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Use Modi–Medi diet to treat depression

Executive Summary

Modern science is finding that depression is affected by chemical, dietary, and environmental factors.

The article describes a score called MADRS to determine the severity of depression.

A study called SMILES trial found dietary intervention to be an excellent supportive treatment in clinical depression. The scientists came up with a Modified Mediterranean (Modi–Medi) diet, based on it. Certain nutrients, such as omega–3 fats, zinc, magnesium, iron, and vitamin B–12 are very effective in preventing depression.

The article describes many foods that increase or decrease the risk of depression.

Depression is a serious mental health condition, involving significant physical, financial, and social consequences.

Traditionally, depression was considered as an attitudinal, mental problem. However, modern science is finding chemical, environmental, dietary, and physical reasons that aggravate, if not cause, the condition.

Since the side–effects of the medicines used to treat depression could be significant, scientists have been putting efforts to come up dietary solutions that will help in the same.

Over the years, there is a lot of new evidence that shows that diet patterns are strongly correlated to the risk of depression. For example, refined carbohydrates and highly processed foods are correlated with higher risk for depression. However, there have been no clinical trials that show the effect of dietary intervention in the treatment of depression.

The SMILES trial

A recent study, called the SMILES trial, tried to ascertain dietary improvement as a treatment strategy for depression. The acronym, SMILES, stands for Supporting Modification of Lifestyle in Lower Emotional States.

The results were published in the journal BMC Medicine. Link to the original paper: A randomised controlled trial of dietary improvement for adults with major depression (the ‘SMILES’ trial).

Study design

This was the first–ever clinical trial to test the effect of diet as a treatment for clinical depression.

The study involved several hundreds of patients, who had moderate to severe depression.

One group of patients received seven 60–minute sessions of dietary counseling. They were told to increase consumption of food in certain healthy food categories, such as whole grains, fruits, vegetables, nuts, legumes, lean meats, chicken, and seafood. They were also told to reduce consumption of empty starches, sugars, and processed foods.

Another group — the control group — received matching social support protocol, but no dietary counseling.

Almost all the participants also received either psychotherapy, medications, or both. Thus, diet and social support were not the only treatments administered to the patients. They were already receiving some conventional treatment, and the trial tried to find out if dietary intervention would improve anything further.

The study was performed for 12 weeks on each patient.

Medical Information

Psychiatrists use a 10–point questionnaire to measure the severity of depression. A score is calculated based on it, called Montgomery–Åsberg Depression Rating Scale (MADRS).

The questionnaire asks the patient ten questions on the following symptoms:
1. Apparent sadness
2. Reported sadness
3. Inner tension
4. Reduced sleep
5. Reduced appetite
6. Concentration difficulties
7. Lassitude
8. Inability to feel
9. Pessimistic thoughts
10. Suicidal thoughts.

Each answer is graded from 0 (least depressive) to 6 (most depressive). The total is the MADRS score.

The levels of depression, based on the score are:
No depression: 0 to 6
Mild depression: 7 to 19
Moderate depression: 20 to 34
Severe depression: 34 to 60

Study findings

The study found 32% of the patients in the diet group (treatment) achieved remission, while only 8% of the social support (control) group achieved remission.

The study found reduction in the MADRS scores for patients in both the groups.

However, the treatment group achieved 7.1–point more reduction in the score than the control group.

The scientists calculated that for every 10% adherence to the healthier dietary pattern (there is a scientific way to do this; read the original paper), there was a 2.2–point reduction in the MADRS score.

Study conclusions

Looking at the risk–to–reward ratio of the dietary intervention, it is a very safe and effective way to use in depression.

Based on the findings, the scientists developed a diet to be used in the treatment of depression, called the Modified Mediterranean Diet, or the Modi–Medi Diet.


The depressive people who respond the best to the dietary intervention are people who are already eating a low–nutrition diet. Such a diet consists of refined carbohydrates, pizza, pasta, baked, and highly processed foods.

In conclusion

Dietary intervention is an excellent adjunctive treatment in clinical depression due to its far lesser side effects.

Foods that correlated with lower risk for depression: whole grains, fruits, leafy greens, rainbow (colourful) vegetables, nuts, legumes, chicken, and a wide variety of seafood.

Foods that correlated with higher risk for depression: empty carbohydrates, refined starches and highly processed foods.

Certain nutrients, such as omega–3 fats, zinc, magnesium, iron, and vitamin B–12 are very effective in preventing depression.

First published on: 4th February, 2017

Image credit: Kat Jayne on Pexels.com


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