nutrition for mental health

Study: Caffeine, Stress, and Brain function

By R. Ryan S Patel DO, FAPA OSU-CCS Psychiatrist

According to the Food and Drug Administration, caffeine is widely available and upto 80% of adults have caffeine everyday, upto 200mg, which is about 10 ounces of coffee (1).

Sometimes caffeine is used to help stay awake, alert, keep up with academic demands, etc.

While the many benefits of caffeine have been widely documented, problems and side effects caffeine are not as widely known.

One study looked at the impact of caffeine on stress (2).

Who was involved in the study? (2)

  • 25 participants who used caffeine regularly or were light user of caffeine.
  • Subjects received placebo or caffeine (3.5mg per kilogram of body weight, about 238mg for a person weighing 150 pounds)

What was measured? (2)

  • Blood pressure, cortisol (stress hormone), norepinephrine and epinephrine (also involved in stress response and other functions).
  • Measurements were taken at rest, during a stressful laboratory task, and afterwards at rest.

What were the results? (2)

  • Compared to placebo, caffeine caused more than DOUBLE the levels of epinephrine and cortisol, both involved in stress response.
  • Effects were similar in both habitual and light users.
  • Habitual use of caffeine did not development of tolerance to the bodily response.
  • Even at rest, caffeine increased blood pressure and plasma norepinephrine levels.

What do the results mean?

Caffeine may increase your stress level whether you are using caffeine sporadically or regularly.

What are some other effects of too much caffeine?

  • Caffeine had as early as 7am lead to less efficient sleep and reduced total sleep at 9pm (3).
  • Some people have more daytime sleepiness because of caffeine related sleep disruption (4).
  • Caffeine can reduce bloodflow to the brain by up to 27% (5)
  • Too much caffeine can cause (1):
    • Worsening of anxiety
    • Jitteriness
    • Nervousness
    • Sleep disturbance
    • Headaches
    • Make your heart beat faster,  palpitations, high blood pressure, abnormal heart rhythms

What are some caveats?

  • This is a small study and there are many studies showing positive and negative effects of caffeine.
  • Not everyone has the same benefits or side effects caffeine.
  • The AMOUNT of caffeine that has beneficial and harmful effects can be different for different people.
  • Some people can metabolize caffeine much faster or slower than others (6).
  • For some people, it can take days to weeks to see benefits from reducing or eliminating caffeine.
  • Stopping caffeine abruptly can lead to withdrawal headaches, irritability, and other symptoms.

Are you feeling stressed, irritable or anxious? How is your caffeine intake? Could you benefit from less?

Disclaimer: This article is intended to be informative only. It is advised that you check with your own physician/mental health provider before implementing any changes. With this article, the author is not rendering medical advice, nor diagnosing, prescribing, or treating any condition, or injury; and therefore claims no responsibility to any person or entity for any liability, loss, or injury caused directly or indirectly as a result of the use, application, or interpretation of the material presented.

References:

  1. https://www.fda.gov/downloads/ucm200805.pdf
  2. Land JD, Adcock RA, Williams RB, Kuhn CM. Caffeine effects on cardiovascular and neuroendocrine responses to acute psychosocial stress and their relationship to level of habitual caffeine consumption.  Psychosom Med. 1990 May-Jun;52(3):320-36.
  3. H.P. Landolt, E. Werth, A.A. Borbely, D.J. Dijk.  Caffeine intake (200 mg) in the morning affects human sleep and EEG power spectra at night. Brain Research, 675 (1–2) (1995), pp. 67–74.
  4. T. Roehrs, T. Roth. Caffeine: sleep and daytime sleepiness. Sleep Med Rev, 12 (2) (2008), pp. 153–162.
  5. Addicott M.A., Yang L.L., Peiffer A.M., Burnett L.R., Burdette J.H., Chen M.Y.. et al. The effect of daily caffeine use on cerebral blood flow: how much caffeine can we tolerate? Hum. Brain Mapp. 2009;30:3102–3114.
  6. Cornelis, M. C. et al. Genome-wide meta-analysis identifies six novel loci associated with habitual coffee consumption. Mol. Psychiatry 20, 647–656 (2015).

Improving your likelihood of antidepressant medication response

By R. Ryan S Patel DO, FAPA OSU-CCS Psychiatrist

As of 2014, about 15.7 million people in the US had at least 1 major depressive episode in the last year, and about two thirds of the individuals had a severe impairment in their ability to manage at home, work/school, or relationships with others (1).

Treatment options for major depression include counseling, medications, life-style, and other strategies. These options can be used alone or in combination with each other.

A recent study looked at a major factor impacting your response to antidepressant medication for major depression.

How do you define depression?

A major depressive episode is defined as an episode of depressed mood or loss of pleasure in daily activities lasting 2 weeks or longer in the past 12 months and at least some additional symptoms, such as problems with sleep, eating, energy, concentration, and self-worth (2).  Additionally there must be some impairment in a person’s ability to function at home, work, relationships or social settings.

What was the study? (3)

792 patients receiving usual care for depression in 83 clinics for at least six months between 2008 and 2010 (4).

How was depression measured?

Depression was measured using, Patient Health Questionnaire–9, a validated instrument to measure the severity and treatment response to depression (3,4).

Was there a key finding?

According to the study article, patients reporting fair or poor health were significantly less likely to improve depression compared with patients with good, very good, or excellent health (3).

What do the results mean?

In my practice, I often discuss the mental health benefits of healthy lifestyle habits such as healthy eating habits, healthy (not excessive) exercise, adequate sleep, avoidance of alcohol, illicit drugs; yoga, meditation, etc.

This study suggests that individuals suffering from Major Depression with good overall health had a better chance of benefiting from antidepressant medications than those with depression who reported fair or poor health.

In other words, while good overall health might help many people with depression, if you are still depressed, having good overall health improves your chances of responding to medications.

This is a small study and further studies would be helpful.

What are some resources regarding health improvement?

What are some of OSU’s campus resources that might help with reducing depression?

What are some resources regarding depression?

• Counseling at the OSU Student Life Counseling and Consultation Service
• Mindfulness and Body scan techniques at the OSU Wexner Medical Center
• Depression information at the National Institute of Mental Health
• Anonymous mental health screen
• Depression and Bipolar Support Alliance

National Alliance on Mental Illness (NAMI)

Disclaimer: This article is intended to be informative only. It is advised that you check with your own physician/mental health provider before implementing any changes. With this article, the author is not rendering medical advice, nor diagnosing, prescribing, or treating any condition, or injury; and therefore claims no responsibility to any person or entity for any liability, loss, or injury caused directly or indirectly as a result of the use, application, or interpretation of the material presented.

References:

  1. Center for Behavioral Health Statistics and Quality. (2015). Behavioral health trends in the United States: Results from the 2014 National Survey on Drug Use and Health (HHS Publication No. SMA 15-4927, NSDUH Series H-50). Retrieved from http://www.samhsa.gov/data/
  2. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
  3. Rossom RC, et. al.  Predictors of Poor Response to Depression Treatment in Primary Care.  Published online: July 15, 2016. Psychiatric Services in Advance (doi: 10.1176/appi.ps.201400285)
  4. Kroenke K, Spitzer RL, Williams JBW. The PHQ-9: Validity of a Brief Depression Severity Measure.J Gen Intern Med. 2001 September; 16(9): 606–613.

Study: Can Adjusting Gut Bacteria Impact Emotions?

By R. Ryan S Patel DO, FAPA OSU-CCS Psychiatrist

An increasing number of studies show that the bacteria in our gut (probiotics) may have an impact on our emotions, depression, anxiety, and other conditions (1,2).

A review of 1,089 abstracts and 183 articles; suggested that probiotics may have a role in anxiety, bipolar disorder, schizophrenia, obesity, and autism (1).

A recent small study had intriguing findings (3).

What did the study involve?

  • 40 individuals with a diagnosis of Major depression.
  • Ages ranged between 20 and 55 years old.
  • Randomized, double-blind, placebo-controlled clinical trial.

What probiotics were given?

  • Lactobacillus acidophilus, Lactobacillus casei, Bifidobacterium bifidum

What were some of the results?

  • After 8 weeks, subjects getting probiotic supplements were slightly less depressed on the Beck Depression inventory scale (5.7 +/- 6.4 vs. 1.5 +/- 4.8, P<0.001) compared with the placebo.

There were also decreases in:

  • Insulin levels and insulin resistance
  • High sensitivity C-Reactive protein (a marker for inflammation)

How can gut bacteria impact your brain health?

Some theories include (1,2,4 ) an impact on:

  • Hormones
  • Serotonin (a brain transmitter, particularly involved in depression and anxiety)
  • Immune/inflammatory system

What are some causes of an imbalance of gut bacteria?

  • Unhealthy consumption of processed grains, unhealthy fats, sugars, refined carbohydrates, junk foods, etc. (1,2,4)
  • Certain antibiotics

Is it possible to improve health/balance of my gut bacteria?

Certain foods may  help the good bacteria (a balance of proteins (lean meats, eggs, seafood, etc) , healthy fats, vegetables, and whole unprocessed grains)

Certain foods contain pro-biotics:

  • Sauerkraut with live cultures
  • Kimchi
  • Unsweetened yogurt (natural artificial and added sugars may negate benefits)
  • Probiotic supplements

What are some caveats?

  • Taking probiotics is NOT safe for everyone and you should check with your doctor first (5).
  • There are many studies linking probiotics to brain health, and this is a small study with a small effect size.
  • Further study is needed.
  • The exact type, amount, and duration of probiotics for emotional health has not been established.
  • While further research is needed, it has been established that unhealthy eating habits can impact emotional health.
  • According to NCCIH, “The people who are most at risk of severe side effects from probiotics include critically ill patients, those who have had surgery, very sick infants, and people with weakened immune systems” (5)

How are you feeling? Could you feel better by eating healthy foods and reducing/avoiding unhealthy foods? How do you know?

What are some resources to improve nutrition?

Disclaimer: This article is intended to be informative only. It is advised that you check with your own physician/mental health provider before implementing any changes. With this article, the author is not rendering medical advice, nor diagnosing, prescribing, or treating any condition, or injury; and therefore claims no responsibility to any person or entity for any liability, loss, or injury caused directly or indirectly as a result of the use, application, or interpretation of the material presented.

References:

  1. G. Fond et al. The ‘‘psychomicrobiotic’’: Targeting microbiota in major psychiatric disorders: A systematic review/ Pathologie Biologie 63 (2015) 35–42.
  2. Luna RA, Foster JA. Gut brain axis: diet microbiota interactions and implications for modulation of anxiety and depression. Current Opinion in Biotechnology 2015, 32:35–41.
  3. Akkasheh G, et. al. Clinical and metabolic response to probiotic administration in patients with major depressive disorder: A randomized, double-blind, placebo-controlled trial. Nutrition (2015) 1-6.
  4. Wang Y, Kasper LH. The role of microbiome in central nervous system disorders. The role of microbiome in central nervous system disorders.
  5. National Center for Complimentary and Integrative Health.  https://nccih.nih.gov/health/probiotics/introduction.htm