What is Depression?

According to the National Institute of Mental Health (NIMH), depression is one of the most common mental disorders in the US. It is a common, but serious illness involving unbalanced brain-body chemistry. Different from how everyone feels sad or has the blues every now & again, having severe depression means it interferes with your daily life & causes real pain.

The NIMH defines several types of depression including:

1. Major depression—severe symptoms that interfere with the ability to work, sleep, study, eat, and enjoy life. An episode can occur only once in a person’s lifetime, but more often, a person has several episodes.
2. Persistent depressive disorder—depressed mood that lasts for at least two years. A person diagnosed with persistent depressive disorder may have episodes of major depression along with periods of less severe symptoms, but symptoms must last for two years.
3. Psychotic depression – occurs when a person has severe depression plus some form of psychosis, such as having disturbing false beliefs or a break with reality (delusions), or hearing or seeing upsetting things that others cannot hear or see (hallucinations)
4. Postpartum depression - when hormonal and physical changes and the new responsibility of caring for a newborn can be overwhelming. It is estimated that 10 to 15 percent of women experience postpartum depression after giving birth.
5. Seasonal affective disorder (SAD) - characterized by the onset of depression during the winter months, when there is less natural sunlight. The depression generally lifts during spring and summer. SAD may be effectively treated with light therapy, but nearly half of those with SAD do not get better with light therapy alone.
6. Bipolar disorder - is not as common as major depression or persistent depressive disorder. Bipolar disorder is characterized by cycling mood changes—from extreme highs (e.g., mania) to extreme lows (e.g., depression).

Who is at Risk for Depression?

Each year about 6.7% of U.S adults experience major depressive disorder. Women are 70 % more likely than men to experience depression during their lifetime.  The average age of onset is 32 years old. Additionally, 3.3% of 13 to 18 year olds have experienced a seriously debilitating depressive disorder.

Symptoms of depression cause at least some level of difficulty in function for most, with 35% of depressed ales & 22% of depressed females experiencing symptoms severe enough to make it difficult to handle daily activities such as working, household chores, or being social (Pratt & Brody, 2008).

Common Signs & Symptoms (Mathews Larson, 2006)

• Withdrawal from activity
• Isolation
• Constant fatigue
• Indecisiveness
• Lack of motivation
• Boredom
• Loss of interest in life
• Feeling hopeless
• Sleeping in excess
• Insomnia
• Lack of responsiveness to good news
• Loss of appetite or binge eating
• Ongoing anxiety
• Easily upset or angered, lashing out
• Lack of sex drive
• Impatience, hostility
• Suicidal thoughts

Possible Causes of Depression

1. Nutrient Deficiencies
   • Such as EFAs, B Vitamins, Vitamin C, Vitamin D, Calcium, Magnesium, Zinc
2. Neurotransmitter Deficiency
   • There are several theories of what exactly causes depression including that an imbalance of neurotransmitters can produce depression. Neurotransmitters are chemical messengers whose job is to relay, amplify, & modulate electrical signals between neurons to influence behavior of other cells. They affect mood, sleep, concentration, & weight. According to Eric Braverman, these neurotransmitters are likely the most important determinants of mood & cognitive ability (Braverman, 2004):
     • Dopamine
       • Controls the body’s electrical voltage, produces energy, alertness, blood pressure, metabolism, & digestion
       • Deficiencies of dopamine can result in depression, addictions, obesity, severe fatigue, & Parkinson’s disease
     • Acetylcholine
       • Determines the brain’s speed
       • Deficiencies can create language disorders, memory loss, & cognitive disorders
     • GABA
       • The brain’s natural tranquilizer (amino acid precursor is glutamine)
       • Can be calming to the body, but is also involved in the manufacture of endorphins (feel good chemicals)
       • Deficiencies can lead to headaches, hypertension, heart palpitations, seizures, lowered sex drive, & heart disorders
     • Serotonin (5HT)
       • Mind & body’s regenerator from the amino acid tryptophan
       • It’s job is to reduce food cravings by producing a sense of satiety after eating, regulates the body’s ability to rest & helps us sleep by converting to melatonin at dark
       • Deficiencies can cause depression, food cravings, eating disorders, pain (like fibromyalgia), sleep disorders, panic attacks, & PMS.
       • Sufficient protein intake is essential for maintaining adequate levels
3. Genetics
   • Depression often runs in families (Levinson, 2006), however, gene-environment interplay is important to consider as genes only confer susceptibility, while environmental factors provide the trigger 
4. Blood Sugar Imbalances
   • Several studies have linked impaired glucose tolerance and insulin resistance, as well as diabetes, to depression (Timonen et al, 2004; Lombard, 2007)
   • Hypoglycemia kills neurons
5. Chronic Stress
   • Cortisol elevations lead to increased uptake of serotonin & eventual depletion (same for norepinephrine & dopamine)
     • Can also lead to chronic inflammation. Depressed people have been found to have elevated levels of pro-inflammatory and inflammatory chemicals (Raison, Capuron, & Miller, 2006)
6. Lipid levels
   1. Cholesterol levels <160 have been linked to depression (Sinatra et al, 2007) as well as elevated triglycerides
7. Environmental Toxins
8. Hypothyroidism
9. Food Allergies/Sensitivities
10. Candida
11. Drug Interactions
12. High Histamine

General dietary guidelines for dealing with depression include:

1. Eat high-protein meals to maintain stable blood sugar levels & provide amino acid precursors for neurotransmitters
2. Higher proportion of protein at breakfast & lunch, more carbohydrates later in the day to provide calm late in the day
3. Eat greens at each meal to calm nervous system
4. Avoid harsh stimulants to the extent your body requires it (ie: caffeine & alcohol)
5. Include booster foods such as algae, sea veggies
6. Include low-glycemic fruits & grains
7. Eat plenty of omega-3 fatty acids

References:

Braverman, E.R. (2004). The Edge Effect. New York, NY: Sterling.
Eby, G.A. & Eby, K.L. (2006, Mar 17). Rapid recovery from major depression using magnesium treatment. Medical Hypotheses, 67 (2):362–370. doi:10.1016/j.mehy.2006.01.047
Hedaya, R. (2010, Nov 22). Nutrition and depression. Retrieved from ttp://www.wholepsychiatry.com/blog/author/Dr.+Robert+Hedaya.aspx
Levinson, D.F. (2006, Jul 15). The genetics of depression: A review [Abstract]. Biological Psychiatry, 60 (2):84–92. doi:10.1016/j.biopsych.2005.08.024
Lombard, J. (2007, Sep/Oct). Exploring the brain-mind- body connection. Interview in Alternative Therapies in Health and Medicine, 13 (5):67–76. PMID:17900045
Mathews Larson, J. (2006). Dissolving biochemical depression. Health Recovery Center.
Murray, M. (2005). The Encyclopedia of Healing Food. New York: Atria Books.
Murray, M. (2012). The Encyclopedia of Natural Medicine. New York: Atria Books.
Pratt, L.A. & Brody, D.J. (2008, Sep). Depression in the United States household population, 2005–2006 [PDF]. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics. Available at http://www.docstoc.com/docs/1926814/Depression- Statistics- in- US- Households
Raison, C.L., Capuron, L., & Miller, A.H. (2006, Jan). Cytokines sing the blues: Inflammation and the pathogenesis of depression [Abstract]. Trends in Immunology, 27 (1):24–31. doi:10.1016/j.it.2005.11.006
Sinatra, S. & Roberts, J.C. (2007). Reverse Heart Disease NOW. Hoboken, NJ: John Wiley & Sons.
Timonen, M., Laakso, M., Jokelainen, J., Rajala, U., Meyer-Rochow, V.B., & Kiukaanniemi, S.K. (2004, Dec 30). Insulin resistance and depression: Cross sectional study [Abstract]. BMJ, 330:17–18. doi:10.1136/bmj.38313.513310.F71