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Diet versus antidepressants in studies
What triggers depression
Depression and anxiety have many causes. Genetics plays a strong role, but the tendency needs an environmental trigger. A poor state of gut health and a very bad diet could be that trigger, since the gut then lacks the chemicals that keep a person from tipping over into it.
A growing epidemic
Part of the epidemic of anxiety and depression comes from having few good gut microbes to start with, plus junk food diets that make it worse. Once someone is depressed, food stops being a priority and becomes just fuel, a cycle that feeds on itself.
Why drugs fail
Antidepressants often don't work well, which probably relates to individual differences in microbes, because the microbes break the tablet down into its active chemicals. Feeding the gut is one of the best examples of food improving mood.
How did diet compare with depression therapy in trials?
In the SMILES trial, published in BMC Medicine in 2017, Felice Jacka and colleagues at Deakin University randomized 67 adults with moderate to severe depression to either 12 weeks of dietary support based on a Mediterranean pattern or 12 weeks of social support. The diet group improved more on depression scores. About a third of the diet group reached remission, compared with 8 percent of the social-support group.
How do gut microbes break down medications?
In a 2019 paper in Nature, Michael Zimmermann and colleagues at the European Molecular Biology Laboratory tested 271 oral drugs against 76 gut bacterial strains. About two thirds of the drugs were chemically altered by at least one strain. An earlier study in Science by Henry Haiser showed that the gut bacterium Eggerthella lenta inactivates the heart drug digoxin.
Why do antidepressants work for only some people?
The STAR*D trial, run by the US National Institute of Mental Health, followed thousands of patients and reported in 2006 that about a third reached remission on the first antidepressant tried. Many needed a second or third medication. The trial gave no way to predict beforehand which drug would work for whom.
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