Włodarczyk Adam, Cubała Wiesław J, Stawicki Mateusz
Department of Psychiatry, Faculty of Medicine, Medical University of Gdansk, Poland.
Department of Psychiatry, Faculty of Medicine, Medical University of Gdansk, Poland.
Prog Neuropsychopharmacol Biol Psychiatry. 2021 Jul 13;109:110257. doi: 10.1016/j.pnpbp.2021.110257. Epub 2021 Jan 23.
Approximately 30% of patients with major depressive disorder (MDD) present resistance to current pharmacological therapies. There is the possibility that an appropriate nutritional regimen can maintain euthymia. Poor dietary pattern and lack of nutritional knowledge are common among today's population; nutrient-rich foods are being replaced by highly processed foods that lead to a higher risk of developing chronic diseases such as metabolic syndrome, hypercholesterolemia, and diabetes. There is growing evidence of the beneficial role of vitamins and dietary supplements for improving symptoms in a range of affective disorders by regulating the gut microbiome, gut-brain axis, and neurotransmitter levels. Reduced GABA neurotransmission is regularly observed in MDD. Moreover, positive allosteric GABA modulators (i.e benzodiazepines) are widely prescribed to alleviate depression symptoms, but their use needs to be limited, as it can lead to addiction. An alternative option may be the adherence to a ketogenic diet, which consists of low-carbohydrate, moderate-protein, and high-fat intake. It is mainly known for its beneficial role in weight-loss, refractory epilepsy treatment, and balancing glucose levels. A ketogenic diet can also increase GABA levels to aid the mechanism of action of monoaminergic drugs. Thus, it could potentially be used in the treatment for affective disorders due to its potential role in GABA/glutamate balance. While more research is needed before this regimen can be regularly recommended to patients, here we discuss evidence that may encourage physicians to prescribe ketogenic diet as an adjuvant for patients receiving psychotherapy and pharmacology.
大约30%的重度抑郁症（MDD）患者对目前的药物治疗存在耐药性。适当的营养方案有可能维持情绪正常。不良的饮食模式和缺乏营养知识在当今人群中很常见；营养丰富的食物正被高度加工的食物所取代，而这些高度加工的食物会增加患慢性疾病的风险，如代谢综合征、高胆固醇血症和糖尿病。越来越多的证据表明，维生素和膳食补充剂通过调节肠道微生物群、肠-脑轴和神经递质水平，对改善一系列情感障碍的症状具有有益作用。在MDD中经常观察到γ-氨基丁酸（GABA）神经传递减少。此外，阳性变构GABA调节剂（如苯二氮䓬类药物）被广泛用于缓解抑郁症状，但其使用需要受到限制，因为可能导致成瘾。另一种选择可能是坚持生酮饮食，即低碳水化合物、适量蛋白质和高脂肪摄入。它主要因其在减肥、难治性癫痫治疗和平衡血糖水平方面的有益作用而闻名。生酮饮食还可以提高GABA水平，以辅助单胺能药物的作用机制。因此，由于其在GABA/谷氨酸平衡中的潜在作用，它有可能用于情感障碍的治疗。虽然在可以定期向患者推荐这种方案之前还需要更多的研究，但在此我们讨论一些证据，这些证据可能会鼓励医生为接受心理治疗和药物治疗的患者开生酮饮食作为辅助治疗。
