Depression

What should I know about depression?

Depression has been part of the human condition since antiquity. Hippocrates, the ancient Greek “Father of Medicine,” is generally credited with the first description of an emotional disorder and is thought to have coined the term “melancholia,” literally translated as “black bile.”

Although life is filled with unexpected events such as the death of a loved one, loss of a job, major illness, or other catastrophic events, not everybody becomes depressed. Most individuals suffer only temporary feelings of depression and find ways to adjust to life’s challenges. However, there are certain individuals who experience a major depressive episode when faced by stressful situations.

Depression has been classified as a mood disorder or “affective” disorder. Mood is defined as a powerful, sustained emotion that, in the extreme, markedly affects a person’s perception of the world and ability to adequately function in society. Mood disorders are among the most common health problems doctors see every day. Mood disorders are divided into two major categories: depressive disorders and bipolar disorders.

Depression affects approximately 5 percent of the population at any given time, and about 30 percent of adults will suffer from depression over a lifetime. Commonly thought of as a disorder of young to middle adulthood, with an average age of onset in the late 20′s, depression is also a common psychiatric illness in the elderly. Women are two to three times more likely to experience depression than men.

Mood disorders, depression, and anxiety are common illnesses in our society. Lost work time, family conflicts, personal strife, and other consequences of the disease can eventually lead to complete disruption of one’s life. Depression and mood disorders have become increasingly recognized as widespread health problems. In spite of this they are often under-diagnosed and under-treated.

Causes of Depression

The causes of depression are too complex to be totally explained by a single social, biological, or developmental theory. Several factors seem to work together to trigger depressive disorders. Heredity does seem to have a role, as studies have shown. Depressive disorders and suicide tend to run in families, and first-degree relatives of patients with depression are one and one half to three times more likely to develop depression than people with no depression in the immediate family.

Depression is not simply “all in the head.” Depression has physical causes, linked to abnormalities in brain chemistry. The symptoms of major depression consistently reflect changes in “neurotransmitters,” substances that regulate function of the brain and nervous system. The neurotransmitters closely related to depression are norepinephrine, serotonin, and dopamine.

Serotonin is a key neurotransmitter for maintaining mental and emotional health. Low serotonin plays a big role in depression. Prolonged stress—physical, mental, or emotional can deplete the body’s serotonin supply. A host of other health problems can contribute to depression by robbing serotonin, including adrenal exhaustion, hypothyroidism, heavy metal toxicity, and “leaky gut” syndrome with subsequent food intolerance. Deficiencies in nutrients such as vitamin B12, folic acid, and certain amino acids can also be involved.

Signs and Symptoms

The American Psychiatric Association has a list of criteria that are used to diagnose depressive disorders. These criteria include:

1. Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from the individual’s previous emotional state; at least one of the symptoms is either depressed mood or loss of interest or pleasure.

Depressed mood most of the day, nearly every day.
Markedly diminished interest in pleasure in all, or almost all, activities.
Significant weight loss (not dieting) or weight gain, or increase or decrease in appetite nearly every day.
Insomnia or excessive sleep nearly every day.
Sluggishness or agitation nearly every day.
Fatigue or loss of energy nearly every day.
Feelings of worthlessness or excessive or inappropriate guilt (may be delusional) nearly every day.
Diminished ability to think or concentrate, or indecisiveness.
Recurrent thoughts of death, recurrent suicidal thoughts without a specific plan, or a suicide attempt or specific suicide plan.

2. The symptoms cause significant distress or impair the person’s ability to function in everyday tasks. The symptoms are not due to the direct psychologic effects of a substance or general medical condition.

The symptoms occur most of the day, nearly every day and can not be due to any drugs, substance or general medical condition

Treatment Options

Conventional

Depression is a one-two punch that knocks the sufferer out of the ring on a daily basis. Number one, the symptoms themselves make life miserable. Number two, the depressed individual struggles to function and keep up with the life’s normal demands. Conventional treatment for depression is aimed both at reducing symptoms and helping the individual regain the ability to function they once enjoyed. Usually the treatment includes psychotherapy and the use of anti-depressant medications.

The most commonly used drugs for uncomplicated depression are the tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors, (SSRIs). If a patient does not respond to one type, therapy is often switched to the other. Of the tricyclic antidepressants, amitriptyline and imipramine are the most extensively studied and used. TCAs work by blocking the “reuptake” of norepinephrine and serotonin into brain and nerve cells.

These neurotransmitters conduct electrical impulses from cell to cell, allowing us to think and feel. Once a neurotransmitter molecule has carried an impulse across the gap between two neighboring cells, called the “synapse,” the molecule is reabsorbed. If neurotransmitters are in short supply to begin with, brain and nerve function may be impaired. By inhibiting neurotransmitter reuptake, TCAs in effect increase the amount available in the synapse.

TCAs, unfortunately are like a shotgun; they interfere with other neurotransmitters that regulate a variety of body functions. For this reason, TCAs have a lot of side effects. SSRIs, on the other hand, are much more precise. These drugs block the re-uptake of serotonin by itself, without touching other neurotransmitters. SSRI’s have fewer side effects and are generally preferred by physicians over the traditional TCAs. People who fail to benefit from a SSRI may respond to a TCA, and vice versa.

If neither type of medication works, others are considered. Buproprion blocks the reuptake of dopamine, another important neurotransmitter in the brain. Mirtazapine a tetracyclic antidepressant with mixed effects on both serotonin and norepinephrine, may be prescribed. Triazolopyridine (trazodone or nefazodone), has a dual action as a serotonin antagonist and also a reuptake inhibitor.

Yet another type of anti-depressants are the “monoamine oxidase inhibitors” such as phenelzine, and tranylcypromine. Commonly known as “MAO inhibitors,” these drugs are used in cases of atypical depression. Symptoms of atypical depression that are usually improved by MAO inhibitors include mood reactivity, irritability, excessive sleeping, overeating, bodily agitation, and over sensitivity to rejection.

Another very good reason for trying to avoid these medications include addiction to anxiety medications and sleep aids as well as suicidal ideation on antidepressants. For more information on the dangers of these psychotropic medications go to the resources tab and click on Prozac – 1991 FDA antidepressant hearings video and Citizens Commission on Human Rights-Mental Health Database.

Nutritional and Herbal Supplementation

There are a great many vitamins, minerals, herbal supplements and other natural remedies that have been shown to effectively reduce and eliminate many mood disorders such as anxiety and depression safely and effectively. Which therapies are chosen will be based on the root cause of the mood disorder and not just the symptom. Your practitioner will carefully evaluate your situation and put together an effective protocol at treating your condition with natural remedies rather than dangerous medications that merely treat the symptom and come with extremely dangerous side effects.

Diet & Lifestyle

Some of the other things you can do to help with mood disorders include:

Eliminate sugar, caffeine, and alcohol.
Identify and eliminate food allergies.
Exercise.
Light therapy.
Stress reduction can take form in a variety of ways. Some of the more structured forms include; counseling, tai chi, yoga, meditation, deep breathing.

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Anxiety

What should I know about Anxiety?

Anxiety is an emotional state commonly caused by the perception of real or potential danger that threatens the security of the individual. Everyone experiences a certain amount of nervousness and apprehension when faced with a stressful situation. Usually, the response is reasonable and adaptive, and contains a built-in control mechanism to return to a normal physiologic state. For some people, however, anxiety is more than just a temporary discomfort. For these individuals anxiety can be debilitating. It is when anxiety states become excessive or prolonged, particularly if it produces such psychological and physical stress, that the person cannot perform the activities of daily living, that medical help should be sought.

In general, anxiety disorders are a group of illnesses that develop before age 30 and are more common in women and those with a family history of anxiety and depression. Anxiety disorders are among the most frequent mental disorders encountered in a clinical setting. Approximately 8% of the population will experience at least one anxiety disorder in their lifetime. Unfortunately, the majority of people with anxiety disorders receive no professional treatment. This is unfortunate because there is a great deal of success in treating anxiety disorders and a life that has been paralyzed can be renewed with appropriate treatment.

The Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) classifies anxiety disorders into several categories. The characteristics of these illnesses are anxiety and avoidance behavior and include: generalized anxiety disorder, panic disorder (with or without agoraphobia), agoraphobia without history of panic disorder, phobic disorders (social phobia or specific phobia), obsessive-compulsive disorder, post-traumatic stress disorder, and acute stress disorder.

Research studies have shown that there is a difference between normal anxiety and pathologic anxiety states. This difference involves multiple brain structures and neurotransmitter systems. Current drug therapy centers around the use of drugs which alter activity of one or more neurotransmitters, or act at the neurochemical receptor site.

Signs and Symptoms

According to the DSM-IV, the diagnostic criteria for generalized anxiety disorder (GAD) require persistent symptoms for at least six months. The essential feature of GAD is unrealistic or excessive worry about a number of events or activities.

General

Excessive anxiety- (apprehensive expectation) occurring more days than not for at least six months, about a number of events or activities.
Difficult to control worry.
Anxiety or worry, associated with three or more of the following six symptoms:

Restlessness or feeling keyed up or on edge.
Being easily fatigued.
Difficulty concentrating or mind going blank.
Irritability.
Muscle tension.
Sleep disturbance.

Anxiety and worry not confined to features of another psychiatric illness.
Constant worry causing significant distress, and significant impairment in social, occupational, or other important areas of functioning.
Excessive anxiety and worry not caused by a drug substance or general medical disorder, and not occurring exclusively as part of another psychiatric disorder.

Panic attacks

Panic disorder begins as a series of unexpected panic attacks, involving an intense, terrifying fear, similar to that caused by life threatening danger. The unexpected panic attacks are followed by at least one month of persistent concern about having another panic attack, worry about possible consequences of having another panic attack, or a significant behavior change related to the attacks.

Panic attacks have also been classified and include four of the following symptoms:

Palpitations or accelerated heart rate
Sweating
Trembling or shaking
Sensations of shortness of breath or smothering
Feeling of choking
Chest pain or discomfort
Nausea or abdominal distress
Feeling dizzy, lightheaded, unsteady, or faint
Fear of losing control or going crazy
Fear of dying
Numbness or tingling sensations
Chills or hot flushes

Panic attacks usually last no more than 20-30 minutes, with the strongest symptoms occurring within the first 10 minutes. Many patients eventually develop agoraphobia secondary to the panic attacks. This is due to fear of not being able to escape or find help in the event of a panic attack. Complications also include work impairment, depression, alcohol abuse, and increased use of medications, health services, and emergency rooms. Patients with panic disorders have a high lifetime risk of suicide attempts compared to the general population.

Phobias

The third category usually considered with anxiety disorders is phobia. Phobias are generally classified into social or specific phobias. Social phobia can be defined as a marked and specific fear of social situations or performance areas, while specific phobias refer to fear of an object or situation (e.g., animals, water, enclosed places). Apart from contact with the feared object or situation, the individual is usually free of symptoms. Most persons simply avoid the feared object and adjust to certain restrictions on their activities.

Treatment Options

Conventional

Generalized anxiety disorder is usually treated by a combination of psychotherapy and drug therapy. Treatment often includes counseling, stress management, psychotherapy, meditation, or exercise. Individuals with anxiety disorder should avoid caffeine, nonprescription stimulants, and diet pills. There are several prescription drugs that are used with a general anxiety disorder. Some of these include benzodiazepines, buspirone, adrenergic blocking agents, and antidepressants.

Panic disorder is treated slightly differently than GAD. Individuals with panic disorder should be educated to avoid substances that may precipitate panic attacks including caffeine, drugs of abuse, and nonprescription stimulants. If agoraphobia is present, cognitive-behavioral therapy is recommended to help the patient focus on correction of thoughts and behaviors. Panic disorder is effectively treated with several drugs including Benzodiazepines (alprazolam, clonazepam, diazepam, lorazepam), tricyclic antidepressants (imipramine, desipramine), MAO inhibitors (phenelzine), and Selective Serotonin Reuptake Inhibitors (fluoxetine, fluvoxamine, paroxetine, sertraline). These SSRIs are usually the first drug prescribed because they are well tolerated; however, they are significantly more expensive than tricyclic antidepressants and benzodiazepines.

Again as mentioned above, another very good reason for trying to avoid these medications include addiction to anxiety medications and sleep aids as well as suicidal ideation on antidepressants. For more information on the dangers of these psychotropic medications go to the resources tab and click on Prozac – 1991 FDA antidepressant hearings video and Citizens Commission on Human Rights-Mental Health Database.

Nutritional and Herbal Supplementation

Diet & Lifestyle

Some of the other things you can do to help with mood disorders include:

Dietary changes may be helpful. All sources of caffeine should be avoided, including coffee, tea, chocolate, caffeinated sodas, and caffeine-containing medications.
Also avoid sugar and refined carbohydrates.
Stress reduction can take form in a variety of ways. Some of the more structured forms of anxiety relief include; counseling, tai chi, yoga, meditation, and deep breathing.

Overall, it’s more important to focus on the root cause and what are the underlying mechanisms that are causing the condition rather than just treating it symptomatically. Each person is encouraged to seek out a qualified nutritionist or other qualified healthcare practitioner in order to assess exactly which nutrients, herbs, homeopathics and natural remedies; in which combination; in what proportion are right for the particular individual and are intended at treating the root cause rather than just a symptom.