Dealing with depression

Depression is a common psychological disturbance that is characterized by loss of pleasure in life, lack of joy or happiness, melancholic outlook and generalized ill health.

It is the most common psychological disorder in the general population. Ten per cent to 20% of the general population suffer from this affliction at one time or another. Twenty per cent to 50% of patients in general practice are affected by depression to some degree. Thirty per cent to 60% of general hospital in-patients suffer from depression.

Signs and symptoms of this disorder include poor appetite with weight loss or increased appetite with weight gain, lack of sleep or insomnia, too much sleep or hypersomnia, agitation or depression of movement and muscle coordination, loss of interest or pleasure in usual activities, loss or decrease in sexual drive, feelings of worthlessness, self-reproach or inappropriate guilt, diminished ability to think and concentrate and recurrent thoughts of death or suicide.

There are two main categories of depression. Unipolar depression is characterized by one or more episodes of depression alone. Bipolar depression is characterized by episodes of depression alternating with periods of mania. Additionally, seasonal affective disorder (SAD) is another type of depression that occurs with decreased levels of sunshine experienced in the winter months.

Undiagnosed medical illness often presents as depression and should be considered in the evaluation of any sick patient. Hormone dysfunction, infectious disease, cancer, nutritional deficiencies and stress can present with signs and symptoms of depression.

Diagnosis of depression is based on symptoms presented to the clinician. Asking a direct and straight forward question of asking if the patient thinks they are depressed or not, is helpful.

Often referred to as a disease of exclusion, there is not a reliable blood or lab test that confirms the diagnosis of depression. Lab tests rule out other underlying conditions that may cause or contribute to depression.

Anemia, low iron, low Vitamin b12, other Vitamin B deficiencies, hypothyroidism, diabetes and blood sugar irregularities and other abnormalities may be diagnosed through proper blood tests.

Cortisol abnormalities have been suggested to be related to depressive episodes. Both low and high levels and abnormalities in daily rhythm of cortisol levels have been observed in depressed patients. Cortisol levels vary throughout the day and lab tests have a broad range. The clinical utility of measuring cortisol levels does little to change treatment.

Conventional medical treatment of depression is based on drug therapy. Tricyclic antidepressants were discovered in the 1950s and marketed later that decade. Amitriptyline, doxepin, imipramine, and nortriptyline are examples of tricycle antidepressants. While effective they are often not prescribed because of side effects including fatigue, weight gain and digestive disturbance.

Slow serotonin re-uptake inhibitors are a newer category of antidepressant that increases serotonin levels by decreasing its breakdown between adjacent nerves or neurons. Prozac or fluoxetine was the first SSRI drug marketed in the late 1980s for depression. Other SSRIs now include citalopram or Celexa, escitalopram or Lexapro, paroxetine of Paxil and sertraline or Zoloft. They all work by the same mechanism of increasing serotonin levels but have different affinities for different subtypes of serotonin receptors, different half life duration of activity and slightly different side effect profiles.

Atypical antidepressants drugs usually affect more than one type of neurotransmitter including adrenaline, dopamine and serotonin. These drugs include Bupropion or Wellbutrin, Effexor or venlafaxine, mirtazapine and trazadone.

Lifestyle habits are important in helping overcome depression. Daily exercise can be effective in improving moods. Moderate daily aerobic exercise between 30 and 60 minutes in the form of cycling, swimming, walking or other sport is recommended. Also, exercise in outdoor green space appears to be better than sterile, indoor exercise. Sleeping habits are also important in maintaining mood.

A lack of good quality sleep contributes to low mood and depression. Maintaining good sleep habits, such as avoiding stimulation before bedtime, going to bed at the same time and sleeping in a slightly cooler environment is important.

Diet is important in the treatment of depression. Neurotransmitters are made from specific amino acid precursors in our food. Specific amino acids for this purpose include gamma aminobutyric acid or GABA, phenylalanine, theanine, tryptophan and tyrosine. These amino acids are found in good quality protein foods. Highly processed foods are usually low in vitamin and mineral nutrient quality. Specifically, B-vitamins and trace minerals affect brain and neurological function and as cofactors in the manufacture of neurotransmitters. High sugar foods directly affect brain function, cause blood sugar fluctuations and contribute to irregularities in mood and behaviour. Good oils found in fish and vegetable oil such as olive oil help to nourish nerves or neurons in the brain.

Supplements such as B-complex vitamins, trace minerals like chromium, selenium and selenium are important for proper brain and neurotransmitter function. Amino acid supplements such as 5-hydroxytryptophan and tyrosine can improve specific neurotransmitter levels. Herbal medicines including Ashwagandha, Lion’s mane, saffron, Saint John’s wort and Siberian ginseng have also been reported to improve moods.

The information provided in this article does not, and is not intended to, constitute medical advice. All information and content are for general information purposes only.

This article is written by or on behalf of an outsourced columnist and does not necessarily reflect the views of Castanet.