Mood Food? Depressed People Eat More Chocolate

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May 3, 2010 — A new cross-sectional study suggests individuals with depressive symptoms eat more chocolate, but it does not explain why.

"There is a lot of lore about chocolate and depression and precious little in the way of scientific evidence, which is what motivated us to do this study," Beatrice A. Golomb, MD, PhD, of the Department of Family and Preventive Medicine, University of California, San Diego, told Medscape Psychiatry.

The study, published in the April 26 issue of the Archives of Internal Medicine, included 931 adults not using antidepressants. The mean age of study subjects was 57.6 years and mean body mass index was 27.8 kg/m² or less; 70.1% were male, 80.4% were white, and 58.8% were college educated. Subjects provided information on chocolate consumption (frequency and amount) and completed the Center for Epidemiological Studies-Depression (CES-D) scale.

Subjects who screened positive for depression, defined as a CES-D score of 16 or higher, reported consuming significantly more chocolate than those not screening positive for depression (8.4 vs 5.4 servings per month; P = .004).

Those with CES-D scores of 22 or greater, indicating probable major depression, consumed 11.8 servings of chocolate per month (P value for trend < .01). These associations were evident for men and women.

According to the researchers, several nutrient factors that could be linked to mood, such as increased caffeine, fat, carbohydrate, or energy intake, bore no significant correlation with mood symptoms, suggesting relative specificity of the chocolate finding.

"The study," Dr. Golomb emphasized, "does not address the issue of whether chocolate is beneficial or harmful in terms of mood, as this is an observational and cross-sectional study."

"A lot of people perceive that they get a mood lift when they eat chocolate; whether that's true or whether that’s short lived, which is why people with higher depression scores are still seen as eating more chocolate," is unclear, Dr. Golomb said.

There was no evidence in the study that chocolate had a sustained benefit on mood. "In our sample, if there is a 'treatment benefit,' it did not suffice to overcome the depressed mood on average," she and colleagues note in their report.

Future prospective studies are needed to elucidate the foundation of the chocolate-mood association and determine whether chocolate has a role in depression "as a cause or cure," they conclude.

Commenting on the findings, Gordon Parker, MD, PhD, of the School of Psychiatry, University of New South Wales, Australia, who was not involved in the study, said people who crave chocolate and judge it as beneficial when depressed may be "more likely to have certain personality styles." These personality styles that underpin chocolate cravings reflect "neuroticism or what we would call emotional dysregulation."

"Thus, rather than view chocolate craving as a symptom, it may well be an attempt by individuals who are emotionally dysregulated to reset their ‘mood state,’ and then this invites the question as to what are the components in chocolate that might settle emotional dysregulation."

Dr. Golomb and Dr. Parker have disclosed no relevant financial relationships.

Arch Intern Med. 2010;170:699-703.

Clinical Context

Conventional wisdom suggests that eating chocolate may improve mood. Polyphenols in chocolate may affect neurotransmitter pathways, suggesting theoretically plausible mechanisms underlying this association.

To date, scientific data validating or refuting this association are limited. One exploratory analysis of the relationship of food to mood suggested a specific link between depressive symptoms and chocolate consumption, but there were methodologic issues with that study.

Study Highlights

• The goal of this cross-sectional study was to determine the association of chocolate consumption with depressed mood in 1018 adults (694 men and 324 women) from San Diego, California.
• Exclusion criteria were diabetes, known coronary artery disease, and use of antidepressant medications.
• 931 subjects did not have these exclusion criteria and provided information regarding chocolate consumption.
• The CES-D scale was used to evaluate mood.
• Positive screen for depression was defined as a CES-D score of 16 or more.
• Probable major depression was defined as a CES-D score of 22 or more.
• 1009 subjects provided information on chocolate servings per week, and 839 subjects also provided chocolate consumption frequency and rate data using the Fred Hutchinson Food Frequency Questionnaire.
• Participants with lower vs higher CES-D scores were compared regarding chocolate consumption, and a test of trend was also performed.
• Compared with participants not screening positive for depression, those screening positive for possible depression had higher chocolate consumption (8.4 servings per month vs 5.4 servings per month; P = .004).
• Participants with probable major depression had a mean chocolate consumption of 11.8 servings per month (P value for trend, < .01).
• These associations were observed in men as well as in women and did not appear to be explained by a general increase in fat, carbohydrate, or energy intake, suggesting greater specificity of the association between depression and chocolate intake.
• There was no association of caffeine with mood in this sample.
• The investigators concluded that higher CES-D scores were associated with greater chocolate consumption.
• However, they recommended future prospective study to determine whether there is a causal connection and, if so, in which direction, between chocolate consumption and depression.
• Limitations of this study were that the study was conducted for a different initial purpose, dietary data were based on self-report, and the CES-D as a screening test was used without diagnostic confirmation of mood disorder.
• In addition, potential mediating factors such as phenylethylamine, anandamine, and theobromine levels were not addressed; different chocolate products were not distinguished; and cross-sectional design prevented any inferences about causality or even directionality.

Clinical Implications

• In a cross-sectional analysis, participants screening positive for possible depression had higher chocolate consumption than those not screening positive for depression. Highest chocolate consumption was reported in participants with probable major depression.
• These associations were observed in men as well as in women and did not appear to be explained by a general increase in fat, carbohydrate, or energy intake, suggesting greater specificity of the association between depression and chocolate intake. There was no association of caffeine with mood in this sample.

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