Magnesium intake is not related to depression risk in Spanish university graduates

Nutritional considerations in major depressive disorder: current evidence and functional testing for clinical practice

Depression is a multifaceted condition with diverse underlying causes. Several contributing and inter-related factors such as genetic, nutritional, neurological, physiological, gut-brain-axis, metabolic and psychological stress factors play a role in the pathophysiology of depression. This review aims to highlight the role that nutritional factors play in the aetiology of depression. Secondly, we discuss the biomedical and functional pathology tests which measure these factors, and the current evidence supporting their use. Lastly, we make recommendations on how practitioners can incorporate the latest evidence-based research findings into clinical practice. This review highlights that diet and nutrition greatly affect the pathophysiology of depression. Nutrients influence gene expression, with folate and vitamin B12 playing vital roles in methylation reactions and homocysteine regulation. Nutrients are also involved in the tryptophan/kynurenine pathway and the expression of brain-derived neurotrophic factor (BDNF). Additionally, diet influences the hypothalamic-pituitary-adrenal (HPA) response and the composition and diversity of the gut microbiome, both of which have been implicated in depression. A comprehensive dietary assessment, combined with appropriate evaluation of biochemistry and blood pathology, may help uncover contributing factors to depressive symptoms. By employing such an approach, a more targeted and personalised treatment strategy can be devised, ultimately leading to improved patient outcomes.

Impact of dietary magnesium intake on depression risk in American adults: a cross-sectional study of the National Health and Nutrition Examination Survey 2005-2020

Introduction

Depression is a major global mental health challenge. Previous research suggests a link between magnesium consumption and depression, but the dose-response relationship remains unclear. This study investigates the relationship between dietary magnesium intake and depression risk among American adults.

Methods

Data from the 2005-2020 National Health and Nutrition Examination Survey (NHANES) were examined. Depression was measured with the Patient Health Questionnaire-9 (PHQ-9), and dietary magnesium consumption was calculated from two 24-h meal recalls. We used restricted cubic spline models, logistic regression, and sensitivity analyses to assess the connection.

Results

Among 35,252 participants (mean age: 49.5 ± 17.6 years; 49.9% women), we observed a nonlinearity in the relationship between dietary magnesium intake and depression. Below the inflection point (366.7 mg/day), the odds ratio (OR) was 0.998 (95% CI: 0.997-0.999, p < 0.001). Above this point, the OR was 1.001 (95% CI: 1.000-1.002, p = 0.007). In participants aged ≥60 years, the association was inverse L-shaped, with magnesium intake ≥270.7 mg/day increasing depression incidence by 0.1% per 1 mg/d increase.

Conclusion

A nonlinear dose-response relationship exists between dietary magnesium intake and depression risk among US adults. Age significantly moderates this association, suggesting dietary recommendations should be tailored to different age groups.

Dietary Magnesium Intake in Relation to Depression in Adults: A GRADE-Assessed Systematic Review and Dose-Response Meta-analysis of Epidemiologic Studies

CONTEXT

The relation of magnesium (Mg) intake with depression was previously investigated by meta-analyses. However, due to limited data, a dose-response analysis was not performed.

OBJECTIVE

Considering the recently published articles, a systematic review and dose-response meta-analysis was conducted to summarize the relation of dietary Mg intake with depression in adults.

DATA SOURCES

Medline (PubMed), ISI Web of Science, Scopus, and Google Scholar were comprehensively searched up to August 2023.

DATA EXTRACTION

Observational studies that reported the relation of dietary Mg intake and depression in adults were included and their data were extracted.

DATA ANALYSIS

A total of 63 214 participants from 10 cross-sectional and 3 cohort studies were included in the current study. Pooling 15 effect sizes from 12 studies (including 50 275 participants) revealed that individuals with the highest Mg intake had a 34% lower risk of depression, compared with those with the lowest Mg intake (RR: 0.66; 95% CI: 0.57, 0.78). Moreover, the linear dose-response analysis revealed that each 100-mg/d increment in Mg intake was associated with a 7% reduced risk of depression (RR: 0.93; 95% CI: 0.90, 0.96). Additionally, based on nonlinear dose-response analysis, increasing Mg intake from 170 to 370 mg/d was associated with a reduced risk of depression. Analyses were also conducted on 9 studies (49 558 participants) with representative populations, and similar results were found in the meta-analysis (RR: 0.71; 95% CI: 0.61, 0.83) and linear (RR: 0.93; 95% CI: 0.90, 0.96) and nonlinear dose-response analysis.

CONCLUSION

The current study shows an inverse dose-dependent association between dietary Mg intakes and risk of depression in both a general and representative population of adults in a dose-response manner.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD42024506570.

A randomized clinical trial investigating the impact of magnesium supplementation on clinical and biochemical measures in COVID-19 patients

BACKGROUND

This study sought to examine the impact of magnesium supplementation on clinical outcomes and biochemical factors among hospitalized patients with COVID-19.

METHODS

This double-blind, randomized clinical trial was conducted at Razi Hospital, Ahvaz, Iran, between September 2021 and March 2022. Participants aged 18-70 years with moderate disease severity were enrolled. Magnesium supplementation (300 mg daily) was administered to the intervention group, while the control group received a placebo. Clinical outcomes, including the need for oxygen therapy, oxygen saturation, respiratory rate, fever, hs-CRP and TNF-α levels, as well as quality of life and mental health, were assessed. Blood samples were collected to measure biochemical variables.

RESULTS

The main result was the count of individuals requiring oxygen therapy. Additional outcomes comprised of oxygen saturation, respiratory rate, fever, hs-CRP and TNF-α levels, as well as quality of life and mental health. Out of 64 participants, 60 completed the study. The results showed that magnesium supplementation significantly reduced the number of patients requiring oxygen therapy (9 vs. 14; P < 0.001). Moreover, the magnesium group demonstrated improved oxygen saturation compared to the control group (4.55 ± 2.35 vs. 1.8 ± 1.67; P < 0.001). Furthermore, we observed a noteworthy enhancement in the quality of life and depression score in the magnesium group. No significant differences were observed in respiratory rate, fever, hs-CRP, and TNF-α levels (P > 0.05).

CONCLUSION

The findings suggest that magnesium supplementation may have beneficial effects on clinical outcomes and arterial oxygen saturation in COVID-19 patients. More investigation is necessary to delve into its potential mechanisms and long-term effects on patient outcomes.

TRIAL REGISTRATION

This study is registered on Iranian Registry of Clinical Trials (IRCT) under identifier IRCT20210413050957N1. (The registration date: May 1, 2021).

Impact of Magnesium and Ferritin Deficiency on Depression Among Adolescent Students

BACKGROUND

Depression is considered the fourth-leading cause of health problems. It is the fourth-leading cause of health problems and disability, which causes 16% of the worldwide burden of disease and injury among adolescents.

OBJECTIVE

The aim of the present study was to evaluate the possible association of magnesium (Mg) and ferritin deficiency with depression in adolescent students.

PATIENTS AND METHODS

This case control study in secondary schools at Al-Ghanayem discrete. The total number included was 358 students. All were screened for depression by the Arabic version of the Beck questionnaire. The students who had positive score was selected as cases 86 and a matched same number of students with negative score was selected as controls. Serum level of ferritin and magnesium was measured in the 2 groups.

RESULTS

There was statistically significant difference between the studied groups when comparing depression grade with each of ferritin and Mg Depressed group cases had lower mean values of ferritin and Mg. The ferritin cut-off level for the prediction of depression was (35.5 μg/dL, which had a sensitivity of 74.4% and a specificity of 75.6%. The magnesium cut-off levels for the prediction of depression were1.95 mg/dL and 104.5 ng/dL which had a sensitivity of 70% and 64%, respectively.

CONCLUSION

There was a statistically significant negative correlation between depression severity and each of socio-economic status ferritin and Mg. Each of ferritin and Mg were predictors for depression.

Correlation of Ionized Magnesium with the Parameters of Oxidative Stress as Potential Biomarkers in Patients with Anxiety and Depression: A Pilot Study

Background

Magnesium (Mg) is the second most abundant intracellular cation. Ionized Mg is the only active form of Mg. The concentration of ionized Mg could be a potentially novel biomarker for anxiety and depression.

Aim

The aim of this study was to assess the serum concentration of ionized Mg and its correlation with biomarkers of oxidative stress and inflammation in patients with anxiety and depression.

Methods

In this study included 93 respondents were divided into 3 groups: C (control group—18 respondents); A (patients with anxiety disorder, dissociative/conversion disorders and somatoform disorders—36 patients); D (patients with depression—39 patients). Clinical diagnosis was based on ICD-10 criteria. Blood samples were used for standard laboratory analysis, ionized Mg analysis, oxidative stress, and inflammatory parameters.

Results

Statistical significance was recorded between healthy volunteers and patients (anxiety/depression) in ionized Mg values. In anxious patients, malondialdehyde (MDA) had a positive correlation between the parameters of oxidative stress with ionized Mg. In depressive patients, MDA had a positive correlation, and glutathione peroxidase 1 (GPX1) a negative correlation with the concentration of ionized Mg.

Conclusion

Ionized Mg and its correlation with parameters of oxidative stress could be potential biomarkers in anxious and depressive patients.

Healthy diet, depression and quality of life: A narrative review of biological mechanisms and primary prevention opportunities

Unipolar depressive disorder (UDD) affects more than 264 million people worldwide and was projected well before the severe acute respiratory syndrome coronavirus 2 pandemic to be the leading cause of disability-adjusted life years lost in 2030. It is imperative for leading economies to implement preventive strategies targeted towards UDD, given consistent policies are currently lacking. Recently established similarities between the aetiological hypotheses of depression and cardiometabolic diseases are shifting paradigms within this field. It is believed that dietary practices could potentially reduce the incidence of depression; similar to their effects on metabolism. Thus, the aim of this review was to compile current evidence on healthy dietary patterns as suitable contributors towards primary prevention strategies against UDD. Most of the well-known biological mechanisms behind depression have been positively associated with healthful diets and dietary patterns to varying degrees. Interestingly, a common factor of UDD is the production and overall effects of inflammatory cytokines, such as interleukin-6, tumor necrosis factor-α, and C-reactive protein. These compounds have been associated with depressive symptoms, disturbances in neuroendocrine function, leaky gut, monoamine activity and brain function, while also being key factors in the development of cardiometabolic diseases. The Mediterranean diet (MD) in particular, is well supported by first-level evidence regarding its preventive qualities against metabolic and cardiovascular diseases and thus considered a model for healthy eating by various organizations. In one of the few clinical trials investigating these associations, the PREDIMED trial, individuals with diabetes assigned to a MD supplemented with mixed tree nuts experienced a 41% relative risk reduction for developing depression. Lastly, there is a need to include health related quality of life as an indicator of physical and mental well-being, considering its putative associations with depression and suicide risk. Going forward, focusing on clinical trials, using precise nutritional assessments, and identifying nutritional biomarkers which may be related to depression are needed to fully support the implementation of dietary recommendations in the field of psychiatry.

Magnesium intake was inversely associated with hostility among American young adults

Hostility is a complex personality trait associated with many cardiovascular risk factor phenotypes. Although magnesium intake has been related to mood and cardio-metabolic disease, its relation with hostility remains unclear. We hypothesize that high total magnesium intake is associated with lower levels of hostility because of its putative antidepressant mechanisms. To test the hypothesis, we prospectively analyzed data in 4,716 young adults aged 18-30 years at baseline (1985-1986) from four U.S. cities over five years of follow-up using data from the Coronary Artery Risk Development in Young Adults (CARDIA) study. Magnesium intake was estimated from a dietary history questionnaire plus supplements at baseline. Levels of hostility were assessed using the Cook-Medley scale at baseline and year 5 (1990-1991). Generalized estimating equations were applied to estimate the association of magnesium intake with hostility as repeated measures at the two time-points (baseline and year 5). General linear model was used to determine the association between magnesium intake and change in hostility over 5 years. After adjustment for socio-demographic and major lifestyle factors, a significant inverse association was observed between magnesium intake and hostility level over 5 years of follow-up. Beta coefficients (95% CI) across higher quintiles of magnesium intake were 0 (reference), -1.28 (-1.92, -0.65), -1.45 (-2.09, -0.81), -1.41 (-2.08, -0.75) and -2.16 (-2.85, -1.47), respectively (Plinear-trend<.01). The inverse association was independent of socio-demographic and major lifestyle factors, supplement use, and depression status at year 5. This prospective study provides evidence that in young adults, high magnesium intake was inversely associated with hostility level independent of socio-demographic and major lifestyle factors.

Assessment of Relationship of Ketamine Dose With Magnetic Resonance Spectroscopy of Glx and GABA Responses in Adults With Major Depression: A Randomized Clinical Trial

IMPORTANCE

A single subanesthetic dose of ketamine produces an antidepressant response in patients with major depressive disorder (MDD) within hours, but the mechanism of antidepressant effect is uncertain.

OBJECTIVE

To evaluate whether ketamine dose and brain glutamate and glutamine (Glx) and γ-aminobutyric acid (GABA) level responses to ketamine are related to antidepressant benefit and adverse effects.

DESIGN, SETTING, AND PARTICIPANTS

This randomized, parallel-group, triple-masked clinical trial included 38 physically healthy, psychotropic medication-free adult outpatients who were in a major depressive episode of MDD but not actively suicidal. The trial was conducted at Columbia University Medical Center. Data were collected from February 2012 to May 2015. Data analysis was conducted from January to March 2020.

INTERVENTION

Participants received 1 dose of placebo or ketamine (0.1, 0.2, 0.3, 0.4, or 0.5 mg/kg) intravenously during 40 minutes of a proton magnetic resonance spectroscopy scan that measured ventro-medial prefrontal cortex Glx and GABA levels in 13-minute data frames.

MAIN OUTCOMES AND MEASURES

Clinical improvement was measured using a 22-item version of the Hamilton Depression Rating Scale (HDRS-22) 24 hours after ketamine was administered. Ketamine and metabolite blood levels were measured after the scan.

RESULTS

A total of 38 individuals participated in the study, with a mean (SD) age of 38.6 (11.2) years, 23 (60.5%) women, and 25 (65.8%) White patients. Improvement in HDRS-22 score at 24 hours correlated positively with ketamine dose (t36 = 2.81; P = .008; slope estimate, 19.80 [95% CI, 5.49 to 34.11]) and blood level (t36 = 2.25; P = .03; slope estimate, 0.070 [95% CI, 0.007 to 0.133]). The lower the Glx response, the better the antidepressant response (t33 = -2.400; P = .02; slope estimate, -9.85 [95% CI, -18.2 to -1.50]). Although GABA levels correlated with Glx (t33 = 8.117; P < .001; slope estimate, 0.510 [95% CI, 0.382 to 0.638]), GABA response did not correlate with antidepressant effect. When both ketamine dose and Glx response were included in a mediation analysis model, ketamine dose was no longer associated with antidepressant effect, indicating that Glx response mediated the relationship. Adverse effects were related to blood levels in men only (t5 = 2.606; P = .048; estimated slope, 0.093 [95% CI, 0.001 to 0.186]), but Glx and GABA response were not related to adverse effects.

CONCLUSIONS AND RELEVANCE

In this study, intravenous ketamine dose and blood levels correlated positively with antidepressant response. The Glx response correlated inversely with ketamine dose and with antidepressant effect. Future studies are needed to determine whether the relationship between Glx level and antidepressant effect is due to glutamate or glutamine.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT01558063.

The Association between Serum Magnesium Levels and Depression in an Adult Primary Care Population

Depression is common, places a large burden on the patient, their family and community, and is often difficult to treat. Magnesium supplementation is associated with improved depressive symptoms, but because the mechanism is unknown, it is unclear whether serum magnesium levels act as a biological predictor of the treatment outcome. Therefore, we sought to describe the relationship between serum magnesium and the Patient Health Questionnaire (PHQ, a measure of depression) scores. A cross-sectional analysis of medical records from 3604 adults (mean age 62 years; 42% men) seen in primary care clinics between 2015 and 2018, with at least one completed PHQ were included. The relationship between serum magnesium and depression using univariate analyses showed a significant effect when measured by the PHQ-2 (−0.19 points/mg/dL; 95% CI −0.31, −0.07; P = 0.001) and the PHQ-9 (−0.93 points/mg/dL; 95% CI −1.81, −0.06; P = 0.037). This relationship was strengthened after adjusting for covariates (age, gender, race, time between serum magnesium and PHQ tests, and presence of diabetes and chronic kidney disease) (PHQ-2: −0.25 points/mg/dL; 95% CI −3.33, −0.09; P < 0.001 and PHQ-9: −1.09 95% CI −1.96 −0.21; P = 0.015). For adults seen in primary care, lower serum magnesium levels are associated with depressive symptoms, supporting the use of supplemental magnesium as therapy. Serum magnesium may help identify the biological mechanism of depressive symptoms and identify patients likely to respond to magnesium supplementation.

Dietary magnesium intake and risk of depression

BACKGROUND

Depression is an important public health problem. The aim of the present study is to examine the association of dietary magnesium intake with risk of depression.

METHODS

We assessed the association between dietary magnesium intake and risk of depression in a nationally representative sample of 17,730 adults from the 2007-2014 National Health and Nutrition Examination Survey. Magnesium intake was assessed by 24 h dietary recalls. Depression was assessed using the Patient Health Questionnaire-9. Logistic regression and restricted cubic spline models were applied to assess the relationship between dietary magnesium intake and risk of depression.

RESULTS

Dietary magnesium intake was inversely associated with risk of depression, and the multivariate adjusted odds ratio (95% confidence interval) of depression for the highest vs lowest category of dietary magnesium intake was 0.47(0.34-0.66). In subgroup analysis, dietary magnesium intake was inversely associated with risk of depression among women whereas no association was found among man. The inverse association between dietary magnesium intake and risk of depression was statistically significant among all age groups. A linear relationship (P_{for nonlinearity} = 0.34) was found between dietary magnesium intake and risk of depression in dose-response analysis.

LIMITATIONS

This was a cross-sectional study, thus causality cannot be inferred. In addition, data was based on self-reports.

CONCLUSIONS

Dietary magnesium intake was inversely associated with the risk of depression in a linear manner, which still needs to be confirmed by larger prospective studies.

Association between Lower Intake of Minerals and Depressive Symptoms among Elderly Japanese Women but Not Men: Findings from Shika Study

The aim of this cross-sectional study was to examine the relationship of mineral intake, including sodium, potassium, calcium, magnesium, phosphorus, iron, zinc, copper and manganese, with depressive symptoms in both genders in the Japanese elderly population. A total of 1423 participants who were older than 65 years old were recruited in this study. Mineral intake was analyzed using a validated and brief self-administered diet history questionnaire. Depressive symptoms were assessed with a short version of the Geriatric Depression Scale. A logistic regression model was applied to determine the relationship between mineral intake and depressive symptoms. The prevalence of depressive symptoms was 20%. Except for sodium and manganese, mineral intake was significantly lower in the depressive symptoms group. There was no difference of mineral intake between male participants with depressive symptoms and those without such symptoms. However, in female participants, mineral intake was significantly lower in participants with depressive symptoms compared to those without such symptoms. Potassium, calcium, magnesium, phosphorus, iron, zinc, and copper were significantly and negatively correlated with depressive symptoms among female participants, but not male participants. Our results suggest that the deficiencies in mineral intake may be related to depressive symptoms, especially in women.

Micronutrient intake adequacy and depression risk in the SUN cohort study

PURPOSE

The aim of the study was to prospectively assess the association between micronutrient intake adequacy and risk of depression.

METHODS

This dynamic cohort study involves Spanish university graduates (SUN Project). Dietary intake was assessed at baseline and after 10 years of follow-up with a semi-quantitative food frequency questionnaire. Micronutrient intake adequacy for vitamins B1, B2, B3, B6, B12, C, A, D, E, folic acid, zinc, iodine, selenium, iron, calcium, potassium, phosphorus, magnesium and chrome was estimated. Inadequate intake for each nutrient was defined when the intake of the nutrient was below the estimated average requirements (EAR) if available or the adequate intake levels, if EARs were not available. We compared participants with inadequate intake for ≥4 nutrients vs. those with one nutrient. Participants were classified as having incident depression if they had no previous history of depression or antidepressants use at baseline, but they reported during follow-up a new clinical diagnosis of depression by a physician, use of antidepressant drugs, or both. Time-dependent multivariable Cox regression models were fitted.

RESULTS

After a median follow-up of 8.5 years, 953 new cases of depression were observed among 13,983 participants. Participants with inadequate intake for ≥4 nutrients showed a significantly higher risk of depression [multivariable hazard ratio (HR) = 1.37; 95% confidence interval (CI) 1.01-1.85]. When the analyses were updated with repeated assessments of intakes, the association was attenuated and it was no longer statistically significant (Multivariable HR = 1.11; 95% CI 0.82-1.51).

CONCLUSIONS

Micronutrient inadequacy in four or more micronutrients could exert a moderate role in the development of depression.

Effects of Magnesium Supplementation on Unipolar Depression: A Placebo-Controlled Study and Review of the Importance of Dosing and Magnesium Status in the Therapeutic Response

Animal studies using tests and models have demonstrated that magnesium exerts an antidepressant effect. The literature contains few studies in humans involving attempts to augment antidepressant therapy with magnesium ions. The purpose of our study was to assess the efficacy and safety of antidepressant treatment, in combination with magnesium ions. A total of 37 participants with recurrent depressive disorder who developed a depressive episode were included in this study. As part of this double-blind study, treatment with the antidepressant fluoxetine was accompanied with either magnesium ions (120 mg/day as magnesium aspartate) or placebo. During an 8-week treatment period, each patient was monitored for any clinical abnormalities. Moreover, serum fluoxetine and magnesium levels were measured, and pharmaco-electroencephalography was performed. The fluoxetine + magnesium and fluoxetine + placebo groups showed no significant differences in either Hamilton Depression Rating Scale (HDRS) scores or serum magnesium levels at any stage of treatment. Multivariate statistical analysis of the whole investigated group showed that the following parameters increased the odds of effective treatment: lower baseline HDRS scores, female gender, smoking, and treatment augmentation with magnesium. The parameters that increased the odds of remission were lower baseline HDRS scores, shorter history of disease, the presence of antidepressant-induced changes in the pharmaco-EEG profile at 6 h after treatment, and the fact of receiving treatment augmented with magnesium ions. The limitation of this study is a small sample size.

The association between dietary intake of magnesium and psychiatric disorders among Iranian adults: a cross-sectional study

Findings from clinical trials on the effect of Mg supplementation on depression and anxiety are not generalisable to the community owing to high-dose intervention in short-term periods. Limited observational data are available linking dietary intake of Mg and psychiatric disorders. We aimed to investigate the association between dietary intake of Mg and psychiatric disorders in a large cross-sectional study on Iranian adults. A total of 3172 Iranian adults (with an age range of 18-55 years) were included in this study. Data on dietary intakes were collected using a validated dish-based 106-item semi-quantitative FFQ. To assess depression and anxiety, an Iranian validated version of the Hospital Anxiety and Depression Scale was used. Furthermore, psychological distress was examined using the General Health Questionnaire. The mean age of men and women was 38·4 (sd 8·2) and 35·1 (sd 7·4) years, respectively. In unadjusted analyses, we found that higher dietary Mg intake was associated with lower odds of anxiety among women (OR 0·61; 95 % CI 0·41, 0·90), such that after taking potential confounders into account women in the highest quintile of Mg intake had a 39 % lower odds of anxiety compared with those in the lowest quintile (OR 0·61; 95 % CI 0·40, 0·93). Moreover, deficient Mg intake was positively associated with anxiety among all women (OR 1·80; 95 % CI 1·19, 2·72) and also normal-weight women (OR 1·73; 95 % CI 1·01, 2·95). In addition, a significant inverse association was found between dietary Mg intake and depression among normal-weight men (OR 0·45; 95 % CI 0·20, 0·99) and overweight women (OR 0·45; 95 % CI 0·24, 0·85). In conclusion, dietary intake of Mg was inversely associated with depression and anxiety. However, such findings were not seen for psychological distress.

Zinc, Magnesium, Selenium and Depression: A Review of the Evidence, Potential Mechanisms and Implications

Micronutrient deficiency and depression are major global health problems. Here, we first review recent empirical evidence of the association between several micronutrients—zinc, magnesium, selenium—and depression. We then present potential mechanisms of action and discuss the clinical implications for each micronutrient. Collectively, empirical evidence most strongly supports a positive association between zinc deficiency and the risk of depression and an inverse association between zinc supplementation and depressive symptoms. Less evidence is available regarding the relationship between magnesium and selenium deficiency and depression, and studies have been inconclusive. Potential mechanisms of action involve the HPA axis, glutamate homeostasis and inflammatory pathways. Findings support the importance of adequate consumption of micronutrients in the promotion of mental health, and the most common dietary sources for zinc and other micronutrients are provided. Future research is needed to prospectively investigate the association between micronutrient levels and depression as well as the safety and efficacy of micronutrient supplementation as an adjunct treatment for depression.

Role of magnesium supplementation in the treatment of depression: A randomized clinical trial

Current treatment options for depression are limited by efficacy, cost, availability, side effects, and acceptability to patients. Several studies have looked at the association between magnesium and depression, yet its role in symptom management is unclear. The objective of this trial was to test whether supplementation with over-the-counter magnesium chloride improves symptoms of depression. An open-label, blocked, randomized, cross-over trial was carried out in outpatient primary care clinics on 126 adults (mean age 52; 38% male) diagnosed with and currently experiencing mild-to-moderate symptoms with Patient Health Questionnaire-9 (PHQ-9) scores of 5–19. The intervention was 6 weeks of active treatment (248 mg of elemental magnesium per day) compared to 6 weeks of control (no treatment). Assessments of depression symptoms were completed at bi-weekly phone calls. The primary outcome was the net difference in the change in depression symptoms from baseline to the end of each treatment period. Secondary outcomes included changes in anxiety symptoms as well as adherence to the supplement regimen, appearance of adverse effects, and intention to use magnesium supplements in the future. Between June 2015 and May 2016, 112 participants provided analyzable data. Consumption of magnesium chloride for 6 weeks resulted in a clinically significant net improvement in PHQ-9 scores of -6.0 points (CI -7.9, -4.2; P<0.001) and net improvement in Generalized Anxiety Disorders-7 scores of -4.5 points (CI -6.6, -2.4; P<0.001). Average adherence was 83% by pill count. The supplements were well tolerated and 61% of participants reported they would use magnesium in the future. Similar effects were observed regardless of age, gender, baseline severity of depression, baseline magnesium level, or use of antidepressant treatments. Effects were observed within two weeks. Magnesium is effective for mild-to-moderate depression in adults. It works quickly and is well tolerated without the need for close monitoring for toxicity.

Manganese intake is inversely associated with depressive symptoms during pregnancy in Japan: Baseline data from the Kyushu Okinawa Maternal and Child Health Study

BACKGROUND

One epidemiological study in Canada has addressed the association between zinc intake and depressive symptoms during pregnancy while another epidemiological study in Korea has examined the association between iron intake and depressive symptoms during pregnancy. The present cross-sectional study in Japan examined the association between intake of zinc, magnesium, iron, copper, and manganese and depressive symptoms during pregnancy.

METHODS

Study subjects were 1745 pregnant women. Dietary intake during the preceding month was assessed using a self-administered diet history questionnaire. Depressive symptoms were defined as a score ≥16 on the Center for Epidemiologic Studies Depression Scale. Adjustment was made for age, gestation, region of residence, number of children, family structure, history of depression, family history of depression, smoking, secondhand smoke exposure at home and at work, employment, household income, education, body mass index, and intake of saturated fatty acids, eicosapentaenoic acid plus docosahexaenoic acid, calcium, vitamin D, and isoflavones.

RESULTS

In crude analysis, significant inverse associations were observed between intake levels of zinc, magnesium, iron, copper, and manganese and the prevalence of depressive symptoms during pregnancy. After adjustment for confounding factors, only manganese intake was independently inversely associated with depressive symptoms during pregnancy: the adjusted prevalence ratio between extreme quartiles was 0.74 (95% confidence interval:0.56-0.97, P for trend=0.046).

LIMITATIONS

Information was obtained between the 5th and 39th week of pregnancy.

CONCLUSIONS

The current cross-sectional study of Japanese women demonstrated higher manganese intake to be independently associated with a lower prevalence of depressive symptoms during pregnancy.

Dietary magnesium and calcium intake and risk of depression in the general population: A meta-analysis

OBJECTIVE

Several epidemiological studies have evaluated the associations between dietary magnesium (Mg) and calcium (Ca) intake and the risk of depression. However, the results of these studies remain controversial. Thus, we performed a meta-analysis to explore these associations and to investigate the possible dose-response relationship between dietary Mg intake and risk of depression.

METHODS

MEDLINE, Web of Science, Embase, Cochrane CENTRAL, CINAHL database, Chinese National Knowledge Infrastructure, Wan fang databases and Databases of Chinese Scientific and Technical Periodicals were searched for eligible publications up to September 2016. Pooled relative risks with 95% confidence intervals were calculated using random-effects model. Publication bias was estimated using Egger's test and the funnel plot. Dose-response relationship was assessed by restricted cubic spline functions.

RESULTS

A total of 17 epidemiological studies from 12 articles were included in the present meta-analysis. Among these studies, 11 studies evaluated the association between dietary Mg intake and risk of depression and 6 studies evaluated the association between dietary Ca intake and risk of depression. When comparing the highest with the lowest intake, the pooled relative risks of depression were 0.81 (95% confidence interval = [0.70, 0.92]) for Mg and 0.66 (95% confidence interval = [0.42, 1.02]) for Ca. Dietary Mg intake was significantly associated with a reduced risk of depression among studies conducted in Asia (relative risk  = 0.57; 95% confidence interval = [0.44, 0.74]) and in studies adjusting for energy intake (relative risk  = 0.73; 95% confidence interval = [0.58, 0.92]). For dose-response analysis, evidence of a nonlinear relationship was found between dietary Mg intake and risk of depression, and the largest risk reductions were observed for 320 mg/day.

CONCLUSION

This meta-analysis indicated that moderate Mg intake may be inversely associated with the risk of depression, which still needs to be confirmed by larger prospective cohort studies.

Effect of magnesium supplementation on depression status in depressed patients with magnesium deficiency: A randomized, double-blind, placebo-controlled trial

OBJECTIVES

The aim of this study was to determine the effect of magnesium supplementation on the depression status of depressed patients suffering from magnesium deficiency.

METHODS

Sixty depressed people suffering from hypomagnesemia participated in this trial. The individuals were randomly categorized into two groups of 30 members; one receiving two 250-mg tablets of magnesium oxide (MG) daily and the other receiving placebo (PG) for 8 wk. The Beck Depression Inventory-II was conducted and the concentration of serum magnesium was measured.

RESULTS

At the end of intervention, 88.5% of the MG and 48.1% of the PG (P = 0.002) had a normal level of magnesium. The mean changes of serum magnesium were significantly different across the two groups. After the intervention, the mean Beck score significantly declined. However, in the MG, this reduction was more significant than in the PG (P = 0.02), so that the mean changes in this group experienced 15.65 ± 8.9 reduction, but in the PG, it declined by 10.40 ± 7.9.

CONCLUSIONS

Daily consumption of 500 mg magnesium oxide tablets for ≥8 wk by depressed patients suffering from magnesium deficiency leads to improvements in depression status and magnesium levels. Therefore, assessment of the magnesium serum and resolving this deficiency positively influence the treatment of depressed patients.

Serum Magnesium Status in Patients Subjects with Depression in the City of Yazd in Iran 2013-2014

Depression is the most common mental disorder and involves many factors. The regulatory effects of magnesium on N-methyl-D-aspartate (NMDA) channels make it a factor in the treatment of depression. The present study investigated the level of serum magnesium in subjects diagnosed with depression in the city of Yazd in Iran. This cross-sectional study was done from January 2013 to January 2014 on 650 patients with depression who agreed to participate in this study. Diagnosis was made using the Beck Depression Inventory test (BDI-II); those scoring higher than 11 were sent to the medical school laboratory for further testing of serum magnesium levels. The mean age of the patients was 34.16 ± 9.12 years. Of the 650 subjects, 195 were male (30 %) and 455 were female (70 %). The total mean serum magnesium was 2.1 ± 0.26 mg/dl. The prevalence of hypomagnesemia 13.7 %, hypermagnesemia 8.3 %, and sub-optimal magnesium levels was 26.5 %. Sub-optimal prevalence in women (28.1 %) was higher than in men (26.2 %). A significant relationship was observed between depression and serum magnesium level (p = 0.02). The results indicated that the prevalence of hypomagnesemia in subjects diagnosed with depression is high compared to non-depressed individuals. Moreover, there was a significant relationship between hypomagnesemia and intensity of depression that suggests a role for this element in the pathogenesis of the disorder. The high sub-optimal prevalence among women indicates that increased attention should be paid to this group.

Dietary magnesium intake and the incidence of depression: A 20-year follow-up study

BACKGROUND

Depression is a major global public health concern. The aetiology of depression is partly unclear; however, intake of nutrients, such as magnesium, have been suggested to affect depressive symptoms and modify depression risk.

METHODS

This research is a part of the Kuopio Ischemic Heart Disease Risk Factor (KIHD) Study, conducted on a sample of 2320 Eastern Finnish men aged 42-61 years old at the baseline. Magnesium intake was assessed by a 4-day food record. Hospital discharge diagnosis of unipolar depressive disorder was used as an outcome variable.

RESULTS

Participants in the middle tertile of dietary magnesium intake had a statistically significantly decreased risk of getting a hospital discharge diagnosis of depression compared to participants in the lowest tertile of magnesium intake (HR 0.49, CI 0.25-0.95, P=0.035) in the prospective setting after multivariable adjustments. In addition, an inverse association between magnesium intake and the risk of depression was found when the combined middle and highest tertiles of magnesium intake were compared with the lowest tertile (HR 0.53, CI 0.29-0.95, P=0.033).

LIMITATIONS

Our findings may not be generalizable to individuals below middle-age or women. Moreover, we were unable to consider cases with mild depression in the longitudinal setting.

CONCLUSIONS

The results of this study suggest that magnesium intake may have an effect on the risk to develop depression. Further studies are needed to investigate whether sufficient magnesium intake could have implications for prevention or treatment of depression.

A pilot in vivo proton magnetic resonance spectroscopy study of amino acid neurotransmitter response to ketamine treatment of major depressive disorder

The N-methyl-D-aspartate receptor antagonist ketamine can improve major depressive disorder (MDD) within hours. To evaluate the putative role of glutamatergic and GABAergic systems in ketamine's antidepressant action, medial prefrontal cortical (mPFC) levels of glutamate+glutamine (Glx) and γ-aminobutyric acid (GABA) were measured before, during, and after ketamine administration using proton magnetic resonance spectroscopy. Ketamine (0.5 mg kg(-1) intravenously) was administered to 11 depressed patients with MDD. Glx and GABA mPFC responses were measured as ratios relative to unsuppressed voxel tissue water (W) successfully in 8/11 patients. Ten of 11 patients remitted (50% reduction in 24-item Hamilton Depression Rating Scale and total score ⩽10) within 230 min of commencing ketamine. mPFC Glx/W and GABA/W peaked at 37.8%±7.5% and 38.0%±9.1% above baseline in ~26 min. Mean areas under the curve for Glx/W (P=0.025) and GABA/W (P=0.005) increased and correlated (r=0.796; P=0.018). Clinical improvement correlated with 90-min norketamine concentration (df=6, r=-0.78, P=0.023), but no other measures.

A longitudinal analysis of diet quality scores and the risk of incident depression in the SUN Project

BACKGROUND

Some studies have pointed out that several dietary patterns could be associated with a reduced risk of depression among adults. This association seems to be consistent across countries, cultures and populations. The objective of the study was to compare and to establish the type of relationship between three diet quality scores and depression in the SUN (Seguimiento Universidad de Navarra) Cohort study.

METHODS

We performed a dynamic cohort study based on Spanish university graduates free of depression at baseline. Dietary intake was repeatedly assessed at baseline and after 10 years of follow-up with a validated semi-quantitative food-frequency questionnaire. Three previously described diet quality scores: Mediterranean Diet Score (MDS), Pro-vegetarian Dietary Pattern (PDP) and Alternative Healthy Eating Index-2010 (AHEI-2010) were built. Participants were classified as having depression if they reported a new clinical diagnosis of depression by a physician or initiated the use of an antidepressant drug during follow-up. Time-dependent Cox regression models with cumulative averages of diet and restricted cubic splines were used to estimate hazard ratios of depression according to quintiles of adherence to the MDS, PDP and AHEI-2010.

RESULTS

One thousand and fifty one incident cases of depression were observed among 15,093 participants from the SUN Cohort after a median follow-up of 8.5 years. Inverse and significant associations were observed between the three diet quality scores and depression risk. The hazard ratios and 95 % confidence intervals for extreme quintiles (fifth versus first) of updated adherence to MDS, PDP and AHEI-2010 were 0.84 (0.69-1.02), 0.74 (0.61-0.89) and 0.60 (0.49-0.72), respectively. The dose-response analyses showed non-linear associations, suggesting that suboptimal adherence to these dietary patterns may partially be responsible for increased depression risk.

CONCLUSIONS

Better adherence to the MDS, PDP and AHEI-2010 was associated with a reduced risk of depression among Spanish adults. However, our data suggested a threshold effect so that although the risk of depression was reduced when comparing moderate versus lower adherence, there was not much extra benefit for the comparison between moderate and high or very high adherence.

Low dietary intake of magnesium is associated with increased externalising behaviours in adolescents

OBJECTIVE

Adequate Zn and Mg intakes may be beneficial for the prevention and treatment of mental health problems, such as depression, anxiety and attention-deficit hyperactivity disorder. We aimed to investigate the prospective association between dietary intakes of Zn and Mg and internalising and externalising behaviour problems in a population-based cohort of adolescents.

DESIGN

Prospective analysis (general linear mixed models) of dietary intakes of Zn and Mg assessed using a validated FFQ and mental health symptoms assessed using the Youth Self-Report (YSR), adjusting for sex, physical activity, family income, supplement status, dietary misreporting, BMI, family functioning and energy intake.

SETTING

Western Australian Pregnancy Cohort (Raine) Study.

SUBJECTS

Adolescents (n 684) at the 14- and 17-year follow-ups.

RESULTS

Higher dietary intake of Mg (per SD increase) was significantly associated with reduced externalising behaviours (β = -1.45; 95% CI -2.40, -0.50; P = 0.003). There was a trend towards reduced externalising behaviours with higher Zn intake (per SD increase; β = -0.73; 95% CI -1.57, 0.10; P = 0.085).

CONCLUSIONS

The study shows an association between higher dietary Mg intake and reduced externalising behaviour problems in adolescents. We observed a similar trend, although not statistically significant, for Zn intake. Randomised controlled trials are necessary to determine any benefit of micronutrient supplementation in the prevention and treatment of mental health problems in adolescents.

Lifestyle management of unipolar depression

OBJECTIVE

To be used in conjunction with 'Pharmacological management of unipolar depression' [Malhi et al. Acta Psychiatr Scand 2013;127(Suppl. 443):6-23] and 'Psychological management of unipolar depression' [Lampe et al. Acta Psychiatr Scand 2013;127(Suppl. 443):24-37]. To provide clinically relevant recommendations for lifestyle modifications in depression, derived from a literature review.

METHOD

A search of pertinent literature was conducted up to August 2012 in the area of lifestyle factors and depression. A narrative review was then conducted.

RESULTS

There is evidence that level of physical activity plays a role in the risk of depression, and there is a large and validated evidence base for exercise as a therapeutic modality. Smoking and alcohol and substance misuse appear to be independent risk factors for depression, while the new epidemiological evidence supports the contention that diet is a risk factor for depression; good quality diets appear protective and poor diets increase risk.

CONCLUSION

Lifestyle modification, with a focus on exercise, diet, smoking and alcohol, may be of substantial value in reducing the burden of depression in individuals and the community.

Low dietary calcium is associated with self-rated depression in middle-aged Korean women

It is thought that calcium (Ca) and magnesium (Mg) may be related to mental disorders such as depression; however, there have been few studies investigating the association between Ca and Mg nutrition status with depression in middle-aged female adults. Study subjects in this study included 105 women between the ages of 41 and 57 years. The subjects were divided into three groups according to the Zung Self-rating Depression Scale (SDS) score: Group I (SDS score < 33 percentile; n = 32), Group II (33 percentile ≤ SDS score < 67 percentile; n = 37), and Group III (67 percentile ≤ SDS score; n = 36). Anthropometric measurements, dietary intake survey using 3-day dietary records, SDS questionnaire and measurement of serum Ca and Mg were obtained and analyzed. No differences were observed in Ca, plant Ca, and Mg intake among the three groups. However, animal Ca intake by Group III was 141.3 mg, which was significantly lower than 207.6 mg by Group I and 198.3 mg by Group II (P = 0.0345). There were no significant differences in serum levels of Ca, and Mg among the three groups. Correlation analysis indicated that the SDS score had negative correlations with Ca intake (r = -0.2927, P < 0.01) and animal Ca (r = -0.3411, P < 0.001) after adjusting for age, menopause and energy intake. In conclusion, dietary Ca and animal Ca had negative associations with SDS score among middle-aged Korean female adults. Additional analysis of factors related to the association of calcium and magnesium nutritional status and depression is necessary.