Healthy eating for people with depression, anxiety and related disorders


Healthy eating for people
with depression, anxiety
and related disorders
FACT SHEET 30
Food can play a vital role in maintaining mental health as well as physical health. In general, eating a nourishing
diet gives people an overall sense of well-being. There are also some specific nutritional strategies that can help
improve mood, maintain healthy brain functioning and help people with depression, anxiety and related disorders.
DIETARY GUIDELINES
The Dietary Guidelines for Australian Adults1 provide simple instructions for selecting a healthy diet. They are relevant to all Australians,
including people experiencing a mental illness. Here are some examples of how the following guidelines can benefit someone with
depression and anxiety, in addition to promoting physical health.
Dietary Guideline for Australian Adults1 Example of mental health benefit
Enjoy a wide variety of nutritious food. Increasing the variety in your diet can help stimulate interest in food when appetite is poor.
Eat plenty of vegetables, legumes and fruits. Some of these foods, such as green leafy vegetables, are particularly good sources of folate.
The nutrient folate has been shown to improve the effect of antidepressant medications.
Eat plenty of cereals (including bread, rice, Wholegrain cereals (those with intact kernels) and many fruits, vegetables and legumes have a low
pasta and noodles), preferably wholegrain.  glycaemic index which means that the sugar in these foods is absorbed slowly into the blood
stream. This helps to stabilise blood sugars and optimise mental as well as physical performance.
(To check the glycaemic index of a food visit www.glycemicindex.com)
Wholegrain cereals are good sources of fibre. Eating high fibre foods daily and drinking plenty of
water helps prevent constipation, a side-effect of some antidepressant medications.
Include lean meat, fish, poultry and/or These high protein foods are made up of amino acids  essential nutrients for repairing or building
alternatives. new cells. One essential amino acid is called tryptophan. Regular consumption of protein-rich
foods ensures a steady supply of tryptophan to the brain where it is used to produce serotonin.
Oily fish, such as tuna, salmon, mackerel, perch, sardines and herring are good sources of long
chain omega-3 fatty acids. Consuming about 500 mg a day of long chain omega-3 fatty acids
is a good preventative measure for mental health, as well as physical health. Two to three meals
a week of oily fish or a weekly dose of one oily fish and one white fish meal, together with some
omega-3 enriched foods (such as eggs, bread and milk) will achieve this.
Include milks, yoghurts, cheeses and/or Dairy products are ready to eat, nutrient-dense foods that can serve as palatable snacks for people
alternatives. Reduced-fat varieties should be experiencing loss of appetite and weight. Low-fat varieties are useful when trying to lose or maintain
chosen where possible. weight. Milk is a good source of tryptophan. A warm milk drink before bed can help induce sleepiness.
Drink plenty of water. This can help alleviate the side-effects of some antidepressants such as dry mouth and
constipation. Drinking plenty of water also helps prevent dehydration. Even mild dehydration can
affect mood, causing irritability and restlessness.
Limit saturated fat and moderate total fat intake. This assists with weight control and promotes a healthy metabolism and healthy heart.
Limit your alcohol intake if you choose to drink. Heavy drinking can actually contribute to depression or make it worse, since alcohol is a
depressant. Even at moderate levels, alcohol can interact with antidepressant medication,
reducing its effectiveness.
1 Dietary Guidelines for Australian Adults National Health and Medical Research Council, Australian Government, Canberra 2003.
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Healthy eating for people
with depression, anxiety
and related disorders
FACT SHEET 30
Dietary Guideline for Australian Adults1 Example of mental health benefit
Consume only moderate amounts of sugar and Many high sugar foods are not good sources of essential nutrients.
foods containing added sugar.
High sugar foods such as cakes, pastries and biscuits are often high in saturated fat and kilojoules
that increase blood cholesterol and encourage weight gain. Other foods/drinks such as soft drink
have a high glycaemic index, causing an initial surge of sugar (glucose) into the bloodstream. This
effect soon wears off leaving a person feeling tired and low.
Additional Suggestions
Limit caffeine intake. For people who experience anxiety, avoiding caffeine is wise. Caffeine, especially for those who
are particularly sensitive to it, increases anxiety and contributes to insomnia. Coffee, tea, energy
drinks (such as  Red Bull and  Guarana ) and cola drinks all contain caffeine, as do cocoa and
chocolate in lesser amounts.
For those who don t experience anxiety, limiting daily caffeine intake to the equivalent of two cups
of coffee, or four to five cups of tea is acceptable.
Eat regular meals (and snacks if hungry) This helps stabilise blood sugars and mood.
throughout the day.
Also, at the doses used in trials to treat depression (typically
SUPPLEMENTS
two to three grams a day), omega-3s work in a similar way to
General vitamin/mineral supplements
antidepressant medication and can occasionally cause side-effects.
While supplements are no substitute for a healthy diet, there may
be occasions when they are helpful. If you have been under-eating
NUTRITIONAL CHALLENGES
and/or eating poor quality foods for prolonged periods, a multi-
Having a mental illness can make it challenging to eat well. Lack
vitamin/mineral supplement can help to meet your nutritional needs
of motivation, loss of appetite, irregular meals, feeling isolated,
until you re able to resume better eating patterns.
financial insecurity and the use of comfort eating, drugs or alcohol
If you decide to take a supplement, choose one with moderate
as a coping strategy can all undermine adequate nutrition.
levels of a whole range of vitamins and minerals. While there s some
People with depression and anxiety and their carers can try some
evidence that specific nutrients, such as folate, can play a role in the
simple strategies for optimising nutrition when faced with these
treatment of depression, more evidence is needed before specific
challenges.
doses of individual vitamins and minerals can be recommended.
Some nutrients are toxic in high doses (such as the fat-soluble
Lack of motivation
vitamins A, D and E) so check your supplement choice with a
dietitian or a doctor. Lack of energy and motivation is one of the most difficult barriers
to eating well for people with depression and anxiety. Keeping it
Omega-3 fatty acids
simple and asking for support can help.
There is evidence that the long chain omega-3 essential fatty
" Draw up a daily timetable and schedule in food-related activities
acids found in seafood, (primarily eicosapentaenoic acid (EPA) and
such as shopping, cooking and eating.
docosahexaenoic acid (DHA)) play a role in depressive illnesses.
" Learn to prepare very simple meals. Baked beans on wholemeal
While several studies do show promising results for the use of long
toast for example, with cherry tomatoes and spinach is a healthy
chain omega-3s in the treatment of mood disorders, important
meal that can be prepared in five to ten minutes.
questions remain regarding the optimal dose, optimal proportions of
" If you live on your own and aren t eating proper meals, consider
DHA and EPA, and whether omega-3s alone have an antidepressant
using frozen or home-delivered meals (e.g. Meals on Wheels or
effect or only in conjunction with antidepressant medication.
from commercial providers). These are better than no meals at all.
If you want to try taking omega-3 supplements, do so under
" Make use of shopping online and home delivered groceries.
medical supervision with someone who has experience in the area,
as there can be complications such as blood-clotting disorders.
" Make use of the times when you feel good to prepare meals
ahead of time (e.g. if you feel good in the morning, make dinner
1 Dietary Guidelines for Australian Adults National Health and Medical Research Council,
Australian Government, Canberra 2003. then)  or cook large quantities of food and freeze it.
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" There may be times when partners, parents and relatives will and high sugar foods and drinks (such as soft drinks, sweet
need to take on the role of food preparation until you are well biscuits, chocolate).
enough to do this yourself.
" Snack on nutritious, lower-kilojoule foods such as fruits, raw
vegetables, low-fat crackers and dips (such as rice crackers
Weight change
and hommous).
People with depression often lose or put on weight.
" If you have trouble with excessive comfort eating or binge eating,
professional help from a dietitian or psychologist can help.
Weight loss
Loss of appetite and interest in food is a common symptom of " If you think your weight gain is medication-related, ask your
depression that typically results in weight loss. doctor to review your medication.
" Be realistic about your weight loss expectations. Weight
Dealing with weight loss
maintenance may be the most achievable result to aim for.
" Eating can stimulate appetite. Try to snack regularly throughout
" If you are unable to lose weight, this doesn t mean you inevitably
the day on energy-dense and nutrient-dense foods such as
lose health. Increasing your fitness can offset the health risks
cheese and biscuits, dried fruit and nuts or leftover dinner.
associated with carrying extra weight.
" Exercise can also help stimulate appetite. Try to include some
moderate activity, such as walking, as often as you can.
Drugs and alcohol
" If you can t manage to eat solid food, try some nutritious drinks,
Drinking alcohol, smoking cigarettes and taking other drugs to
such as smoothies or soups. Adding skim milk powder to these
cope with depression all have nutritional consequences. Regular
boosts the protein, energy and nutrient content.
use of these substances can deplete the body of certain nutrients
" If you have become very underweight and are struggling to
and disrupt regular eating patterns, exacerbating mood fluctuations
eat at all, ask your doctor for a referral to a dietitian who can
and challenging a person s ability to establish healthy eating habits.
prescribe adequate meal replacement supplements until you
Tobacco smoking, for example, suppresses appetite and can lead
recover your appetite.
to a person not eating enough. It also increases the demand for
" Pharmacists can also advise on meal supplements.
antioxidants to cope with the damage caused by smoking and
can leave smokers low in these protective nutrients. Thiamine
Weight gain
and other vitamin deficiencies are common in heavy drinkers and
During recovery, as appetite improves, lost weight is usually restored.
these deficits can cause low mood, irritability and/or aggressive
This weight gain can be regarded as a healthy sign of recovery.
behaviour. Cannabis, or marijuana, can stimulate appetite and in
Further weight gain can occur if physical activity levels are low,
some cases lead to over-eating however, taking amphetamines can
if comfort eating is common and with regular use of high-fat,
lead to going days without eating.
high-sugar foods and drinks.
Since most illegal drugs and alcohol interfere with the effects of
Some antidepressant medications also cause weight gain. The
antidepressant drugs, it s important to tell your doctor if you are
medications most commonly associated with weight gain include
taking them, so you can get the appropriate treatment.
Mirtazapine, tricyclic antidepressants and the mood stabiliser, lithium.
For suggestions on how to cut down your alcohol and drug intake
For most people, the weight gain is small and soon stabilises. For
see beyondblue Fact sheet 9: Reducing alcohol and other drugs.
a small number of people, the weight gain can be large. Regular
exercise and healthy eating can help minimise weight gain, whether
medication or lifestyle induced.
POSTNATAL DEPRESSION, NUTRITION
Dealing with weight gain
AND BREASTFEEDING
" Ensure you eat regular meals  this stops you from becoming
Breastfeeding increases a mother s requirement for energy (calories/
too hungry, which can lead to impulsive choices or overeating.
kilojoules), certain nutrients (such as calcium) and fluid. The loss of
" Get as much physical activity as possible. Include some aerobic
appetite and anxiety that usually accompanies postnatal depression,
activity (such as swimming, walking or cycling) as well as some
and the fatigue that is common to many new mothers, can make
resistance training (weights, squats, push ups) if you can.
meeting these extra requirements difficult. If a mother s overall food
" Limit saturated fats (such as butter, cream, processed or fatty and energy intake is too low, this can reduce the volume of milk
meats, fried fast foods, pastries, cakes, biscuits, hard cheese) produced, and can also leave the mother depleted.
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Healthy eating for people
with depression, anxiety
and related disorders
FACT SHEET 30
Good support is crucial in assisting a woman with postnatal Improved nutrition, regular eating patterns and restoration of a
depression to breastfeed. This includes practical support in buying healthy weight are an essential part of the recovery from an eating
and preparing food. disorder and any associated depression. This usually requires help
from a team of professionals with psychological, nutritional and
Tips for meeting extra nutritional demands of breastfeeding
medical expertise. While weight gain helps resolve the malnutrition
" Relax. You don t have to eat perfectly to be able to breastfeed
component of depression, psychological therapy is often required
successfully.
for full restoration of mental health. This allows any personal, family
" Prioritise your own feeding. For example, make sure you
and social issues that may have contributed to the disorder to be
eat breakfast straight after the first feed and then eat before
addressed while also supporting the person through the challenges
breastfeeding throughout the rest of the day.
of recovery.
" Keep a bowl of nutritious finger food on your bench top that you
RECIPES AND MEAL PLANS
can snack on throughout the day (e.g. low-fat cheese cubes,
nuts, fruit).
For recipes and meal plans based on healthy eating principles,
" Don t try to diet or lose weight in the first few months after birth
visit the Better Health Channel www.betterhealth.vic.gov.au/
 you need the extra nourishment for breastfeeding, which helps
bhcv2/bhcsite.nsf/pages/bhc_recipes?opendocument
you lose weight naturally anyway.
or Nutrition Australia www.nutritionaustralia.org/Recipe_of_the_
Week/Recipe_Archive.asp
" Ask for and accept help. If friends offer support, ask them to
cook you a meal. Ask your partner or relatives to help with the
The National Heart Foundation also provides information on healthy
weekly shopping and cooking.
recipes. See www.heartfoundation.org.au and click on Recipes.
" Ask your doctor to check your iron levels. Iron deficiency is
common in women, especially among those who have just given
MORE INFORMATION
birth. Its symptoms, such as exhaustion, fatigue and low mood,
Dietitians Association of Australia
can mimic those of depression. Iron supplements can alleviate
www.daa.asn.au
these symptoms.
Search for an Accredited Practising Dietitian near you via this website.
" While there is no conclusive evidence yet that omega-3
supplements can treat postnatal depression, there appears to
Meals on Wheels
be no harm in increasing intake either through eating more oily
www.mealsonwheels.org.au
fish (tuna, mackerel, perch, sardines and herring) or through
Provides home-delivered midday meals to those unable to cook or
fish oil supplements. Talk to your doctor or dietitian about
shop for themselves.
appropriate doses if you choose to try supplements.
For advice relating specifically to your situation, consult an
Blue Pages
Accredited Practising Dietitian.
www.bluepages.anu.edu.au/treatments/what_works/
Provides a summary of what research tells us about the effectiveness
EATING DISORDERS AND DEPRESSION
of various treatments for depression, including dietary treatments.
Depression is common among people experiencing an
eating disorder.
For some, depression can lead to an eating disorder. For the
majority, having an eating disorder leads to depression.2 This
is particularly so for people with anorexia nervosa, where the
physiological effects of semi-starvation and extremely low body
weight undermine mental health. There may also be a nutritional
component to the mood disorder of people whose weight is within
© beyondblue: the national depression initiative, 2009.
 normal range and who have an eating disorder (typically someone
PO Box 6100, Hawthorn West VIC 3122
T: (03) 9810 6100
with bulimia nervosa), due to fasting, purging and chaotic eating.
beyondblue info line 1300 22 4636
F: (03) 9810 6111
E: bb@beyondblue.org.au
2 www.healthyplace.com/Communities/Eating_Disorders/Site/depression/depression_preceds_ed.htm W: www.beyondblue.org.au
04/09
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For more information www.beyondblue.org.au or beyondblue info line 1300 22 4636


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