Dealing with Depression

What Is Known About Depression
Healthy Steps: Depression—First Steps
Healthy Steps: Depression—Full Program
Preventing Depression
From Dr. Deborah's Desk

Not to be confused with sadness lingering after a grievous loss, depression arises without apparent cause and drains us of vitality and casts a gloomy pall on everything we experience and do. It makes the simplest tasks seem daunting and can leave us feeling helpless, hopeless, and alone.

If you experience such feelings, you've got company: A 2010 U.S. Centers for Disease Control and Prevention study revealed that 10% of adult Americans suffer from depression, making it one of the most common psychiatric disorders.

While most of us have a general sense of what depression feels like, its wide range of emotional and physical symptoms can operate interactively in ways that may not be obvious.

Psychological symptoms often include feelings of sadness or numbness, a loss of interest in things that used to give you pleasure, and a tendency to avoid social contact. You may find it hard to make decisions or concentrate and are often irritated or anxious. Dwelling on death and suicidal thoughts as well as feelings of guilt and worthlessness are further signs of depression.

Physical symptoms are often intensified in people with depression. Some of the most common symptoms include muscle, back, and joint pain. Insomnia, exhaustion, headaches, chest pain, and various digestive complaints can also accompany depression. Rapid changes in appetite and weight are further potential signs. Some people lose their appetite while others crave carbohydrates leading to weight gain.

Addressing depression through diet and lifestyle changes as well as talk therapy can not only alleviate depression's black moods but also reduce or eliminate the physical symptoms. It is important however to rule out other physiological causes for symptoms such as chest pain by discussing them with your health care provider.

Don't assume that because you're depressed your symptoms are all in your head. Depression can cause brain chemistry imbalances that alter the ways in which you experience pain. It can also produce abnormalities such as slowed digestion that in turn may result in GI tract symptoms. 

What Is Known About Depression

The interactions between mind and body can set up vicious cycles in which our depressed emotional state is mirrored by physical symptoms. Conversely, illness and physical disabilities can intensify depression. A multifaceted approach that incorporates nutrition, lifestyle changes, exercise, and emotional support will usually improve both our psychological and physical condition.

While conventional medicine largely relies on antidepressants, it is telling that the American Medical Association acknowledges these drugs have little or no value in treating mild to moderate depression. Even when prescribed in cases of severe depression, pharmaceuticals have only modest success in alleviating symptoms, and in many cases produce side effects that only increase suffering. Specifically, many antidepressant manufacturers warn that their products may actually heighten the risk of suicide.

Because of the lackluster results produced by antidepressant drugs, patients and clinicians have increasingly sought out non-pharmaceutical supplements. One of the most promising and most-studied is S-adenosyl-L-methionine (SAMe), a molecule that naturally occurs in all living cells. Trials have shown SAMe supplementation to be as effective as tricyclic antidepressants for treating major depressive disorder (MDD).

Magnesium supplementation has also been identified as a promising approach for the 60% of all clinically depressed people who have treatment-resistant depression (TRD). Administering magnesium to animals has shown effects equivalent to strong antidepressants. Further, people with treatment-resistant suicidal depression and those who have attempted suicide have been shown to have low levels of cerebral spinal fluid magnesium. Processed foods typically have had most of their magnesium content removed. Inadequate dietary magnesium levels result in reduced serotonin production-a neurotransmitter associated with happiness and a sense of wellbeing.

About 95% of the serotonin in our bodies is produced in the gut and among other things helps regulate digestion. Recent research shows that that there are strong correlations between what goes on in our digestive tracts and our emotional health. Disturbances and imbalances in intestinal and stomach bacteria have been shown to produce depression and anxiety in lab rats, and many people with psychiatric issues also have significant gastrointestinal problems.

The small intestine has more than 100 million neurons that communicate with the brain and appear to have a profound effect on how we feel emotionally. Eating a healthy, natural diet that includes probiotic-rich foods such as yogurt can help maintain optimal levels of intestinal bacteria. Some people with digestive issues will find that enhancing their diet with digestive-support supplements such as those we list below will not only help resolve their digestion complaints, but make them feel emotionally better too.

Omega-3 fatty acids also play a critical role in normal brain function. Diets low in these nutrients have been implicated in numerous studies with depression. In countries such as Japan and Taiwan, where fish with its high levels of omega-3s is consumed, people experience one-tenth the levels of depression seen in North America.

Folic acid, a B vitamin, is also commonly deficient in depressed people. Found in liver, leafy greens and other vegetables, beans, and grains, some chronic diseases as well as medications such as aspirin and birth control pills can cause folate deficiencies. People with abnormalities in the MTHFR gene are unable to properly use folic acid or vitamin B12, resulting  in a wide variety of potential problems, one of which can be depression.  

Healthy Steps: Depression—First Steps

For the great improvement of depression with the fewest steps, do the following:

• Choose brain healthy foods rich in organic fats and pasture-raised meat proteins. No raw egg whites.
• Begin Barleans Omega Swirl, 1 Tbsp daily, or Designs for Health OmegAvail, 1 or 2 softgels daily.
• Avoid sweets and caffeine.
• Start a regular exercise program. Include vigorous exertion for 30 or more minutes 4 or 5 days a week.

Heathy Steps: Depression—Full Program

A comprehensive program involves many areas in which action steps can be taken, gradually or all at once. Start by following my basic nutrition and healthy lifestyle guidelines, with the following special tips.

Savor Helpful Foods

• Healthy Fats from
  • Pasture-raised Eggs. Eggs provide necessary cholesterol and omega 3 fatty acids, and can reverse the depression associated with low cholesterol. Eggs also have biotin, needed for mental and emotional health. Avoid raw egg whites that block biotin absorption.
  • Coconut Oil. Keep the brain well-fed with coconut's medium chain triglycerides. Use in cooking or dissolve in warm water for coconut broth.
  • Butter. Organic butter has saturated fats and cholesterol necessary for healthy brain function.
  • Cold water fish. Wild Alaskan salmon as well as herring, mackerel, and sardines, are rich in brain healthy omega 3 fatty acids.
• Proteins. Healthy proteins provide essential B vitamins, including B6 necessary for serotonin production, and amino acids key for neurotransmitters (messenger chemicals in the brain).
  • Pasture-raised beef, chicken, lamb, and pork. Choose fresh, local, and organically raised meat where possible.
  • Free-range chicken and eggs.
  • Sustainable fish. For the most current information on fish recommended for eating, visit the Monterey Bay Aquarium Seafood Watch.

Avoid Problematic Foods

• Raw egg whites. As mentioned above, raw egg whites block biotin absorption.
• Sweets. Sweets, especially high fructose liquid sweets such as soda, can wreak havoc with moods.
• Caffeine. Susceptible people report caffeine produces a high followed by a crash that persists until more caffeine is taken. It feels like depression.
• Alcohol. Alcohol is medically classified as a depressant. For some people, it's a direct effect, for others it's a secondary effect when the alcohol buzz wears off. Keep alcohol intake to zero or very little.

Supplements can Help

• Begin Barleans Omega Swirl, 1 Tbsp daily, or Designs for Health OmegAvail, 1 or 2 softgels daily.
• Vitamin D3. Normal Vitamin D levels (40-65 ng/ml) support healthy moods. When in doubt, take Biotics Research Bio-D- Mulsion Forte, 2000 IU per drop, take three drops daily for 6000 IUs when you're not exposed to overhead sunshine on bare skin.
• B vitamins. Food-based B vitamins such as Integrative Therapeutics Active B-Complex provide nervous system support to both the energizing and calming aspects of the nervous system.
• Probiotics. People with or without digestive problems (cramping, indigestion, heartburn) might benefit from supplements that improve the diversity and numbers of healthy gut flora, according to recent studies. Start with probiotics such as Bio-Immersion Triple Berry Probiotic Formula (for anti-oxidants and probiotics), take 1/2 - 1 tsp daily between meals. A second step would be Thorne Bio-Gest, take 1-2 capsules with each meal.
• Tryptophan. As the precursor for serotonin, tryptophan was the feel good hormone before the pharmaceutical industry released the many versions of Prozac for depression. For many people, tryptophan relieves either anxiety or depression, as well as sleep disorders. Thorne Research 5-hydroxytryptophan (5HTP) can be taken at bedtime or divided into two or three doses, taking a total of 150-300 mg. daily.
• Thorne Research 5-MTHF. People with certain genetic markers (abnormal versions of the MTHFR gene) must take methylated folate for it to be effective. A two-month trial of 5-MTHF is a reasonable trial to gauge its effect on mood.
• DHEA. Past the age of 40, many people benefit from adrenal support, as our own DHEA levels decline. Thorne Research Dehydrone-5 is a safe low-dose support for adrenals, taking 1-3 capsules daily.
• Allergy Research Group SAMe. Perhaps the most widely studied supplement used for depression, SAMe has been found effective, even in major depressive disorder. Effective doses range from 200 mg once daily to 800 mg twice daily, depending on the severity of the depression. A good starting dose is 100 mg twice daily, increasing slowly to an effective dose.

Daily Life Activities

• Listen to your body. Do you have other health problems besides depression? Many times the clue to one problem is found in healing another one. Digestive problems particularly once resolved, can help ease depression.
• Exercise. A review of studies dating back decades verify the usefulness of exercise in relieving depression. Several factors seem to make exercise the most effective.
  • Program of exercise. Exercise according to a schedule or with a goal in mind is more helpful than spontaneous and erratic exercise.
  • Social exercise. Exercising with others provides community as well as exertion.
  • Strenuous exercise. A harder workout is more effective than a gentle one.
• Normalize sleep. Sleep disturbance and depression often go hand in hand. Shift work that disturbs sleep is particularly problematic for people who have a tendency to depression. Review my recommendations for insomnia if you have any trouble sleeping.
• Pets. Pets provide companionship and a legitimate purpose. If adopting a dog is feasible, they are ideal anti-depressants with their unconditional love and need for exercise.

Seeking Care

• Therapy. Talking with a skilled counselor or therapist can be supportive and in some cases very helpful. Interview more than one if you are able, and pick the one you feel most comfortable working with.
• Meditation. For some people, talking makes depression worse, but they benefit from quieting their worried mind. A simple meditation instruction consists of the following:
  • Sit comfortably. Pick a comfortable chair and set a clock within sight.
  • Eyes open or closed. Busy minds may do better with closed eyes, sleepy minds may do better with open eyes.
  • Pay attention to your breath. Starting with 5 minute periods and increasing to 15, pay attention to some physical effect of your breath: the movement of your nostrils or chest, or the sensation in your nose or throat.
  • Return to the breath gently. Your mind will wander, everyone's mind wanders. When you notice it, give yourself a little smile and return to the breath.
  • Set a regular time. Once or twice daily, five to seven days a week. Set a time and stick to it. Re-schedule if need be, and be gentle with yourself. Since our minds always wander, we worry that we're doing it wrong. It's the gentle return to the breath that is the only important part about doing it “right”.
• Check with your physician. Medical conditions that can cause depression include the use of statin drugs, deficiencies of vitamin D3, hypothyroidism and other hormonal problems. 

Depression Prevention

Even if you follow the advice we offer in regard to diet and lifestyle, it's quite possible that a bout of depression may sneak up on you at some time in your life. Illnesses, losses, deaths-even gloomy weather-can conspire to bring on a persistent case of the blues. Being attuned to stress-inducing factors in your life and acting promptly to alleviate them can help minimize an episode of depression. Friendships and support groups can also be invaluable in staying emotionally afloat during tough times. Making the lifestyle suggestions offered above an ongoing part of your life may provide the most reliable insurance for keeping depression at bay. 

From Dr. Deborah's Desk

It's hard to make yourself exercise when you're depressed, even if someone promises you that exercise is the best cure. When I'm working with someone who's depressed, getting them to exercise is my goal but not always my first step. If I were a talk-therapist I would definitely take brisk walks with my clients who came for regular appointments.

In my medical practice, I always work with diet and a few supplement choices to begin with. It's amazing how often the elimination of junk or processed food smoothes out the highs and lows that can send people into depression. Real food is definitely more nourishing, and in real food I include fish oils and a basic multi-vitamin. I have only once used puppy placement (I was fostering a litter from the shelter, how handy) to treat depression, but the match was a good one and effective.

By far the most commonly useful supplements in my experience are tryptophan, 5-MTHF and DHEA. Theo first came to see me about 1990 for allergies, but it didn't take long to get to the depression that had been his companion since he cared for his dying mother. He had resentments about her suffering that bolstered his underlying shyness and wariness around most people. He slept poorly, so I suggested he start with Thorne Research 5-hydroxytryptophan 2-3 capsules at bedtime, and Thorne Research Dehydrone-5 in the morning instead of a cup of coffee. We kept up a funny cycle for a few years where he would take the supplements, feel some relief, go about his business and forget the supplements and return to see me with the complaints renewed. We met about three times yearly at that time.

Starting about 2005, our visits dropped to once a year when he checked in about his allergies. He chuckled to reassure me that he was remembering the tryptophan and DHEA on his own, so I was out a couple office visits on his account, which I assured him was fine.

This information is provided for educational purposes only, and any individual diagnosis or treatment should be determined by you and your doctor. See Additional Information.