Recovery from (treatment-resistant) depression after lifestyle changes and micronutrient precision supplementation: a preliminary field study in patients – BMC Psychology

Overview and Process

In this field study conducted in Austria, we measured a subset of common monoamine biosynthesis and nervous system cofactors in 17 adults. The participants included 11 patients with depression and 6 healthy volunteers. The study recruited both healthy volunteers and volunteers with depression through a single posting on Facebook. Interested individuals messaged privately to declare their interest. To participate in the study, individuals had to be at least 18 years old and participants with depression had to have a diagnosis of depression without any other psychiatric conditions. Participants were provided with complete information about the study process, conditions, and data protection protocol to ensure transparency and informed consent. The study used participant names only in the data protection declaration, while all other documents were labeled with a case number. Participants provided written consent by signing the data protection declaration and agreeing to the study conditions. Participant names were not entered into any database or digital files. Questionnaires were sent out as PDFs and returned by mail or email using the assigned case number. All study recommendations were confirmed with the participants’ treating physicians to ensure their safety and well-being. A total of 17 participants successfully completed the entire study process and were included in the final analysis.

Hypotheses

• Patients with depression are more likely to show micronutrient deficiencies than healthy controls.
• Precision supplementation improves patients’ symptoms.
• Adopting a set of healthy lifestyle habits supports relief or recovery.

Parameter Selection for the Serum Laboratory Test

In this field study, we tested a limited number of parameters related to depression in serum laboratory tests. The parameters tested included:

• Micronutrient deficiencies or insufficiencies
• Vitamin B9 (folate)
• Cobalamin (vitamin B12)
• Vitamin C (ascorbic acid)
• Vitamin D (ergocalciferol, cholecalciferol)
• Endocrine function (DHEA-S)
• Other tests (standard blood count)

Micronutrient Deficiencies or Insufficiencies

For this field study, a limited number of micronutrients were tested. The micronutrients considered for testing were selected based on their known or researched involvement in neuromodulator metabolism or comorbidities linked to depression. The blood tests were analyzed in licensed public laboratories in Austria. The micronutrients tested included:

• Vitamin B9 (folate)
• Cobalamin (vitamin B12)
• Vitamin C (ascorbic acid)
• Vitamin D (ergocalciferol, cholecalciferol)

Vitamin B9 (Folate)

Vitamin B9 (folate) is required for DNA synthesis, repair, and methylation. Folate deficiency can result in anemia, irritability, and behavioral disorders. Although the connection between folate status and depression is still considered unclear, folate deficiency has been reported in depression. Folate is a cofactor in the biosynthesis of serotonin, norepinephrine, and dopamine. Vitamin B12 is also considered due to its codependency with folate. Reference ranges used in the study for folate were 3.9-19.8 mg/L.

Cobalamin (Vitamin B12)

Cobalamin (vitamin B12) is essential for neurological function, red blood cell formation, and DNA synthesis. Deficiency of cobalamin can cause damage to peripheral nerves and lead to conditions such as psychosis and severe depression. Cobalamin is also involved in homocysteine metabolism and is considered a biomarker for cardiovascular disease and neurodegenerative diseases. Reference ranges used in the study for vitamin B12 were 156-672 pmol/L.

Vitamin C (Ascorbic Acid)

Vitamin C is essential for the biosynthesis of dopamine, adrenaline, serotonin, and melatonin. It plays a role in maintaining iron in its reduced form and is associated with depression, anxiety, schizophrenia, and neurodegenerative diseases. Reference ranges used in the study for total vitamin C in plasma were 4-15 mg/L.

Vitamin D (Ergocalciferol, Cholecalciferol)

Vitamin D deficiency is common and has been linked to depression. It regulates the synthesis of levodopa and acts as a cofactor in serotonin biosynthesis. Reference ranges used in the study for 25-hydroxy vitamin D were 20-120 mg/L (50-300 nmol/L).

Endocrine Function

Endocrine system disorders, particularly related to glucocorticoids and steroid hormones, have been identified as possible contributors to depression. In this study, DHEA-S (dehydroepiandrosterone sulfate) in serum was selected for laboratory testing as an indicator of stress and overall availability of neuroactive steroids. Reference ranges used in the study for DHEA-S were 110-510 μg/dl for men and 15-325 μg/dl for women.

Other Tests

In addition to the specific parameters related to depression, a standard blood count was performed to cross-check and validate the information provided in the questionnaires. Specific diagnostic tests for pre-existing comorbidities were not conducted in this study. Participants were asked to provide information about their existing diagnoses as established by their treating physicians.

Questionnaire based on the DASS-21

The DASS-21 (Depression Anxiety Stress Scales with 21 items) is a set of three scales used to measure the emotional states of depression, anxiety, and stress. The questionnaire consists of seven items for each scale and focuses on the core psychological aspects of these emotional states. The DASS-21 was used in this study to generate quantitative data and classify participants based on their symptoms.

DASS-21 Questionnaire

Participants were asked to read each statement and circle a number (0, 1, 2, or 3) indicating how much the statement applied to them over the past week. The standard rating scale ranged from 0 (did not apply at all) to 3 (applied very much or most of the time). The questionnaire included statements related to various symptoms of depression, anxiety, and stress.

Additional Questions in Questionnaire 1

The first questionnaire included additional questions about participants’ living conditions, working conditions, existing diagnoses, medication, known triggers of depression, allergies, and current lifestyle. Participants were asked to provide information about their treatment, medications/supplements, allergies/intolerances, current well-being, duration

SDGs, Targets, and Indicators

Analysis

1. Which SDGs are addressed or connected to the issues highlighted in the article?

• SDG 3: Good Health and Well-being
• SDG 2: Zero Hunger
• SDG 10: Reduced Inequalities

2. What specific targets under those SDGs can be identified based on the article’s content?

• Target 3.4: By 2030, reduce by one-third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being.
• Target 2.1: By 2030, end hunger and ensure access by all people, in particular the poor and people in vulnerable situations, including infants, to safe, nutritious, and sufficient food all year round.
• Target 10.2: By 2030, empower and promote the social, economic, and political inclusion of all, irrespective of age, sex, disability, race, ethnicity, origin, religion or economic or other status.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

• Indicator: Measurement of micronutrient deficiencies and their impact on mental health (relevant to Target 3.4).
• Indicator: Measurement of micronutrient deficiencies and their impact on overall health (relevant to Target 2.1).
• Indicator: Inclusion of both healthy volunteers and volunteers with depression in the study (relevant to Target 10.2).

SDGs, Targets, and Indicators

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Source: bmcpsychology.biomedcentral.com

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