Low-carbohydrate diet as a nutritional intervention in a major depression disorder: focus on relapse prevention

ABSTRACT

Objectives: Mood disorders are trending to be among the leading causes of years lived with disability. Despite multiple treatment options, around 30% patients with major depressive disorder (MDD) develop treatment resistant depression (TRD) and fail to respond to current pharmacological therapies. This study aimed to explore the potential benefits of nutritional treatment strategies, along with their molecular mechanisms of action, focusing especially on low-carbohydrate diet (LCHD), ketogenic diet (KD) and other strategies based on carbohydrates intake reduction.

Methods: A comprehensive literature review was conducted to determine the impact of LCHD on alleviating depressive symptoms in patients with MDD, along with an explanation of its mode of action.

Results: The study revealed significant impact of nutritional interventions based on restriction in carbohydrate intake such as LCHD, KD or sugar-sweetened beverages (SSB) exclusion on anxiety or depression symptoms reduction, mood improvement and lower risk of cognitive impairment or depression. The efficacy of these approaches is further substantiated by their underlying molecular mechanisms, mainly brain-derived neurotrophic factor (BDNF) which is a potential key target of sugar restriction diets in terms of neuroplasticity.

Discussion: Healthcare professionals may consider implementing LCHD strategies for MDD and TRD patients to modify the disease process, maintain euthymia, and prevent depressive episode relapses. Ranging from the exclusion of SSB to the adherence to rigorous LCHD regimens, these nutritional approaches are safe, straightforward to implement, and may confer benefits for well-being and relapse prevention in this specific patient population.

KEYWORDS:

• Depression
• low-carbohydrate diet
• ketogenic diet
• relapse prevention
• BDNF
• neuroplasticity
• nutritional psychiatry
• MDD

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

Data sharing is not applicable to this article as no new data were created or analysed in this study.

Additional information

Funding

Wiesław Jerzy Cubała declares grants from Acadia, Alkermes, Allergan, Angelini, Auspex Pharmaceuticals, BMS, Celon, Cephalon, Cortexyme, Ferrier, Forest Laboratories, GedeonRichter, GWPharmaceuticals, HMNC Brain Health, IntraCellular Therapies, Janssen, KCR, Lilly, Lundbeck, Minerva, MSD, NIH, Novartis, Orion, Otsuka, Sanofi, Servier and honoraria from Adamed, Angelini, AstraZeneca, BMS, Celon, GSK, Janssen, KRKA, Lekam, Lundbeck, Minerva, NeuroCog, Novartis, Orion, Pfizer, Polfa Tarchomin, Sanofi, Servier, Zentiva.

Notes on contributors

Michał Walaszek

Michał Walaszek is a fifth-year medical student at the Medical University of Gdańsk (MUG). He is also an active member of the Psychiatry Student Scientific Circle and the Child and Adolescent Psychiatry Student Scientific Circle.

Zofia Kachlik

Zosia Kachlik is a sixth-year medical student at MUG. She is also a leader of the Child and Adolescent Psychiatry Student Scientific Circle.

Wiesław Jerzy Cubała

Wiesław Jerzy Cubała is the head of the department of psychiatry at the Medical University of Gdansk, Poland. His research interests focus on the psychopharmacology of mood and anxiety disorders with a particular interest in ketamine and other rapid-acting antidepressants use in mood disorders. Prof. Cubała is focussed on the study of ketamine use in treatment-resistant and treatment-refractory major depression, as well as clozapine use in treatment-resistant bipolar depression with a particular focus on suicidality and the rapid-cycling specifiers. Prof. Cubała is involved in training initiatives in postgraduate education in psychiatry and cognitive–behavioural therapy, including the development of the treatment guidelines for mood and anxiety disorders for psychiatrists and general practitioners. He is devoted to teaching both the clinical and research aspects of psychopharmacology.