Effects of Dietary Interventions on Depressive Symptoms

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SBU Enquiry Service

Responds to queries received from Swedish healthcare and social service providers, or governmental organisations. Queries have a limited scope and the process is designed to enable a more rapid response, typically within two to three months. Reports are based on systematic reviews, that are identified through structured searches and critically appraised for risk of bias.

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Published: Report no: ut202610 Registration no: SBU 2025/967

Question

What systematic reviews exist on the effects of dietary interventions, in the form of whole-diet approaches or dietary supplements, on depressive symptoms.

PICO

  • Population: Adults diagnosed with depression
  • Intervention: Dietary interventions, both whole-diets and dietary supplements
  • Comparison: No or other invention, placebo, waiting list or care as usual
  • Outcome: Changes in depressive symptoms
  • Study design: Systematic reviews fully or partly based on studies with experimental designs

Method

A systematic literature search was performed using the following databases: Medline (via Ovid) and Scopus.

Two authors independently assessed the abstracts of all identified studies.

Risk of bias in relevant systematic reviews was assessed using an assessment tool based on AMSTAR.

Identified literature

Nine relevant systematic reviews with low to moderate risk of bias were identified [1-9]. Due to overlap in the primary studies, only four are presented with results and conclusions. The results and conclusions are presented in Table 1 to 4. In 33 relevant systematic reviews, the risk of bias was considered to be high, therefore the results and conclusions are not reported [10-42].

Table 1 Systematic review of dietary patterns with moderate risk of bias.
RCT = randomized controlled study; UK = United Kingdom; SMD = standardized mean difference; CI = confidence interval
Included studies Population, Intervention, Control Outcome and Results
Tavakoly et al, 2025 [9]
Effect of Different Dietary Patterns on Patients with Depressive Disorders: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Included studies:
5 RCT 

Setting:
Australia: 3 studies
Spain: 1 study
Four European countries
(Germany, Spain, UK,
Netherlands): 1 study

Population:
952 adults with clinically
diagnosed depressive disorders
or elevated depressive
symptoms 

Intervention:
Interventions were broadly
defined as dietary patterns
delivered as standalone
interventions, but all included
studies examined
the Mediterranean diet. 

Control:
Both active controls such as
befriending intervention
(2 studies) and passive controls
such as habitual diet (2 studies)
or placebo (1 study)

 Depressive symptom severity
(short term)
Compared to active control
(2 studies, n=142)
Statistically non-significant results
SMD: −1.25
(95% CI, −5.11 to 2.61) 

Compared to passive control
(3 studies, n=810)
Statistically non-significant results
SMD: −0.22
(95% CI, −0.74 to 0.29) 

Depressive symptom severity
(intermediate term)
Compared to passive control
(2 studies, n=709)
Statistically non-significant results
SMD: −0.14
(95% CI, −0.98 to 0.70) 

Depressive symptom severity
(long term)
Compared to passive control
(2 studies, n=709)
Statistically non-significant results
SMD: −0.16
(95% CI, −1.13 to 0.81)
Authors' conclusion:
“[Mediterranean diet] interventions appear to have no potential influence on major depressive disorder; however, this finding should be interpreted with caution due to the small number of RCTs available. Further studies on dietary patterns and depressive disorders are needed for more robust conclusions.”

 

Table 2 Systematic reviews about polyunsaturated fatty acids with moderate risk of bias.
DHA = docosahexaenoic acid; EPA = eicosapentaenoic acid; RCT = randomized controlled study; SMD = standardized mean difference; CI = confidence interval
Included studies Population, Intervention, Control Outcome and Results
Mocking et al, 2016 [8]
Meta-analysis and meta-regression of omega-3 polyunsaturated fatty acid supplementation for major depressive disorder
Included studies:
15 RCT 

Setting:
No information provided		 Population:
Adult patients with MDD
according to the Diagnostic and
Statistical Manual of Mental
Disorders (DSM) as assessed by
a standardized clinical interview
(n=1253) 

Intervention:
Omega-3 fatty acid
supplementation
EPA doses between 0 to 4400
DHA doses between 0 to 2200
EPA+DHA ratio of 0 to 1) 

Control:
Placebo		 Depressive symptoms
Omega-3 vs placebo
Patients with depressive
symptoms in major depressive
disorder (13 studies, n=1233):
Statistically significant results
in favour of omega-3
SMD = 0.398
(95% CI, 0.114 to 0.682),
P=0.006
Authors' conclusion:
“[...]the present meta-analysis observed a beneficial overall effect of omega-3 PUFA supplementation in patients
with MDD according to diagnostic criteria, which seemed larger in studies that supplemented higher doses of EPA
and included patients taking antidepressants.”

 

Table 3 Systematic review about pre- and probiotics with moderate risk of bias.
RCT = randomized controlled study; UK = United Kingdom; SMD = standardized mean difference; CI = confidence interval
Included studies Population, Intervention, Control Outcome and Results
Asad et al, 2024 [3]
Effects of Prebiotics and Probiotics on Symptoms of Depression and Anxiety in Clinically Diagnosed Samples: Systematic Review and Meta-analysis of Randomized Controlled Trials
Included studies:
23 RCT 

Setting:
Iran: 6 studies
China: 6 studies
Japan: 2 studies
UK: 2 studies
Netherlands: 1 study
Australia: 1 study
Poland: 1 study
India: 1 study
Canada: 1 study
New Zealand: 1 study
Switzerland: 1 study		 Population:
Adults aged 18–65, clinically
diagnosed with depression
and/or anxiety. Analyses are
outcome-based, and
populations may include
comorbid conditions (n=1401) 

Intervention:
Prebiotics and/or probiotics as a
stand-alone or adjunctive
intervention 

Control:
Placebo or treatment as usual;
no additional pre- or probiotic
supplementation. Standard
depression treatment (e.g.,
antidepressants/psychotherapy)
allowed in both groups.		 Depression severity
Probiotics vs control group
(18 studies, n=969)
Statistically significant
reduction
SMD=–0.96 (–0.64 after
exclusion of studies at high
risk of bias)
(95% CI, –1.31 to –0.61)
Certainty of evidence: Low
(downgraded two levels)
according to GRADE

Prebiotics vs control group
(3 studies, n=144)
Statistically non-significant
results
SMD=–0.28
(95% CI, –0.61 to 0.04)
Authors' conclusion:
“Probiotic interventions, either as a stand-alone treatment or combined with antidepressant medication use,
show effectiveness in reducing symptoms in clinically diagnosed patients […] Further research into probiotic
effectiveness across various demographic factors, such as ethnicity, age, gender, and mental health diagnoses, with and without comorbid clinical conditions, is recommended.”

 

Table 4 Systematic review about vitamins with moderate risk of bias.
RCT = randomized controlled study; CI = Confidence interval
Included studies Population, Intervention, Control Outcome and Results
Mikola et al., 2023 [7]
The effect of vitamin D supplementation on depressive symptoms in adults: A systematic review and meta-analysis of randomized controlled trials
Included studies:
41 RCTs 

Setting:
Iran: 18 studies
USA: 6 studies
Australia: 5 studies
Norway: 3 studies
Denmark: 2 studies
China: 2 studies
Netherlands: 2 studies
New Zealand: 1 study
Austria: 1 study
India: 1 study		 Population:
Adults from general and clinical
populations, including
participants with major
depressive disorder (MDD),
depressive symptoms, and
various somatic conditions
(n=53 235). 

Intervention:
Vitamin D supplementation
(cholecalciferol, ergocalciferol
or calcitriol), with or without
calcium supplementation. 

Control:
Placebo		 Depressive symptoms
(all studies)
41 studies, n=53 23
5Statistically significant
reduction in depressive
symptoms.
Hedges' g = −0.317
(95% CI, −0.405 to −0.230)
GRADE: Very low certainty of
evidence 

Major depressive disorder
(MDD)
7 studies, n=1166
Statistically significant
reduction in depressive
symptoms
Hedges' g = −0.729
(95% CI, −1.100 to −0.358)
None of the studies were
rated as having low overall
risk of bias. 

Studies at low risk of bias
(primarily non-MDD
populations)
5 studies, n=9981
No statistically significant
effect.
Hedges' g = 0.037
(95% CI, −0.002 to 0.077)
Authors' conclusion:
“Vitamin D supplementation has beneficial effects in both individuals with MDD as well as in those with milder,
clinically significant depressive symptoms. There was, however, evidence of high heterogeneity and publication
bias that needs to be considered in the interpretation of findings.”

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Search strategies

Medline via OvidSP 18 May 26

Title: Diet and depression
/ = Term from the MeSH controlled vocabulary; .sh = Term from the MeSH controlled vocabulary; exp = Term from MeSH including terms found below this term in the MeSH hierarchy; .ti,ab = Title or abstract; .tw = Title or abstract; .kf = Keywords; .kw = Keywords, exact; .bt = Book title. NLM Bookshelf; .pt = Publication type; .ja = Journal abbreviation; .af = All fields; adjn = Adjacent. Proximity operator retrieving adjacent words, adj3 retrieves records with search terms within two terms from each other; * or $ = Truncation; “ “ = Citation Marks; searches for an exact phrase
Search terms Items found
Population: 
1. exp depression/ or (depressi* or anxiety or "mental dis*" or "mental health" or "mood dis*").ti. 437 947
Intervention: 
2. exp Food/ or exp Diet/ or exp Meals/ or exp Nutritional Sciences/ or exp Nutrition Therapy/ 1 931 416
3. ((nutrition* or diet*) adj6 (treatment* or intervention* or therap*)).ti,ab,kf. 135 031
4. ((diet* or nutrition*) adj3 supplement*).ti,ab,kf. 85 178
  2 OR 3 OR 4 1 947 752
Study types: systematic reviews and meta-analysis
5. ((Systematic Review/ or Meta-Analysis/ or Cochrane Database Syst Rev.ja. or (((systematic or realist or integrative or qualitative or mixed method* or evidence or critical) adj4 (review or synthe*)) or "meta analys*" or metaanalys* or meta synthe* or metasynthe* or "meta narrative" or meta aggreg* or meta ethnograph*).ti,bt,ab,kf.) not (editorial/ or letter/ or case reports/)) 670 234
Combined sets:
6. 1 AND (2 or 3 or 4) AND 5 521
Final result
7.   521

Scopus via scopus.com 18 May 26

Title: Diet and depression
TITLE-ABS-KEY = Title, abstract or keywords (including indexed keywords and author keywords); ALL = All fields; W/n = Within. Proximity operator retrieving terms within n words from each other; PRE/n = Precedes by. Proximity operator, the first term in the search must precede the second by n words; LIMIT-TO (X) = Includes only results of specified type, e.g., publication type or time range; DOCTYPE = Publication type; “re” = review; “le” = letter; “ed” = editorial; “ch” = book chapter; “cp” = conference proceedings; * = Truncation; “ “ = Citation Marks; searches for an exact phrase
Search terms Items found
Population:
1. TITLE ((depressi* OR anxiety OR "mental dis*" OR "mental health" OR "mood dis*")) 506 914
Intervention:
2. (TITLE-ABS (vitamin* OR mineral* OR carbohydrate* OR protein* OR "fatty acid*" OR omega-3 OR omega-6 OR fibre* OR keto* OR mediterran* OR LCHF OR antiinflammatory OR prebiotic* OR probiotic* OR "amino acid*" OR antioxidant*)) OR (TITLE-ABS ((diet* OR nutrition*) W/2 supplement*)) OR (TITLE-ABS (((nutrition* OR diet*) W/5 (treatment* OR intervention* OR therap*)))) 7 938 587
Study types: systematic reviews and meta-analysis / randomized controlled trials
3. (TITLE-ABS ((systematic OR realist OR integrative OR qualitative OR evidence OR critical OR "mixed method") W/2 ( review OR synthes*)) OR TITLE-ABS ("meta analys*" OR metaanalys* OR meta synthe* OR metasynthe* OR "meta narrative" OR meta aggreg* OR meta ethnograph*)) AND (EXCLUDE (DOCTYPE,"le") OR EXCLUDE (DOCTYPE,"ed") OR EXCLUDE (DOCTYPE,"ch") OR EXCLUDE (DOCTYPE,"cp")) 648 918
Combined sets:
4. 1 AND 2 AND 3 639
Final result
5.   639

 

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