Are supplements useful adjuncts in mental health treatment?

Matt Woodley

11/09/2019 4:06:42 PM

The largest ever study into mental health and nutrient supplementation has identified what can help – and what doesn’t.

Omega-3 supplements as an add-on treatment for major depression were found to reduce symptoms beyond the effects of antidepressants alone.

The international project, led by Western Sydney University’s (WSU’s) Dr Joseph Firth, examined 33 meta-analyses of randomised control trials (RCTs) and data from 10,951 people with mental health disorders.
It found that while the majority of nutritional supplements assessed did not significantly improve mental health, there is strong evidence supporting certain supplements as effective additional treatments for some mental disorders.
Integrative medicine expert Dr Vicki Kotsirilos told newsGP the study’s findings are valuable to GPs, as they provide scientific evidence to help practitioners decide which supplements may be useful as adjuncts to the treatment of patients with mental health problems.
Research has shown that if we encourage a healthier lifestyle, it can improve moods,’ she said.
‘Obviously, first-line treatment would be counselling and lifestyle advice – encouraging patients to exercise and eat well – so that they’re getting their sources of nutrients from food.
‘[But] supplements can be used as an adjunctive treatment to complement the treatment of depression, and they can also be safely used with antidepressants as well.’
According to the study, the strongest evidence relates to the use of omega-3 supplements as an add-on treatment for major depression, as they were found to reduce symptoms beyond the effects of antidepressants alone.
There was also some evidence to suggest that omega-3 supplements may have small benefits for attention deficit hyperactivity disorder (ADHD), along with emerging evidence for the amino acid N-acetylcysteine as a useful adjunctive treatment in mood disorders and schizophrenia.
Special types of folate supplements may be effective as add-on treatments for major depression and schizophrenia; however, folic acid is ineffective and there is a lack of compelling evidence supporting the use of vitamins (such as E, C, or D) and minerals (zinc and magnesium) for any mental disorder.
Given the role of nutrition in mental health is becoming more widely acknowledged, the study’s senior author, WSU researcher Professor Jerome Sarris, believes more investigation is vital.
‘Future research should aim to determine which individuals might benefit most from evidence-based supplements and to better understand the underlying mechanisms so we can adopt a targeted approach to supplement use in mental health treatment,’ Professor Sarris said.
‘The role of the gut microbiome in mental health is a rapidly emerging field of research; however, more research is needed into the role of “psychobiotics” in mental health treatment.’
Dr Kotsirilos supports the need for more research, but emphasised diet should always be the primary source of nutrients, rather than supplements.
‘When we’re sitting with our patients and they’re suffering from major depression or resistant depression, it means that we’ve now got research to support the use of nutrients – but diet must come first,’ she said.
‘There’s no point in eating junk food and taking supplements. It’s best to get your nutrients from a healthy diet and the gold standard diet for mood improvement is the Mediterranean diet.
‘If lifestyle changes haven’t impacted mood, this is where we can consider nutrients in conjunction with appropriate psychiatric management, such as cognitive behaviour therapy … [and] medication.’

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