Depression and anxiety: exploring micronutrient interventions

Meredith Blampied introduces us to the NoMAD trial, a pioneering study in micronutrient interventions for depression and anxiety.

Image © University of Canterbury, 2019

Wellbeing and the media

You would likely notice an increase in a variety of wellbeing interventions in the media recently. Some of these are called complementary and alternative medicines. These approaches are often popular as add-ons to conventional medications or as alternatives to seeking medical intervention. Complementary and alternative medicines are increasing in popularity as more people look for additional ways to improve their health. Vitamins and mineral supplementations are one such health-care alternative that have had increasing exposure in both social media and scientific literature, with sometimes conflicting messages about their uses. Supplementation can be expensive and confusing, as there is a huge variety of different options available, advertised for different purposes in regards to both physical and mental wellbeing. This can make it difficult to know if taking vitamins and/or minerals is actually useful for us as individuals.

Depression and anxiety

Depression and anxiety combined affect over 50% of the population at some point during their adult life. They can also be very debilitating conditions, making life difficult for many people and their whānau. It is therefore incredibly important to target anxiety and depression for successful treatment, given how many people it affects and the impact it has on our society.  It is unsurprising that complementary and alternative approaches also exist for anxiety and depression and this includes the use of vitamins and minerals as potential treatments for these conditions. The popularity of vitamins and minerals and their appeal as a “natural” intervention can mean that selling the product can really get ahead of the science. Our mental and physical health is important and the consequences of using a treatment or intervention that doesn’t work for you or potentially could be harmful is something that needs to be taken seriously.

Testing micronutrient treatments

If you want to find out about a novel treatment or intervention for an issue, there is a progression of exploration that can help create good quality data.

Firstly, you start with some published case studies. Case studies follow a single participant through the course of an intervention.

[ Read more: Example case studies for micronutrients 1 and 2. ]

Once there are a number of positive case studies in the published literature, it is a sensible next step to look at a group of people who undergo the treatment or intervention and see if their progress changes over the course of the intervention. This is called an open label phase. However, this is where the placebo effect needs to be taken into account. The placebo effect is a common phenomenon in psychological research: an expectation people have that a product or treatment is going to help them. This can mean that between 40-50% of people can experience improvement from a non-active intervention. Open label trials don’t control for the placebo effect.

[ Read more: Open label trials of micronutrients ]

red pill and blue pill

Randomised controlled trials include a placebo condition alongside a treatment, to account for the placebo effect. They are considered the “gold standard” of treatment research. Briefly, a randomised controlled trial will compare a product or intervention (in this case, a supplement containing a mix of vitamins and minerals) to a placebo (a product with no active ingredients). Participants and researchers in these trials are “blind”, in that neither know what the participants are taking- either placebo or the vitamin/mineral product (a “micronutrient” supplement). This allows the research to take into account the placebo effect. We need these trials as the final step in deciding whether or not a treatment or intervention is helpful, before the treatment or intervention is recommended.

[ Read more: Randomised controlled trials; the placebo effect and its importance in research and treatment ]

Micronutrients and the NoMAD trial

So far, there have been 23 trials like these looking at micronutrients for anxiety and depression in adults. It is difficult to compare the results of these trials, as they all use a variety of micronutrient products in different populations. Another issue that impacts our ability to draw conclusions from these studies is the differences in doses that studies use. Some studies give nutrient supplements at or below the recommended daily allowance (RDA), while others are above the RDA. Any variability in the outcome of these studies therefore could be due to insufficient doses, rather than micronutrients not working to improve symptoms.

There is a significant shortage of trials in people who are experiencing significant symptoms of anxiety and depression. In the 23 studies mentioned earlier, the majority of this research was conducted with “well” participants, who were had never experienced any mental health difficulties. It is very hard to see any potential treatment effects for micronutrients when the population has no symptoms. This is called a “floor effect” and can really impact the conclusions we are able to draw from research and make it difficult to find if micronutrients might be an effective treatment.

The UC Mental Health and Nutrition Research Group identified this gap and developed the Nutrients for Mental Health, Anxiety and Depression (NoMAD) trial. The NoMAD trial is recruiting for adults over the age of 18 who are experiencing symptoms of anxiety and depression that get in the way of their lives. We want to test out if micronutrients might be a helpful in improving their symptoms, helping them get on with their lives. If you are:

  • Over 18 years old
  • Living in Canterbury
  • Experiencing symptoms of anxiety and depression that stop you from living your life
  • Not currently taking medications for anxiety, depression or sleep,

you may be suitable to participate in the trial. More information can be found here.  

We want to work closely with General Practitioners (GPs) in Canterbury, as GPs are usually the first people to identify difficulties with anxiety and depression in their patients. Therefore, referrals to the trial need to come from your GP. Electronic referrals for the trial can be found here.

The field of nutritional supplementation for mental health is racing to keep up with changing consumer trends. It is absolutely crucial for this research to continue to expand, in order for us to have the best, effective, safe and cost-effective treatments available for us. Help us achieve this goal by participating in our research or sharing our research with friends and family. Find out more about micronutrients and our other research here.

Meredith Blampied is a PhD student at the Mental Health and Nutrition Research Group at the University of Canterbury, and a registered clinical psychologist.
Meredith’s research interests include investigating the role of nutrition in mental health,  exploring feedback-informed treatment and best-evidence practice for anxiety disorders, particularly obsessive compulsive disorder.  Meredith has also worked on a number of research project in the areas of child development and learning and social psychology. She has had experience working clinically with adults experiencing a range of mental health issues including anxiety disorders, depression, substance abuse and dependence, adjustment, stress and offending behaviours.