Tuesday, March 5, 2019

Specialized Therapy, Micronutrient Supplements Fail to Prevent MDD in Overweight Patients

Nutritional supplements and/or a special kind of therapy focused on improving dietary behaviors do not appear to prevent overweight adults with mild symptoms of depression from episodes of major depressive disorder (MDD) within a year, according to a study published today in JAMA. While some studies have found that improving diet reduces depressive symptoms in adults with depression, this study examined its effects on prevention for overweight adults with mild symptoms of depression.

The type of therapy used in this study was food-related behavioral activation. Behavioral activation is a treatment whose goal is to teach people that their behavior is linked to their mood and that by changing their behavior, they can change their mood.

“This study showed that multinutrient supplements containing omega-3 PUFAs [polyunsaturated fatty acids], vitamin D, folic acid, and selenium neither reduced depressive symptoms [and] anxiety symptoms, nor improved health utility measures,” wrote Mariska Bot, Ph.D., of the Amsterdam Public Health research institute and colleagues. “In fact, they appeared to result in slightly poorer depressive and anxiety symptoms scores compared with placebo.”

The trial included 1,025 overweight adults, aged 18 to 75 years, in four western European countries (Germany, the Netherlands, Spain, and the United Kingdom) with mild depressive symptoms (Patient Health Questionnaire-9, or PHQ-9 scores ≥5). The study participants were randomly assigned to one of four groups: multinutrient supplements with food-related behavioral activation therapy; multinutrient supplements without therapy; placebo supplements with food-related behavioral activation therapy; or placebo supplements without therapy. Participants receiving supplements were assigned to take omega-3 polyunsaturated fatty acids, selenium, folic acid, vitamin D3, and calcium for one year. Those assigned to food-related behavioral activation were invited to participate in a maximum of 21 sessions (15 individual, six group) focused on improving dietary habits for one year.

Bot and colleagues followed the participants in the trial for 12 months to evaluate symptoms of depression, anxiety, and more.

In total, 105 participants (10%) developed an MDD episode during the 12-month follow-up: 25 participants (9.7%) had received placebo alone; 26 (10.2%), placebo with therapy; 32 (12.5%), supplements alone; and 22 (8.6%), supplements combined with therapy. Neither of the interventions nor the combination of the two had an effect on decreasing the participants’ likelihood of developing an MDD episode in the following 12 months.

“Despite the large sample size and selection of people with elevated depressive symptoms, the onset of MDD was lower than expected, which reduced the statistical power to detect a statistically significant effect,” Bot and colleagues wrote. Nonetheless, the authors concluded, “These findings do not support the use of these interventions for prevention of major depressive disorder in this population.”

For additional information, see the American Journal of Psychiatry article “Adjunctive Nutraceuticals for Depression: A Systematic Review andMeta-Analyses.”

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