Micronutrients and Mental Health

Zinc supplementation combined with antidepressant drugs for treatment of patients with depression: a systematic review and meta-analysis

The overall aim of this 2022 study was to examine if vitamin C levels influence vitality and psychological functions. Firstly, a sample of healthy young adults (aged 20-39 years) were tested on their vitamin C concentrations, vitality, and mood status (stress, depression, and positive and negative affect). Next, those with inadequate levels of vitamin C were randomly selected to take either 500 mg of vitamin C or placebo twice a day for 4 weeks. The data was analyzed to find that serum vitamin C concentration was positively associated with level of attention, but not strongly related to mood and fatigue. Compared to the placebo group, the vitamin D intervention group showed significantly enhanced attention and work absorption. Moreover, adults given vitamin C performed better in the neuropsychological test, Stroop color-word test, compared with the placebo group. However, vitamin D supplementation did not appear to affect mood or serum brain-derived neurotrophic factor (BDNF). The authors concluded that low vitamin C status is related to a low level of mental vitality. Vitamin C supplementation effectively increased work motivation and attentional focus and contributed to better performance on cognitive tasks requiring sustained attention. [NPID: micronutrients, nutrients, diet, vitamin C, supplements, supplementation, cognition, mood, vitality, mental health, attention]

Since vitamin D deficiency is associated with poorer mental and physical health among patients with psychotic disorders, this 2021 study assessed whether vitamin D supplementation can improve clinical outcomes in first-episode psychosis (FEP). This clinical trial recruited adults (aged between 18 to 65 years) within 3 years of a first presentation with a functional psychotic disorder and no contraindication to vitamin D supplementation. In total, 149 participants were included and randomized to either receive 120,000 international units (UI) of cholecalciferol (vitamin D3) supplement or placebo monthly. After 6 months, 104 of these subjects made up the follow-up data and were examined on their mental health. The primary outcome measure was total Positive and Negative Syndrome Scale (PANSS), which can identify the presence and severity of positive and negative symptoms. There were no differences found in the intention-to-treat analysis in the PANSS between baseline and the 6-month follow-up, or between the 3-month and 6-month scores. Other tests conducted in this trial include the Global Assessment of Function (measures how much a person's symptoms affect their day-to-day life), Calgary Depression Scale score (determines the level of depression), waist circumference, body mass index, and glycated hemoglobin, total cholesterol, and C-reactive protein. There were also no differences in these measures between the baseline and 6-month outcomes. Vitamin D levels were very low in the study participants, particularly in Black participants and those who identified as another minoritized racial and ethnic group. Around 93% of these minority ethnic groups showed low levels of vitamin D. This study did not find an association between vitamin D supplementation and mental health or metabolic outcomes at 6 months. But so few patients had satisfactory vitamin D levels, which suggests that future population health strategies could target and help this group. [NPID: vitamin D, cholecalciferol, supplements, diet, micronutrients, nutrients, ethnic groups, psychosis, schizophrenia, depression]

Since it is not clear what role magnesium supplementation plays in the management of depressive symptoms, this 2017 trial investigated the effects of over-the-counter magnesium chloride on the symptoms of depression. The study compared 6 weeks of 240mg (milligrams) magnesium per day to 6 weeks of no treatment (control). The participants were adults with an average age of 52, and with mild to moderate depressive symptoms. Symptoms were monitored through twice-weekly phone calls. In addition to depression, everyone was assessed on signs of anxiety, adverse effects, and likelihood to use magnesium supplements in the future. Overall, there was a clinically significant net improvement in Patient Health Questionnaire-9 (PHQ-9) scores and net improvement in Generalized Anxiety Disorders-7 scores, following the 6-week magnesium supplement intervention. These supplements were well tolerated, and participants stated that they would take magnesium again in the future. Similar trends were seen regardless of age, gender, baseline severity of depression, baseline magnesium level, or use of antidepressant treatments. The impact of these supplements were noticed within 2 weeks. Magnesium acts quickly and effectively in improving mild-to-moderate depression in adults, while demonstrating a good safety profile. [NPID: magnesium, nutrients, micronutrients, nutrition, minerals, multivitamins, supplements, supplementation, depression]

To test the long-term safety of taking multivitamins, this 2019 study provided patients with psychiatric symptoms with one of two commercially available broad-spectrum micronutrient formulas (EMPowerplus and Daily Essential Nutrients) at doses above the Recommended Dietary Allowances. On average, the micronutrients were consumed for 2.66 years. Participants were examined on their full blood count, coagulation profile, liver, and kidney function, fasting glucose, iron, key nutrients, and prolactin. All but one of the blood tests were within the test reference ranges (B12 was elevated in many of the subjects). One patient was diagnosed with hemochromatosis, which is known as iron overload, but there were no other clinically relevant adverse changes in blood tests performed pre- and post-treatment. Moreover, 85% of the participants were in nonclinical ranges for measures of attention-deficit hyperactivity disorder (ADHD), depression, anxiety, and stress. This article provides preliminary evidence of the long-term safety of commercially available micronutrients, although there remain some unexplained questions. All in all, the psychiatric benefits of these micronutrient formulations appear to outweigh the risk in these patients. Screening for potential medical problems is recommended pre-treatment. [NPID: micronutrients, multivitamins, vitamins, minerals, safety, toxicity, depression, anxiety, stress, ADHD]

This 2014 study analyzed the diet of some patients that were visiting an outpatient traumatic brain injury (TBI) clinic. The patients completed food frequency questionnaires to find out their estimated nutrient intake, while their medical records were also examined to report diagnoses, body mass index, and neurobehavioral subscale scores. Nutrients were assessed individually as well as summarized into summary scores. While the study recognized 14 key micronutrients with defined dietary intake reference ranges that are considered important for brain health, none of the subjects met the recommended dietary allowances (RDAs) for all 14 micronutrients. Ten people met the RDAs for 6 or fewer nutrients, and 10 met the RDAs for 11-12 nutrients. While there were 12 nutrients for which there was sufficient sample size to analyze, eleven of these were associated with lower mean somatic scores, nine were linked with worse cognitive scores, and eight had connections with worse affective scores, when comparing individuals who consumed the least amount of nutrients with those who had the highest nutrient intakes. Only folate, magnesium, vitamin C, and vitamin K were statistically related to the somatic mean score. None of the nutrients was linked with cognitive or affective scores. It was discovered that diets commonly failed to meet recommended dietary allowances for important brain nutrients in an outpatient TBI clinic. Notably, the patients who did not meet the estimated average requirements obtained the worst mean neurobehavioral scores. [NPID: traumatic brain injury, brain, patient, clinic, nutrients, micronutrients, RDA, somatic, cognitive, folate, magnesium, vitamin C, vitamin K, vitamins]

Since nutrition and vitamin intake may have connections to cognitive function and decline in older adults, the aim of this 2012 study was to dive into the effects of nutritional supplementation on cognition in older men. The paper exclusively focused on the multivitamin, mineral and herbal supplement called Swisse Men's Ultivite®, and its impact on cognitive performance in older men. The 51 volunteers of this study were aged between 50 and 74 years, and with an inactive lifestyle. Tests confirmed that contextual recognition memory performance significantly improved after the consumption of the multivitamin, although the subjects’ performances in other cognitive tasks were not affected. Blood samples were also taken to reveal that vitamin B12 and folate levels increased while homocysteine concentrations dropped following supplementation. To conclude, the study found that daily multivitamin supplementation may enhance episodic memory in older men at risk of cognitive decline. [NPID: nutrition, vitamins, multivitamins, supplements, supplementation, minerals, herbal, older, memory, cognition]

This 2013 study addresses the limitations of the previous research suggesting a link between multivitamin supplementation with improved mood and general well-being. Previously, the studies have often only recruited male participants, the duration of treatment has typically been less than 90 days, and the acute effects have not been differentiated from chronic effects clearly enough. Therefore in this present article, 138 healthy young adults (aged between 20 and 50 years) each took a multivitamin supplement daily for 16 weeks. A mood rating scale called Bond-Lader VAS was used to assess subjective feelings. There were also several other measures of chronic mood that were administered at baseline, and at the 8- and 16- week mark. In addition, Pipingas et al. examined the changes in Bond-Lader and Visual Analogue Scales (VAS) in response to a multitasking framework (MTF). Some of the participants were also tested on their mood states at home using their mobile phones. The results showed no significant treatment effects for any of the chronic laboratory mood measures. Furthermore, the male participants in the multivitamin group appeared to experience increased levels of stress as time passed. This finding may be explained by the large percentage of the males in the multivitamin group being students. However, the at-home mobile-phone assessments taken post-dose revealed significantly reduced stress, physical fatigue, and anxiety in the multivitamin group, compared with the placebo group across several time points. There is still further research required to absolutely differentiate between the acute and chronic effects of multivitamins. [NPID: supplements, supplementation, vitamins, multivitamins, mood, well-being, mental health, chronic mood, acute mood]

It has been established that diets lacking in micronutrients are correlated with poorer health, this 2011 paper states. Since multivitamins contain a wide range of nutrients, these supplements may be effective in enhancing mood. Few studies have explored this potential link in randomized controlled trials, which is why this present study examined if multivitamins, minerals, and herbal supplements affect mood and stress in a group of healthy, older men. These 50–69-year-old volunteers were given either a placebo capsule or a multivitamin formulation consisting of vitamins (at levels above recommended daily intakes), minerals, antioxidants, and herbal extracts. Questionnaires were completed at baseline and after supplementation, to assess the participants’ mood and stress levels. Compared with the placebo control group, the individuals that received the multivitamins showed increased alertness, better general functioning, and significantly lower overall scores on depression, anxiety, and stress scales. This study therefore deduced that consuming supplements containing multivitamins, minerals, and herbal components can potentially enhance alertness, reduce negative mood symptoms, and improve feelings of general day-to-day well-being. [NPID: supplements, supplementation, vitamins, multivitamins, minerals, herbs, herbal, health, diet, nutrition, mood, stress, antioxidants, depression, anxiety]

Johnstone et al. (2020) conducted a systematic review on randomized controlled trials (RCTs) involving multinutrient interventions consisting of at least 4 vitamins and/or minerals in people with psychiatric symptoms, producing 16 RCTs (total 1719 participants) that met the inclusion criteria. The trials were related to various psychiatric categories including depression, post-disaster stress, antisocial behavior, behavioral deficits in dementia, attention-deficit/hyperactivity disorder, and autism. Grading of Recommendations, Assessment, Development and Evaluations (GRADE) assisted with the rating of evidence base, while significant clinical benefit was determined by using minimal clinically important differences (MIDs). The meta-analysis was performed on the trials in the Attention-Deficit/Hyperactivity Disorder (ADHD) category only because of the heterogeneity in participants, multinutrient formulas, outcome measures, and the absence of complete data. In samples with ADHD, the multinutrient intervention significantly improved (statistically and clinically) global functioning [mean difference (MD) −3.3, p = 0.001, MID −3.26; Standardized Mean Difference (SMD) −0.49 p = 0.001 MD −0.5), clinician ratings of global improvement (MD −0.58, p = 0.001, MID −0.5) and ADHD improvement (MD −0.54, p = 0.002, MID −0.5), and clinician (but not observer) measures of ADHD inattentive symptoms (MD −1.53, p = 0.05, MID −0.5)]. Narrative synthesis also revealed an improving trend of global measures among those subjects with autism and those with behavioral deficits in dementia. Furthermore, multinutrient interventions were associated with improvements in anxiety experienced post-natural disaster, and in the number of violent incidents among prisoners. According to this review, broad-spectrum formulas containing both vitamins and minerals had more substantial impacts than other formulas with fewer ingredients. Importantly, the reviewers have exposed the need for robust RCTs with full data (means and standard deviations for all outcomes) in order to find strong evidence for the role of multinutrients in psychiatric disorders. [NPID: micronutrients, nutritional supplements, depression, stress, antisocial behavior, autism, ADHD, dementia]

As various studies have determined that the disturbances in the production, storage and utilization of brain energy are relevant in the development and maintenance of depression, Kious et al. (2019) proposes creatine as a nutritional supplement as it can possibly help correct this dyshomeostasis and has shown potential as an antidepressant in early clinical trials. [NPID: micronutrients, nutritional supplements, depression, dyshomeostasis, creatine, antidepressants]

This 2019 study recruited 60 patients with MDD and 60 individuals for control, matched by age and gender, and investigated the relationship between trace elements and vitamins with depressive disorders. The participants were examined on Cu, Zn, Ni, Cr, Mn, Mg, and Al serum levels (determined by atomic absorption spectrometry) and vitamin (E & A) concentrations (using high-performance liquid chromatography). Cu, Cr, and Al readings were found to be significantly higher in MDD patients than control, while the levels of Zn, Ni, Mn, Mg, vitamin E, and vitamin A were significantly lower in individuals diagnosed with depression. Finally, the ratio of Cu/Zn was high among depressed patients, which may have an important role in diagnosing and monitoring MDD. The results also suggest that disturbances in the level of trace elements and vitamins (E and A) are significantly related with MDD, studying Cu and Zn may be crucial in accumulating knowledge on the pathogenesis of depressive disorders, and that vitamin E deficiency may heighten the risk of developing MDD. Apparently, further exploration into trace element supplementation is required. [NPID: micronutrients, nutritional supplements, depression, Cu, Zn, Ni, Cr, Mn, Mg, Al, vitamin E, vitamin A, MDD, major depressive disorder]

To examine the serum levels of amino acids and non-enzymatic antioxidants in major depressive disorder (MDD) and study its interaction with depression, Islam et al. (2020) gathered 247 patients with MDD and 248 healthy controls (HCs) matched by age and sex, and employed the HPLC system (for amino acids, vitamin A and E), UV-spectrophotometer (to assess vitamin C) and Hamilton Depression Rating Scale (Ham-D, to measure severity of depression). It was revealed that subjects with MDD had significantly lower readings of the four amino acids (methionine, phenylalanine, tryptophan, and tyrosine) and of the three non-enzymatic antioxidants (vitamin A, E, and C), relative to healthy controls. In addition, lower methionine and tyrosine concentrations were linked with higher Ham-D scores. These findings suggest that lower methionine, phenylalanine, tryptophan, tyrosine, and non-enzymatic antioxidant levels in the blood are connected with depression, and may have been a contributing factor in the development of major depression among MDD patients. [NPID: micronutrients, nutritional supplements, non-enzymatic antioxidants, major depressive disorder, MDD, depression, amino acids, vitamin A, vitamin E, vitamin C, methionine, phenylalanine, tryptophan, tyrosine]

Since the dyshomeostasis of copper and zinc is connected with neurodegeneration, Mravunac et al. (2019) set out to explore the relationship between copper and zinc serum levels, copper/zinc ratio, cognitive function, and signs of depression and anxiety among 139 Australian adults. Along with blood concentrations of zinc and copper, neurotrophic factors such as brain-derived neurotrophic factor (BDNF), vascular endothelial growth factor, and insulin-like growth factor-1 were assessed, while the Hospital Anxiety and Depression Scale and the Cogstate battery and the Behavior Rating Inventory (BRI) of Executive Function (Adult version) allowed evaluation of the participants’ anxiety and depressive symptoms, respectively. Associations with lower depressive symptoms were found for copper and copper/zinc ratio but not for cognition. Also, plasma copper was positively correlated with BDNF while zinc was not associated with any of the outcomes. To summarize, higher blood copper levels and copper/zinc ratios were related to lower depressive symptoms, and copper was also positively associated with BDNF concentrations among an older population in Australia. [NPID: micronutrients, nutritional supplements, zinc, neurodegeneration, copper, zinc, cognitive function, BDNF, anxiety, depression, executive function, Australia]

To assess the relationship between chocolate consumption and depressive symptoms, this 2019 study applied the data of 13,626 adults (≥20 years) participating in the National Health and Nutrition Examination Survey between 2007-08 and 2013-14, deriving daily chocolate intake (no chocolate, non-dark chocolate, dark chocolate) and quantity of chocolate consumed (g/day) from two 24-hr dietary recalls and using the Patient Health Questionnaire (PHQ-9) to determine clinically relevant depressive symptoms (scores ≥10). Following the exclusion of diabetics, the consumption of any chocolate was reported in 11.1% of the population, while 1.4% revealed eating dark chocolate. Although the intake of dark chocolate was not significantly associated with depressive symptoms (OR=0.30), those participants who consumed dark chocolate were found to have lower odds of developing clinically relevant depressive symptoms. Moreover, the subjects in the highest quartile for chocolate consumption (104-454 g/day) were 57% less likely to develop signs of depression when compared with those who did not eat any chocolate (OR = 0.43) and after adjusting for dark chocolate consumption. These results suggest the relevance of consuming chocolates, particularly dark chocolate, in enhancing the odds of avoiding depressive symptoms, although additional longitudinal studies and further long-term investigation of chocolate consumption will be required to explain the causality of this relationship and confirm these conclusions. [NPID: micronutrients, nutritional supplements, depression, chocolate]

This 2019 study focused on the possible relationship between dietary phytochemical index (DPI) and symptoms of depression, anxiety and psychological distress among 488 Iranian women (aged 20-50). The DPI was estimated using the formula: (daily energy derived from phytochemical-rich foods (kJ)/total daily energy intake (kJ))×100. Questionnaires were used to assess diet (validated and reliable FFQ) and symptoms of depression, anxiety and psychological distress (validated depression, anxiety, stress scales). The study participants were recruited from health centres in the south of Tehran, and averaged 31·9 (sd 7·7) years in age. Signs of depression, anxiety and psychological stress were seen in 34·6, 40·6 and 42·4 % (respectively) of the studied population. Results showed women in the highest tertile of DPI had 78%, 67% and 70% lower risks in developing depression, anxiety and psychological stress, respectively, compared with those in the lowest tertile. Although this study showcases the significant association between DPI and mental health in Iranian women, prospective studies are required for further confirmation. [NPID: micronutrients, nutritional supplements, depression, anxiety, psychological distress, anxiety, stress, women, female, Iran]

This 2019 study assessed the correlation between dietary vitamin K intake (data collected through a semi-quantitative food frequency questionnaire) and depressive symptoms [diagnosed using the 20-item Center for Epidemiologic Studies-Depression (CES-D) ≥ 16] among 4,375 adult participants (aged 45-79) from North America. Around 10% (n=437) of the subjects exhibited symptoms of depression. After adjusting for potential confounders in the logistic regression analysis, those adults with the highest vitamin k intake were associated with lower incidences of depressive symptoms (OR = 0.58; 95%CI: 0.43–0.80), although this observation only applied to subjects not taking vitamin D supplements. Since this study provides evidence on the relevance of higher dietary vitamin K with lower appearance of depressive symptoms, further research is encouraged, especially to inspect the directionality of this association. [NPID: micronutrients, nutritional supplements, vitamin K, depression, vitamin D]

This 2015 paper analyzes the micronutrients copper, selenium, manganese, iodine and vanadium and their roles in depression and anxiety. Młyniec et al. (2015) discuss potential mechanisms in which these elements may be linked with either depression or anxiety, including possible interactions between some of these micronutrients with enzymes that are involved in the pathophysiology of mental disorders. Furthermore, the authors inspect the dynamic between these elements and depression/anxiety, even the quantity of an element in the diet or in the blood associated with the symptoms of these disorders. [NPID: micronutrients, nutritional supplements, copper, selenium, manganese, iodine, vanadium, depression, anxiety]

This 2019 review summarizes the influence that polyphenols can have on the neural inflammation and mitochondrial dysfunction aspects of diet-induced hypothalamic dysfunction. Polyphenols were seen to help reduce oxidative stress and inflammation within the hypothalamus, enhancing leptin signaling and mitochondrial biogenesis in the process. The role of polyphenols in reducing the production of reactive oxygen species and in augmenting the natural oxidative defense systems also assists the prevention of neurodegeneration. Samodien et al. (2019) appreciate polyphenols as nutraceuticals with excellent potential as they have shown protective qualities against hypothalamic inflammation, mitochondrial dysfunction, and neurodegeneration. As hypothalamic inflammation spreads as an individual ages, polyphenol’s ability to possibly increase longevity should be studied, along with its therapeutic value in the management of mental health disorders since they are characterized too by advanced neuroinflammation. [NPID: micronutrients, nutritional supplements, polyphenols, neural inflammation, mitochondria, hypothalamic dysfunction, hypothalamus, oxidative stress, neurodegeneration, nutraceuticals, neuroinflammation, inflammation]

This 2019 meta-review appraised all the meta-analyses conducted on randomized controlled trials (RCTs) investigating the efficacy and safety of nutrient supplements in common and severe mental disorders. The 33 meta-analyses identified by a systematic search produced outcome data of 10,951 participants. While early evidence suggests polyunsaturated fatty acids (PUFAs) may have positive impacts on attention-deficit/hyperactivity disorder, there is greater support for the use of PUFAs, and particularly eicosapentaenoic acid, in the treatment of depression. While folate-based supplementation in patients with depression and schizophrenia has been explored, high-dose methylfolate and its positive influence on major depressive disorder was highlighted. In addition, back-up for N-acetylcysteine as an adjunctive treatment in mood disorders and schizophrenia is increasing. All the nutrient supplements had good safety profiles, with no adverse effects or contraindications with psychiatric medication reported. It is therefore important that clinicians note the nutrients that are well established in their efficacy, and also be mindful of those lacking in evidence. Next research should look into the population that would benefit the most from these supplements, developing our understanding of the underlying mechanisms in the process. [NPID: micronutrients, nutritional supplements, PUFAs, ADHD, eicosapentaenoic acid, folate, depression, schizophrenia, methylfolate, major depressive disorder, MDD, depression]

This 2020 study explored the correlation between intake of vitamin B6 with depression and anxiety among 3362 adults. Kafashani et al. (2020) used a validated 106 item self-administered Willett-format dish-based semi quantitative food-frequency questionnaire (DFQ) and an Iranian validated version of the Hospital Anxiety and Depression Scale (HADS) questionnaire to obtain data on the participants’ diet and mental health. The results exposed the significantly lower consumption of vitamin B6 in anxious and depressed individuals, compared to healthy subjects. After making adjustments for potential confounders, less vitamin B6 in the diet of the women and of the whole sample population was associated with increased risk in developing depression (OR = 1.41, P < 0.001. OR = 1.33, P = 0.02, respectively) and higher odds of suffering from anxiety (OR = 2.30, P < 0. 001, OR = 2.30, P = 0.04). This data provides further evidence of the association between lower vitamin B6 intake and increased prevalence of depression and anxiety. Enhancing nutritional status is thought to help cut down on these disorders, but further research, particularly robust randomized controlled trials, are necessary to provide more proof. [NPID: micronutrients, nutritional supplements, vitamin B6, depression, anxiety, Iran, B6]

Bakian et al. (2020) examined the association between dietary creatine and depression in U.S. adults, using the data dietary creatine intakes and patient health questionnaires obtained by the 2005 to 2012 National Health and Nutrition Examination Survey (NHANES) on its 22,692 participants (aged ≥20 years). This study compared the depression prevalence in the subjects in the lowest quartile of dietary creatine intake (rate of 10.23/100) to occurrence in those in the highest quartile of creatine consumption (5.98/100 persons). While an inverse association was confirmed between dietary creatine and depression [adjusted odds ratio (AOR) = 0.68], the strongest correlations were seen in females (AOR = 0.62) and participants not taking antidepressant/anxiolytic medication (AOR = 0.58). These results highlighted a significant negative relationship between creatine intake and depression in a nationally representative cohort. This leaves the role that creatine plays in depression among women and across the lifespan to be investigated in the future. [NPID: micronutrients, nutritional supplements, creatine, depression, anxiolytic medication, women, female]

The purpose of this 2018 study was to explore the association between magnesium uptake from diet and psychiatric disorders among a large group of Iranian adults (n=3172; age 18-55). Dietary consumption was documented with a validated dish-based 106-item semi-quantitative food frequency questionnaire, while depression and anxiety, and psychological distress were evaluated using an Iranian validated version of the Hospital Anxiety and Depression Scale, and the General Health Questionnaire. The results demonstrated a significant inverse correlation between magnesium intake and depression among normal-weight men (OR 0·45) and overweight women (OR 0·45). Low Mg intake was also connected with higher prevalence of anxiety among all women (OR 1·80) and normal-weight women (OR 1·73). While women in the highest quartile of Mg intake were 39% less likely to experience anxiety, compared with those in the lowest quartile. Even in unadjusted analyses, higher dietary Mg intake was associated with lower odds of anxiety among women (OR 0·61). Anjom-Shoae et al. (2018) were able to find evidence that dietary intake of magnesium was inversely associated with depression and anxiety but not with psychological distress. [NPID: magnesium, depression, anxiety, distress, Mg]

The purpose of this 2018 study was to explore the association between magnesium uptake from diet and psychiatric disorders among a large group of Iranian adults (n=3172; age 18-55). Dietary consumption was documented with a validated dish-based 106-item semi-quantitative food frequency questionnaire, while depression and anxiety, and psychological distress were evaluated using an Iranian validated version of the Hospital Anxiety and Depression Scale, and the General Health Questionnaire. The results demonstrated a significant inverse correlation between magnesium intake and depression among normal-weight men (OR 0·45) and overweight women (OR 0·45). Low Mg intake was also connected with higher prevalences of anxiety among all women (OR 1·80) and also normal-weight women (OR 1·73). While women in the highest quartile of Mg intake were 39% less likely to experience anxiety, compared with those in the lowest quartile. Even in unadjusted analyses, higher dietary Mg intake was associated with lower odds of anxiety among women (OR 0·61). Anjom-Shoae et al. (2018) were able to find evidence that dietary intake of magnesium was inversely associated with depression and anxiety but not with psychological distress. [NPID: micronutrients, nutritional supplements, magnesium, psychiatric disorders, depression, anxiety, psychological distress]

Using the data from the Eating Habit and Well-being study in Japanese workers, Nakamura et al. (2019) analyzed the relationship between the intake of six minerals with mental disorders. Among the 2089 participants of the study, there was no history of depression but 6.9% developed mental disorders (detected by Kessler's six-item psychological distress scale using a cut-off score of 12/13). The subjects’ dietary mineral intakes were estimated with the validated food frequency questionnaires, revealing the association between mental disorders with the lowest quartiles of zinc, copper, and manganese consumption. Whereas, the lowest quartiles of calcium, magnesium, and iron intake did not correlate with mental disorders. Also, combination analysis of high (≥median) or low (

Li et al. (2018) studied the relationship between the total consumptions of zinc, iron, copper and selenium, with depression. This cross-sectional study extracted the data of 14,834 adults (18+ years, 7399 male: 7435 female) from the National Health and Nutrition Examination Survey (NHANES) 2009-2014. In unadjusted model and age- and gender-adjusted models, total zinc, iron, copper and selenium intakes were inversely associated with depression; when the highest quartile of copper and selenium intakes were compared to the lowest quartile, the multivariate adjusted odds ratios (ORs) of depression was recorded as 0.68 and 0.46, respectively. In addition, when quartile 3 for total zinc and iron consumption was compared to the lowest quartile, the inverse associations of depression were statistically significant, with OR of 0.7 for zinc and 0.66 for iron. Furthermore, those adults who met the Recommended Dietary Allowances (RDAs) for zinc (OR: 0.74), copper (OR: 0.68) and selenium (OR: 0.52) had significantly lower odds of depression, compared to those below the RDA. These results suggest inverse associations between total zinc, iron, copper and selenium intakes with depression. [NPID: micronutrients, zinc, iron, copper, selenium, depression]