Can a Mediterranean Diet Ease Depression in Young Men?

This transcript has been edited for clarity.

Drew Ramsey, MD: Welcome back, everyone. I'm Dr Drew Ramsey. I'm on the editorial board with Medscape Psychiatry and I'm an assistant clinical professor of psychiatry at Columbia University. We have a special guest today.

I'm here with nutritionist Jessica Bayes, who's at the University of Technology Sydney, and she's the lead author of the AMMEND trial. [Editor's note: Since completing her PhD, Bayes is now at Southern Cross University.] The AMMEND trial is our most recent trial in nutritional psychiatry, finding that giving or helping young men eat a Mediterranean diet can be helpful in the treatment of depression.

Jessica, welcome to Medscape.

Jessica Bayes, PhD: Thank you for having me.

The AMMEND Trial

Ramsey: Thank you for coming on board and helping all of us as clinicians understand some of your research and some of what is suggested by your research — that young men can change their diet and it helped their depression. Tell us a little bit about the AMMEND trial.

Bayes: The AMMEND trial was a 12-week randomized controlled trial in young men, 18-25 years old, who had diagnosed moderate to severe clinical depression. They had a poor baseline diet and we got them to eat a healthy Mediterranean diet, which improved their symptoms of depression.

Ramsey: It was a remarkable trial. Jessica, if I recall, you helped individuals improve the Mediterranean dietary pattern score by 8 points on a 14-point scale. That led to a 20-point reduction in their Beck Depression Inventory. Tell us what that looked like on the ground.

Bayes: It's a huge improvement. Obviously, they were feeling much better in the end in terms of their depressive symptoms, but we also measured their energy, sleep, and quality of life. Many of them at the end were at a score cutoff that suggests no depression or in remission.

Ramsey: There were 72 people in your total trial, so 36% in your intervention arm went into full remission.

Bayes: Which is just amazing.

Ramsey: It also follows up the SMILES trial, which was a little bit of a different trial. You had two nutritional counseling sessions and the SMILES trial had seven, but in the SMILES trial, 32.3% of the patients went into full remission when they adopted a Mediterranean-style diet.

Jessica, what is the secret that you and your team know? I think many clinicians, especially clinicians who are parents and have teens, are kind of shaking their heads in disbelief. They've been telling their kids to eat healthy. What do you guys know about how to help young men change their diet?

How to Aid Adherence to Mediterranean Diet

Bayes: Prior to starting this, when I would say this idea to people, everyone would say, "Great idea. There's no way you're going to get depressed young men to change their diet. Not going to happen." We went to them and we asked them. We said, "We're going to do this study. What do you want from us? What resources would you need? How many appointments would you like? What's too little or too many?"

We really got their feedback on board when we designed the study, and that obviously paid off. We had a personalized approach and we met them where they were at. We gave them the skills, resources, recipes, meal ideas — all those things — so we could really set them up to succeed.

Ramsey: You were telling me earlier about a few of the dietary changes that you felt made a big difference for these young men. What were those?

Bayes: Increasing the vegetables, olive oil, and legumes are probably the big ones that most of them were really not doing beforehand. They were really able to take that on board and make significant improvements in those areas.

Ramsey: These are really some of the top food categories in nutritional psychiatry as we think about how we help our efforts to improve mental health by thinking about nutrition, nutritional quality, and nutritional density. Certainly, those food categories — nuts and legumes, plants, and olive oil — are really what help get us there.

You also gave the students a food hamper. If you were going to be in charge of mental health in Australia and America and you got to give every college freshman a little box with a note, what would be in that box?

Bayes: I'd want to put everything in that box! It would be full of brightly colored fruits and vegetables, different nuts and seeds, and legumes. It would be full of recipes and ideas of how to cook things and how to prepare really delicious things. It would be full of different herbs and spices and all of those things to get people really excited about food.

Ramsey: Did the young men pick up on your enthusiasm and excitement around food? Did they begin to adopt some of that, shifting their view of how they saw the food and how they saw that it is related to their depression?

Bayes: Hopefully. I do think energy is infectious. I'm sure that played a role somewhat, but trying to get them excited about food can be really quite daunting, thinking, I've got to change my entire diet and I've got to learn to cook and go out and buy groceries. I don't even know what to do with a piece of salmon. Trying to get them curious, interested, and just reminding them that it's not all-or-nothing. Make small changes, give it a go, and have fun.

Ramsey: You also have a unique aspect of your research that you're interested in male mental health, and that's not something that's been widely researched. Can you tell us a little bit about what these men were like in terms of coming into your trial as depressed young men?

Bayes: In the context of the COVID-19 pandemic, mental health was at the forefront of many people's minds. They joined the study saying, "I've never seen anything like this before. I've never seen myself represented in research. I wanted to contribute. I want to add to that conversation because I feel like we are overlooked."

Ramsey: I love hearing this notion that maybe young men aren't quite who we think they are. They are wanting to be seen around their mental health. They can learn to use olive oil and to cook, and they can engage in mental health interventions that work. We just need to ask, give them some food, encourage them, and it makes a big difference.

Jessica Bayes, thank you so much for joining us and sharing some of your research. Everyone, it's the AMMEND trial. We will drop a link to the trial below so you can take a peek and tell us what you think.

Please, in the comments, let us know what you think about this notion of helping young men with depression through nutritional interventions. Take a peek at the great work that Jessica and Professor Sibbritt from the University of Technology Sydney have published and put out into the scientific literature for us all.

Thanks so much, Jessica. I look forward to seeing you soon.

Bayes: Thank you.

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