PATIENT ENQUIRY

Natural Treatments for Depression


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What Is?
What is Depression
How to Treat Depression
Natural Treatments for Depression

What is depression?

Depression and anxiety are ever-present and a reality of everyday life. When approp¬riate to life events, depression is usually of no major significance, but occasionally may require supportive care and counselling.

A person with depression finds it hard to function properly even with simple day-to-day activities, and doesn’t enjoy life – even the good times. While it’s normal to feel sad occasionally when things don’t go according to plan, the sadness usually passes with time. However, people with clinical depression are sad and depressed most of the time and these feelings impede their ability to function and enjoy life. Their sadness and depression is so prevalent that the people around them are affected.

In recent times, there has been a definite push to define grief, emotional hurt, and unhappiness as depression and institute drug therapy to ease personal distress. As a result, emotional grief and unhappiness have become medicalised, which has resulted in antidepressant medication overuse and substan¬tial emotional, financial, and productivity costs to individuals and the community.

Depression is also called clinical depression or major depressive disorder.
Although the triggers are similar and the two problems often happen at the same time, anxiety is different to depression. Some people with depression also have an overlapping anxiety disorder. Persistent anxiety is one symptom of depression.

Depression can be a chronic illness than has a major negative impact if left undiagnosed and not properly treated and managed.

Depression is a mental state or chronic mental disorder characteriaed by feelings of sadness, loneliness, despair, low self-esteem, and self-reproach; accompanying signs include psychomotor retardation (or less frequently agitation), withdrawal from social contact, and vegetative states such as loss of appetite and insomnia.

Three types – reactive depressions, major affective disorders, secondary depression

Reactive depressions

Reactive depressions

Reactive depression usually occurs in reaction to an adverse life situation, such as financial loss, the loss of a person by death or divorce, or the loss of an established role.

Repressed anger, guilt, and anxiety are often associated with reactive depression, which can range from mild sadness, worry, irritability, impaired concentration, feelings of discouragement, and somatic complaints, to the more severe symptoms of psycho¬motor retardation that are typical of major affective disorders.

Major affective disorders

Major affective disorders are generally more severe than reactive depression and often have no apparent precipitating cause or event. Major affective disorders classically exhibit severe psychomotor retardation with vegetative symptoms and suicidal thoughts. The three clinical sub-types are unipolar depression, hypomania, and bipolar depression.

Three types of major affective disorder are unipolar depression, hypomania or mania, and bipolar disorders.

Unipolar depression

Unipolar depression is a major endogenous depressive episode that occurs relatively independently of the patient’s life situations or events. Unipolar depression may occur during childhood or adult life. The prevalence is higher for women than men, and often begins during the perimenopausal or post¬menopausal period also called ‘change of life’.

Complaints vary widely, but most frequently include: loss of interest and pleasure in living, withdrawal from life activities, pervasive feelings of guilt and worthlessness, inability to concentrate, recurrent anxiety, chronic fatigue, somatic complaints, and loss of libido (sexual drive).

Vegetative signs are frequent and present as sleep disorder with early morning awakening, anorexia with weight loss, and constipation.

Occasionally, severe agitation and psychotic thoughts (paranoid thinking, somatic delusions) are present. Paranoid symptoms may range from general suspiciousness to ideas of reference, while somatic delusions frequently revolve around feelings of impending annihilation or hypochondriacal beliefs that the body is rotting away with cancer. However, true hallucinations seldom occur.

Unipolar depression is associated with diurnal variation and symptoms often improve during the day.

Hypomania or mania

Hypomania or mania is a mood change characterised by undue elation and hyperactivity, with over-involvement in life activities, undue exuberance and flight of ideas, low irritability threshold, easy distractibility, and little need for sleep.

The overenthusiastic mood and expansive behaviour are initially attractive but irritability, mood changes, aggressive behaviour, and grandiosity usually lead to marked difficulties relating to other people.

Impulsive behaviour is frequent and includes: excessive spending, job resignation, hasty marriage, exhibitionistic behaviour, sexual acting out and promiscuity, and alienation of acquaintances and friends. Atypical manic episodes often include gross delusions, paranoid thoughts, and auditory hallucinations usually related to grandiose perceptions or plans.

Atypical manic episodes must be differentiated from schizophrenia. Manic patients differ from schizophrenia patients in that they use more effective interpersonal manoeuvres, are more sensitive to the social manoeuvres of others, and are more able to use weakness and vulnerability in others to their own advantage.

Schizophrenia patients are more withdrawn, less sensitive to nuances, less flexible, and unlike the manic patient, seldom function on an effective interpersonal level.

Manic episodes usually begin abruptly and last several days to months, but episodes are generally of shorter duration than depressive episodes. In most cases, the manic episode is part of a broader bipolar (manic-depressive) disorder.

Bipolar disorders

Bipolar disorders consist of depressive episodes interspersed with manic episodes, although individual manic episodes usually occur earlier, in the late teens or early adult life, than the depressive episodes.

Cyclothymia is a milder form of bipolar disorder, which is often apparent from an early age. Dysthymic disorders (persistent depressive disorders) differ from the major affective disorders in the magnitude of the person’s symptoms. Severity and duration vary and there are no psychotic features. In the past, these conditions were frequently called depressive neuroses.

Secondary depression

Secondary depression

Any illness can cause a secondary depressive disorder, particularly chronic illness. Conditions such as rheumatoid arthritis, multiple sclerosis, and chronic heart disease are often associated with depression. Varying degrees of depression are frequently associated with schizophrenic disorders and organic mental states, in particular alcoholism and chronic drug use.

Long-term drug use, whether recreational or prescribed medications, can cause secondary depression. Multiple medications are reported to induce often-severe depressive illness.

Commonly used drugs that can cause secondary depression include:

  • Resperine, which causes the classic model of drug-induced depression, and other antihypertensive medications such as alpha methyldopa, guanethidine, clonidine, and propranolol
  • Corticosteroids, oral contraceptives, hormone therapy, and anti-hormone therapy
  • Benzodiazpines and other sedatives
  • Disulfiram and anticholinesterase drugs and less frequently associated with depression
    Appetite-suppressing drugs, while initially stimulating brain function, can cause a depressive syndrome when withdrawn, and

  • Alcohol, sedatives, opiates, and most psychedelic drugs are brain depressants, but are often used in the self-treatment of depression, which makes the problem worse. The rate of suicide is highest with use of these drugs.

Risk factors for depression

The precise cause of depression remains unknown. Depression often begins during the teenage years, but it can develop at any age for a variety of reasons.

Women are twice as likely to develop depression compared with men. Often this is because a woman is more likely to talk about her problems with family or friends and seek professional advice and treatment.

Depression in teenagers is a serious medical problem that can affect how a person thinks, feels, and behaves, which can result in emotional, functional, and physical ailments. Undue peer group pressure, high academic expectations, relationship problems, and pubescent physical and emotional changes, can result in lasting feelings of worthlessness.

Older people encounter more physical illness, chronic health problems, and personal loss, which can trigger depression. Chronic pain, side effects from medications, loss of independence, social isolation, and hospitalisation can create additional stress for older people.

While many couples are relieved when they finally have their home to themselves after decades of caring for children, some parents are adversely affected. When the last adult child leaves home, feelings of sadness and loss can result. Even parents who actively encourage their children to become independent and self-reliant can develop ‘empty nest’ syndrome, which when profound can lead to depression, alcohol abuse, low self esteem and identity crisis, and marital problems.

Types 1 and 2 diabetes double the rick of depression and anxiety because of the stress of managing a chronic illness. Conversely, having depression can double the risk of developing Type 2 diabetes, because of elevated stress hormones and weight gain, and increases the likelihood of diabetes complications.

Any factor that increases stress can lead to anxiety and depression. The additional stress encountered during pregnancy and early parenthood can lead to mental health problems, but providing practical and emotional support can alleviate the stress. A stressful or unplanned pregnancy, fertility problems, complicated labour, difficulty with breast-feeding, and infant health problems can all lead to post-natal depression. Being a single parent, or teenage parent, or having twins or triplets also increases stress levels.

A person with a gambling problem has an increased risk of having a severe mental disorder, and drug or alcohol problem. The divorce rate for people with a gambling problem is much higher (5.6-fold risk) compared with people without a gambling problem.

People in the gay, lesbian, bi-sexual, transgener and intersex (GLBTI) community show high prevalence rates for depression and anxiety, probably due to discrimination because they are different to the majority of people. And racism and discrimination can lead to depressions and anxiety for Aboriginal and Torres Strait Islander people.

Seasonal affective disorder is a type of depression that results from seasonal change. Also called ‘the winter blues’, symptoms usually start during autumn and continue into winter. Seasonal affective disorder is much more common in countries that experience colder, longer winters and so the problem is less common in Australia. Treatment usually involved light therapy, psychotherapy, and medications.

Psychiatrists have identified a number of circumstances that can increase the risk of depression, including:

  • Having biological relatives with depression
  • Traumatic childhood experience – incest, loss of a parent or sibling
  • Stressful life events – divorce or death of a loved one
  • Social isolation
  • Recently having given birth – postpartum depression
  • Previous episodes of depression
  • Chronic or terminal illness (cancer, diabetes, heart disease, Alzheimer’s or HIV/AIDS)
  • Low self-esteem and being overly dependent, self-critical or pessimistic
  • Alcohol, nicotine or illicit drugs abuse
  • Certain medications, such as sleeping pills

Talk to your doctor before stopping any medication you think could be affecting your mood.

How is depression managed?

How is depression managed?

A person with clinical depression needs medical assessment and treatment in order to get back to normal. In addition to psychological and medical treatment, increasing activity levels in previous or new interests can lead to a sense of accomplishment. Simply feeling like you’re getting even the simplest day-to-day tasks done can help self-esteem enormously.

Depressive episodes usually result in a significant lack of motivation. To overcome this, a simple list of daily tasks and enjoyable activities to complete each day or week can help develop a healthy routine and positive focus. As recovery progresses the sense of enjoyment will return and hopefully increase back to normal.

Start with small goals and build from there. Brisk walks around the block, a chat to a neighbour, or a catch up with a treasured friend are some examples of how to get started. Reaching out and building supportive relationships plays a big role in lifting the fog of depression and preventing future episodes.

What are the symptoms of depression?

Most people experience short periods (a few days) of sadness when we feel upset, sad, or lonely. These feelings can result from loss, difficult challenges, or in reaction to unfair or unkind treatment by others. When these feelings of sadness become overwhelming and adversely affect a person’s ability to go about daily activities, he or she could have clinical depression.

While symptoms vary between people, the most common features of depression are feelings of hopelessness and sadness, and a loss of interest in activities once enjoyed.

The following symptoms are present in most episodes of minor depression:

  • Lowered mood, varying from mild sadness to intense feelings of guilt and hopelessness
  • Impaired thinking and concentration and lack of decisiveness
  • Loss of interest in life with diminished involvement in work and recreation
  • Somatic complaints such as headache; disturbed sleep (frequent wakening, delayed sleep onset or excessive sleep); increased tiredness and fatigue; loss of appetite; muscle aches and pains; decreased libido and sexual drive; and
  • Anxiety.

These symptoms are present in severe depression:

  • Psychomotor retardation, withdrawal from activities and isolation behaviour
  • Physical symptoms of major severity, for example anorexia, insomnia, reduced sexual drive, weight loss, and various complaints affecting the body
  • Suicidal thoughts – means thinking about harming or killing oneself or planning or trying to do so, and
  • Delusions of a hypochondriacal (excessive concern about your health) or persecutory nature (feeling of ill treatment).

The social effects of depression may include:

  • Underperforming at work
  • Not doing well at school
  • Avoiding keeping in touch with friends
  • Abandoning interests and hobbies, and
  • Having family problems at home.

How is depression diagnosed?

How is depression diagnosed?

Unlike other medical problems where a physical examination, medical imaging, or laboratory tests lead to a diagnosis, in order to diagnose depression a doctor must understand how a person is feeling and how those feelings are affecting day-to-day life.

To enable a doctor to effectively diagnose and treat depression, a patient must talk about things such as daily moods, behaviours, any problem dealing with work and home life, and lifestyle habits. Depression can manifest in a variety of ways. Some people withdraw, while others become agitated and irritable. Some people curl up and sleep for days, others eat excessively, and others withdraw and avoid contact with the outside world. Despite profound inner turmoil, some people can appear outwardly quite normal.

In order to diagnose depression a doctor might begin with a physical examination, personal interview, and laboratory tests. A full history of physical and mental symptoms and any family history of depression or other mental illness will need to be evaluated.

A doctor will perform a physical exam and request certain blood or urine tests to rule out any thyroid disease or other chronic disease that might be causing secondary depression. A list of current medications will help rule out secondary depression due to medical treatment. If your symptoms are due to some other medical condition, treating that illness may also help ease the depression.

Anxiety and depression checklist
http://www.beyondblue.org.au/the-facts/depression/signs-and-symptoms/anxiety-and-depression-checklist-k10

How to treat depression – conventional medicine

A range of effective treatments is available to enable a person to recover from depression. Finding the right treatment and the right health professional to manage the treatment is an important consideration and can affect recovery. Psychological, medical and group support can be used in combination to aid recovery from depression.

Psychological treatments help with changing negative patterns of thinking and improve coping skills. Cognitive behaviour therapy, interpersonal therapy, behaviour therapy, and mindfulness-based cognitive therapy are all psychological treatments that can help a person recover. These therapies also reduce likelihood of recurrence because they enable a person to cope better with life’s stresses and conflicts.

The main medical treatment for moderate and severe depression is antidepressant medication. Conventional medical therapy typically uses psychotropic antidepressant medications, which alter the brain neurotransmitter balance. Antidepressant medications affect either neurotransmitter synthesis or synapse re-uptake, and improve neurotransmitter receptor activity. Psychotherapy and counselling are often used in conjunction, when the episode is event or outcome focused and of short-duration.

Outcome studies report that combined medication and psychotherapy provides somewhat better outcomes compared with just medication or psychotherapy alone. Psychotherapy on its own generally resulting in the poorest outcome.

If you have been prescribed antidepressant medication, do not stop taking medication without first discussing that option with your doctor.

Because depression and anxiety can be chronic disorders that last for many months, even years, support and understanding from family and friends is key to recovery.

Exercise and keeping active helps to improve moods, the quality of sleep, energy levels, social contact, and general well being. Exercise provides a break from day-to-day worries and stimulates useful chemicals in the brain, such as serotonin, endorphins, and stress hormones.

Selective serotonin re-uptake inhibitors

Serotonin depletion is the primary biological disturbance in most patients with depression. However, in about 10–20% dopamine-catecholamine depletion is the primary abnormality.

The commonest antidepressant medications currently used are the selective serotonin re-uptake inhibitors (SRRIs), which reduce pre-synaptic serotonin re-uptake and enhance post-synaptic serotonin activity.

Serotonin receptors occur in multiple forms and so generalised 5-HT receptor stimulation may occur, and long-term use can trigger adverse side

effects including:

  • Stimulation of 5-HT1 receptors is associated with antidepressant and anxiolytic effects
  • Stimulation of 5-HT2 receptors produces nervousness, insomnia, and sexual dysfunction, and blockade is associated with alleviation of depression, and
  • Stimulation of 5-HT3 receptors is associated with nausea and headache, and blockade reverses the nausea.

SSRIs have a wide therapeutic margin, are relatively easy to administer, and rarely need dose adjustment – features that contribute to their wide acceptance as antidepressant therapy.

SSRIs are also effective in the treat¬ment of depression-related disorders, such as dysthymic disorder (persistent depressive disorder), atypical depression, seasonal affective disorder, obsessive-compulsive disorder, social phobia, bulimia, premens¬trual syn¬drome, and possibly borderline personality disorder.

Heterocyclic antidepressants

Heterocyclic antidepressants

Heterocyclic antidepressants inhibit the nerve cell’s ability to re-uptake noradrenaline and serotonin. Once the mainstay of treatment, this group of antidepressant medication includes tricyclic, modified tricyclic, and tetracyclic antidepressants.

With prolonged administration, the postsynaptic alpha-1-adrenergic receptor is down regulated, which is thought to account for their antidepressant activity.

Heterocyclic antidepressants appear to be effective in around 65% of patients suffering depression and are thought to be more effective than SSRIs in patients requiring hospitalisation, or with severe melancholia.

Because of their stimulatory effect on catecholamine activity, these medications have a narrow therapeutic window and can cause adverse effects, including cardiac arrhythmia, gastrointestinal hypomotility, and cerebral stimulatory symptoms, even at therapeutic dosage.

Accidental or deliberate overdose can trigger fatal cardiac arrhythmia and cardiovascular collapse. Therefore, continued use of heterocyclic antidepressants is being continually scaled back as newer and safer medications, such as the SSRIs, become more available.

Venlafaxine

Venlafaxine is a serotonin-norepinephrine reuptake inhibitor (SNRI) class antidepressant, whichworks in a similar manner to the tricyclic antidepressants, but is better tolerated.

Venlafaxine extended-release capsules are also used to treat generalised anxiety (excessive worrying that is difficult to control), social anxiety (extreme fear of interacting with others), and panic disorder (sudden, unexpected attacks of extreme fear).

Monoamine oxidase inhibitors

Monoamine oxidase inhibitors (MAOIs) are drugs that inhibit the activity of the monoamine oxidase enzyme family. MAOIs have little or no effect on normal mood, are generally safe from abuse, and are effective in treating atypical depression and when other anti¬depressants have failed. However, MAOI therapy is usually the last line of treatment reserved for patients who are resistant to safer antidepressant medications.

Because of potentially lethal dietary and drug interactions, patients taking MAOIs must be cautioned about specific foods and over-the-counter medications that can trigger hypertensive crises (high blood pressure emergency).

Patients taking MAOIs should avoid foods containing tryamine, including mature cheeses, overripe and aged foods such as bananas, fava or broad beans, yeast extracts, canned figs, raisins, yoghurt, cheese, sour cream, soy sauce, pickled herring, caviar, liver and tenderised meats.

Ingredients that can cause problems include phenylpropanolamine and dextromethorphan, which can be found in many over-the-counter nasal decongestants and cough suppressants, reserpine and meperidine, as well as malted beers, Chianti wines, sherry and liqueurs.

Moclobemide is a reversible, selective MAOI drug used to treat depression and social anxiety. Moclobemide has a relatively fast onset of action and is safer than other MAOIs. However, Moclobemide does not appear to confer the same clinical effectiveness as the older MAOI drugs.

Lithium

Lithium

Lithium is a naturally occurring alkali metal used to treat uncomplicated euphoric mania, though haloperidol or another antipsychotic medication may also initially be required, because the benefits might not take affect for four to 10 days.

Lithium reduces bipolar mood swings and lessens aggressive action, but has no effect on normal mood and does not directly produce sedation or cognitive impairment.

Around 67% of patients with uncomplicated bipolar disorder respond to lithium therapy. However, lithium is less effective in patients with mixed states, rapid-cycling forms of bipolar disorder, co-morbid anxiety, substance abuse, or a neurologic disorder.

Patients with acute mania demonstrate a high tolerance for lithium. Adolescents need higher doses than elderly patients to achieve the same therapeutic effect.

Lithium has a narrow therapeutic index and so lithium blood levels must be strictly monitored. Acute adverse effects are generally mild and transient and include: fine tremor, muscle twitching, nausea, diarrhoea, excessive urine production, excessive thirst, and weight gain.

Chronic lithium toxicity presents as gross tremor, increased deep tendon reflexes, persistent headache, vomiting, and mental confusion, which might progress to stupor, seizures, and cardiac arrhythmias. Lithium toxicity is more likely in elderly patients and in patients with impaired renal function (creatinine clearance) or increased sodium loss, which may result from fever, vomiting, diarrhoea, or diuretic use.

Electroconvulsive therapy (ECT)

Electroconvulsive therapy (ECT)

Electroconvulsive therapy or electroshock is usually reserved for the most severe cases of mania and suicidal depression, in particular in patients who don’t respond to conservative therapy, such as medication and psychotherapy. Electroconvulsive therapy electrically induces seizures to treat depression. The actual treatment mechanism remains unclear. About 70% of ECT patients are women, because women and twice as likely to develop depression.

Suicidal thoughts means thinking about harming or killing oneself or planning or trying to do so.

How nutritional medicine specialists assess and treat depression

As with other major brain disorders, such as autism, anxiety disorder, and Parkinson’s disease, the significant increase in mental illness and depressive disorders during the past 50 years can be linked to substantial societal change.

Increased stress, environmental pollution, and substantial changes in our general diet are linked to brain function and mental health issues. People eat more processed foods, which are high in fat and carbohydrate content, and low in omega-3-fatty acids, antioxidants, and beneficial nutrients.

All these factors are associated with increased demand on neuronal function and, in some instances, may directly impair brain function and mood.

Nutrition medicine therapy assesses a patient’s individual nutritional status, genetic nutrient requirements, and social and environmental habitat, and then corrects all trigger factors and metabolic mediators that might cause disease.

While no unique diet has been developed specifically to treat depression, making healthy food choices and taking regular exercise are essential elements for managing depression.

Environmental factors that might cause depression

Multiple toxic chemicals and heavy metals can cause depressive disorders, and other psychiatric and neurological problems. Low-level but chronic build-up of these chemicals in the brain alters neuronal and brain metabolism, which can lead to secondary dysfunction that affects hormonal and immunological control systems.

The resultant hormonal and immunological imbalances produced can further interfere with brain tissue metabolism, producing progressive decline in neuronal function.

To ensure normal brain metabolism, a thorough evaluation of heavy metal and chemical exposure is needed. If heavy metals and chemicals are found, detoxification therapy combined with supportive nutrition and hormone therapy can restore cerebral metabolic competency.

Nutrition-related diseases that might cause depression

Nutrition-related disease is a common predisposing problem in patients with depression. Insulin resistance and diabetes, cardiovascular disease, autoimmune disease, chronic inflammatory disease, allergic disorders, and liver disease can all affect brain health. An integrated diet-nutrient program can reduce and correct these types of nutrition-related diseases and relieve long-term depression.

Lifestyle factors that might cause depression

Lifestyle factors that might cause depression

Lifestyle choices can have a significant effect on mental health. Poor choices can aggravate the symptoms associated with both depression and anxiety. And conversely, making positive changes to how you lead your life can speed recovery.

Excessive caffeine and alcohol intake, and cigarette smoking can lead to depression. Regular physical exercise helps to reduce chronic depression.

  • Little or no physical exercise can lead to poor mood
  • Excessive caffeine can
  • Avoiding family and friends and so living in isolation
  • Poor diet and excess weight can lower your mood can affect the way you feel about yourself
  • Not getting enough sleep is both a symptom and cause of depression
  • Personal conflicts and relationship problems can trigger depression
  • Working too hard can cause stress and impact relationships at home
  • Alcohol and recreational drugs are mood-altering substances that can increase your risk of developing serious depression
  • Drink coffee and alcohol in moderation, and avoid illicit drugs
  • Take regular exercise to keep fit and maintain a healthy diet
  • Make a effort to get along with and help others, which will improve mood
  • Make sure you get at least eight hours sleep each night, from no later than 10 pm
  • Maintain a sensible work-life balance and make time for friends and family

    Alcohol can lead to impulsive behaviour and there is a know link between alcohol and suicide. And alcohol can exacerbate anxiety attacks. Drinking alcohol may negate the benefits of antidepressant medication and it might be unsafe to take them at the same time. Talk to your doctor if you think that

    Preliminary research strongly suggests that having a poor diet can make you more vulnerable to depression. Eating ‘junk food’ with too much high-GI foodscan result in reactive hypoglycaemia and mood swings. A person whose diet is high in processed meat, chocolates, sweet desserts, fried food, refined cereals and high-fat dairy products is more likely to develop depression.

    High dietary saturated fat versus essential fatty acid intake, food allergy reactions particularly involving gluten intolerance, and milk and yeast allergies are strongly associated with depressive illness.

    Fortunately simple changing to a healthy diet that includes fresh fruits and vegetables, low and moderate GI foods, and fish can reduce the likelihood of developing depression.

    Nutrient insufficiency that might cause depression

    Nutrient insufficiency that might cause depression

    Nutrient insufficiency is frequently present in patients with depressive illness.

    Folic acid and vitamin B12 are essential to the regulation of homo¬cysteine metabolism and the conservation of S-adenosyl-methionine (SAMe).

    Tetrahydrobiopterin (BH4) insufficiency is reported in recurrent depression patients, possibly related to inadequate SAMe synthesis and/or insufficient brain levels of vitamins C and B12 or folic acid. Supplementary ascorbate, folic acid and SAMe have all been reported to improve BH4 levels and exhibit positive antidepressant effects in depressed patients.

    Pyridoxine insufficiency is reported in depressed patients, particularly in women with Premenstrual Syndrome and those on contraceptive pills and oestrogen therapy. As vitamin B6 is essential to the synthesis of the monoamine neurotransmitters and GABA and pyridoxine activation is compromised with high oestrogen levels and magnesium depletion, supplementary pyridoxal-5-phosphate may be beneficial in depressed patients with evidence of hormone imbalance or magnesium deficiency.

    Omega-3-Fatty Acid insufficiency is reportedly associated with depression and is well known to promote cell membrane dysfunction and impaired cell signalling, reduced neuro¬transmitter and hormone receptor activity, reduced neurotransmitter synthesis and increased monoamine oxidase activity.

    Vitamins B1 and B3 insufficiency have been reported to also induce depression and are not uncommonly present in substantial proportions of depressed patients.

    Impaired neurotransmitter balance: reduced serotonin activity is well documented as the causative factor in the majority of depressed patients and is reflected in the use of SSRI medications as the primary treatment for depression. Reduced serotonin synthesis may occur from enzyme cofactor insufficiency (Vitamin B6, zinc, magnesium), or from diversion of tryptophan into the alternative kynurenine pathway, due to low central nervous system vitamin B3 concentration or availability. Conversely, MAO enzyme activity, which depends partially on polymorphic gene expression and partially on hormonal status, may enhance serotonin degradation, thereby reducing brain tissue serotonin levels.

    Correction of impaired serotonin activity may require not only tryptophan but also adequate supplements of pyridoxal-5-phosphate (B6), vitamin B3, zinc and magnesium, as well as ascorbate, folic acid and vitamin B12.

    Alternatively, supplementation with 5-hydroxytryptophan may produce a more effective response than tryptophan, as it is not diverted down the kynurenine metabolic pathway.

    In patients with Seasonal Affective Disorder, depression appears to be directly linked to serotonin deficiency and secondarily reduced melatonin synthesis. It occurs in people living at high latitudes and manifests during winter months, when sunlight exposure is minimal and blood vitamin D levels fall.

    Seasonal Affective Disorder responds well to bright-light therapy, supplementary pyridoxine and tryptophan, and a high dietary omega-3-FA intake appears to confer a significant degree of protection against the disorder.

    Noradrenaline concentration may be altered in about 20% of depressed patients. Noradrenaline reuptake inhibitor therapy is more effective than SSRI therapy, in these patients. Tyrosine uptake into the brain may be compromised by excessive dietary carbohydrate consumption, particularly in the presence of a low dietary protein intake, thereby reducing dopamine and noradrenaline synthesis.

    Nutrient supplementation with the dopamine precursors, phenylalanine and tyrosine, has been used to enhance brain dopamine and noradrenaline levels and may be enhanced by co-supplementation with vitamin B6, ascorbate, folic acid, vitamin B12, magnesium and zinc.

    An added benefit of supplementary tyrosine may be an increased conversion of tyrosine to thyroxine, which has been shown to enhance antidepressant medication effectiveness. In addition, phenylalanine supplementation has consistently been shown to increase central nervous system concentration of phenylethylamine, which has amphetamine-like stimulant properties, elevating mood and cognitive processing.

    A supportive nutrient program and an appro¬priately structured diet is essential for neurotransmitter precursor therapy to be effective, particularly in patients with severe depression.

    Because of the complexity and interactive relationship between all factors that impinge upon neurotransmitter activity, supplementation with a single precursor will not exhibit antidepressant activity similar to medications, which exert wide-spread alterations in neuronal metabolism.

    Inositol or phophatidylinositol intervention at high dosage is reported to reduce depression, without overt side effects. Inositol is known to enhance intracellular cyclic-AMP activation in response to cell membrane neurotransmitter and hormone receptor stimu¬lation and it is postulated that this enhanced cyclic-AMP activity is the mechanism behind its beneficial effect.

    Several phytonutrient extracts, in particular hypericum (St John’s Wort) and gingko biloba may also enhance neurotransmitter activity.

    Hypericum is thought to inhibit serotonin reuptake, though to a lesser extent than SSRI drugs, modulate immune system signalling and cytokine production, and inhibit MAO enzyme activity. Hypericum alleviates the effects of stress, enhances cytochrome P450 activity, and improves the liver’s ability to remove unwanted toxins and hormones. Side effects are mild and hypericum is very safe compared with antidepressant medications.

    Gingko biloba extracts are known to improve intracerebral circulation and act as antioxidants. Gingko biloba extracts improve serotonin receptor activity and retard the loss of receptor activity with aging. Studies in depressed patients have documented a greater than 60% improvement in depression ratings during an eight-week period.

  • Hormone insufficiency or imbalance

    Hormone insufficiency or imbalance

    Hormone insufficiency or imbalance can play a significant role in depressive illness. Hormone-related central nervous system metabolic alterations can compound those caused by nutritional, environmental, and genetic factors.

    a) Perimenopausal and postmenopausal women exhibit a higher than usual prevalence of depressive illness that responds to oestrogen replacement therapy, while older males with depression often respond to testosterone replacement therapy.

    b) Anabolic hormone therapy, using synthetic drugs or natural DHEA, has also been reported to improve therapeutic response in both men and women with depression.

    c) When low-dose thyroxine is added to their regimen, the majority of depressed patients, particularly those resistant to medication, demonstrate improvement. One of the benefits of tyrosine and vitamin B6 therapy is the increased thyroxine production, which can augmented by ascorbate and the correction of any selenium insufficiency.

    Nutrition medicine provides patients with a flexible therapeutic program of diet, supplementary nutrients and neurotransmitter precursors, and hormonal therapy that seeks to regenerate brain function and provide long-term remission from depressive illness.

    Nutrient supplementation

    Nutrient supplementation

    While society today understands the link between nutrition and physical illness, many fail to understand that nutritional deficiencies can lead to mental health issues, such as depression. Nutrition can affect how a person feels about themselves and others, and if depression develops, a person’s nutritional state can determine how severe the depression is and how long the problem lasts.

    The modern Western diet means that many people are lacking in essential vitamins, minerals and omega-3 fatty acids. A person with a severe mental health problem will often present with a severe deficiency of nutrients and daily treatment with vitamins, minerals, and omega-3 fatty acids can aid recovery.

    Treatment with amino acids can provide essential neurotransmitters such as seritonin, dopamine, noradrenaline and GABA, which can alleviate depression. Researchers have shown that the amino acids tryptophan (converts to seratonin), tyrosine and phenylalanine (convert to dopamine and norepinephrine), and methionine can improve many mood disorders including depression.

    Herbal extracts, in particular St John’s Wort (hypericum perforatum) and gingko biloba, enhance neurotransmitter activity.

    Hypericum can aid recovery from depression. Hypericum is thought to inhibit serotonin reuptake, modulate immune system signalling and cytokine production, and inhibit MAO enzyme activity. Hypericum enhances cytochrome P450 activity, which improves the liver’s ability to clear unwanted toxins and hormones. Side effects are mild and hypericum is very safe compared with antidepressant medications.

    Gingko biloba extracts act as antioxidant, improve brain circulation and serotonin receptor activity, and retard the loss of receptor activity with aging. Studies in depressed patients have documented a greater than 60% improvement in depression ratings, when gingko biloba is taken during a minimum period of eight-weeks.

    Mineral supplementation

    Mineral supplementation

    Calcium supplements

    Calcium depletion affects the nervous system resulting in nervousness and irritability. A person taking selective serotonin uptake inhibitors (SSRIs) will benefit from calcium supplements. A recent study showed that SSRIs can inhibit absorption of dietary calcium into the bones, which need calcium for strength. Long-term medication with SSRIs to manage depression could lead to osteoporosis.

    Chromium supplements

    While it’s not entirely clear how chromium works against depression, a daily dose of 600 mcg assists those living with atypical depression. Chromium helps control blood sugar levels and effectively curbs overeating in those with depression.

    A person with depression is at higher risk of insulin resistance. The stress hormone cortisol, which leads to insulin resistance, is elevated in those with depression.

    Iodine supplements

    The thyroid provides an essential supply of iodine, which plays an important role in mental health. Iodine provides the energy needed by cells in the brain. Usually we get enough iodine from the salt we eat. Iodine is abundant in the oceans and good quality salt is made from sea salt. But these days many salt products lack iodine and we are told to reduce the amount of salt we eat. This combination can lead to an iodine deficiency.

    A nodular swelling of the thyroid is called a goite. When a goiter develops as a result of iodine deficiency the thyroid is under functioning and doesn’t produce enough thyroid hormone.
    An adequate amount of thyroid hormone is needed for proper energy metabolism, in particular for brain cell function.

    Iron supplements

    A person needs iron for adequate blood oxygenation and to produce enough energy in for brain cell function, through cytochrome oxidase. Iron is essential for the synthesis of neurotransmitters and myelin.Iron deficiency in infants is called infantile anemia, which can adversely affect the development of cognitive functions.

    The gender disparity between men and women could be due to an iron deficiency, which results in women through menstruation. Women are twice as likely to develop clinical depression compared with men. Iron deficiency anaemia can lead to apathy, fatigue, and depression.

    Lithium supplements

    The benefits of lithium are well known in psychiatry, in particular for treating bipolar disorder. The therapeutic use of lithium aids the treatment of depression, overeating and drug, and alcohol dependence. Lithium is more effective in treating mania than clinical depression.
    Lithium supplements have an associated toxicity and side effects and should only be taken under medical supervision, with blood levels monitored during treatment.

    Selenium supplements

    Low levels of selenium are associated with a lowered mood status. Selenium supplementation is associated with improved mood and reduced anxiety.

    Manganese supplements

    The body needs adequate levels of manganese to use essential B vitamins and vitamin C properly. Without adequate manganese, the body can’t form the amino acids needed to make the neurotransmitters serotonin and norephinephrine. Manganese helps to control blood sugar levels and prevent mood swings associated with low blood sugar levels called hypoglycaemia.

    Zinc supplements

    Low levels of zinc can result in apathy, lack of appetite, and lethargy. A number of studies about the depression have shown a link between depression and low levels of zinc, possibly because zinc keeps copper levels in check. The effectiveness of antidepressant medication is aided by zinc supplements. Zinc provides protection for delicate brain cells against damage by free radicals.

    Glossary

    Glossary

    Antidepressant– apharmaceutical drug prescribed by doctors to treat depression.

    Anxiety disorder– chronic condition that causes anxiety so severe it interferes with your life. Some people with depression also have overlapping anxiety disorders

    Bipolar disorder– type of depression that can cause extreme mood swings between depression and mania, or hypomania

    Depression – a disorder that involves the body, mood, and thoughts, that affects daily functioning and the way one feels about oneself, and the way one thinks about things.

    Endogenous – originating internally

    Dysthymia– type of chronic, low-grade depression that is less severe than major depression

    Electroconvulsive therapy (ECT)– treatment for depression that uses an electric current to create a brief, controlled seizure

    Hypochondriacal – persistent conviction that one is ill or likely to become ill when illness is neither present nor likely, and despite medical reassurance to the contrary

    Hypothyroidism – when the thyroid doesn’t produce adequate amounts of thyroid hormone, which leads to depression, fatigue, and weight gain.

    Major depression– the medical diagnosis for depression that lasts for at least two weeks and interferes with daily life.

    Mania– symptom of bipolar disorder, mania is a period of intense energy, euphoria or irritability, sleeplessness, or recklessness.

    Monoamines – are neurotransmitters and neuromodulators that include serotonin, dopamine, norepinephrine and epinephrine

    Mood stabilisers– class of drugs used to treat some types of depression, like bipolar disorder.

    Neurotransmitter– chemical in the brain, like serotonin or norepinephrine, that sends messages between brain cells. Medicines that treat depression often alter the levels of these chemicals.>

    Panic attack– sudden feeling of intense fear or anxiety, accompanied by physical symptoms, in the absence of a real danger. Panic attacks are common in many anxiety disorders.

    Postpartum depression– depression that affects women who have recently given birth and more severe than any mild mood changes known as the ‘baby blues’.

    Psychotherapy– way of treating a mental or emotional disorder by talking with a therapist.

    Psychologist–health professional who specialises in the treatment of mental or emotional disorders.

    Psychologists typically use psychotherapy to treat people with depression and other conditions.

    Psychiatrist– specialist medical doctor who treats psychological disorders. Because psychiatrists are doctors, they can prescribe drugs such as antidepressants. >

    Seasonal affective disorder (SAD)–depression that occurs seasonally, usually starting in autumn or winter and ending in spring or early summer.

    Suicidal ideation – suicidal thoughts

    Somatic – of the body rather than the mind

    Stress – the daily challenges at work and at home that impact on an individual and place pressure to perform in a certain way, by a certain time.

    Tetrahydrobiopterin – a naturally occurring essential cofactor of the three aromatic amino acid hydroxylase enzymes, used in degradation of amio acid phenylalanine and biosynthesis of neurotransmitters, such as serotonin, melatonin, dopamine, noradrenaline and adrenaline.
    Vegetative – an activity that is passive and monotonous

    Website links
    Mayo clinic
    http://www.mayoclinic.com/health/depression/DS00175
    Beyond Blue

    http://www.beyondblue.org.au/the-facts/depression

    Readings
    Textbook of Natural Medicine, Joseph Pizzorno and Michael Murray
    Affective Disorders – Chapter 126 pages 1039-1058
    5-Hydroxytryptophan – Chapter 92 pages 783-795
    Hypericum – Chapter 93 pages 797-805
    Nutritional influences on mental illness, A sourcebook of clinical research (1999, 2nd Edition, Melvin Werbach
    Depression pages 302-316
    Bipolar disorder pages 174-9
    Modern Nutrition in Health and Disease, 9th edition, Shils, ME, Olson, JA, Shike, M and Ross, AC, Chapter 94, Nutrition and Diet in Alcoholism, pages 1523-1542

    Journal Readings
    Birdsall, T C, 5-Hydroxytryptophan: A Clinically-Effective Serotonin Precursor, Altern Med Review 1998Aug; 3(4): 271-280

    Meyers, S, Use of Neurotransmitter Precursors for Treatment of Depression,Altern Med Review 2000 Feb; 5(1): 64-71.

    Kerr, L K, Screening tools for depression in primary care: the effects of culture, gender, and somatic symptoms on the detection of depression, West J Med. 2001 Nov; 175: 349-352

    Leng, G C et al
    Impact of antioxidant therapy on symptoms of anxiety and depression. A randomised controlled trial in patients with peripheral artery disease; Journal of Nutritional and Environmental Medicine1998; 8(4): 321-28

    Niculescu, A B, and Akiskal, H S, Sex hormones, Darwinism and depression, Arch Gen Psychiatry 2001; 58(11): 1083-1086.

    Altshuler, L L et al, Does thyroid supplementation accelerate tricyclic antidepressant response? A review and meta-analysis of the literature, Am J Psychiatry, 2001 Oct; 158(10): 1617-1622.

    Smith, K A, Fairburn, C G and Cowen, P J, Relapse of depression after rapid depletion of tryptophan, Lancet 1997 Mar; 349: 915-919 NCBI

    Bauer, J. 2001, Can St. John’s wort really alleviate depression? RN; Montvale; 64(9): p. 20