1. In this randomized controlled trial, overweight or obese adults with subsyndromal depressive symptoms were just as likely to develop major depressive disorder (MDD) when treated with food-related behavioral activation therapy plus dietary supplementation than care as usual.
2. Food-related behavioral activation therapy was related to a significant improvement in generalized anxiety and depression symptom scores.
Evidence Rating Level: 1 (Excellent)
Study Rundown: Major depressive disorder (MDD) is the second leading cause of years-lived-with-disability. However, few studies have addressed interventions aimed to prevent MDD, especially in overweight or obese adults. In this randomized controlled trial, two nutritional interventions, multi-nutrient supplementation and food-related behavioral activation therapy, did not reduce the incidence of MDD after one year of follow-up compared to patients who received care as usual. Additionally, neither intervention reduced time to MDD onset. The food-related behavioral intervention did significantly reduce participant’s anxiety and depression symptom scores at one year.
Overall, while the interventions had a significant effect on self-assessed anxiety and depression symptom scores, they showed no effect on progression from subsyndromal symptoms to MDD. It is important to note that more than three-fourths of the subjects in this study were female and nearly one-quarter of the participants did not complete the one-year follow-up, thus attrition bias cannot be ruled out.
In-Depth [randomized controlled trial]: The MooDFOOD study was a 2 x 2 international randomized control trial that enrolled 1,025 patients with subsyndromal depressive symptoms between July 30, 2015 and October 13, 2017. Patients were randomized to receive dietary intervention (omega-3-omega acids, selenium, folic acid, vitamin D, and calcium) or placebo. Additionally, patients were randomized to receive group therapy sessions or none. After randomization, patients were followed for up to 1 year with self-assessments and the Mini International Neurpsychiatric Interview at 3, 6, and 12 months. The primary outcome was 12-month cumulative incidence of MDD. Overall, during the follow-up period, 105 (10%) patients developed MDD. 25 (9.7%) patients were in the placebo without therapy group, 26 (10.2%) were in the placebo with therapy group, 32 (12.5%) were in the supplement without therapy group, and 22 (8.6%) were in the supplement with therapy group. There was no significant effect of supplements (HR 1.05; p = .65), therapy (HR 0.91; p = .32), or supplements plus therapy (HR 0.91; p = .36) on the time of first onset of MDD. For secondary outcomes, it was found that food-related behavioral activation resulted in significantly lower generalized anxiety disorder scores at 12 months (p = .01). Additionally, there was a significant effect of supplements on reduction in depression scores on the Patient Health Questionnaire 9 (PHQ-9) at 12 months (p = .02).
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