Food-Based Strategies for Depression Management From Iranian Traditional Medicine Resources

3.1. Materials and Methods in ITM

Since in ITM resources, “depression” has not been determined as a distinct heading, the related materials were extracted in several steps. These steps can be categorized as follows:

Step one: seven keywords “Jaza”, “hozn”, “khobs-e-nafs” (in ITM this means sadness without cause), “Gham”, “Karb”, “Vasvas” (“Vasvas” in ITM is different from obsession and means suspicion) and “Melancholia” were selected. These keywords are related to depression based on their definitions.

Step two: all parts of important ITM sources namely Kamel al-Sanaat al-Tibbyyah, Al-Qanun fi al-Tibb and Zakhireh Kharazmshahi, were studied and the related issues were extracted by using the aforementioned keywords.

Step three: in extracting the related contents, we were faced with two different applications for each of the mentioned keywords. They were used in some cases “as a symptom” and in some other cases “as a cause”. For example, “melancholy” may lead to the state of “Gam”. In this case “Gam” is a symptom (9-11). On the other hand, “Gam” can lead to indigestion. In this case “Gam” is a cause (10). Therefore, those cases in which the mentioned keywords had been used “as a cause” and involved psychosomatic disorders were put aside. Next, food strategies were extracted based on cases in which the mentioned keywords had been used “as a symptom”.

Step four: in this step the selected food strategies in step three were classified into prevention and treatment parts. For example if the moods of sadness and immerse appear in someone without an external cause and this person does not receive any attention, such conditions may lead to melancholy (9). Therefore, food strategies for melancholy were situated in the treatment part. On the other hand, moods of sadness typically exist in a melancholic patient (9-11). Therefore, food strategies for melancholy were part of the treatment section.

Step five: after separation of the prevention and treatment parts, three categories were considered for the extracted food strategies: a) Food strategies related to titles in which the keywords were symptoms of a general physical disease whose origin was the brain, heart, liver, stomach, spleen or uterus. b) Food strategies related to titles in which the keywords were independent symptoms by themselves. For example, if someone is accustomed to have only one meal a day but unlike his habit he eats two meals a day, a state of sadness without a cause will catch him (10). Here, sadness does not happen because of a disease and it is considered as an independent symptom. c) Food strategies related to melancholy. In this step, in order to use the most specialized findings for this paper the main part of the extracted content was put aside and only parts b and c were selected.

Step six: food strategies, selected through the described method, were arranged under three headings, including; singular foodstuffs, combined foodstuffs, and nutritional rules.

Step seven: under each heading prohibited and prescribed cases were separated.

Step eight: finally for the ease of use, among the entire singular and combined foodstuffs only foodstuffs, which are usually available in today’s societies, were selected.

3.2. Materials and Methods in Modern Medicine

In this review study, databases including PubMed and Magiran were searched for related studies by using fourteen keywords including; depression, depressive, mood, antidepressant, antidepressive, nutrition, nutritional, diet, meal, food, functional food, healthy food, healthy diet, medicinal food and also scientific and English terms of all singular foodstuffs and some combined foodstuffs, which are introduced in this paper. In the search procedure, appropriate Booleans and truncations were also used to retrieve the best queries. In the first step, only human studies done during the time period between 2000 and 2012 were selected. In cases where human studies were not available, inevitably the search was repeated again for animal studies. Thus, 250 papers were retrieved in the primary search. In the next step, 38 papers were selected after screening the titles. It should be noted that the accompaniment of depression with other diseases was considered as an exclusion criterion.

Due to the extensive domain of the study, care must be taken to select exactly related articles as much as possible. To this end, the objective and main findings of each paper was carefully studied and relevance was assessed as “exactly related”, “related” and “less related”. Ultimately, 17 papers did not possess good relevance and only 21 papers were selected. The type of each study was considered as a criterion for quality assessment but due to the low number of papers ultimately selected, all types of studies including “randomized controlled trial” (RCT), “cohort”, “case-control” and “cross-sectional” other than “reports” were considered in this study. Consequently, according to our findings all of the selected articles in the relevance assessment were also chosen in the quality assessment. It should be noted that all of the papers were reviewed twice but by only one reviewer. Since some of the combined foodstuffs belonged merely to the Persian culture, it was impossible to search for findings related to such foodstuffs in databases. Also, it was impossible to search modern medicine databases for concepts such as “Sodazaee” (defined as causing black bile), “Safrazaee” (defined as causing yellow bile), “warmness”, “coldness”, “wetness”, and also being “Mofarrah” (defined as enlivening) because they are only defined in ITM.

4.1. Results Based on ITM

In this section, food-based strategies for depression management presented in ITM are summarized as follows.

increasing amounts of food for a person who is accustomed to eat a few amounts of food (9), eating meal befor the accustomed time of each meal (9), consuming two meals a day for a person who is used to consume one meal a day (10), and consuming “Sodaza” foodstuffs (9).

consuming foods causing “warmness” and “wetness” such as “Esfidba” (9) which is cooked lamb with onion and chickpeas.

Consuming “Safraza” foodstuffs (9), Consuming “Sodaza” foodstuffs (9), consuming food before elimination of dyspepsia symptoms following the last meal (10), consuming salty foodstuffs (10), consuming tart foodstuffs (10), and consuming highly fried foods (11).

Treatment / prohibition / singular foodstuffs: onion (9), garlic (9), mustard (9), vinegar (9), cabbage (9, 10), beef (9), lentil (9, 10), and broad bean (10).

Treatment / prohibition / combined foodstuffs: foodstuffs modified with honey (9), bread with plenty of barn (9), and corned beef (9).

Treatment / prescription / nutrition rules: consuming foods causing “wetness” (9, 11), hypnotic foods (9), foods causing “warmness” and “wetness” (10), meats that can be digested quickly (10), suitable foods that cause fatness (10), fatty and sweet foodstuffs (10), moderate amounts of food chosen according to the person’s digestion ability (11), food and drinks with “cold” and “wet” nature (11), one type of food in each meal (11), and “Mofarrah” foods with a “warm” nature (11).

Treatment / prescription / singular foodstuffs: currant (9), spinach (9, 11), watermelon (9), sweet apple (9), dried fig (9), lettuce (9, 11), peach (9), pomegranate (9), rainbow trout (9, 10), slightly fried egg (9, 11), grape (9), pistachio (9), oregano (9), squash (9), cucumber marrow (9), young lamb (9), almond (9), bananas (9), mint (9), chard (11), celery (11), chicory (11), and milk (10).

Treatment / prescription / combined foodstuffs: officinal beer (9) which is a filtrated liquid produced from boiling 1 unit of barley (without bran) with 14 units of water, “Esfidba” with shoulder lamb (9), shoulder lamb gently fried with olive oil or almond oil (9), shoulder lamb cooked with squash, spinach or lettuce (9), “Esfidba” with chicken meat (9), “Zirba” with chicken meat (9) (“Zirba” is a kind of stew cooked with vinegar, saffron, cumin and materials with a sweet taste), white bread (9), chicken meat cooked with squash or spinach (9), and lamb’s leg and neck cooked with water and salt (11).

4.2. Results Based on Modern Medicine

In this section, related results for the mentioned food strategies have been arranged in two categories as follows:

Diets: the relationship between mood and nutrition has been shown by several studies. For example consuming fast foods and commercial baked goods increase the risk of depression (12, 13). Also, the results of existing studies indicate a direct connection between depression and diets containing processed or fried foods, refined grains, sugary products and beer (14). On the other hand, the positive effects of a Mediterranean diet, which includes vegetables, fruits, grains, frijol, nuts, dairy, olive oil and aquatic food has been shown to prevent depression. These foodstuffs are important sources of nutrients linked for depression prevention (7). Previous research (15) has indicated that the nutrition recommendations based on the Australian guidelines for healthy eating with particular attention to fruits, vegetables and whole grains have a good effect on depressed patients. Also, it has been indicated that in addition to the benefits of moderate-sodium dietary approaches that stop the negative effects of hypertension (DASH type diet) on blood presser and bone health, this diet also has positive effects on improving mood. This low fat diet includes lean red meat, wholegrain breads and cereal (16). A previous study (17), indicated that the dietary predictors of depression prevalence are similar to those that predict coronary heart disease and diabetes and as already mentioned such illnesses have a greater prevalence in depressed patients (2, 4).

Foodstuffs: many studies have been done regarding the effectiveness of fish, as a good source of omega-3 fatty acids, on depression (18). Two previous researches (19-21) showed that the low consumption of fish results in a depressed mood in men yet in another study the low frequency of fish consumption had an association with depression in women, but not in men (22). In an animal study (23), the mechanisms of the antidepressant-like effects of garlic were demonstrated. Furthermore, it has been shown (24, 25) that milk consumption effectively improves depressed mood. In a study conducted on animal models, oregano was introduced as a brain activator (26). The impacts of mint on increasing alertness and memory have been demonstrated (27). In an animal model, spinach caused increased levels of brain serotonin and decreased levels of norepinephrine and dopamine (28). The antidepressant effects of saffron (used in drug-based strategies for depression management) have also been shown by previous studies (29, 30).