A lack of essential nutrients is known to contribute to the onset of poor mental health in people suffering from anxiety and depression, bipolar disorder, schizophrenia and ADHD. Nutritional psychiatry is a growing discipline that focuses on the use of food and supplements to provide these essential nutrients as part of an integrated or alternative treatment for mental health disorders.
But nutritional approaches for these debilitating conditions are not widely accepted by mainstream medicine. Treatment options tend to be limited to official National Institute for Care Excellence (NICE) guidelines which recommend talking therapies and antidepressants.
Use of antidepressants
Antidepressant use has more than doubled in recent years. In England 64.7m prescriptions were issued for antidepressants in 2016 at a cost of £266.6m. This is an increase of 3.7m on the number of items prescribed in 2015 and more than double than the 31m issued in 2006.
A recent Oxford University study found that antidepressants were more effective in treating depression than placebo. The study was led by Dr Andrea Cipriani who claimed that depression is under treated. Cipriani maintains that antidepressants are effective and a further 1m prescriptions should be issued to people in the UK.
This approach suggests that poor mental health caused by social conditions is viewed as easily treated by simply dispensing drugs. But antidepressants are shunned by people whom they could help because of the social stigma associated with mental ill-health which leads to discrimination and exclusion.
More worrying is the increase in the use of antidepressants by children and young people. In Scotland, 5,572 children under 18 were prescribed antidepressants for anxiety and depression in 2016. This figure has more than doubled since 2009/2010.
But according to British psychopharmacologist Professor David Healy, 29 clinical trials of antidepressant use in young people found no benefits at all. These trials revealed that instead of relieving symptoms of anxiety and depression, antidepressants caused children and young people to feel suicidal.
Healy also challenges their safety and effectiveness in adults. He believes that antidepressants are over-prescribed and that there is little evidence that they are safe for long-term use. Antidepressants are said to create dependency, have unpleasant side effects and cannot be relied upon to always relieve symptoms.
Nutrition and poor mental health
In developed countries such as the UK we eat a greater variety of foodstuffs than ever before – but it doesn’t follow that we are well nourished. In fact, many people do not eat enough nutrients that are essential for good brain health, opting for a diet of heavily processed food containing artificial additives and sugar.
The link between poor mental health and nutritional deficiencies has long been recognised by nutritionists working in the complementary health sector. However, psychiatrists are only now becoming increasingly aware of the benefits of using nutritional approaches to mental health, calling for their peers to support and research this new field of treatment.
It is now known that many mental health conditions are caused by inflammation in the brain which ultimately causes our brain cells to die. This inflammatory response starts in our gut and is associated with a lack of nutrients from our food such as magnesium, omega-3 fatty acids, probiotics, vitamins and minerals that are all essential for the optimum functioning of our bodies.
Recent research has shown that food supplements such as zinc, magnesium, omega 3, and vitamins B and D3 can help improve people’s mood, relieve anxiety and depression and improve the mental capacity of people with Alzheimer’s.
Magnesium is one of most important minerals for optimal health, yet many people are lacking in it. One study found that a daily magnesium citrate supplement led to a significant improvement in depression and anxiety, regardless of age, gender or severity of depression. Improvement did not continue when the supplement was stopped.
Omega-3 fatty acids are another nutrient that is critical for the development and function of the central nervous system – and a lack has been associated with low mood, cognitive decline and poor comprehension.
These over-the-counter” supplements are widely available in supermarkets, chemists and online health food stores, although the cost and quality may vary. For people who have not responded to prescription drugs or who cannot tolerate the side effects, nutritional intervention can offer hope for the future.
There is currently much debate over the effectiveness of antidepressants. The use of food supplements offer an alternative approach that has the potential to make a significant difference to the mental health of all age groups.
The emerging scientific evidence suggests that there should be a bigger role for nutritional psychiatry in mental health within conventional health services. If the burden of mental ill health is to be reduced, GPs and psychiatrists need to be aware of the connection between food, inflammation and mental illness.
Medical education has traditionally excluded nutritional knowledge and its association with disease. This has led to a situation where very few doctors in the UK have a proper understanding of the importance of nutrition. Nutritional interventions are thought to have little evidence to support their use to prevent or maintain well-being and so are left to dietitians, rather than doctors, to advise on.
But as the evidence mounts up, it is time for medical education to take nutrition seriously so that GPs and psychiatrists of the future know as much about its role in good health as they do about anatomy and physiology. The state of our mental health could depend on it.
Individuals who have suffered mild depression or anxiety, or one-off mental health episodes, have been consistently refused life and other kinds of insurance, adding to their financial insecurity.
Dozens of customers told the Guardian they had been refused cover based on long-distant episodes of depression or if their medical report mentioned suicidal thoughts or self-harm. They said they were denied cover even when they had no physical health complaints.
Charities and campaigners said this was worrying and accused insurers of working from an outdated understanding of mental health. The concern is that insurers are dismissing customers with depression and anxiety to minimise risk and boost profits.
Labour and Liberal Democrat MPs have joined a growing number of voices calling for action. The shadow minister for mental health, Barbara Keeley, said:“It is unacceptable for insurers to discriminate flatly against people with mental health conditions or clobber them with higher premiums, particularly for mild conditions or historic episodes … Labour is calling for the government to investigate, as a matter of urgency.”
The Liberal Democrat MP Norman Lamb launched a Commons early day motion, a parliamentary device used to highlight an issue. Lamb said these practices amount to a serious discrimination and urged the government, the Equality and Human Rights Commission and the Financial Conduct Authority to look into it.
“These alleged practices are deeply shocking and, in my view, amount to an outrageous discrimination against people with mental ill health … the government must look into this as a matter of urgency and stamp out any loopholes in the law which are allowing these practices to continue,” he said.
Gaps in legislation mean customers have little protection against this form of prejudice, according to charities. Michael Henson-Webb, head of legal at the mental health charity Mind, said that the current definition of disability under the Equality Act does not cover everyone with a mental health problem, making it “difficult for individuals with mental health problems and their legal advisers to clearly determine their rights”.
The motion launched by Lamb has already been backed by the Labour MP Luciana Berger. She said: “The government has time and again told us how it is committed to equality for mental health. If they are serious they must act now to end this wholly unacceptable and discriminatory practice.”
She added: “It’s the government’s responsibility to ensure that insurance companies are obeying both the letter and the spirit of anti-discrimination laws.”
Prof Wendy Burn, the president of the Royal College of Psychiatrists, said: “It is deeply worrying to hear that insurance companies are making sweeping judgments about people without true understanding of their condition.”
The Guardian has also heard allegations from new complainants. Tony Blair’s former director of communications Alastair Campbell, an ambassador for Time to Change, said: “Whenever my partner Fiona and I have engaged with insurance, it is harder and more expensive for me than for her, because I have been open about having had mental illness, something she has not had.”
He added: “People are judged on past mental health problems differently to how they are judged on past physical health problems. It encourages people not to open up, which in turn means the stigma and taboo are reinforced. It is there in black and white in the NHS constitution – there should be parity between physical and mental health. But this scandal is just one more example of how far the reality is from the words in law.”
Dozens of others spoke out on Twitter. One person said: “[The same] happened to me. I was denied [insurance] as I struggled after a divorce and sought help from GP, so it was on my medical records.” Another said: “My husband can’t get life insurance because of his depression … we have six children. I’m just glad if anything happens to me my family is covered. Just disgraceful.”
Helen Undy, the head of external affairs at the Money and Mental Health Policy Institute, said: “One in four of us will experience a mental health problem each year, and by some estimates this rises to almost half of us across a lifetime. So if the insurance market isn’t working for all these people, then it really isn’t working at all.”
A treasury spokesperson said: “It is wrong for people to be refused insurance purely on the basis of a mental health condition. Insurance companies should follow both the best-practice guidelines from the Association of British Insurers, and equality law to ensure that full cover should be offered wherever possible.”