NON-PHARMACEUTICAL TREATMENTS THAT WORK*
What Is Depression?
Depression is a complicated illness that can involve a number of contributing factors including genes, environment, diet, lifestyle, brain chemicals, psychology and personality.
A number of disorders have depression as a key feature. These include:
ź Major depressive disorder
ź Bipolar disorder (manic depressive illness)
ź Postnatal depression
ź Seasonal affective disorder
ź Dysthymic disorder (mild chronic depression)
ź Cyclothymic disorder (mild chronic alternating mood swings of elation and depression).
Depression is not just feeling sad. Everyone feels sad from time to time. People with depression experience severe and prolonged feelings of sadness, dejection and hopelessness that are a change from their usual self.
It is normal to be ‘depressed’ when you experience some major disaster or have suffered a severe loss, ie exogenous depression.
Exogenous depression is that which results from life events, or things and happenings external, whereas endogenous depression is that which results from some inherent or biochemical imbalance in the patient’s brain.
It was once thought that those with exogenous depression did not respond to antidepressant medication, presumably because their depression was not a function of their physiology, but rather a reaction to their life situation. It was believed that depression precipitated by the loss of a loved one, or any other grief-inducing event (grief being the response to loss), would not respond to antidepressants because it was exogenous, i.e. not physiological.
The depression of the exogenous type is still the result of alterations in the neurotransmitters. Hence, antidepressants may give some benefit. However these changes resolve more readily when the grief or loss is dealt with by supportive psychotherapy (see below). Genetics have a minimal role in exogenous depression. It is not associated with hypomania or mania, going ‘high’.
The symptoms of depression include:
ź Feeling sad, hopeless and despairing
ź A loss of interest and pleasure in normal activities
ź Loss of appetite and weight
ź Loss of sex drive
ź Sleeping problems, such as inability to get to sleep or early morning waking
ź Feeling physically tired all the time
ź Poor concentration
ź Feeling guilty and worthless
ź Feeling life is not worth living.
Are you Depressed? If for more than two weeks you have:
1) felt sad, down or miserable most of the time and/or
2) lost interest or pleasure in most of your usual activities
and have at least three symptoms in the following checklist, then you probably have a depressive illness.
ź Behaviour: stopped going out, not getting things done at work, withdrawn from close family and friends, relying on alcohol and sedatives, stopped doing things you enjoy, unable to concentrate.
ź Thoughts: “I’m a failure”, “It’s all my fault”, “Nothing good ever happens to me”, “I’m worthless”, “Life is not worth living”.
ź Feelings: overwhelmed, unhappy, irritable, frustrated, no confidence, guilty, indecisive, disappointed, miserable, sad.
ź Physical: Tired all the time, sick and run down, headaches and muscle pains, churning gut, can’t sleep, poor appetite /weight loss.
Risk factors are many and include:
ź A life-changing event, for example the death of a loved one or the arrival of a new baby.
ź Chronic illness. This is a loss, the loss of health. (Loss results in a grieving process and depression is an integral part of grief).
ź Certain medications, for example some drugs for the treatment of hypertension, steroid drugs.
ź Sustained stress or problems at home or work or socially.
ź A history of child abuse.
ź Alcohol excess.
ź A family history of depression.
ź Chronic anxiety.
Although the diagnosis of depression is generally made from the history, the following diagnostic methods may be necessary to exclude physical illnesses and identify treatable causes of depression:
ź Physical examination - to check for any underlying physical illness.
ź Medical history - for example, drug usage (such as antihypertensive drugs, steroid drugs, alcohol) which can cause depression as a side effect.
ź Detailed questioning - asking about triggering life events etc.
ź Psychological tests - to help identify the type of depression.
ź Laboratory studies - for example, blood counts, thyroid activity etc.
Treatment of Depression with Pharmaceutical Drugs
The traditional paradigm in the treatment of depression is the prescription of antidepressants. Antidepressants are one of the most-prescribed drugs.
Drugs are regarded by the orthodox medical profession as the ‘quick fix’, and indeed the only ‘fix’, for depression. If you suffer from depression, understandably you want relief quickly. Whether endogenous or exogenous depression, the G.P. or psychiatrist will prescribe an antidepressant drug.
There is a range of different types of antidepressant medications (and many different drugs within each category). These include:
ź Tricyclic antidepressants
ź Tetracyclic antidepressants
ź Selective serotonin reuptake inhibitors (SSRI)
ź Monoamine oxidase inhibitors (MAOI)
ź Selective noradrenaline reuptake inhibitor
ź Reversible inhibitors of monoamine oxidase.
Non-Pharmaceutical Alternatives in the Management of Depression
The purpose of this newsletter is to look at the non-pharmaceutical alternatives in the management of depression that may be used instead of drugs, or combined with prescribed medications, to give a better outcome.
If you are currently taking medication (drugs) for depression, consult with the prescribing physician before stopping them or altering the dosage, especially if there is any suicidal intent.
Non-drug treatments require more time and patience to achieve results. And in the acute, severely depressed case, intensive and close follow-up may be needed, especially using a psychological approach.
1. Psychological treatments
Cognitive Behavioural Therapy (CBT). This is a scientifically, well-established and effective treatment for depression. CBT seeks to help people change how they think about things. It focuses on the ‘here and now’ problems and difficulties. Interpersonal therapy is similar.
Numerous clinical studies, published in such journals as the Archives of General Psychiatry and the American Journal of Psychiatry, have consistently shown that CBT is as effective as antidepressant medication in the treatment of major depression.
2. Supportive Counselling
Counselling, including psychotherapy, has a very important role in the overall management of depression. The details of this therapeutic modality are described in my August 2006 newsletter ‘Supportive Counselling’.
Where necessary, it is also important to address any contributing problems, such as relationship difficulties, grief and the grieving process.
In dealing with exogenous depression, it is essential to isolate the main life problem that caused the depression. When you are feeling depressed, everything seems to be bad and thus it is possible to fail to recognise just what the main problem actually is. In doing so (failing to identify the true problem) other problems may be solved but not reduce the depression. It is not uncommon for the real cause of the depression to be denied or suppressed by the patient.
3. Physical Activity and Exercise
Physical exercise is one of the most powerful antidepressants there is. Numerous studies have shown that aerobic exercise can improve mood and is an antidote for mild depression and anxiety. Aerobic exercise is that which increases the heart rate to a calculated level or greater (210 minus age in years, times 0.75).
Physical exercise changes the level of serotonin in the brain (similar to the effect of the SSRI drugs). It also increases the level of endorphins, the ‘feel-good’ hormones.
Exercise has the extra benefit of improving physical functioning and weight control.
Start an exercise routine today. Regard this as a crucial part of getting healthier and happier.
4. Healthy Diet
A healthy diet is an essential part of the management of depression, whether pharmaceutical drugs are taken or not. It is very common for the depressed person to be on a poor diet of ‘fast’ convenience foods. In part this is because they feel it requires too much effort to buy and prepare healthy meals. A diet of junk food is often linked to depression.
The principles of a healthy diet have been set out in detail in my book ‘How to Live to 100+ Years Free from Symptoms and Disease’ (see home page), in my September 2005 newsletter ‘Acid Alkali Balance - The Ideal Diet’ and my March 2009 newsletter ‘Foods for Health’.
5. St John’s Wort
St John’s wort is a herb, hypericum perforatum. It is commonly used for the treatment of depression, especially the mild to moderate forms. It is a reasonable choice for patients who prefer natural medicines over pharmaceutical drugs.
St John’s wort inhibits the reuptake of the neurotransmitters serotonin, nor epinephrine and dopamine.
Numerous double-blind, placebo-controlled studies have examined the effectiveness of St John’s wort in the treatment of mild to moderate depression, and most have found the herb to be more effective than placebo and at least as effective as some of the antidepressant drugs, especially the tricyclic antidepressants.
6. 5-Hydroxytryptophan. (5-HTP)
5-HTP and tryptophan are natural alternatives to pharmaceutical drugs and have been shown to be more effective than placebo at alleviating depression.
When the body manufactures serotonin, it first makes 5-HTP. The theory behind taking 5-HTP as a supplement is that providing the raw ingredient might raise serotonin levels.
Massage is one of the oldest health practices. It has been used as a healing therapy for centuries, in nearly every culture around the world. Massage enhances feelings of well-being and produces chemical changes in the brain increasing serotonin and dopamine, neurotransmitters that help reduce depression. It also brings about a feeling of relaxation, calm and well-being. Massage reduces levels of stress hormones such as adrenaline and cortisol, which in some people can trigger depression.
8. Relaxation, Hypnotherapy, Yoga and Meditation
Depression IS a very serious condition, however it is not a ‘disease’, especially exogenous depression. Rather it is a sign that your body and your life are out of balance. It is important that the balance of life is restored, and one of the key ways to do this is to address stress.
Relaxation techniques, hypnotherapy, yoga and the various types of meditation are useful ways to cope with stress and anxiety. These techniques need to be taught by a trained professional and then practised daily.
Emotional Freedom Therapy (EFT) is an effective method of coping with emotional issues. The manual setting out the rationale, and the ‘how to’, of EFT can be accessed at www.emofree.com. The technique is straight forward to learn and only takes minutes to carry out.
Vitamin supplements are generally recommended as part of a healthy diet. The rationale for these is set out in Chapter 11 ‘Vitamin Supplements’ of my book ‘How to Live to 100+ Years free from Symptoms and Disease’ (see homepage).
The following are specifically linked to the management of depression:
· Folic acid. Deficiency of folic acid has been noted among people with depression. Deficiency of folic acid has also been linked to a poor response to antidepressant medication.
· Vitamin B3. Niacin or nicotinic acid or vitamin B3 deficiency is called pellagra and is characterised by depression.
· Vitamin B6. Pyridoxine, or vitamin B6, is the cofactor for enzymes that convert L-tryptophan to serotonin and L-tyrosine to nor epinephrine. Consequently, vitamin B6 deficiency might result in depression.
· Vitamin B12. There is some evidence that people with depression respond better to treatment if they have higher levels of vitamin B12.
10. S-Adenosylmethionine (SAMe)
SAMe is an amino acid derivative that occurs naturally in all cells. It plays a role in many biological reactions by transferring its methyl group to DNA, proteins, phospholipids and biogenic amines. This could result in SAMe indirectly influencing neurotransmitter metabolism. Several studies have shown that SAMe may be useful in the treatment of depression.
11. Light Therapy
Seasonal Affective Disorder (SAD) is depression which is more common in the winter months in the northern hemisphere with reduced sunlight exposure due to short days and long nights. Brain chemistry is affected by sunlight exposure and some studies have shown that light hitting the back of the eye (retina) stimulates the brain to make chemicals that lift a person’s mood.
Bright light therapy may be used to stimulate the brain to make these mood-enhancing chemicals. It is seldom necessary in a well-lit country like Australia.
Healthy vitamin D levels are a crucial factor in the treatment and prevention of depression. One study showed that people with the lowest levels of vitamin D were 11 times more prone to be depressed than those with normal levels. Sunlight on exposed skin is the ideal way for the body to manufacture vitamin D. The importance of sunlight in disease prevention is set out in my November 2007 newsletter ‘Sunlight and Health’.
13. Omega-3 Fatty Acids
Docosahexaenoic (DHA). A DHA supplement of 200-600mg daily is recommended. This essential omega-3 fatty acid supports optimal brain function. Dr Joseph Mercola has stated: “…[DHA] may be the single most important nutrient to battle depression.”
DHA can be combined with another omega-3 essential fatty acid eicosapentaenoic acid (EPA), 200-400mg daily.
14. Hospital Admission
This should be considered in the case of very severe depression, attempted suicide, threatened suicide or serious suicidal intent.
Depression is a complicated condition that involves a number of factors as set out above. There are many disorders that have depression as a key factor.
Depression is not simply normal sadness, being moody or just low in mood, but is a serious ‘illness’. It causes both physical and psychological symptoms. It can absolutely devastate your health.
Depression is common. It is estimated that one in four females and one in six males will experience depression in her/his lifetime.
Depression is the leading cause of suicide.
Depression is often not recognised or treated. It is suggested that up to two-thirds of people with depression go undiagnosed.
‘Adequate treatment’ of depression in a traditional model is really a nearly universal synonym for drug therapy.
This newsletter sets out alternatives to pharmaceutical drug therapy. They may be combined with prescribed medication to give a better outcome.
Where depression is more than mild, and especially if there is any suicidal ideation, supervision by a competent health professional is essential.
Always seek help if you feel depressed.
*Copyright 2009: The Huntly Centre.
Disclaimer: All material in the Huntlycentre.com.au website is provided for informational or educational purposes only. Consult a health professional regarding the applicability of any opinions or recommendations expressed herein, with respect to your symptoms or medical condition.
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