Abstract
Major depressive disorder (MDD) is an incapacitating condition characterized by loss of interest, anhedonia and low mood, which affects almost 4% of people worldwide. With rising prevalence, it is considered a public health issue that affects economic productivity and heavily increases health costs alone or as a comorbidity for other pandemic non-communicable diseases (such as obesity, cardiovascular disease, diabetes, inflammatory bowel diseases, etc.). What is even more noteworthy is the double number of women suffering from MDD compared to men. In fact, this sex-related ratio has been contemplated since men and women have different sexual hormone oscillations, where women meet significant changes depending on the age range and moment of life (menstruation, premenstruation, pregnancy, postpartum, menopause…), which seem to be associated with susceptibility to depressive symptoms. For instance, a decreased estrogen level promotes decreased activation of serotonin transporters. Nevertheless, sexual hormones are not the only triggers that alter neurotransmission of monoamines and other neuropeptides. Actually, different dietary habits and/or nutritional requirements for specific moments of life severely affect MDD pathophysiology in women. In this context, the present review aims to descriptively collect information regarding the role of malnutrition in MDD onset and course, focusing on female patient and especially macro- and micronutrient deficiencies (amino acids, ω3 polyunsaturated fatty acids (ω3 PUFAs), folate, vitamin B12, vitamin D, minerals…), besides providing evidence for future nutritional intervention programs with a sex-gender perspective that hopefully improves mental health and quality of life in women.
Highlights
Major depressive disorder (MDD), commonly known as depression, is an incapacitating global health problem characterized by altered mood, including loss of interest and pleasure, as well as impaired cognitive and vegetative functions [1]
It would be interesting to carry out studies in which, when monitoring pregnant women, it can be detected if their frequent lack of appetite or other irregularities [122] are related to prevalence of postpartum depression; or to determine if, in women with postpartum depression, there is a tendency towards loss of appetite or binge eating in pregnancy
It should be noted that vitamin D could play an important role in improving depression in this group, but the lack of studies casts uncertainty on whether its effect is due to the relationship in the HPA axis, serotonin, hormonal and inflammatory levels or other mechanisms involved in the pathophysiology of postpartum depression (PPD) [199–201]
Summary
Major depressive disorder (MDD), commonly known as depression, is an incapacitating global health problem characterized by altered mood, including loss of interest and pleasure, as well as impaired cognitive and vegetative functions [1]. The impact of socioeconomic aspects, age, race and the presence of other comorbidities cannot be ignored [18] In this sense, it has been shown that the risk of suffering from MDD worsens when the framework of difference in political participation or economic independence is less egalitarian, leading to a clear increase in symptoms, as well as persistent depression [19,20]; if we find ourselves again in the range between 14 and 25 years, the dissimilarity will be more accentuated between both sexes, while it is not so evident in older age groups [21]. It is true that the patient’s nutritional status is closely related to depression and may be a key tool for its prevention and treatment [22] In this line, repeated eating patterns and specific physiological situations have been observed in the case of women (menstrual cycle, childbirth, postpartum, menopause), which lead to marked nutritional deficiencies, especially micronutrients such as vitamin D, omega-3 fatty acids (FA ω-3), methyl-folate and S-adenosyl methionine (SAMe). The main objective of this paper is to critically and descriptively review the impact of malnutrition on the pathophysiology of MDD in women, evaluating possible strategies based on nutritional intervention that may be helpful in limiting the progression or promoting recovery from depression, as well as preventing the appearance of future depressive episodes
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