Mental Health

Mental health encompasses cognitive, emotional, and behavioral wellbeing, including the absence of disorders like depression, anxiety, and bipolar illness but also positive functioning domains like resilience, emotional regulation, and meaningful engagement. Nutritional psychiatry examines the evidence base for dietary and supplement interventions as adjuncts to established treatments (psychotherapy, pharmacology), not as replacements. For moderate-to-severe conditions, professional diagnosis and first-line treatment remain prerequisites.

Several nutraceuticals have accumulated RCT-level evidence for mood indications. EPA-dominant omega-3 (at least 60% EPA, 1-2g EPA daily) shows effect sizes approximately SMD −0.5 in major depression, with stronger effects in inflammatory subtypes (elevated hs-CRP). Saffron (Crocus sativus extract, 30mg/day) demonstrates non-inferiority to SSRIs in mild-to-moderate depression in multiple head-to-head RCTs. SAM-e (400-1600mg/day) has evidence as augmentation for partial responders to SSRIs. L-methylfolate (15mg/day) benefits depression with documented MTHFR polymorphisms or folate deficiency.

Safety considerations are non-trivial. SAM-e and folate interventions can unmask or precipitate mania in bipolar-spectrum individuals; screening with validated instruments (MDQ, bipolar history, family history) is essential before initiating. St. John’s Wort induces hepatic CYP3A4 and reduces serum levels of many medications including contraceptives and anticoagulants. Foundation interventions (sleep regulation, physical exercise, cognitive behavioral therapy, social connection) consistently outperform any supplement intervention and should not be displaced by supplementation.