Major depressive disorder (MDD) affects about 10.4 percent of adults in one year and 20.6 percent over a lifetime (Hasin, 2018). Unfortunately, by themselves, psychotherapy and antidepressants only achieve full relief from symptoms in about 38 percent of treated patients. Combining psychotherapy and antidepressants modestly improves the outcomes.

Clearly, more must be done for patients with MDD who have only a partial improvement from psychotherapy and/or antidepressants. Fortunately, there are several options, including adding additional medications, transcranial magnetic stimulation, electroconvulsive therapy, intranasal esketamine, and lifestyle interventions.

Lifestyle interventions typically include behavioral activation (engaging in enjoyable, meaningful, or mastery-building activities, engaging in physical exercise, etc.), enhancing relationships, improving sleep, and dietary changes. Utilizing food and fluids to improve mental health is receiving greater attention due to increasing interest in nutritional psychiatry.

What we eat and drink is vitally important for brain health, but what is equally important is what not to eat. Limiting ultra-processed foods is one of the most important nutrition-related things we can do to enhance our health, including brain health. In fact, "...greater ultra-purified food intake, particularly artificial sweeteners and artificially sweetened beverages, is associated with increased risk of depression" (Samuthpongtorn, 2023).

Although dietary interventions are used to treat a range of mental disorders, this review is focused on depression. We know that "diet and nutrition play significant roles in the prevention of depression and its clinical treatment" (Huang, 2019).

The SMILES trial treated........

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