• Felice N Jacka, Adrienne O'Neil, Catherine Itsiopoulos, Rachelle Opie, Sue Cotton, Mohammadreza Mohebbi, David Castle, Sarah Dash, Cathrine Mihalopoulos, Mary Lou Chatterton, Laima Brazionis, Olivia M Dean, Allison Hodge, and Michael Berk.
• IMPACT Strategic Research Centre, Deakin University, Geelong, VIC, Australia. f.jacka@deakin.edu.au.
• Bmc Med. 2018 Dec 28; 16 (1): 237237.

AbstractThe SMILES trial was the first intervention study to test dietary improvement as a treatment strategy for depression. Molendijk et al. propose that expectation bias and difficulties with blinding might account for the large effect size. While we acknowledge the issue of expectation bias in lifestyle intervention trials and indeed discuss this as a key limitation in our paper, we observed a strong correlation between dietary change and change in depression scores, which we argue is consistent with a causal effect and we believe unlikely to be an artefact of inadequate blinding. Since its publication, our results have been largely replicated and our recent economic evaluation of SMILES suggests that the benefits of our approach extend beyond depression. We argue that the SMILES trial should be considered an important, albeit preliminary, first step in the field of nutritional psychiatry research.

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