Depression

HEALTH INFORMATION SERIES

This is a very common complaint although true clinical depression is much less common than is often supposed. Sadness, grief, moodiness etc are normal emotions in the human experience. Depression occurs when they become ingrained behavior patterns and disrupt normal social relations. One in every four people will experience some form of depressive disorder at some time in their lives with women being slightly more at risk. Culture, social; class and race have not been shown to have a bearing on the incidence and distribution of depression. The American Psychiatric Association has defined the following criteria as being indicative of clinical depressive states:

The APA has determined that the presence of 5 of these 7 states for at least one month constitutes clinical depression. Note that many of the symptoms of depression have contradictory states of hyper and hypo activity of aspects of the psyche. This reflects the fact that frequently depression will manifest as bipolar mood disorder meaning that the person will switch from low to high and back again (this is also called manic depression). 

Etiology

There are a great many postulated causes of depression and most likely it is a multi-factorial condition. Essentially the aetiology can be considered in two categories: psychological and biochemical. Psychological explanations include the 'aggression-turned-inwards' model, the 'loss' model and the 'manipulative-controlling' model. To address these issues it is best to refer the depressed person to a skilled counselor/psychotherapist who has the tools to explore the convolutions of the subconscious mind.

Diet

Food and environmental allergens may cause or trigger depressive states. Allergy testing by Vega machine or kinesiology may be used and if the person is not too depressed to follow instructions then elimination and challenge diets can be used to determine specific food allergies.

Nutritional considerations

Niacin deficiency will lead to decreased energy metabolism in the brain. This results in apathy, anxiety, feelings of loss and sadness, irritability, mania, memory losses, and emotional lability. A deficiency of niacin is frequently due to a deficiency of tryptophan from which it is made.

Tryptophan deficiency will lead to reduced serotonin synthesis, this neurotransmitter being involved in relaxation, sleep and mood regulation. Low tryptophan will also reduce melatonin synthesis, this hormone being involved with the regulation of biological clocks and reproductive cycles. Depressed people appear to have diminished ability to uptake tryptophan into the brain. The active transport mechanism for the uptake of tryptophan is shared with other large neutral amino acids including leucine, isoleucine, valine, tyrosine and phenylalanine. These are usually abundant in animal proteins and less prevalent in vegetable proteins. Thus a meat or dairy based meal may trigger depression in sensitive people whereas a meal based on unrefined carbohydrate/protein foods (beans and cereals) should not cause a problem. 

Phenylalanine is converted in the body into phenylethylamine (PEA) which is an endogenous stimulant and anti-depressive substance. Levels of PEA are found to be low in many depressive patients and this may be why many depressives crave chocolate which is notably high in phenylalanine. 

Tyrosine deficiency is seen in some depressives and may be associated with low thyroid function, reduced monoamine synthesis and reduced tyramine and PEA levels.

Folic acid and vitamin B12 stimulate the synthesis of tetrahydrobiopterin which is an essential co-enzyme in the formation of several neurotransmitters. Many depressive patients show deficiency of BH4 which can be corrected by administration of B12 and folate. Approximately 30% of psychiatric patients are deficient in folic acid and supplementation may correct many psychiatric disorders. B12 deficiency may also be associated with depression and especially with dementia and mania. 

Methionine deficiency is associated with a deficiency of S-adenosylmethionine which acts as an endogenous anti-depressant. Supplementing the diet with methionine and with folate and B12 which are involved in methionine metabolism any be helpful. 

Pyridoxine (vitamin B6) is involved in the synthesis of many monoamine neurotransmitters (serotonin, adrenaline, dopamine) and is frequently deficient in people with depression. 

Caffeine is known to cause clinical symptoms similar to those of anxiety states when taken in large doses (or in small doses by sensitive individuals). Symptoms include anxiety, irritability, moodiness, palpitations, headache and muscle twitching.

Hypoglycemia may be a factor in some aspects of the depressive state.
 

Other factors to consider:

Smoking impairs blood flow to the head via its vasoconstrictive action and displaces CO₂ in the erythrocytes. It also uses up vitamins C and B6. Stimulation of the adrenal glands by nicotine leads to excessive release of both adrenaline which may contribute to anxiety states and cortisol which inhibits the uptake of tryptophan by the brain.

Thyroid deficiency may lead to general sluggishness, increased neuronal transport times and depression. 

Pharmacological causes of depression may include steroidal contraceptives, reserpine, amphetamine withdrawal, cimetidine, indomethacin, phenothiazine, thallium, mercury, cycloserine, vincristine and vinblastine.

Infectious causes of depression may include influenza, syphilis (tertiary), viral pneumonia, viral hepatitis, infectious mononucleosis and TB.

Endocrine causes of depression may include hypothyroidism, hyperparathyroidism, Cushing's syndrome and Addison's disease.

Collagen disease causes of depression may include fibromyalgia, SLE and RA.

Neurologic causes of depression may include MS, Parkinson's disease, head trauma, seizures, cerebral tumors, stroke and early dementia.

Chronic fatigue syndrome may also be a cause of depression.

Lack of sunlight leads to particular type of depression known as seasonally affective disorder which is well recognized in northern countries with long, dark winters. It is treated by exposure to full spectrum lighting. Any person with depression should be advised to get outside as much as possible and to buy only full spectrum light bulbs.
 

Holistic Treatment of Depression

All of the above dietary and physiological factors need to be considered when treating depression. Whatever biochemical manipulations you decide to make, the depressed patient always needs some form of counseling and psychotherapeutic approach as well. Some form of relaxation therapy and/or visualizations will also be helpful.

Supplements for depression

- Vitamin B complex 100 mg. three times daily
- Vitamin C to bowel tolerance.
- Folic acid 400 mcg./day.
- Vitamin B12 250 - 100 mcg./day.
- Magnesium 500 mg./day.
- Calcium 1 gram/day.
- GABA 750 mg./day
- Amino acids as determined by blood tests of serum levels.

A multivitamin and mineral supplement may also be taken. Blue Green algae is useful for persistent fatigue and apathy.

Herbal remedies for depression

Tonics
Hypericum perforatum (St. John's Wort)
Avena sativa (Oats)
Turnera diffusa (Damiana)
Equisetum arvense (Horsetail)
Borago off. (Borage)
Stachys betonica (Wood betony)
Baccopa monniera (Brahmi)
Vinca major / minor (Periwinkle)

Stimulants
Turnera diffusa (Damiana)
Cola vera (Kola)
Zingiber off. (Ginger)
Ginkgo biloba (Ginkgo)
Rosmarinus off. (Rosemary)
Avena sativa (Oats)
Panax ginseng (Korean ginseng)

Relaxants
Verbena off. (Vervain)
Avena sativa (Oats)
Lavandula off. (Lavender)
Humulus lupulus (Hops)
Melissa off. (Lemon Balm)
Chamomilla recutita (Chamomile)
Stachys betonica (Wood Betony)
Scutalleria lateriflora (Skullcap)
Valeriana off. (Valerian)
Passiflora incarnata (Passion Flower)
Viburnum opulus (Cramp Bark)
Viscum album (European mistletoe)
Tilia europea (Linden)
Lactuca virosa (Wild Lettuce)
Borago off. (Borage)

Typical formula for bipolar depression

Formula # 1 - take when feeling 'hyper'

Scutalleria lateriflora	15
Hypericum perforatum	25
Verbena off.	15
Leonurus cardiaca	15
Withania somniferum	15
Piper methysticum	15
	100 mL

Dose at 5 mL three times daily in water before meals
 

Formula # 2 - take when feeling down

Hypericum perforatum	25
Verbena off.	15
Rosmarinus off.	15
Centella asiatica	15
Withania somniferum	15
Melissa off.	15
	100 mL

Dose at 5 mL three times daily in hot water before meals