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. High potency multiple vitamin and mineral formula; Vitamin D3 2,000-5,000 IU/day; Fish oil, EPA+DHA 3,000 mg/day.
Fish oil is especially important in supporting any brain issue including our mood. The long chain omega-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) are critical to the health of the brain cell membrane. Low levels of EPA and DHA lead to altered brain cell structure and function that can also affect mood and behavior. Dosage: 3,000 mg of EPA+DHA.
5-Hydroxytryptophan (5-HTP) is extracted from the seed of an African plant (Griffonia simplicifolia) and is the direct precursor to serotonin – a key brain chemical that regulates our mood. In addition to increasing serotonin levels, 5-HTP causes an increase in levels of endorphin and other neurotransmitters that boost our mood. Numerous double-blind studies have confirmed this mood boosting effect. 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).
St. John’s wort extract (Hypericum perforatum) is now a well-known natural mood elevator. The dosage for St. John’s wort extract (0.3% hypericin content) is 900 to 1800 mg daily. Since St. John’s wort extract activates enzymes in the liver and gut that detoxify certain drugs, do not use SJW if you are taking cyclosporine; indinavir; oral contraceptives; and anticoagulants, such as warfarin (Coumadin®) without consulting a physician first.
Dehydroepiandrosterone (DHEA) levels typically drop as people age and may lower mood. The dosage recommendation for gentle support for men 45+ is 15 to 25 mg daily; for women 45+ the dosage is 5 to 15 mg daily.
S-adenosylmethionine (SAMe) is utilized in the manufacture of many brain compounds including serotonin and other neurotransmitters. SAMe supplementation has been shown to be useful in improving mood in published clinical trials. Dosage: 200 to 400 mg three times 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