Overcoming Depression For Dummies

by Smith, Laura L.

  St John’s wort has been widely studied throughout Europe and in the US. Some studies show that St John’s wort is as effective as certain antidepressant medication, while other studies show it to be about as effective as a placebo (see the nearby sidebar ‘The placebo effect’).

  The conclusion you can draw from most studies is that St John’s wort is likely to be an effective treatment for mild depression, for some people.

  If you decide to take St John’s wort, buy it from a reputable company. Make sure that it has at least 5 per cent hyperforin, which researchers believe is the active ingredient in St John’s wort. Watch out for side effects, including gastrointestinal upset, over-sensitivity to sunlight, and agitation.

  SAM-e

  S-adenosylmethionine, or SAM-e (a compound found in human cells), is a more recent dietary supplement that appears to have a variety of positive effects on the body (from treating liver disease, to combating memory loss, and for arthritis).

  A growing body of research supports the usefulness of SAM-e for treating mild depression. SAM-e is thought to boost mood and even improve the effectiveness of medication when given with other antidepressants. Because SAM-e is associated with fewer side effects than prescribed antidepressants, it has also become a popular complementary treatment for depression. Nevertheless, more research is needed to find out how exactly how effective SAM-e is in the treatment of depression.

  And SAM-e does have its drawbacks:

  It’s not available on the NHS, so it can be quite expensive.

  People with bipolar disorder should never use it because it may trigger an episode of mania (refer to Chapter 2 for more information about bipolar disorder and mania).

  It can cause heart palpitations, gastrointestinal upset, and headaches.

  Tryptophan and 5 HTP

  Tryptophan is an amino acid found in many common foods such as milk, potatoes, turkey, sunflower seeds, and chicken. The body converts tryptophan into 5 HTP (another type of amino acid), which it can then convert into serotonin, a chemical messenger that seems to have a positive effect on mood.

  Tryptophan as a dietary supplement was banned in the US after a contaminated batch caused severe illness and death. Thirty-seven people died and about 1,500 people were permanently disabled after taking tryptophan in the late 1980s. They contracted the disease EMS, or eosinophilia myalgia syndrome, which resulted in paralysis, neurological problems, fatigue, and heart problems. Almost all the people who were affected had taken a supplement from one Japanese company that was believed to have supplied a contaminated batch of the supplement.

  However, 5-HTP is still available in the US as a dietary supplement for the treatment of depression. Because many antidepressants increase levels of serotonin, it is believed that 5-HTP can be an effective antidepressant.

  The most recent comprehensive review in the UK in 2002 concluded that tryptophan and 5-HTP are better than placebo in easing depression. However, they suggest that further studies are needed to evaluate the efficacy and safety of 5-HTP and tryptophan before their widespread use can be recommended.

  Because the safety of 5-HTP hasn’t been firmly established, getting your serotonin boost from foods such as turkey or sunflower seeds is probably a better bet at this time. Organic produce is always safer, because it is less likely to contain pesticides. As with all supplements and complementary therapies, make sure that you first seek advice from your doctor.

  Omega-3 fatty acids

  Omega-3 fatty acids play a role in the function of dopamine and serotonin – critical neurotransmitters affecting mood (refer to Chapter 15 for more information about neurotransmitters). You find omega-3 fatty acids in flax seed, soya beans, avocados, tofu, and fish, or you can buy it as a supplement.

  Research shows that increased levels of omega-3 may help lessen depression, and for manic depressives it may cut the chance of relapse. Also, studies clearly show that increasing your intake of omega-3 helps reduce the risk of cardiovascular problems and may even help lower cholesterol levels. So make sure that you include foods that are rich in omega-3 in your diet, or think about taking a supplement. Once again, do first discuss it with your doctor.

  Multivitamins

  If you’re suffering from moderate to severe depression, taking extra vitamins and minerals isn’t likely to cure you. But a lack of certain vitamins and minerals does seem to be related to depression and memory problems. The research clearly shows that when people have a deficiency of vitamin B (especially B6, B12, and folic acid) they are also often depressed. These critical vitamins help keep neurotransmitters working properly, (see Chapter 15 for more on neurotransmitters).

  Deficiencies in calcium, magnesium, potassium, iron, selenium, zinc, and sodium also seem to be associated with depression. However, research shows that most people suffering from depression haven’t any marked deficiencies in these vitamins or minerals.

  Try taking a complete multivitamin and multmineral supplement. Be sure that the vitamin contains the recommended daily values of the B vitamins. Increasing your intake of folic acid may also help improve the effectiveness of some antidepressant medication. Between 400 to 800 milligrams of folic acid is recommended daily.

  You don’t need to take mega quantities of vitamins and minerals, and doing so isn’t likely to help your depression. Too much of certain vitamins can actually be downright dangerous, so stick to the recommended daily doses. Remember, rather than lifting your mood, too many supplements can have the effect of raising your credit card bill instead.

  Hyped-up herbs?

  Visit any health food shop or Internet herbal website and you’ll find masses of herbs claiming they contain properties that can lessen depression. Some of the herbal remedies listed include:

  Basil

  Black hellebore

  Clove

  Ginger

  Oat straw

  Rosemary

  Sage

  Thyme

  Before rushing out and spending your hard earned cash on herbs be aware that the actual research showing that these and many other herbs and tonics are effective for treating depression still remains scarce – although you may still be able to cook up some interesting and tasty dishes. Tell yourself that sometimes it’s more beneficial to stick with what’s known to work.

  Food for Thought

  Depression can cause a loss of appetite and lead to weight loss. Depression can also give rise to cravings, which means you start putting on weight. Eating too little food or too much unhealthy food leads to poor nutrition, the body is deprived of the nutrients your brain needs for proper functioning. And when the brain doesn’t function well, the intensity of depression increases. When you’re depressed, maintaining a healthy diet is especially important.

  We recommend that you:

  Eat sensible, well-balanced meals.

  Don’t skip meals.

  Drink alcohol only in moderation, or not at all.

  Don’t beat yourself up if you occasionally indulge in ‘naughty food’ such as sweets and chocolate.

  Also look at your carbohydrate intake. Put simply, carbohydrates boost mood. Have you ever craved something sweet when you felt sad or upset? Just think of the yummy smell of freshly baked chocolate chip cookies. A craving for sweets may be your body’s way of telling you that it needs a carbohydrate fix. The body breaks down carbohydrates and converts them to glucose (sugar), which is the fuel that keeps you going.

  There are two different kinds of carbohydrates: simple and complex. The body quickly converts simple carbohydrates (such as white rice, bread, cakes, crackers, beer, wine, and most pastas) into sugar. The spike in your blood sugar level after eating simple carbohydrates may temporarily lift your spirits.

  The problem with simple carbohydrates is that the quick conversion into sugar also tells your body to produce extra insulin. The insulin then causes your blood sugar level to fall. For many, the drop in blood sugar then leads to a lowered mood, irritability, and more craving for sugar. Docto
rs believe that these rapid peaks and troughs in insulin levels aren’t good for you for many reasons, but there is a real possibility that they may contribute to the development of diabetes and heart disease.

  Eating complex carbohydrates is a good way of improving your mood. You find complex carbohydrates in whole grains, beans, vegetables, roots, and fresh fruits. They break down into sugar more slowly, allowing your insulin levels to stay more stable. They don’t increase cravings or lower moods. Some nutritionists argue that complex carbohydrates also raise serotonin levels. So eating complex carbohydrates may be helpful in improving your mood without the peaks and troughs that occur with simple carbohydrates.

  Lighting Up the Darkness: Light Therapy

  If you’re continually feeling sad and blue in winter (assuming you’re wearing sufficient warm clothing!) then you may be suffering from seasonal affective disorder, or SAD (refer to Chapter 2 for more information on SAD). Winter is a time when many people feel a little down, the sun rising late and setting early day after day, and heavy clouds blotting out the sun. However, people with SAD feel more than just a bit low – experiencing symptoms of a major depressive disorder (refer to Chapter 2), such as loss of pleasure and interest, and having very little energy.

  In the UK, researchers believe that SAD affects at least 1 in 50 people, and many more, up to 1 in 8, get the winter blues – a less severe form of the condition. SAD is less common in people who live in countries near to the equator where the hours of sunlight are more constant and it’s brighter throughout the year. In Europe people usually first develop SAD in their twenties, It can happen at any age, and is four times more common in women than men.

  You can treat SAD with all the usual treatments for depression that we discuss in this self-help book. Light therapy is becoming a highly popular treatment. With light therapy, a light box exposes you to bright light that is 10 to 100 times more powerful than a standard 100-watt light bulb. You use it for between 30 minutes to two hours a day.

  The effectiveness of light therapy is disputable. Some studies suggest that two out of three people respond well to this therapy, but a few studies show no more improvements than those obtained with a placebo (see the earlier sidebar ‘The placebo effect’). Light therapy for SAD isn’t available on the NHS, although some private medical insurance policies may cover the equipment. But you can buy your own light box for around £50 to £300, and some companies allow you to ‘try before you buy’.

  Some advantages of light therapy are:

  It often works quite rapidly (sometimes within three to four days).

  It has fewer side effects than most medication.

  After the initial purchase of the equipment, it’s inexpensive to run.

  However, light therapy does have a few, usually mild, side effects. These include headaches, nausea, eye strain, jumpiness, sleep disturbance, and agitation. Studies show that patients who use light therapy for many years don’t suffer from eye problems. However, the long-term effects of light therapy aren’t yet known. If you do suffer from any eye problems, check with an ophthalmologist before trying light therapy.

  To help drive away SAD many doctors recommend a daily walk outside during the brightest part of the day as an alternative to light therapy.

  Treating Severe Depression

  Unfortunately, some cases of depression are particularly difficult to treat, and both medication and psychological therapy can fail to ease the pain and suffering. The following complementary treatments are used specifically for what is termed treatment-resistant depression. We include these treatments in this chapter on alternative therapies because they’re not now regularly used as a treatment for depression.

  Electrifying results

  In April 1938, Italian doctors gave a severely psychotic man an electric shock, after which the man apparently lived a normal life. Thus, electroconvulsive therapy (ECT), popularly known as electric shock therapy, was born. Interest in ECT for the treatment of depression steadily grew through the 1950s, but then the emergence of antidepressant medication heralded a decrease in the popularity of ECT. However, ECT is still in use, particularly for cases of severe, treatment-resistant depression.

  Thanks to old black and white horror films ECT conjures up images of patients strapped onto a table and thrashing wildly with electrodes attached to their scalps. But the reality of modern-day ECT contrasts sharply with that image.

  Eddie suffers from major depressive disorder. Severe depression runs through both sides of his family, and his eldest brother and two uncles committed suicide. Eddie is on several different antidepressant medications and has tried a variety of psychological therapies over a number of years. Yet, after a particularly stressful month, his medication seems to be ineffective and he’s tormented with suicidal thoughts. Eddie’s psychiatrist suggests ECT as an alternative. Desperate for help, Eddie agrees.

  Eddie’s psychiatrist carries out several tests, checks his heart, and declares him fit for the procedure. The doctor then administers general anesthesia and muscle relaxants. Eddie isn’t going to feel a thing. The doctors attach monitors and put electrodes on the right side of his head. The treatment lasts for about 30 seconds. Eddie’s big toe wiggles a bit. He wakes up confused, muttering, ‘Where am I? What’s going on?’

  Eddie doesn’t remember anything about the procedure, but as he leaves the hospital, his mood already starts brightening. Eddie remarks to his wife that the procedure was so much easier than he’d feared.

  If your doctor recommends ECT, your experience is probably going to be similar to Eddie’s. However, be aware that some patients complain about a variety of memory problems, and others have headaches. Generally, these side effects are mild and short-term, but they can be more serious.

  Most ECT treatments take place within a series of sessions, such as two to three times a week for a month. Patients typically respond to ECT soon after receiving treatment.

  Overall, ECT appears to be more effective in the short-term than drug therapy, especially for difficult, severe cases of depression. In that sense, ECT can be considered a mainstream treatment for depression. However, we’re including ECT in this chapter on alternative treatments because doctors use ECT much less frequently than medication and psychological therapy for depression, with the important exception of especially severe cases.

  Unfortunately, relapse rates are high following ECT, probably because of the severity of the depression in the people who undergo the treatment (see Chapter 17 for more information about relapse). But the relapse may be due to something about the ECT itself. Patients often need antidepressants, psychological therapy, or extra ECT to stay depression-free. And like drug therapy, the effects of receiving ECT over many years are not known, because long-term studies of patients having ECT haven’t yet been carried out.

  Stimulating nerves

  Scientists are constantly searching for new treatments for depression. One of the newest currently under investigation is vagus nerve stimulation (VNS). It was first found to be effective in preventing seizures during the 1980s. More recently doctors have used VNS for serious, treatment-resistant depression.

  The vagus nerve is one of the 12 nerves running through the head, controlling your heart rate, vocal cords, bronchial constriction, and movements within the digestive tract. A study reported in the Journal of Psychosomatic Medicine shows that VNS can interfere with memory of negative information, thus acting as an effective antidepressant.

  The procedure involves implanting a device, which intermittently sends out a mild electrical impulse to electrodes woven around the vagus nerve, in the upper part of the chest. Patients who undergo this procedure report mild side effects, including:

  Facial muscle weakness

  Hoarseness or cough

  Mild sore throat

  Shortness of breath

  These side effects are worse while the stimulation is being applied, but they usually decrease over time. Stimulation is typically applied for about a half min
ute every three to five minutes, 24 hours a day. Patients are given ways to shut down the device if they find it too uncomfortable.

  Early evidence suggests that VNS can bring a great improvement for a significant number of patients. The vast majority of those who improve don’t experience early relapse. The treatment takes quite a while to work, but it may also improve in effectiveness the longer it continues.