Priority of nutrition and exercise in depression management: triangulating mini-review of past and recent evidence with clinical practice guidelines

Abstract

Background: Chronic low-grade systemic inflammation (CLGSI) is implicated in depression and its amelioration. Pro-inflammatory nutrition and inactivity are associated with CLGSI. We triangulated the degree to which recent literature on anti-inflammatory nutrition and physical activity/physical exercise (PA/PE) corroborates the extant body of knowledge related to depression management and is reflected in the guidelines of leading mental health domains (national/international mental health associations/bodies).

Methods: We used mini-review methodology. The search was narrowed to recent state-of-the-art literature (2024) in PubMed, on diet and exercise specifications in depression management. Then, we compared recommendations of aforementioned domains regarding diet and PA/PE in depression management.

Results: Of 73 nutrition source studies, 50 (68%) focused on anti-inflammatory whole food, plant-based (WFPB) nutrition to manage depression; 4 (5%) on reducing consumption of animal-sourced foods; 16 (23%) focused on the effect of ultra-processed food (UPF) and its role in depression and its avoidance vis-à-vis its anti-depressant effects. Of the 55 PA/PE source studies, 49 (89%) focused on the effects of aerobic exercise; 14 (29%) described specific parameters to achieve an anti-depressant effect and 35 (71%) were non-specific. Twelve (22%) studies focused on resistance muscle training; 2 (17%) that reported specific training parameters and 10 (83%) that were non-specific. Nine domains were identified with established depression management guidelines: Australia/New Zealand; Canada; Europe (Belgium, Scotland, Spain); United Kingdom; United States; WFSBP and ASLM; and World Health Organization. Regarding nutrition, 5 (55%) domains recommended WFPB nutrition; 4 (44%) reduced animal-sourced foods; and 3 (33%), avoidance of UPF. With respect to sedentarism, 3 (33%) domains recommended reduced prolonged sitting. Eight domains (89%) mentioned aerobic exercise; 3 (33%) resistance training. Three domains mentioned aerobic exercise non-specifically; 5 (56%) made specific recommendations. Three domains mentioned resistance muscle training; 2 (22%) made non-specific recommendations and 1 (11%) made specific recommendations.

Conclusions: Disparities that exist in leading depression management guidelines vis-à-vis inclusion of evidence-informed nutrition and PA/PE recommendations, warrant reconciliation. Evidence supporting anti-depressant WFPB nutrition and limiting pro-inflammatory animal-sourced food and UPF and supporting anti-inflammatory aerobic exercise and resistance training warrants being translated into national/international depression management guidelines as consistently as recommendations for pharmacotherapy and psychotherapy.

Keywords: Anti-depressant; Anti-inflammatory; Diet; Nutrition; Physical activity; physical exercise.