Depression could be described as a mood, a state of
being, or energy level that includes lack of motivation,
a sense of hopelessness, and often a lower level
of physical energy. It is an emotional state that can
result from many aspects of life. In standard medicine, most
doctors label it, and prescribe one or more of a wide variety of
anti-depressant drugs. However, in an integrated approach to
medicine, we ask why a problem is present and look at all the
factors that contribute to it in order to understand its existence
and get to the cause. Then, we can correct and clear those areas
that may be generating the difficulty. For depression, this
could involve diet and substance intake, exercise activity, our
biochemical and mental states, and how we feel about all areas
of our life, such as job, relationships, and family.
The first important step involves determining if your depression
is short term or chronic...and if it is mild, moderate,
or severe. Do some careful self-analysis: how often do you feel
depressed, and how significant is your debilitation? Most people
experience some level of depression occasionally; it’s just
part of our natural biorhythm of emotional and mental activity.
If you are depressed right now, how long has this been going
on? Is it linked to a stressful external cause—for example a life
event, issues at work, or problems in a relationship? Or does
the depression seem to follow you most of the time, like your
own personal dark cloud? A state of constant depression may
suggest persistent stress or a biochemical imbalance.
There are varying degrees of depression, from mild to severe,
from acute to long term. Physicians often define a condition
as chronic if it has persisted more than a month or two.
In the case of depression, if you have experienced an ongoing
low for more than three months, it is likely a chronic condition
and definitely warrants a consultation with a capable, insightful
psychiatrist or therapist (or a nutritionally-oriented practitioner
if you wish to be guided in a natural approach). Anti-depressant
drugs are clearly one solution and have been helpful to millions.
Depression has many causes as well. Western medicine
categorizes depression as endogenous, coming from within,
and exogenous, coming from outside influences. Exogenous depressions
come from reactions to life events and daily stresses,
such as loss of a loved one, job problems, or family crises. We
also may experience depression from inner conflict, or we may
feel overwhelmed by our responsibilities. Many drugs can cause
low to mild levels of depression; these include blood pressure
medications, estrogens in birth control pills, steroids, and antianxiety
drugs, like the benzodiazepines (Valium, Xanax, or Ativan).
The remedy for many cases of exogenous depression often
involves clearing the causative factor, or doing some counseling
to better integrate these life experiences.
Endogenous depression we could call biochemical depression.
It tends to run in families, as in genetic factors, and is
generated by brain chemistry and imbalances of serotonin (one
of the “feel good” hormones that helps us sleep) or other neurotransmitters.
Most of the anti-depressant medications prescribed
currently are chemicals that maintain or improve serotonin
levels. Even the natural approach that utilizes diet, herbs,
and amino acids is geared toward raising serotonin levels.
For problems with depression, Western medicine doctors
most often prescribe from a class of drugs called the SSRIs,
abbreviation for Selective Serotonin Reuptake Inhibitors (help
maintain serotonin levels), or those substances like Prozac,
Paxil, Zoloft, Lexapro and Effexor. These medicines slow the
breakdown and clearing of this important brain chemical, thus
leaving more available to brain function. This then improves
the mood and motivation of its consumer. The problem is that
there are many possible, often likely, side effects of these drugs
rather than the “side benefits” of a natural approach. Common
side effects of the SSRI drugs include weight gain, loss of sexual
energy, and bouts of anger or anxiety.
A hidden problem that contributes to depression is hypothyroidism,
both the classically low thyroid function that any
physician can discover and “sub-clinical hypothyroidism,”
which is based on body/mind symptoms and body temperature.
If you are sluggish, have a slow metabolism, feel cold all
the time, and experience constipation, and some depression,
you may have low thyroid function. Your thyroid numbers may
be okay, but you could benefit from low-dose thyroid support,
as some people who are stressed and fatigued feel much better
as well as with adrenal support. (See the new book, Thyroid and
Mental Health by Richard Shames, MD, and his wife Karilee and
For mild to moderate depression, it is wise to try a course
of natural therapies, which follow here. For severe or persistent
depression, I suggest seeing a conventional or orthomolecular
psychiatrist for evaluation and treatment.
An integrated approach to any medical problem involves
three areas of care: lifestyle (behaviors), natural remedies (diet
and supplements), and pharmaceutical drugs as a last resort or
for more acute and serious problems.
This approach to psychiatry, which incorporates the use of nutrients to rebalance brain chemistry, is described as orthomolecular therapy. Readers can obtain referrals to trained orthomolecular psychiatrists in the U.S. and Canada by calling Orthomolecular Health Medicine in San Francisco at 415-922-6462. Many physician members of ACAM (American College for the Advancement of Medicine) and most naturopathic practitioners also have training in the treatment of depression using nutritional supplements and herbs. ACAM referrals can be obtained by following the instructions at 800.532.3688.
My general philosophy suggests that behavior involves motivation
and attitude, both of which affect how we care for ourselves,
such as whether we make healthy food choices or create and
maintain a regular exercise program. My approach in medicine,
and I think the highest calling of a physician (a philosopher-physician
of the ancient Chinese tradition) is to inspire and educate
patients to care for themselves—to live in a way that generates
health rather than have a lifestyle that causes disease. Other
aspects to depression support and treatment include:
- Self-image and self-love are important conscious and unconscious motivators that affect how we treat ourselves and whether we make the effort to maintain healthy habits.
- Meditation is a tool of ultimate and major significance. Practiced in moderation, meditation can be a meaningful adjunct to any medical regimen.
- Our inner dialogue is also important to our emotional health. (See Feeling Good by Burns, a classic book about the importance of maintaining positive self-talk and the applications of Cognitive Therapy.)
- Appreciation is another key to reestablishing joy. I encourage each of us to assess and appreciate what we have. At the same time, we can acknowledge the challenges we face and do everything in our power to identify and correct the medical and lifestyle approaches that decrease our depression.
- Self-image, how we view ourselves, has a lot to do with behavior and depression. If we feel unworthy of love, particularly of self-love, we may not treat ourselves with respect, or with healthy habits. If we can feel proud of who we are, and believe that we can improve and heal, and grow, we may be more able to rise out of the “blues.” It is common for people with depression to feel withdrawn and to look down, often with a hunched over back. Sit up, look up, and embrace life!
Exercise activity is one way to prevent and chase away depression.
Studies show that regular exercisers feel better and have
a better mood and attitude toward life than those who don’t.
Cleansing toxins from the blood and the body is one positive
way that could help to reduce or shift depression. In addition,
there are positive effects on the brain chemicals from exercise,
such as an increase in the uplifting endorphins. Work toward
a balanced combination of activities that includes aerobic exercise
3–5 times per week for 30–45 minutes, weight training
to improve strength and tone, and stretching to insure flexibility.
I know this takes an effort, even in organizing your time in
the busyness and demands of modern life. However, it is surely
worth it. I realize that it may be difficult to begin, especially if
you feel depressed, but once your routine is established, it will
build and potentially moderate some of the depressed state
naturally over the course of a week or two.
Fatigue, and sometimes anxiety and insomnia, frequently accompany
depression. In these cases, it will challenge your creativity
to work exercise into your life. Yoga and Tai chi, taking classes
or perhaps using a video, can be helpful and require less energy.
Walking continues to be one of the forms of exercise found by
patients, doctors, and research to be the most beneficial.
If you are too tired to exercise: Be sure to seek the care
of a health care professional. Explore some form of sitting Qigong
or Tai chi, such as that used by cancer patients in China
with reported benefit, or explore simple yoga postures and deep
Diet Guidelines to Prevent and Benefit Mild to Moderate Depression:
“Foods and moods” have been written about many times, and
it is clear to me that individual foods as
well as various types of diets contribute
to how we feel. Food nutrients and
chemicals (natural food and synthetic
contaminants and additives) affect
brain function and neurotransmitter
levels, and this leads to experiences
such as depression and anxiety, fatigue
or insomnia. Food reactions, allergies
and hypersensitivities, also affect energy
levels, moods, and mental faculties.
The False Fat Diet book (by myself and
Cameron Stauth) describes a broad
range of mechanisms involving food
reactivity, which can clearly contribute
to and alter mental, physical, and
emotional states. Add to this The Detox
Diet, an alkaline diet that also eliminates
the SNACC habits of Sugar, Nicotine,
Alcohol, Caffeine, and Chemicals,
and we have The Purification Process.
(See next month’s article.) Remember
that sugars—especially refined sugars
and sweet foods as with sodas and candies—
alter the glycemic index and are
often associated with rapid mood changes and depression.
- Get all the appropriate nutrients from wholesome foods and supplements
- Avoid chemicals and junk foods as much as possible
- Rotate your foods and avoid your reactive foods
- Watch your sugar and refined foods intake
- Eat adequate proteins along with fresh vegetables
- Consume fresh fruits and some nuts and seeds
- Eat whole grains and legumes and some sprouts
There is a wide range of vitamins, minerals, amino acids, and
herbs that can help alleviate depression. Many of them support
brain function and specifically serotonin levels. Others support
normal hormone balance, specifically of the thyroid and adrenal
The Role of Serotonin and Treatment Using 5-HTP
The connection between pain and low
serotonin levels is emphasized in a review
on fibromyalgia, “A musculoskeletal
pain and fatigue disorder manifested by
diffuse myalgia (muscle pain), localized
areas of tenderness, fatigue, lowered
pain thresholds, and non- restorative
sleep.” The first step in treatment
suggested is to identify low serum
tryptophan and serotonin levels through
testing. The review also indicates that
supplementing the “serotonin substrate”
through either L-tryptophan or 5-HTP
(5-hydroxytryptophan) has been shown to
improve symptoms of depression, anxiety,
insomnia and somatic pains.
- Start with the B vitamins and some minerals. The most important is pyridoxine, vitamin B6. It assists many brain and neurotransmitter functions. Vitamin B12 along with folic acid supports nerve structure and functions, while pantothenic acid and vitamin C aid the adrenal glands and energy. Choline and inositol also aid the brain. Calcium and magnesium allow relaxation and better sleep when taken at night, and iodine supports normal thyroid function. Many of my patients use trace mineral liquids to support hydration and mineral function, which keep our cells electro-dynamically active. Also, for most people we suggest a good quality multi-vitamin/mineral product that is appropriate for their gender and age.
- Amino acid support may be a valuable key to clearing or reducing depression. Adequate protein in the diet is a good beginning for obtaining needed levels of amino acids. In addition, several specific ones may be helpful when taken in higher amounts as supplements. Phenylalanine seems to improve endorphin levels and reduce pain. Tyrosine is energizing and is needed for proper thyroid function; 500–1,000 mg can be taken in the morning and after lunch. Tryptophan is the most important since it directly makes serotonin, which seems to be low in testing for most people suffering from depression. Tryptophan is available or another serotonin precursor, namely 5-HTP (5-hydroxy-tryptophan), can be obtained at health food stores. The amount to start with is 50–100 mg (up to 200 mg) taken at night, as it aids sleep, with an additional 50–100 mg in the morning. The tryptophan dosage is basically ten times the 5-HTP amount in 500–1,000 mg at bed and sometimes in the morning for depression, although both these amino acids can cause drowsiness during the day (so, for people with anxiety and depression, it often works better than for those with fatigue). These amino acids are also helpful for those suffering from Fibromyalgia (as is magnesium malate or malic acid).
- There are also several herbs that may be helpful in improving depression. St John’s wort, with hypericum as the active ingredient, has been helpful in several research studies and in clinical practice as well. It needs to be taken consistently for a month to two to see the benefits and usually three times daily of 300 mg capsules of 0.3% hypericum. Other herbs can be used to handle other symptoms that go with depression. This might include valerian and hops for insomnia, and kava kava for anxiety (GABA also helps for this). Panax ginsengs can be used for energy and Siberian ginseng utilized more for stress. For women with PMS or menopause, or for men with libido changes, different herbal combinations might be beneficial. SAM-e (S-Adenosyl Methionine) has some benefits in the treatment of depression, with decreases in depression scores. However, some people have uncomfortable physical symptoms such as diarrhea and increased anxiety.
With mild to moderate depression, consider an integrated approach
drawing on the experience of a naturally-oriented physician
who can help you sort out your options. You may be able
to get acceptable results without the use of prescription drugs.
Acupuncture can be helpful, as could the use of homeopathic
remedies. Massage and relaxation therapies may likewise offer
improvement. Meditation can be of great value, as can regular
exercise. As with so many diseases, getting involved in your own
program and finding a way to make things right, and to make
them work for you (becoming your own best doctor) is likely the
highest art in health care. In other words, get involved in your
health and feel empowered. Seek wisdom and guidance from
those trained to help you make the best decisions for you. For
your long-term care, develop a working partnership with your
practitioner. A multi-faceted approach typically holds the greatest
Genetic Links to Depression
Research suggests possible indirect genetic links to depression.
A study of the effects of exercise on depression and hormone
output evaluated 82 healthy male volunteers (age 18 to 26 years
old), who used an exercise bicycle to achieve maximum exertion.
The volunteers were tested regarding their mood using
the Beck Depression Inventory, an anxiety scale, stress scale,
and self-efficacy scale. Blood samples were tested to measure
growth hormone, cortisol, and testosterone.
Remember—genetics is not destiny. With the right guidance
and health plan, you can delay your pre-dispositions to certain
diseases, from heart disease and cancer to depression. Take
care of yourself; it’s worth it!