Depression, Anxiety, Panic, Bipolar Disorder, Mania

The Gluten File


It is possible for depression to be the only symptom of gluten sensitivity or celiac disease, and it often improves remarkably  once gluten is eliminated from the diet. Because celiac disease is a disease of malabsorption, sometimes underlying nutritional deficiency is also a contributing factor to neuropyschiatric symptoms, especially, but not limited to deficiency of  Vitamin B12  and  Vitamin B6 .


From:

Current Approaches to Diagnosis and Treatment of CeliacDisease: An Evolving Spectrum
ALESSIO FASANO and CARLO CATASSI

"Asymptomatic (Silent) Form
This form is characterized by the presence of histologic changes, probably limited to the proximal intestine, that occur in individuals who are apparently asymptomatic.45–47 Most cases in this category have been identified through screening programs involving apparently healthy subjects. However, a more careful clinical anamnesis typically reveals that many of these "silent" cases are indeed affected by low-intensity illness often associated with decreased psychophysical well-being. Common findings include (1) iron deficiency with or without anemia; (2) behavioral disturbances, such as tendency to depression, irritability, or impaired school performance in children; (3) impaired physical fitness, "feeling always tired," and easy fatigue during exercise; and (4) reduced bone mineral density.


From Medscape:

Selection from: Depression: Lifestyle and Complementary Therapies to Promote Healthy Moods in Teens

2007

"Food sensitivities can cause mood problems as well as rashes, asthma, and rhinorrhea. Approximately 6% of children and adolescents have allergies or sensitivities to foods, including 1% who cannot tolerate gluten. The most common food sensitivities are to wheat, corn, soy, dairy, eggs, tree nuts (such as pecans, walnuts and almonds), shellfish, and peanuts. Eliminating the triggering food(s) from the diet can improve mood as well as other symptoms such as chronic headaches, rashes, and gastrointestinal upset."

Also see section 3 about nutritional deficiencies associated with depression.


Other Resources:

Food Allergy and Depression - About.com
LEF on Depression
Nutritional Healing on Depression
Nutritional Healing on Bi-Polar
Alternative Mental Health
eMedicine on Depression


PubMed Abstracts:


Depressed mood associated with gluten sensitivity--resolution of symptoms with a gluten-free diet.
PMID: 23254531  Nov 2012

Increased levels of antibodies to gliadin, which is derived from the wheat protein, gluten, have been reported in schizophrenia and bipolar disorder in cross-sectional studies. We examined longitudinally the levels of antibody reactivity to gliadin in acute mania. The sample included 60 individuals assessed during a hospital stay for acute mania, 39 at a six month follow-up, and a sample of 143 non-psychiatric controls. Antibodies to gliadin were measured by enzyme immunoassay. The relationship of the antibodies to the clinical course of mania was analyzed by the use of regression models. Individuals with mania had significantly increased levels of IgG antibodies to gliadin, but not other markers of celiac disease, at baseline compared with controls in multivariate analyses. However, these levels were not significantly different from those of controls at the six month follow-up. Among the individuals with mania, elevated levels at follow-up were significantly associated with re-hospitalization in the six month follow-up period. The monitoring and control of gluten sensitivity may have significant effects on the management of individuals hospitalized with acute mania.
Markers of gluten sensitivity in acute mania: A longitudinal study.
PMID:22386570  Mar 2012

Celiac Disease (CD) is an immune-mediated disease dependent on gluten (a protein present in wheat, rye or barley) that occurs in about 1% of the population and is generally characterized by gastrointestinal complaints. More recently the understanding and knowledge of gluten sensitivity (GS), has emerged as an illness distinct from celiac disease with an estimated prevalence 6 times that of CD. Gluten sensitive people do not have villous atrophy or antibodies that are present in celiac disease, but rather they can test positive for antibodies to gliadin. Both CD and GS may present with a variety of neurologic and psychiatric co-morbidities, however, extraintestinal symptoms may be the prime presentation in those with GS. However, gluten sensitivity remains undertreated and underrecognized as a contributing factor to psychiatric and neurologic manifestiations. This review focuses on neurologic and psychiatric manifestations implicated with gluten sensitivity, reviews the emergence of gluten sensitivity distinct from celiac disease, and summarizes the potential mechanisms related to this immune reaction.
Neurologic and psychiatric manifestations of celiac disease and gluten sensitivity.
PMID:21877216  Mar  2012

Conclusions:  Individuals with bipolar disorder have increased levels of IgG antibodies to gliadin. However, such antibody increase is not accompanied by an elevation in IgA antibodies to gliadin or the celiac disease-associated antibodies against deamidated gliadin and tTG. These results warrant further detailed examination of the molecular specificity and pattern of reactivity of the antibody response to gluten antigens in bipolar disorder.
Markers of gluten sensitivity and celiac disease in bipolar disorder.
PMID: 21320252  Feb 2011

CONCLUSIONS: Sleep disorders are common in coeliac disease not only at diagnosis but also during treatment with a gluten-free diet. Sleep disorders are related to depression, anxiety and fatigue, and inversely related to quality of life scale scores.

The quality of sleep in patients with coeliac disease.
PMID: 20937049  Oct 2010

Conclusions. Although AGA positivity is of clinical relevance only in a subset of elderly people, it seems to be related to rheumatoid arthritis and depression, both conditions linked to celiac disease. Further studies are needed to reveal the mechanisms underlying this. The poor specificity of AGA for celiac disease was here once more in evidence.  
Positive serum antigliadin antibodies without celiac disease in the elderly population: does it matter?
PMID: 20545470 June 2010

In a significant proportion of cases (10-15%) gluten intolerance can be associated with central or peripheral nervous system and psychiatric disorders. A 38-year-old man was admitted as to our department an inpatient for worsening anxiety symptoms and behavioural alterations. After the addition of second generation antipsychotic to the therapeutic regimen, the patient presented neuromotor impairment with high fever, sopor, leukocytosis, raised rhabdomyolysis-related indicators. Neuroleptic malignant syndrome was strongly suspected. After worsening of his neuropsychiatric conditions, with the onset of a frontal cognitive deficit, bradykinesia and difficulty walking, dysphagia, anorexia and hypoferraemic anaemia, SPET revealed a reduction of cerebral perfusion and ENeG results were compatible with a mainly motor polyneuropathy. Extensive laboratory investigations gave positive results for anti-gliadin antibodies, and an appropriate diet led to a progressive remission of the encephalopathy.
Gluten encephalopathy with psychiatric onset: case report.
PMID: 19558661  June 2009

 
Results. Fifty-seven patients (88%) completed the trial. The tHcy level was baseline median 11.7 mumol/L (7.4 -23.0), significantly higher than in matched population controls (10.2 mumol/L (6.7-22.6) (P<0.01). Following vitamin supplementation, tHcy dropped a median of 34% (P<0.001), accompanied by significant improvement in well-being (P<0.01), notably Anxiety (P<0.05) and Depressed Mood (P<0.05) for patients with poor well-being. Conclusions. Adults with longstanding coeliac disease taking extra B vitamins for 6 months showed normalized tHcy and significant improvement in general well-being, suggesting that B vitamins should be considered in people advised to follow a gluten-free diet.
Clinical trial: B Vitamins improve health in coeliac patients living on a gluten-free diet.
PMID: 19154566 Jan 2009
 
Conclusion: The prevalence of depression in CD is similar to that in other chronic gastrointestinal diseases and healthy controls. However, there is a markedly elevated risk of depression in patients with both type I DM and CD. Differing rates of type 1 DM among celiac populations may account for disparity in published rates of depression in patients with CD.
 
Several extraintestinal clinical manifestations have been reported in celiac disease (CD). Among them, growing evidence suggests the association between CD and affective and psychiatric disorders. In this review the most frequent affective and psychiatric disorders associated with CD and the possible mechanisms involved in these associations were analyzed. The available data suggest that screening for CD in patients with affective and/or psychiatric symptoms may be useful since these disorders could be the expression of an organic disease rather than primary psychiatric illnesses.
PMID: 18431064  April 2008
 
Results: Among patients, 1379 (84.1%) showed state anxiety, 1098 (67%) showed trait anxiety and 442 (27%) showed current depression. The number of gastrointestinal diseases was directly correlated to state anxiety (p < 0.001) and trait anxiety (p = 0.04). Females showed higher levels of anxiety and depression than males (p < 0.001). State anxiety was related to food allergies (p < 0.001), small intestinal bacterial overgrowth (SIBO) (p = 0.001), Hp infection (p = 0.01) and ulcerative colitis in active phase (p = 0.03). Trait anxiety was related to irritable bowel syndrome (IBS) (p < 0.001), Helicobacter pylori (Hp) infection (p = 0.001), food allergies (p = 0.001) and SIBO (p = 0.001). Current depression was related to IBS (p < 0.001) and coeliac disease (p = 0.01), SIBO (p = 0.02).
PMID: 18422970   April 2008

CONCLUSIONS: Based on our findings, the prevalence of neurologic/psychiatric manifestations in this group of children with GS was low but slightly higher than that in the controls (P = .041). Children with known (P = .772) and cryptogenic (P = 1.0) neurologic disorders did not exhibit a higher prevalence of GS.
Low prevalence of neurologic and psychiatric manifestations in children with gluten sensitivity.

PMID: 18206697  Feb 2009

Conclusions. Despite the limited number of cases evaluated, the present study showed a significantly higher prevalence of social phobia in CD patients compared with in healthy subjects. Future studies are needed to clarify the possible social phobia-induced risks such as school and/or work failure in CD patients.
Social phobia in celiac disease
PMID: 18365905  2008

CONCLUSIONS: CD is positively associated with subsequent depression. The risk increase for CD in individuals with prior depression and BD may be due to screening for CD among those with MD.
Coeliac disease and risk of mood disorders - A general population-based cohort study.
PMID: 17030405  Oct 2006   

CONCLUSION: These cases represent atypical forms of CD manifested in childhood only by neuropsychological disorders. To make an early diagnosis and to improve the disease prognosis, the literature and our clinic experience shown that is useful screen the CD in all patients with neuropsychological disorders such as epileptics foci in the parietal-occipital region and/or occipital calcification, headache (mostly if there isn't familiarity), spinocerebellar ataxia, neuromuscular disease of unknown aetiology, Down syndrome, behavioural disorders and some psychiatric troubles.
[Diagnosis of coeliac disease in patients with isolated neuropsychological symptoms. Cases reports] 
PMID: 16922014  Dec 2005

On the basis of current data, we suggest that oral doses of both folic acid (800 microg daily) and vitamin B12 (1 mg daily) should be tried to improve treatment outcome in depression.
Treatment of depression: time to consider folic acid and vitamin B12.
PMID: 15671130 Jan 2005

....they give support to previous findings on patients with coeliac disease, suggesting that serotonergic dysfunction due to impaired availability of tryptophan may play a role in vulnerability to depressive and behavioural disorders also among adolescents with untreated coeliac disease.
Gluten-free diet may alleviate depressive and behavioural symptoms in adolescents with coeliac disease: a prospective follow-up case-series study. 
PMID: 15774013  March 2005 

CONCLUSIONS: The unexpected prevalences obtained for the groups studied suggest that there may be an association between sugar intolerance and depressive symptoms during adolescence
Malabsorption of carbohydrates and depression in children and adolescents. 
PMID: 15861016  May 2005  Full Text

A high prevalence of depressive symptoms, hypothetically related to serotonergic dysfunction, has been reported among adults with celiac disease. Relative to the comparison subjects, the celiac disease patients had significantly higher lifetime prevalences of major depressive disorder (31% versus 7%) and disruptive behavior disorders (28% versus 3%). Celiac disease in adolescents is associated with an increased prevalence of depressive and disruptive behavioral disorders, particularly in the phase before diet treatment.
Mental disorders in adolescents with celiac disease.
PMID: 15232047  Aug 2004

Neurological and psychiatric disorders occur in approximately 10% of patients with celiac disease. There is evidence of regional cerebral blood flow alteration in untreated celiac patients
Regional cerebral hypoperfusion in patients with celiac disease. PMID: 14984816

We describe three adult patients with undiagnosed or untreated celiac disease without particular intestinal signs, causing persistent depressive symptoms in three of the parents of our pediatric patients. In all three patients, the depressive symptoms improved quickly with a gluten-free diet.
Depression in adult untreated celiac subjects: diagnosis by the pediatrician PMID: 10086676

Signs of mental depression are typical in adults presenting with coeliac disease. The results indicate a causal relationship between adult coeliac disease and concomitant depressive symptoms which seems to implicate metabolic effects from pyridoxine deficiency influencing central mechanisms regulating mood.
Reversal of psychopathology in adult coeliac disease with the aid of pyridoxine (vitamin B6).
PMID: 6369511


Patients affected by celiac disease tend to show a high prevalence of PD and MDD and association with subclinical thyroid disease appears to represent a significant risk factor for these psychiatric disorders.
Association between panic disorder, major depressive disorder and celiac disease: a possible role of thyroid autoimmunity PMID: 12217453

As many as 1:163 people are affected by it, but only a small percentage are aware of the condition, which begins either in infancy, with gastrointestinal symptoms, or in childhood and later years with non-Gl signs and symptoms, such as fatigue, depression, anxiety, anemia, stunted growth, and delayed puberty.
Celiac disease PMID: 12683313

She suddenly experienced some esthesic hallucinations, depression, anorexia, affective flattening and autistic behavior. After 12 months of gluten-free diet a spectacular and lasting improvement of both psychotic and depressive symptoms was obtained.
Psychosis revealing a silent celiac disease in a young women with trisomy 21 PMID: 12422480

There are several case reports of coexistence of coeliac sprue and depression, schizophrenia and anxiety. Coeliac disease should be taken into consideration in patients with psychiatric disorders, particularly if they are not responsive to psychopharmacological therapy, because withdrawal of gluten from the diet usually results in disappearance of symptoms.
Psychiatric symptoms and coeliac disease PMID: 12298186