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) are important for brain development and functions (14). Studies have shown that in countries where omega-3 fatty acids are inadequately consumed, such as New Zealand, Canada and Germany, the depression rate is 5%. In places where omega-3 fatty acids are consumed adequately, such as Taiwan and Japan, this rate was found to be 1% (15). Research has focused especially on fish, which is a food with high content of omega fatty acids, EPA and DHA. According to the results, the risk of children suffering from Alzheimer's, dyslexia and depressive diseases in later ages was found to be higher than normal, especially as a result of insufficient consumption during pregnancy. In another study on this subject, the amounts of fatty acids in the red blood cell membrane of non-depressed individuals were examined. The dietary intake of polyunsaturated fatty acids in 10 depressed individuals and 14 healthy individuals participating in the study was also calculated. In conclusion; It has been observed that depressed patients have significantly lower levels of n-3 fatty acids in their red blood cell membranes than in non-depressed individuals, regardless of their reduced energy intake. There is a negative relationship between the degree of depression and the amount of n-3 fatty acids in the red blood cell membrane and dietary intake.
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