Skip to main content Skip to main navigation menu Skip to site footer

The role of psychosocial stressors, carbohydrate and protein intake on serum serotonin and cortisol levels in patients with depression: a preliminary evaluation


Introduction: Depression is a mental disorder associated with biological, environmental and psychological factors. Depression is estimated to be a disease that requires the second largest expense on treatment. Chronic stress will reduce serotonin activity and storage and also stimulate the adrenal cortex to release cortisol and other glucocorticoid hormones. Nutritional intake such as carbohydrates and protein also plays a role in depression with various mechanisms. The study aims to investigate the role of psychosocial stressors, carbohydrate and protein intake on serum cortisol and serotonin levels in patients with depression

Methods: The study used an analytic observational approach with a cross sectional design. Subjects were selected by consecutive sampling and were asked to fill out the general characteristics questionnaire, Beck Depression Inventory (BDI) - II to determine depression levels, Holmes Rahe scale to measure psychosocial stressors, food frequency questionnaires to measure carbohydrate and protein intake. Subjects who met the inclusion criteria were taken blood samples to measure the cortisol and serotonin levels.

Result: Of the 79 subjects, 57 (72%) women and 22 (28%) men with an average age of 43 ± 3 years. A total of 64 (81%) subjects were with mild psychosocial stressors and 5 (6%) were severe. Psychosocial stressor were not significantly correlated with either serotonin (p=0.479), nor cortisol level (p=0.625) Carbohydrate were not significantly correlated with serotonin level (p=0.628) and cortisol level (p=0.252). Protein was not significantly correlated with serotonin level (p=0.688) and cortisol level (p=0.110).

Conclusion: There was no correlation between psychosocial stressors, carbohydrate and protein intake with serum cortisol and serotonin levels in depressed patients.


  1. World Health Organization. Depression and Other Common Mental Disorders: Global Health Estimates. Geneva: WHO Press; 2017.
  2. Research and Development Ministry of Health RI. Basic Health Research. Jakarta: Ministry of Health RI; 2018.
  3. Gilman SE, Trinh N-H, Smoller JW, Fava M, Murphy JM, Breslau J. Psychosocial stressors and the prognosis of major depression: a test of Axis IV. Psychol Assess. 2013;43(2):303–16.
  4. Al-Harbi KS. Treatment-resistant depression: therapeutic trends, challenges, and future directions. Patient Prefer Adherence. 2012;6:369–88.
  5. Sarris J, Logan AC, Akbaraly TN, Amminger GP, Balanzá-Martínez V, Freeman MP, et al. Nutritional medicine as mainstream in psychiatry. The Lancet Psychiatry. 2015;2(3):271–4.
  6. Marx W, Moseley G, Berk M, Jacka F. Nutritional psychiatry: The present state of the evidence. Proc Nutr Soc. 2017;76(4):427–36.
  7. Wurtman RJ, Wurtman JJ. Carbohydrates and depression. Scientific American. 1989;260:68–75.
  8. Sathyanarayana Rao T, Asha M, Ramesh B, Jagannatha Rao K. Understanding nutrition, depression and mental illnesses. Indian J Psychiatry. 2008;50(2):77-86.
  9. Wurtman RJ, Wurtman JJ, Regan MM, McDermott JM, Tsay RH, Breu JJ. Effects of normal meals rich in carbohydrates or proteins on plasma tryptophan and tyrosine ratios. Am J Clin Nutr. 2003;77(1):128–32.
  10. Holmes TH, Rahe RH. The social readjustment rating scale. J Psychosom Res. 1967;11(2):213–8.
  11. Fitri N, Jafar N, Indriasari R. Validation study semi- quantitative food frequency questionnaire with 24-hour food recall on micronutrition intake in adolescent at athirah high school makassar. 2013;1–13.
  12. Shahril. Semi-quantitative food frequency questionnaire for assessment of energy, total fat, fatty acids, and vitamin A, C and E intake among malaysian women: Comparison with Three Days 24-Hour Diet Recalls. Malaysian J Heal Sci. 2008;6(2):75–91.
  13. Szeitz A, Bandiera SM. Analysis and measurement of serotonin. Biomed Chromatogr. 2018;32(1):15-19.
  14. Herman JP, Mcklveen JM, Ghosal S, Kopp B, Wulsin A, Makinson R, et al. Regulation of the hypothalamic-pituitary-adrenocortical stress response. Compr Physiol. 2016;6(2):603–21.
  15. Stachowicz M, Lebiedzinska A. The effect of diet components on the level of cortisol. Eur Food Res Technol. 2016;242:2001–9.
  16. Slominski AT, Zmijewski MA, Zbytek B, Tobin DJ, Theoharides TC, Rivier J. Key role of CRF in the skin stress response system. Endocr Rev. 2013;34(6):827–84.
  17. Godoy LD, Rossignoli MT, Delfino-Pereira P, Garcia-Cairasco N, Umeoka EH de L. A comprehensive overview on stress neurobiology: Basic concepts and clinical implications. Front Behav Neurosci. 2018;12(July):1–23.
  18. Way BM, Taylor SE. The serotonin transporter promoter polymorphism is associated with cortisol response to psychosocial stress. Biol Psychiatry. 2010;67(5):487–92.
  19. Jenkins TA, Nguyen JCD, Polglaze KE, Bertrand PP. Influence of tryptophan and serotonin on mood and cognition with a possible role of the gut-brain axis. Nutrients. 2016;8(1):1–15.
  20. Markus CR. Effects of carbohydrates on brain tryptophan availability and stress performance. Biol Psychol. 2007;76(1–2):83–90.
  21. Shabbir F, Patel A, Mattison C, Bose S, Krishnamohan R, Sweeney E, et al. Effect of diet on serotonergic neurotransmission in depression. Neurochem Int. 2013;62(3):324–9.
  22. Sachs BD, Ni JR, Caron MG. Brain 5-HT deficiency increases stress vulnerability and impairs antidepressant responses following psychosocial stress. Proc Natl Acad Sci USA. 2015;112(8):2557–62.

How to Cite

Fitrikasari, A., Wardani, N. D., Sumekar, T. A., Saktini, F., Asikin, H. G., & Sulchan, M. (2021). The role of psychosocial stressors, carbohydrate and protein intake on serum serotonin and cortisol levels in patients with depression: a preliminary evaluation. Bali Medical Journal, 10(1), 137–141.




Search Panel

Alifiati Fitrikasari
Google Scholar
BMJ Journal

Natalia Dewi Wardani
Google Scholar
BMJ Journal

Tanjung Ayu Sumekar
Google Scholar
BMJ Journal

Fanti Saktini
Google Scholar
BMJ Journal

Hang Gunawan Asikin
Google Scholar
BMJ Journal

Mohamad Sulchan
Google Scholar
BMJ Journal