Conditions

Depression

Clinical depression is persistent depression that is out of proportion to a person's life situation or, in many cases, occurs for no apparent reason.

Signs and Symptoms:

• Extreme feelings of sadness, dejection, despair, worthlessness, hopelessness, and emptiness
• Lack of motivation
• Inability to concentrate
• Mood swings
• Crying fits for no obvious reason
• Chronic fatigue
• Headaches
• Backaches
• Loss of appetite
• Erratic sleeping patterns
• Loss of interest in normal daily activities
• Serious condition may result in complete withdrawal from life and possibly even a refusal, or inability, to get out of bed.
• Thoughts of death and suicide

Diagnosis:

The Hamilton Rating Scale for Depression (HAM-D) or Beck's Depression Inventory (BDI) are used to assess symptoms and severity of depression.

To assess symptoms/degree of severity your doctor may have you take any of the following psychological tests - a clinician-completed rating scale (such as the HAM-D), a psychological test (such as the Minnesota Multiphasic), a personality inventory (MMPI), or a mental status examination (such as the Global Assessment Functioning Scale).

Your doctor will want to evaluate you for concurrent substance abuse, medical conditions, or non-mood psychiatric conditions. He or she may also have you fill out a self-reported questionnaire, e.g., Beck Depression Inventory (BDI).

These tests are normally coupled with a physical examine and may include blood tests for other conditions including ­ nutritional deficiencies, hormone deficiencies, abnormal thyroid function, schizophrenia and sleep apnea.

Treatment Options:

Depending on the type, number, severity, and duration of episodes one or more of the following are recommended: pharmacotherapy, psychotherapy (including interpersonal and cognitive­behavioral psychotherapies), bright light treatment (for seasonal depression), nutritional support, yoga, exercise, meditation, massage, and tai chi may be helpful. Hospitalization may be necessary if suicide is possible.

Traditional Treatments:

• If depression is a reaction to a specific event, counseling, psychotherapy, cognitive-behavioral therapy, and/or the simple passage of time will most likely resolve the problem.
• If there is no obvious cause for the depression, or if reactive depression persists longer than might be expected, or if you are having suicidal thoughts, more aggressive therapy is needed. This means drug therapy and, possibly, hospitalization. The mainstay of drug treatment has long been a group of medications called tricyclic antidepressants, including amoxapine (Asendin), clomipramine (Anafranil), desipramine (Norpramin), imipramine (Tofranil), and nortriptyline (Aventyl, Pamelor). These drugs do not take effect immediately, so a test period of at least two weeks is necessary to determine whether they are working. Toxicity is a problem with these drugs, and therapeutic levels are close to toxic levels, so repeated blood tests to check the level of the drug in the body are necessary. Severe side effects are associated with these medications. Ask your doctor for more information.
• For obvious reasons, newer, less potentially toxic medications are now considered more desirable then the previously mentioned tricyclic antidepressants. Fluoxetine (Prozac) is the best known of these. Others include bupropion (Wellbutrin, Zyban), fluvoxamine (Luvox), nefazodone (Serzone), paroxetine (Paxil), sertraline (Zoloft), and venlafaxine (Effexor). There are still side effects associated with these drugs ­ be sure to consult with your doctor before taking these medications.
• Another type of drug used to treat depression is the monoamine oxidase (MAO) inhibitor. These are usually resorted to only when the others have failed. Phenelzine (Nardil) and tranylcypromine (Parnate) are in this class. These drugs can cause severe side effects, consult your doctor before taking any other medication, whether prescription or over the counter. Also, there are severe diet restrictions that should be followed when on MAO inhibitors. Talk with your doctor for more information.
• Though no one understands why, serious depression may respond ­ and very well ­ to electroconvulsive therapy (ECT). This therapy is not quite as barbaric as it may sound, as the patient is unconscious for the brief procedure. Negative reactions are mostly related to heart rhythm, and are remarkably infrequent, but there is a period of amnesia after treatment that can be very disturbing.
  Seasonal affective disorder may be treated with light therapy. In this treatment, a person is exposed to full-spectrum light by means of special light fixtures, giving a daily dose of the light frequencies that would be available on a bright sunny day.
• Most cases of postpartum depression resolve on their own. Participation in a support group with other new mothers can be helpful. In severe cases, antidepressant medication may be prescribed.
  Treatment is seldom necessary for "Holiday blues" which pass when the season ends.

Complementary and Alternative Therapies:

Usually a combination of relaxation techniques, nutrition, and herbs provide the greatest relief.

Nutritional Supplementation:

• Essential fatty acids aid in the transmission of nerve impulses; needed for normal brain function. Follow label directions.
• 5 Hydroxytryptophan increases the body's production of serotonin. Follow the label directions.
  Warning: Do not use in conjunction with any other antidepressants.
• L-Tyrosine alleviates stress by boosting production of adrenaline. It also raises dopamine levels, which influence moods.
  Warning: Do not take with MAO inhibitor drugs.
• S-adenosylmethionine works as an antidepressant.
  Warning: Do not use if you have manic-depressive disorder or take prescription antidepressants.
• Take a good multivitamin and mineral formula daily to make sure your body has all the basic nutrients it requires.
• Calcium and magnesium are essential to the central nervous system. They work best when taken together. Take a calcium and magnesium combination formula that supplies 500 mg of calcium and 250 to 500 mg of magnesium twice daily.
• Chromium helps keep blood-sugar levels in balance. Take 200 mcg twice a day for one month, then reduce to 200 mcg daily.
• DL-phenylalanine (DLPA) can be very helpful for a short period of time, if taken correctly. Take 500 to 1,000 mg twice a day, between meals, with water or juice only. Take it for up to three weeks.
• Levels of folic acid are often significantly lower than normal in people who are depressed. Take 800 mcg of folic acid twice a day for one month. Thereafter, take 800 mcg once daily. If you take any of the B vitamins individually, you should also take a B-complex supplement at a different time of day.
• Inositol is a B vitamin required for the activity of several important neurotransmitters, including serotonin. Take 500 mg of inositol three times daily for one week. If you note no improvement after that time, discontinue use; otherwise continue taking the inositol. (This dosage of inositol should be used under supervision of a doctor)
• Melatonin may be helpful in some cases of seasonal affective disorder. Take 3 mg each evening, between one-half hour and two hours before bedtime.
• Tyrosine is an important amino acid that stimulates the production of norepinephrine, a hormone that is essential to the central nervous system. This nutrient is especially important for the depressed individual who is feeling excessive fatigue. Take 250 to 500 mg twice a day for up to three weeks.
  Warning: If you are taking a MAO inhibitor drug, do not take supplemental tyrosine, as a dangerous elevation in blood pressure may result.
• A deficiency of vitamin B6 (pyridoxine) usually accompanies depression. Take 50 mg of vitamin B6 twice a day for two weeks, between meals. Thereafter, take a good B-complex formula or a multivitamin and mineral supplement to maintain healthy levels of the vitamins.
• Vitamin B12 can help to increase energy and improve mood. Take 300 to 500 mcg twice a day. If you take any of the B vitamins individually, you should also take a B-complex supplement at a different time of day.

Alternative Therapies:

• Bupleurum and dong quai make up a Chinese herbal formula that helps reduce anxiety, irritability, and depression. Take 1,000 mg of bupleurum and dong quai combination formula two or three times daily for two weeks out of every month (if you are a woman, take it for the two weeks prior to the anticipated onset of your menstrual period).
• Ginkgo biloba can significantly reduce the symptoms of depression. This herb must be taken for at least three months before you can assess its effectiveness. Choose a product containing at least 24 percent ginkgo heterosides (sometimes called flavoglycosides) and take 40 to 60mg two or three times daily.
• Kava kava eases mental anguish and anxiety.
  Warning: In excessive amounts, this herb can cause drowsiness. Do not exceed the recommended dose. Do not use kava kava if you are pregnant or nursing, if you have Parkinson's disease, or if you are taking a prescription medication for depression or anxiety.
• Oat straw is high in silica, which helps support and strengthen the central nervous system. Take 500 mg twice a day.
• St. John's wort gently alters brain chemistry in such a way as to improve mood and ease depression.
• Siberian ginseng improves the balance of important neurotransmitters in the brain.
• Balm, also known as lemon balm, is good for the stomach and digestive organs during stress.
• Ginger, licorice root, and peppermint may also be helpful.
  Warning: Do not use licorice on a daily basis for more than five days in a row. Avoid it completely if you have high blood pressure. Do not use Siberian ginseng if you have hypoglycemia, high blood pressure, or heart disease.
• Valerian is a sedative that aids in digestion.
• Passionflower (Passiflora incarnata) is especially good for emotional upheaval with nervousness and insomnia.
• Homeopathic remedies may help with depression. Contact your local homeopathic practitioner for more information.
• The following acupressure points may give some relief from depression related symptoms: Bladder 23 and 60, Gallbladder 20, Gallbladder 41, Large Intestine 4, Liver 3, and Stomach 36.
• Many essential oils can lift the spirits. Some of the best for this purpose include geranium, jasmine, lavender, neroli, rose and ylang ylang.

General Recommendations:

• Eat a well balanced diet. A diet too low in complex carbohydrates can cause serotonin depletion and depression.
• Omit wheat products from the diet. Wheat gluten has been linked to depressive disorders.
• Avoid diet sodas and other products containing the artificial sweetener aspartame. This additive can block the formation of serotonin.
• Investigate possible food allergies.
• Have a hair analysis to rule out heavy metal intoxication.
• Learn to recognize and "reroute" negative thinking patterns.
• Exercise. Regular physical activity eases depression. Yoga, aerobic walking, and tai chi are gentle exercise programs that seem to work best.

Warnings:

• Consult your doctor before taking any other medication, whether prescription or over the counter, with MAO inhibitors.
• There are severe diet restrictions that should be followed when on MAO inhibitors. Talk with your doctor for more information.
• If you experience thoughts of suicide or death, seek help immediately.
• If you are taking a MAO inhibitor drug, do not take supplemental tyrosine, as a dangerous elevation in blood pressure may result.
• In excessive amounts, kava kava can cause drowsiness.
• Do not exceed the recommended dose of kava kava.
• Do not use kava kava if you are pregnant or nursing, if you have Parkinson's disease, or if you are taking a prescription medication for depression or anxiety.
• Do not use licorice on a daily basis for more than five days in a row.
• Avoid licorice completely if you have high blood pressure.
• Do not use Siberian ginseng if you have hypoglycemia, high blood pressure, or a heart disease.
• Do not use 5 Hydroxytryptophan in conjunction with any other antidepressants.
• Do not use S-adenosylmethionine if you have manic-depressive disorder or take prescription antidepressants.
• Do not take L-Tyrosine with MAO inhibitor drugs.