Depression - diagnosis and treatment
Everybody has mood swings with good days, bad days, good weeks and bad weeks etc., during which there are feelings of sadness, hopelessness or despair. This is normal. Depression is more common in the winter; indeed, arguably a part of our survival package. I know never to make an important decision in January. It will always be a bad one! Happiness is relative. If you spent time in a prisoner-of-war camp, happiness would be a dry crust of bread! If you have severe CFS, happiness is being able to sit outside for 30 minutes! You can't always be happy; there have to be tough times to have good times.
So, one must expect to have times of less happiness. In depression, these times are more severe and may persist for several weeks. The difference between sadness and depression is a matter of degree and duration.
For some, depression is a normal reaction to some horrible life event (so called exogenous depression), such as a death or divorce. This is when you most need friends or family to give support - together with good sleep - until time heals. See Sleep is vital for good health - especially in CFS.
But for many people depression occurs for no apparent reason. Mental pain is far worse than physical pain. The Diagnostic and Statistical Manual of Mental Disorders defines a depressed person as "experiencing feelings of sadness, helplessness and hopelessness. In traditional colloquy, feeling "depressed" is often synonymous with feeling "sad", but both clinical depression and non-clinical depression can also refer to a conglomeration of more than one feeling."
My view is that depression is a symptom of loss of hope, i.e. one can see no future, no horizon. The joy of the environmental approach to depression is that it puts one back in control of one's symptoms! There is often a reason for low mood that can be successfully tackled by the environmental approach.
The evidence that drug treatment for depression is effective is thin. I do recommend "Toxic Psychiatry" by Dr Peter Breggin, which illustrates how badly depression is served by prescription medication. His approach, combined with the ecological approach, makes for the best treatment.
Causes of depression
There is a general assumption that depression is a psychological symptom, but this is not so. My experience is that the majority of depression has a physical cause, and once that is conquered, apparently insurmountable psychological problems are much more easily dealt with.
- Energy supply to the brain. The brain needs much more energy than the body and this it gets in the form of ATP. However ATP is not just the energy molecule; it is a neurotransmittor in its own right. To be precise, it is a co-transmittor which means other neurotranmittors like serotonin and acetylcholine will not work unless there is a molecule of ATP with them. Depression is thought to be due to low levels of such neurotransmittors in the brain; so, increasing ATP will make whatever is there function much better! See Brain fog - poor memory, difficulty thinking clearly etc.
- Allergy and hypoglycaemia
- Food and mood are closely linked. What we eat is so often driven by addiction, complicated by the fact that one gets allergic to one's addiction, and addicted to one's allergens. Blood-sugar levels have a profound effect on mood. This is because when blood-sugar levels run high, the brain can function efficiently and feels cool, calm and collected. Whilst the brain may like this, it's a metabolic disaster for the body: insulin is released and blood sugar levels come swinging down. The sufferer can relieve these symptoms by eating sugar or carbohydrates again and easily recognises his comfort foods. The long-term symptom of this is high insulin levels, weight gain, diabetes, heart disease and so on. Middle-age spread, therefore, is symptomatic of chronic stress driving carbohydrate addiction. Other addictive substances include caffeine, chocolate, nicotine, and alcohol, many of which are addictive because of their effects on blood-sugar levels. Most psychiatric in-patients are obvious addicts. It always amazes me that there is no control in such patient-units over carbohydrate intake (sugar and biscuits), caffeine and - often - cigarette smoking. Indeed, most psychotropic drugs have their action because they increase the blood-sugar levels, whilst also, unfortunately, increasing weight and accelerating the aging process. For many people just doing the Stone Age Diet makes the world of difference. More often I now prescribe the ketogenic diet - please see Ketogenic diet - the practical details and My book The PK Cookbook - Go Paleo-ketogenic and get the best of both worlds.
- If one sees more than minimal consumption of sugar and refined carbohydrates as an addiction, then one can start to understand why they have such profound effects on mood. As with any other addiction, expect short-term withdrawal-symptoms on cutting down. See Hypoglycaemia - the full story
- Allergies to foods can also manifest with depression and a good clue is excessive eating of that particular food. For many people just doing the Stone Age Diet makes the world of difference. More often I now prescribe the ketogenic diet - please see Ketogenic diet - the practical details and My book The PK Cookbook - Go Paleo-ketogenic and get the best of both worlds.
- Micronutrient deficiency
- The brain is the most biochemically complicated and metabolically active organ of the body; so almost any deficiency of almost any micronutrient could have effects on the brain. That is why I like everybody to take Nutritional Supplements. Alcohol, for example, will deplete B vitamins which are essential for maintaining blood-sugar levels and for normal brain biochemistry. High-dose B12 given by injection can be extremely useful for improving mood. Indeed, one has to be careful in a patient prone to mania because high-dose B12 by injection can provoke an attack. Vitamin B3 (niacinamide) is excellent at stabilising blood-sugar levels when used in doses of 500mgs three times a day or more. Just be mindful that it can - rarely - upset the liver, and this is usually accompanied by feeling slightly nauseated. Indeed, in clinical trials B3 given in these doses has been shown to be more effective than diazepam (Valium) at stabilising mood. Magnesium is also described as nature's tranquiliser; it has a generally calming effect. Its use in excitable horses has been described as magical!
- Sleep - poor quality sleep will result in depression. See Sleep is vital for good health.
- Light - Seasonal Affective Disorder (SAD) is a common cause of depression. It is probably a universal natural reaction to winter. To survive the winter, the body needs to slow down in order to conserve energy; so, we go into a sort of hibernation. Depression is a part of this. Full-spectrum light can be very helpful for some people. See HEALTHY HOUSE 0845 450 5950 or HEALTHY HOUSE
- Lack of Exercise - Exercise is very good at decreasing depression. Exercise could be physical or mental - and preferably both. In fact, some people become hooked on exercise and look forward to their daily buzz to stay healthy. I know I do! The problem is getting started. You actually need someone to drag you out for a walk initially or take you swimming or whatever. Try to find an exercise that you actually enjoy, so that it becomes a pleasure instead of a grind.
- Hormonal problems - especially hypothyroidism - can present with depression - see Hypothyroidism - diagnosis of and Hypothyroidism.
- Hyperventilation can cause depression, but this is mainly a problem with chronic anxiety. See Hyperventilation.
- Prescription medication, addictions and toxic chemicals
Drugs and chemicals acting as allergens and/or toxins can certainly cause depression. Organophosphate pesticides, for example, can induce an acute psychotic disorder; in lesser doses they certainly cause depression.
Exploring these issues must be done under the guidance and friendship of an experienced professional such as your GP, community psychiatric nurse, psychotherapist or counsellor. The reason for this is partly because with all depression there is a suicide risk and it takes someone from "outside" to recognise it and act on it.
Is there an obvious trigger? If the depression follows a bereavement, time is the main healer. See below - treatments to raise neurotransmitter levels.
If in a "hole", you must always have a plan so that there is "light at the end of the tunnel". So much depression is actually frustration at people finding themselves in impossible situations. If life is treating you badly, you must have some long-term plan to hang on to. Sometimes you need a kind friend or relative or counsellor to help devise such a plan. It might start off with a trip to Citizens Advice Bureau to see a solicitor!
Analyse your problems! People who get depressed are only too willing to lay the blame for their problems at their own door. Very often they have been put upon unreasonably by others and "cracked" under the strain. Very often I see depression in people who are trapped in some way - i.e. a disastrous relationship in which they are stuck, financial misery, or some situation over which they have no control but which is ruining their lives.
Treatment of Depression
- Stone Age Diet. More often I now prescribe the ketogenic diet - please see Ketogenic diet - the practical details and My book The PK Cookbook - Go Paleo-ketogenic and get the best of both worlds.
- Nutritional Supplements - consider additional B complex, B12 and magnesium
- Sleep is vital for good health
- Correcting Hypothyroidism - diagnosis of
- Chemicals - do a good chemical clean up and Detoxification
- Raise Neurotransmitter Levels - It is believed that the pathology of depression is low levels of neurotransmitter in the brain. Therefore if there is no obvious physical cause of depression, treatment is aimed at raising levels of neurotransmitter.
It is most logical to start off with 5-HTP (5-Hydroxytryptophan), which is the raw material from which serotonin (the "happy" neurotransmitter) is made, but it has only recently come onto the market. It can be bought over the counter and the usual dose is 100-200mgs daily. Prior to 5-HTP being available, tryptophan was widely used and was extremely successful in treating depression - in fact, a serious competitor to Prozac. A contaminated batch came onto the market which caused the eosinophilic myalgic syndrome and all tryptophan was banned. I believe that this contaminated batch was deliberately brought onto the market so that this safe and cheap Prozac-competitor could be kicked into touch leaving the way clear for large profits for Prozac. Tryptophan is an amino-acid, which may partly explain why high-protein diets help patients with depression.
St John's Wort is a herbal preparation which inhibits the breakdown of neurotransmitters and has been shown in drugs trials to be very effective in treating depression. The usual dose is 300 mg three times daily. This can be bought over the counter. CFS patients need to be careful; I have had 2 patients react very badly to the full dose.
There is a range of prescription drugs for treating depression which broadly fall into three categories. Each of these has to be used under the direction of a qualified medical practitioner. The first group is the tricyclic antidepressants, (such as amitriptyline, dothiepin, trimipramine etc). The second group is the SSRIs (selective serotonin re-uptake inhibitors) such as Prozac. However, the SSRIs can cause a sudden worsening in depression with suicidal tendencies, so patients must be carefully monitored. The third group is the MAOIs (monoamine-oxidase inhibitors) which are rarely used because of dangerous side-effects when certain foods are eaten. Allow 2 weeks for them to start to work. Some patients have to remain on them long-term to stay well.
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