Depression is characterized by feelings of low self-esteem, pessimism, and despair. Clinical depression is more than feeling depressed. The official definition of clinical depression is based on the following eight primary criteria:
- Poor appetite accompanied by weight loss, or increased appetite accompanied by weight gain
- Insomnia or excessive sleep habits (hypersomnia)
- Physical hyperactivity or inactivity
- Loss of interest or pleasure in usual activities, or decrease in sexual drive
- Loss of energy; feelings of fatigue
- Feelings of worthlessness, self-reproach, or inappropriate guilt
- Diminished ability to think or concentrate
- Recurrent thoughts of death or suicide
The presence of five of these eight symptoms definitely indicates clinical depression; an individual with four is probably depressed. The symptoms must be present for at least one month to be called clinical depression.
What causes Depression?
Depression can be the result of psychological as well as physiological factors. The most significant psychological theory is the “learned helplessness” model, which theorizes that depression is the result of habitual feelings of pessimism and hopelessness. The chief physiological theory is the “monoamine hypothesis,” which stresses imbalances of monoamine neurotransmitters such as serotonin, epinephrine, and norepinephrine. Serotonin deficiency is the most common biochemical cause
It is important to rule out the simple organic factors that are known to contribute to the depression such as nutrient deficiency, drugs (prescription, illicit, alcohol, caffeine, nicotine, etc.), hypoglycemia, and hypothyroidism.
What dietary factors are important in Depression?
A deficiency of any single nutrient can alter brain function and lead to depression, anxiety, and other mental disorders, especially deficiencies of vitamin B12, folic acid, other B vitamins, and omega-3 fatty acids. Alcohol utilizes many of these nutrients in its metabolism and drinking alcohol regularly replaces calories one would otherwise get from food. In this case, nutrients are just not adequately consumed, and those that are consumed are often needed to rid the body of the alcohol. In the case of hypothyroidism, inadequate iodine intake can be a cause.
Since the brain requires a constant supply of blood sugar to function properly, hypoglycemia must be avoided. Symptoms of hypoglycemia can range from mild to severe and include depression, anxiety, irritability, and other psychological disturbances; fatigue; headache; blurred vision; excessive sweating; mental confusion; incoherent speech; bizarre behavior; and convulsions. Several studies have shown hypoglycemia to be very common in depressed individuals. Simply eliminating refined carbohydrates and caffeine (which can aggravate hypoglycemia) from the diet is sometimes all that is needed for effective therapy in patients whose depression results from reactive hypoglycemia.
Food allergy is also a significant factor in some people suffering from depression. Eliminating offending foods can bring about tremendous relief (see Food Allergy for more information).
What nutritional supplements should I take for Depression?
Foundation Supplements. There are three products from Natural Factors that I think are critical in supporting good health:
- MultiStart (age and gender specific multiple vitamin and mineral formulas). Follow label instructions.
- Enriching Greens – a great tasting “greens drink” containing highly concentrated “greens” like chlorella, spirulina, wheat grass juice, barley grass juice, etc., and herbal extracts. Take one serving (one tablespoon) in 8 ounces of water daily.
- RxOmega-3 Factors – A true pharmaceutical grade fish oil supplement. Take two capsules daily.
5-Hydroxytryptophan (5-HTP) is extracted from the seed of an African plant (Griffonia simplicifolia) and is the direct precursor to serotonin. In addition to increasing serotonin levels, 5-HTP causes an increase in levels of endorphin and other neurotransmitters that are often decreased in cases of depression. Numerous double-blind studies have shown that 5-HTP has equal effectiveness compared to drugs like Prozac, Paxil, and Zoloft (the selective serotonin reuptake inhibitors, SSRIs) and tricyclic antidepressant drugs like imipramine and desipramine in terms of effectiveness, and that it offers several advantages: it is less expensive, better tolerated, and associated with fewer and much milder side effects. The typical recommendation is 50 to 100 mg three times daily (best taken before meals, preferably use an “enteric-coated” product to prevent gastroinstestinal upset). 5-HTP should not be used in combination with antidepressant drugs unless under the supervision of a physician. It can be used in combination with St. John’s wort extract.
St. John’s wort extract (Hypericum perforatum) is now a well-known natural antidepressant. Over 30 double-blind studies involving over 2,000 patients with mild to moderate depression have shown St. John’s wort extract to be very effective. However, while St. John’s wort extract appears to be as or possibly even more effective than conventional antidepressant drugs in mild to moderate depression, it does not appear to be as effective as conventional drugs in severe depression. The main advantage ofusing St. John’s wort extract as opposed to antidepressant drugs was found to be not so much a difference in therapeutic outcome, but rather a significant advantage in termsof side effects, cost, and patient satisfaction. The dosage for St. John’s wort extract (0.3% hypericin content) is 900 to 1800 mg daily. In severe cases, St. Johns wort extract can be used in combination with 5-HTP.
People taking prescription drugs need to check with their doctor or pharmacist before taking St. John’s wort extract as it appears to induce enzymes in the liver and gut that detoxify certain drugs. Drugs that are metabolized by these enzymes include cyclosporine; digoxin; indinavir; oral contraceptives; theophylline; tricyclic antidepressants, such as amitriptyline; and anticoagulants, such as warfarin (Coumadin®). Do not use St. John’s wort if you are taking any of these drugs without consulting a physician first.
St. John’s wort extract may also potentiate prescription antidepressant and anti-anxiety drugs. There is one case report of simultaneous use of St. John’s wort and paroxetine (Paxil®) producing nausea, fatigue, lethargy, and weakness. Do not use St. John’s wort if you are taking a prescription antidepressant or anti-anxiety drug without consulting a physician first.
DHEA levels typically drop as people age. People over 40 patients with depression and low DHEA levels respond quite well to DHEA supplementation. The dosage recommendation for men 45+ is 15 to 25 mg daily; for women 45+ the dosage is 5 to 15 mg daily.
If you are currently on a prescription anti-depressant drug, you will need to work with a physician to get off the drug. Stopping the drug on your own can be dangerous, you absolutely must have proper medical supervision. I have used St. John’s wort and 5-HTP successfully without incident in patients taking Prozac, Zoloft, Paxil, Effexor, and various other antidepressant drugs. The real concern that physicians have when mixing antidepressant drugs with St. John’s wort or 5-HTP is producing what is referred to as the “serotonin syndrome” – characterized by confusion, fever, shivering, sweating, diarrhea, and muscle spasms. Although this syndrome has never been produced when St. John’s wort extract or 5-HTP have been given alone, it is theoretically possible that combining St. John’s wort or 5-HTP with standard antidepressant drugs could produce this syndrome. If symptoms of serotonin syndrome appear, elimination of one of the therapies is indicated.
How do I know if the recommendations are working?
Feelings of depression are mostly subjective. Anti-depressants, whether natural or synthetic, generally take 2-6 weeks to demonstrate an effect. One of the first improvements noted by many is in sleep quality.
Despite the many different antidepressants I’d been prescribed over the past several years (gaining 70 pounds in the process … ugh) the ONLY thing I could take that would give me any sense of feeling “normal” was Vicodin. Thankfully, I found your book on 5-HTP. I took my first 100mg dose one morning, and WITHIN TWO HOURS I felt better than I had in ages!!! It was/is the most amazing thing, Dr. Murray! It has been five weeks since I started taking 5-HTP, and not only do I have more HOPE than I’ve had in years, but I also have felt absolutely no inclination to take Vicodin since I started taking 5-HTP. I no longer need Ambien or Valium to sleep, nor do I need to sleep 14 hours at a time on weekends. Instead, I sleep 7 – 8 hours per night and wake up refreshed and ready to start the day. It truly is like a miracle to me. I cannot thank you enough for touching my life in the way that you have, and I hope this email finds its way to you so you will know how very grateful I am to you.
Best regards, Nancy