Hero

Videos

Slideshows

Articles

Podcasts

Poll

Changing a single ingredient in the diet rarely makes a difference in studies of depression. 

, soy, and matcha tea have all been tried without success.

 Instead, nutritional psychiatry research has 

 the best antidepressant effects with a balanced, Mediterranean-style diet.

 But a small trial of almond supplementation in diabetes shows promise.

The study was a small, randomized controlled 

 of 45 Chinese adults with type-II diabetes.

 All of the subjects were counseled to adopt a low-fat diet that was rich in vegetables and protein and low in salt and carbohydrates. The control group was allowed a daily serving (300 grams) of a carbohydrate-rich food (in China, this was typically rice or noodles), while the intervention group cut that carb dish in half and replaced it with 56 grams of almonds (about half a cup).

After 3 months, those in the almond group had a significant reduction in depression on the self-reported PROMIS scale, while the average mood of the control group did not budge. The effect size was large (0.94 using Hedges’ correction for small sample sizes), although the statistical spread on that effect was wide (+/- 0.62). Importantly, the investigators did not require a diagnosis of depression to enter the trial. On average, their scores (49) fell just below the 55-point cut-off for mild depression on the 

, although some had moderate or severe depression (up to 81 on the PROMIS).

Metabolic parameters (weight and glycated hemoglobin (HbA1c)) improved significantly with both diets, although the reduction in HbA1c was larger (by 1 point) in the almond group (p < 0.01). Next, the investigators looked at changes in the gut microbiome to clarify the mechanism behind this antidepressant effect.

A diverse microbiome in the GI tract is associated with both metabolic and mental health. The gut bacteria 

 with the brain through multiple pathways, including the vagus nerve, inflammatory signaling, and short-chain fatty acids.

 microbiome diversity improved in both groups, but the almond group had a significant increase in bacterial species that produce short chain fatty acids (

). This type of bacteria stimulates production of the metabolic hormone glucagon-like peptide-1, which lowers appetite and regulates insulin. Supporting this hypothesis, levels of glucagon-like peptide-1 rose throughout the trial in the almond group.

is the Mood Disorders Section Editor for 

 He has written several books on mood disorders, most recently 

 with his co-host Kellie Newsome, PMH-NP.

The author does not accept honoraria from pharmaceutical companies but receives royalties from PESI for 

Effects of walnut consumption on mood in young adults-a randomized controlled trial.

2. Simpson EEA, Furlong ON, Parr HJ, et al. 

The effect of a randomized 12-week soy drink intervention on everyday mood in postmenopausal women.

3. Dietz C, Dekker M, Piqueras-Fiszman B. 

An intervention study on the effect of matcha tea, in drink and snack bar formats, on mood and cognitive performance

A randomised controlled trial of dietary improvement for adults with major depression (the 'SMILES' trial).

An almond-based low carbohydrate diet improves depression and glycometabolism in patients with type 2 diabetes through modulating gut microbiota and glp-1: a randomized controlled trial.

Minimally important differences and severity thresholds are estimated for the PROMIS depression scales from three randomized clinical trials

7. Bastiaanssen TFS, Cowan CSM, Claesson MJ, Dinan TG, Cryan JF. 

Making sense of … the microbiome in psychiatry.

Subba R, Sandhir R, Singh SP, Mallick BN, Mondal AC. 

Pathophysiology linking depression and type 2 diabetes: Psychotherapy, physical exercise, and fecal microbiome transplantation as damage control.

Qian F, Liu G, Hu FB, Bhupathiraju SN, Sun Q. 

Association between plant-based dietary patterns and risk of type 2 diabetes: a systematic review and meta-analysis

Francis HM, Stevenson RJ, Chambers JR, Gupta D, Newey B, Lim CK. 

A brief diet intervention can reduce symptoms of depression in young adults - A randomised controlled trial.

Parletta N, Zarnowiecki D, Cho J, et al. 

A Mediterranean-style dietary intervention supplemented with fish oil improves diet quality and mental health in people with depression: A randomized controlled trial (HELFIMED).

Sánchez-Villegas A, Martínez-González MA, Estruch R, et al. 

Mediterranean dietary pattern and depression: the PREDIMED randomized trial.

A daily serving of almonds improved depressive symptoms in diabetes, but will it work in non-diabetic depression?

Almonds May Lift Depression in Diabetes

Obesity is a prevalent global problem that affects patients with major mental illness disproportionately.

 It is associated with cardiovascular risk factors, including hypertension, dyslipidemia, and impaired glucose tolerance. Not surprisingly, the prevalence of these conditions is also high in patients with major mental illness. In fact, patients with major mental illness have a lifespan 

 than the general population, with cardiovascular mortality largely accounts for this difference.

Several biological, psychological, behavioral, and social factors predispose patients with major mental illness to obesity. One well-established risk factor is the weight gain-inducing side effect of antipsychotic drugs.

 Two features of this risk factor make it stand out: It is modifiable, and it is under the control of the prescriber.

Weight Gain-Inducing Risk of Antipsychotic Drugs

Most early antipsychotic drugs caused acute and chronic motor side effects. Clozapine was different because it was not haloperidol-like or a high-potency dopamine-2 full antagonist, but its routine use was prevented by the risk of agranulocytosis. Several safer atypical antipsychotic drugs have become available, and they are now standard treatment for schizophrenia and other approved indications. Despite this progress, an important side effect of clozapine—weight gain—has remained an issue with later-generation antipsychotics.

Researchers use 2 measures to determine the weight gain-inducing side effects of psychotropic drugs

: how many patients exposed to a given drug gain weight and how much weight is gained by patients. The latter can be measured as a crude number, or it can be standardized as a proportion of weight gain from baseline. Generally, weight gain greater than 7% from baseline is considered significant.

We now have extensive research on the weight gain-inducing and metabolic risks of antipsychotic drugs, including meta-analyses of the data.

 If we leave subtle differences and academic discussions aside, the common antipsychotic drugs can be grouped into 3 categories of weight gain-inducing potential (

There are a few important things to remember when contending with weight gain-inducing risk. First, weight gain is an individual-specific phenomenon; therefore, each patient must be monitored individually. Second, young patients who were not previously exposed to an antipsychotic drug (ie, drug-naive patients) are at a much higher risk of weight gain than older individuals who are not drug-naïve.

 Third, there is some evidence that metabolic complications (dyslipidemia and/or glucose intolerance) may result from these drugs independent of significant weight gain.

 Lastly, antipsychotic drug use is associated with weight gain irrespective of the diagnosis.

Limiting and Managing Drug-Induced Weight Gain

A preventive approach. Losing excess weight is tough for anyone and even tougher for individuals with major mental illness.

 Obesity might not receive much clinical attention because it is not acutely distressing or life-threatening. In the long term, however, it contributes to morbidity and mortality. In addition, young, nonobese, drug-naive patients can gain significant weight within a matter of months when exposed to antipsychotic drugs with a high risk of weight gain.

 Once they have gained that weight, many of them will never be able to lose it.

Differences in the efficacy of commonly used antipsychotics are marginal, but differences in their weight gain-inducing potential are huge.

 There is little justification for prescribing an antipsychotic drug that has a high potential to induce weight gain when there are safer alternatives. A more reasonable approach would be to start with a low-risk medication and switch to another medication in case of inefficacy or intolerance.

Despite limited evidence, second-generation antipsychotics are used for several off-label conditions.

 Psychiatric conditions generally have a high placebo response, which may be what off-label antipsychotic use offers, but at a much higher side-effect burden than placebo. It is quite concerning that off-label antipsychotic use is prevalent in children and adolescents, who are particularly prone to these weight gain-inducing and metabolic side effects. The Choosing Wisely 

Baseline assessment and ongoing monitoring. In 2004, the APA along with other associations issued a consensus statement on baseline assessment and monitoring of patients who are prescribed an antipsychotic drug for any indication (

 Measurement of waist circumference may not be practical in some cases, but tracking body mass index should not be a problem. Inquiring about family history of antipsychotic drug use, including response and side effects, could also provide useful information.

According to the guidelines, several factors contribute to nonadherence. These include clinicians’ lack of knowledge, psychiatrists’ limited training in monitoring patients’ physical health, limited resources, time constraints, diffusion of roles, and patient nonadherence.

 If an abnormality is detected that warrants further assessment or treatment, it should be communicated to the patient’s general physician with clarity about role designation for further assessment and management. Poor physical health care of patients with major mental illness is a systemic problem. Psychiatrists should use their social influence to shift health care culture, clinical prompts, and monitoring tools to 

 an integrated or coordinated health care approach.

Prioritizing discussions of weight gain, its complications, and healthy lifestyle. Clinical encounters are often too brief to tackle all important matters. In the hierarchy of priorities, discussion of weight and healthy lifestyle are often at the bottom of the list. However, patients with major mental illness are prone to obesity even without an iatrogenic contribution. Furthermore, personal and socioeconomic factors often make it more difficult for individuals with mental illness to adopt healthy lifestyles.

 Obesity is associated with stigma and poor self-esteem; presenting weight issues as a medical problem can help destigmatize it. Discussions about obesity and its complications would automatically become a focus of clinical attention if the aforementioned APA guidance (

 were incorporated into clinical practice.

Involvement of other experts for healthy lifestyle interventions.

 Healthy lifestyle interventions are most effective in helping obese patients lose weight and offer the best long-term outcome.

 They should be offered to all suitable patients irrespective of other offered interventions.

For a healthy lifestyle intervention to be effective, it should include individualized counseling on diet and exercise, cognitive and behavioral interventions, setting well-defined, attainable goals, objective monitoring of progress, and expertise to plan and implement the interventions.

 Most psychiatrists do not have the time or expertise to take on these tasks, so involving relevant professionals (eg, dieticians, psychologists, occupational therapists, and case managers for obese patients) is a good idea. Patients who are already obese or who are gaining unhealthy amounts of weight should be referred to these professionals after appropriate counseling. In addition to monitoring measures of obesity, the 

 can be used to monitor general physical fitness.

 Adopting a healthy lifestyle is very difficult for patients with major mental illness due to several factors, many of which are not in their control.

 High failure rates in the form of nonadherence and drop-outs are normal and should not be taken as a disappointment in the intervention or the patient.

Nonacademic medical centers may not have access to healthy lifestyle intervention professionals who have experience working with patients with major mental illness. In such situations, psychiatrists who are knowledgeable about the interventions can guide their colleagues on matters specific to this patient population.

Another efficient approach is to offer them in a group setting. A group setting validates the widespread nature of the problem, and patients can draw encouragement from each other. However, only psychiatrically stable patients would be suitable candidates for a group intervention and, in some cases, patient advocacy, staff capacity building, leadership engagement, and change in organizational policy may be needed.

Switching out a higher-risk antipsychotic drug for one that has a lower risk of inducing weight gain can help some patients. The 

summarizes the main elements of drug switching.

Switching antipsychotic medications must take into account various factors, including therapeutic response to the current medication, the patient’s comfort with the switch, and pharmacokinetic and pharmacodynamic properties of both drugs. Furthermore, sufficient time must be allowed to clinically document the process of the switch and its effects. The aim should be to completely replace one drug with another, but in rare cases, combination therapy may be justified based on clinical outcome.

 as adjunctive treatment to counter antipsychotic medication-induced weight gain.

 and topiramate have the best evidence of efficacy and safety.

The metformin studies in patients with major mental illness are heterogeneous in terms of the patient population, duration of current exposure to an antipsychotic drug, and history of chronic exposure to antipsychotic drugs. Review of individual studies shows that metformin is 

 as an add-on treatment for antipsychotic drug-induced weight gain when it is introduced early in the course of treatment of patients who are young, have not been exposed to antipsychotic drugs chronically, and who have gained significant amounts of weight over a short period of time.

 Metformin may also help diminish insulin resistance associated with obesity. The beneficial effect of metformin is likely to diminish over the long term compared with healthy lifestyle interventions.

Topiramate add-on treatment to prevent or reverse antipsychotic drug-induced weight gain has been studied in several trials as well.

 Overall, topiramate was shown to be superior to placebo, with modest weight loss comparable to that observed in the trials with metformin (a mean weight loss of approximately 3 kilograms versus placebo over the course of 16 to 24 weeks).

 As with metformin, the greatest benefit is likely to happen in young, previously drug-naive individuals who gained significant weight over a short period of time. An added benefit of topiramate therapy is that it might address some of the mental illness symptoms as well.

 Long-term benefits of topiramate add-on therapy are less well known than those of metformin.

Weight gain associated with the use of atypical antipsychotic drugs is akin to tardive dyskinesia resulting from high-potency, typical antipsychotics. It evolves over time, leads to chronic complications, and is very difficult to reverse. Pharmacologic interventions used to tackle weight gain, namely switching from a higher-risk antipsychotic to one with a lower risk and adding an adjunct medication to counter weight gain, are modestly effective and worth considering in suitable cases. Healthy lifestyle interventions offer the best long-term outcomes, but their availability is limited by a host of factors.

There are 2 important things that need to be done. First, the iatrogenic burden of obesity should be minimized by using low-risk antipsychotics preferentially over those with higher risk for weight gain whenever possible. Second, patients should be monitored for obesity and its complications, and counseled to improve awareness about obesity and the importance of a healthy lifestyle. Efforts to develop antipsychotic drugs with a neutral affect on weight are ongoing. A few have already become available, but a shift in clinical practice for their preferential use will take its due time.

recently retired as an associate professor of psychiatry at Memorial University of Newfoundland, Canada. He was the head of the divisions of Geriatric and Consultation & Liaison Psychiatry at Eastern Health St. John’s, Newfoundland and Labrador. Currently he is a freelance health care activist focusing on public health education and health care reform.

1. Hasnain M, Vieweg WVR. Do we truly appreciate how difficult it is for patients with schizophrenia to adapt a healthy lifestyle? 

2. de Mooij LD, Kikkert M, Theunissen J. 

Dying too soon: excess mortality in severe mental illness

3. Hasnain M, Vieweg WVR, Hollett B. Weight gain and glucose dysregulation with second-generation antipsychotics and antidepressants: a review for primary care physicians. 

4. Musil R, Obermeier M, Russ P, Hamerle M. Weight gain and antipsychotics: a drug safety review. 

5. Pillinger T, McCutcheon RA, Vano L, et al. 

Comparative effects of 18 antipsychotics on metabolic function in patients with schizophrenia, predictors of metabolic dysregulation, and association with psychopathology: a systematic review and network meta-analysis

6. Bak M, Fransen A, Janssen J, et al. Almost all antipsychotics result in weight gain: a meta-analysis. 

7. Huhn M, Nikolakopoulou A, Schneider-Thoma J, et al. Comparative efficacy and tolerability of 32 oral antipsychotics for the acute treatment of adults with multi-episode schizophrenia: a systematic review and network meta-analysis. 

8. Tek C, Kucukgoncu S, Guloksuz S, et al. Antipsychotic-induced weight gain in first-episode psychosis patients: a meta-analysis of differential effects of antipsychotic medications. 

9. Maayan L, Correll CU. Weight gain and metabolic risks associated with antipsychotic medications in children and adolescents. 

10. Maglione M, Maher AR, Hu J, et al. Off-Label Use of Atypical Antipsychotics: An Update. Comparative Effectiveness Review No. 43. Agency for Healthcare Research and Quality; 2011. AHRQ publication 11-EHC087-EF.

11. American Board of Internal Medicine, American Psychiatric Association. Choosing wisely: five things physicians and patients should question. Accessed February 23, 2021. 

https://www.choosingwisely.org/wp-content/uploads/2015/01/Choosing-Wisely-Recommendations.pdf

12. American Diabetes Association, American Psychiatric Association, American Association of Clinical Endocrinologists, North American Association for the Study of Obesity. Consensus development conference on antipsychotic drugs and obesity and diabetes. 

13. Ali RA, Jalal Z, Paudyal V. Barriers to monitoring and management of cardiovascular and metabolic health of patients prescribed antipsychotic drugs: a systematic review. 

14. Melamed OC, Wong EN, LaChance LR, et al. 

Interventions to improve metabolic risk screening among adult patients taking antipsychotic medication: a systematic review

15. American Diabetes Association. 2. Classification and diagnosis of diabetes: standards of medical care in diabetes—2020. 

16. McGinty EE, Gudzune KA, Dalcin A, et al. Bringing an effective behavioral weight loss intervention for people with serious mental illness to scale. 

17. Naslund JA, Aschbrenner KA, Scherer EA, et al. Lifestyle intervention for people with severe obesity and serious mental illness. 

18. Bernard P, Romain AJ, Vancampfort D, Baillot A, Esseul E, Ninot G. Six minutes walk test for individuals with schizophrenia. 

19. Hasnain M, Vieweg WVR. Weight considerations in psychotropic drug prescribing and switching. 

20. Dayabandara M, Hanwella R, Ratnatunga S, et al. 

Antipsychotic-associated weight gain: management strategies and impact on treatment adherence

21. Goh KK, Chen CH, Lu ML. Topiramate mitigates weight gain in antipsychotic-treated patients with schizophrenia: meta-analysis of randomised controlled trials. 

Metformin for weight gain associated with second-generation antipsychotics in children and adolescents: a systematic review and meta-analysis

23. Hasnain M, Vieweg WVR, Fredrickson SK. 

Metformin for atypical antipsychotic-induced weight gain and glucose metabolism dysregulation: review of the literature and clinical suggestions

24. Correll CU, Maayan L, Kane J, et al. Efficacy for psychopathology and body weight and safety of topiramate-antipsychotic cotreatment in patients with schizophrenia spectrum disorders: results from a meta-analysis of randomized controlled trials. 

Antipsychotic-induced weight gain evolves over time, leads to chronic complications, and is very difficult to reverse. Pharmacologic interventions used to tackle weight gain are modestly effective and worth considering in certain cases.

Addressing Obesity in Patients Taking Antipsychotics

While psychotropic medications for schizophrenia, bipolar disorder, and other psychiatric disorders can cause weight gain, patients can take small steps to improve their health.

15 Steps to Helping Psychiatric Patients Achieve and Maintain a Healthy Weight

Dr Drew Ramsey discusses the role of diet and nutrition in brain and mental health, promising areas of nutrition, and the importance of evidence-based treatment with food. Good nutrition is not a contest between zucchini and medications.



 is assistant clinical professor of psychiatry at Columbia University College of Physicians & Surgeons. His clinical work focuses on the treatment of depression and anxiety with a combination of psychotherapy, diet and lifestyle modification, and psychopharmacology. From 2005 to 2008, he directed the Audubon Continuing Day Treatment Program, a bi-lingual service for the severely mentally ill located in the Washington Heights area of Manhattan; a program of New York State Psychiatric Institute/Columbia Psychiatry.



is a board-certified psychiatrist and assistant professor in Clinical Psychiatry at Columbia University Medical Center and the New York State Psychiatric Institute. She serves as the medical director and team psychiatrist at ONTrackNY Washington Heights Community Service clinic. She completed her public psychiatry fellowship and adult psychiatry residency at Columbia University where she was a chief resident and co-organized the curriculum on racial/ethnic mental health disparities. In addition to her clinical work in the public sector, she also works in Columbia's psychiatric emergency room and has a private practice in Upper Manhattan. 

 is a fellow in consultation-liaison psychiatry at Columbia University Irving Medical Center with a part time private practice. She was formerly a chief resident at Columbia’s psychiatry residency program. Before medical training, she received an MS in Narrative Medicine, an interdisciplinary field that studies illness through a humanities lens. She is co-author of 

Conquering Lyme Disease: Science Bridges the Great Divide

 and has interests in medical education, psychotherapy, and medical humanities.

Thanks to Columbia University Department of Psychiatry for allowing us to present the Breakthrough Session podcast with experts in the field of psychiatry.

In this podcast, Drew Ramsey, MD, an nutritional expert and psychiatrist discusses the importance of diet and nutrition in mental health and wellness.

A Conversation With Drew Ramsey, MD, on Nutrition and Mental Health

The unintended negative consequences of the coronavirus disease 2019 (COVID-19) pandemic continues to be a problem. Reduced social interaction and closure of public places, along with increased home confinement, has led to a sharp decrease in physical activity, a steady increase in food intake, and a 

 Stress has similarly impacted sleep, unhealthy eating, and even increased consumption of alcohol.

Public health and economic crises have been associated with serious, long-lasting negative impact on individual and population-based mental health outcomes. Indeed, a recent meta-analysis found higher rates of 

, depression, posttraumatic stress disorder, psychological distress, and stress during the COVID-19 pandemic.

 To further complicate matters, individuals are less likely to seek non-emergent health care, including care for mental disorders, during the pandemic.

Related health consequences of obesity such as hypertension and diabetes mellitus are a major source of morbidity.

 Stress, fatigue, physical inactivity, and a sedentary lifestyle can advance obesity and, subsequently contribute to a number of mental health disorders.

 Depression and obesity share a bidirectional relationship, where the presence of one disease increases the risk for developing the other (

 Increased carbohydrate consumption, a risk factor for obesity, is common in patients with depression. The presence of obesity often has a chronic course of illness and can result in poor treatment response in depression.

 are predominantly treated with antidepressants as a first-line treatment option, with 79% of primary care physicians prescribing antidepressants to these patients.

 Recent studies have shown that antidepressant medications can contribute to weight gain through various mechanisms, including increased food consumption and abnormal metabolic processes.

 Reductions in depressive symptoms and antidepressant usage may coincide with weight loss (as seen with bariatric surgery patients), and this underscores the importance of monitoring the increasing rates of obesity.

For the last 2 decades, depressive disorders have consistently ranked amongst the top 5 illnesses for years of life lived with a disability.

 Cognitive deficits is a core symptom of depression, and it often persist between affective episodes and beyond the remission of mood symptoms.

 Executive functioning, attention, memory, and learning can be affected.

 Obesity also contributes to impairments in cognition; individuals with obesity exhibit significantly impaired cognitive functioning and structural changes in brain regions associated with executive functioning.

 Moreover, in individuals with obesity, cognitive impairments 

 lower weight loss success, poor treatment adherence, and decreased physical functioning.

Individuals with a longer duration of illness and a higher frequency of depressive episodes are more likely to experience cognitive impairments. Persistent cognitive impairment contributes to consequences in occupational and social domains.

 In particular, evidence from adults with mood disorders implicates cognitive impairment as a mediator of workplace function and attendance, as well as patient-reported outcomes (eg, quality of life).

 Approximately 15% of patients with major depressive disorder attribute their unemployment to cognitive symptoms. Unfortunately, few treatments, including psychotropic medications, have proven effective in improving cognitive function in adults with mood disorders, especially in cases of treatment resistance.

Patients with comorbid depression and obesity often demonstrate higher levels of baseline inflammation, which is characterized by a higher level of inflammatory cytokines (a type of signaling molecule that promotes inflammation). Likewise, obesity involves a pro-inflammatory state. Conversely, findings have shown improved cognition is linked to a reduction in inflammation.

 Indeed, in a meta-analysis evaluating inflammation and treatment response, researchers found increased levels of inflammatory cytokines in patients with depression. In cases that successfully responded to treatment, the levels of inflammatory cytokines were decreased.

There are several proposed mechanisms that may mediate the relationship between chronic stress, inflammation, and mood disorders. Stressful experiences have been shown to increase production of cortisol. Glucocorticoids increase activities of the sympathetic system, such as heart rate and blood pressure, to reduce the stress response. However, if this system is dysregulated, chronic stress and cortisol production can lead to the desensitization of the glucocorticoid receptors. It can be conjectured that the dysregulation of the inflammatory pathway is also worsened by the presence of insulin resistance and increase in adipocytes. The bidirectional relationship between the 2 illnesses and the co-occurrence of an inflammatory state underscores the involvement of inflammation in the pathophysiology of depression and obesity.

Evidence suggests that physical activity aids in alleviating mild to moderate symptoms of depression in patients and may promote clinically significant antidepressant effects. For more severe cases of depression, 

 in conjunction with other treatments (ie, pharmacological).

 Exercise may also help improve cognition in individuals with depression. In a study investigating the dose-dependent effects of 

 on cognition in patients with depression, high-intensity exercise was associated with improvements in executive function and working memory tasks. Meanwhile, other cognitive domains, such as attention, visual memory, and spatial planning, improved regardless of dose.

 Therefore, it is importan that adequate social and physical activities are integrated into treatment plans to promote well-being.

is a researcher at the Canadian Rapid Treatment Center of Excellence and the Institute of Medical Science at the University of Toronto. 

is a professor of psychiatry and pharmacology at the University of Toronto, and Head of the Mood Disorders Psychopharmacology Unit for the University Health Network, Toronto, Canada.

Effect of obesity and body mass index on coronavirus disease 2019 severity: A systematic review and meta‐analysis

2 .Xiong J, Lipsitz O, Nasri F, et al. Impact of COVID-19 pandemic on mental health in the general population: A systematic review.

3. Alosco ML, Spitznagel MB, Strain G, et al. Improved serum leptin and ghrelin following bariatric surgery predict better postoperative cognitive function.

4. Sarris J, O’Neil A, Coulson, et al. Lifestyle medicine for depression.

5. Luppino FS, de Wit LM, Bouvy PF, et al. Overweight, obesity, and depression: a systematic review and meta-analysis of longitudinal studies.

Collaborative care for depression in primary care: how psychiatry could “troubleshoot” current treatments and practices.

7. Gill H, Gill B, El-Halabi S, et al. Antidepressant Medications and Weight Change: A Narrative Review. (Silver Spring)

8. Collaborators G 2016 ORF, GBD 2016 Occupational Risk Factors Collaborators. Global and regional burden of disease and injury in 2016 arising from occupational exposures: a systematic analysis for the Global Burden of Disease Study 2016.

9. McIntyre RS, Lee Y. Cognition in major depressive disorder: a “Systemically Important Functional Index” (SIFI).

10. Motter JN, Pimontel MA, Rindskopf D, Devanand DP, Doraiswamy PM, Sneed JR. Computerized cognitive training and functional recovery in major depressive disorder: A meta-analysis.

11. Spitznagel MB, Garcia S, Miller LA, et al. Cognitive function predicts weight loss after bariatric surgery.

12. Rasmussen LJH, Caspi A, Ambler A, et al. 

Association of Neurocognitive and Physical Function With Gait Speed in Midlife

13. Baune BT, Air T. Clinical, Functional, and Biological Correlates of Cognitive Dimensions in Major Depressive Disorder – Rationale, Design, and Characteristics of the Cognitive Function and Mood Study (CoFaM-Study).

14. McIntyre RS, Lee Y, Mansur RB. Treating to target in major depressive disorder: response to remission to functional recovery.

15. Strawbridge R, Arnone D, Danese A, Papadopoulos A, Herane Vives A, Cleare AJ. Inflammation and clinical response to treatment in depression: A meta-analysis. 

16. Schuch FB, Vancampfort D, Richards J, et al. 

Exercise as a treatment for depression: A meta-analysis adjusting for publication bias

17. Greer TL, Grannemann BD, Chansard M, et al. Dose-dependent changes in cognitive function with exercise augmentation for major depression : results from the TREAD study. 

Evidence suggests that physical activity aids in alleviating mild to moderate symptoms of depression in patients and may promote clinically significant antidepressant effects.

A Recipe for Homemade Obesity: The Association Between Depression, Obesity, and Cognitive Deficits

Aaron Burstein, PharmD, senior vice president of 

, shares the history and current status of development of 

for the treatment of dementia and diabetes, including results recently presented at the 2020 Alzheimer's Association International Conference.

Aaron Burstein, PharmD, shares details from a scientific presentation at the Alzheimer's Association International Conference.

Metabolic Disorders

Almonds May Lift Depression in Diabetes

Addressing Obesity in Patients Taking Antipsychotics

15 Steps to Helping Psychiatric Patients Achieve and Maintain a Healthy Weight

A Conversation With Drew Ramsey, MD, on Nutrition and Mental Health

A Recipe for Homemade Obesity: The Association Between Depression, Obesity, and Cognitive Deficits

Investigational Treatment Shows Potential to Supress Memory Loss

Family History of Diabetes: Is There an Association With Nonaffective Psychosis?

Mini Quiz: Diabetes Distress and Anxiety

Silver Linings After Abuse and Neglect

Is There a Relationship Between Mood and Diet?