Depression

woman with depression, sadness and anxiety

Depression

What are the symptoms of depression?

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), depression, also called major depressive disorder or clinical depression, is a persistent low mood:

  • not explained by another disorder or caused by substance use (e.g., alcohol, drugs, meds)
  • not due to normal grief over the death of a loved one
  • without manic episodes
  • with at least five of the nine symptoms below most of the time for a continuous two weeks or more, and
  • this is a change from your prior level of functioning. One of the five or more symptoms must be either (a) depressed mood, or (b) loss of interest:
  1. Depressed mood. Children and teens may be irritable.
  2. A significantly reduced level of interest in most or all activities.
  3. Weight fluctuations: a 5% or more change in weight over a month when not dieting. There may also be an increase or decrease in appetite. For children, this may be a lack of expected weight gain.
  4. Sleep disorders: difficulty falling or staying asleep, or sleeping more than usual.
  5. Behaviour that is agitated or slowed down.
  6. Fatigue or low energy.
  7. Feelings of worthlessness or extreme guilt.
  8. Reduced ability to think, concentrate, or make decisions.
  9. Frequent thoughts of death or suicide or attempted suicide.

These symptoms are a cause of great distress or create difficulty in functioning at home, work, or other important areas, they continue for more than two months, or they include frequent thoughts of worthlessness or suicide, symptoms that are psychotic, or behavior that is slowed down.

Depression affects twice as many women as men, and over the course of a lifetime, major depression will affect 10%-25% of women and 5%-12% of men.  The average age of onset is the mid-20’s and having a parent or sibling with depression increases the risk of depression by 1.5-3 times the baseline risk.  Two thirds of those with major depression will recover completely, the remaining third will not.

What is the conventional treatment for depression?

Conventional treatment for depression may include anti-depressant medications (SSRI’s like Zoloft, Celexa, Prozac etc, SNRI’s like Effexor, Pritiq, and Cymbalta, NDRI’s like Wellbutrin, Tricyclic Antidepressants and MAOI’s) and cognitive behavioural therapy (CBT).

Medications can be very effective, but can also come with unwanted side effects such as weight gain, and low libido.

What is the naturopathic treatment of depression?

As a naturopathic doctor treating depression involves a thorough understanding all of the factors that may be contributing to the problem, such as:

  1. Hormones

    Cortisol, DHEAs, testosterone, estradiol, allopregnanolone, DHT and androstenedione are hormones that have all been linked to depression. Naturopathic medicine offers a number of approaches to better balance hormones including diet, exercise, stress reduction, vitamins, minerals and herbs.

  2. Neurotransmitter balance

    Serotonin, GABA, dopamine, epinephrine, and norepinephrine may all influence mood.  Neurotransmitter balance requires an adequate supply of amino acids such as tyrosine, tryptophan and glutamic acid, as well as vitamin B6 and magnesium.

  3. Life circumstances

    Work stress, relationship difficulties, family problems, alcoholism, drug use, terminal illness, bereavement can all contribute to feelings of hopelessness and depression.

  4. Sleeplessness

    Sleeplessness can contribute to fatigue, low motivation, and neurotransmitter and hormone imbalance.  Healthy sleep hygiene as well as diet, vitamins, herbs and minerals that are conducive to good quality and quantity of sleep can help.

  5. Thyroid function

    Underactive thyroid gland function or hypothyroidism can cause feelings of depression, along with low energy, weight gain, mental sluggishness and hair loss.

My job as a naturopathic doctor, is to dig deeply to unearth any of these factors that might be contributing to depression in order to address the root of the problem.  Effective, lasting treatment requires a thorough understanding of the cause.

References:

Mocking RJ, Pellikaan CM, Lok A, Assies J, Ruhé HG, Koeter MW, Visser I, Bockting CL, Olff M, Schene AH.DHEAS and cortisol/DHEAS-ratio in recurrent depression: State, or trait predicting 10-year recurrence? Psychoneuroendocrinology. 2015 May 21;59:91-101. doi: 10.1016/j.psyneuen.2015.05.006.

Rodgers S, Grosse Holtforth M, Hengartner MP, Müller M, Aleksandrowicz AA, Rössler W, Ajdacic-Gross V. Serum testosterone levels and symptom-based depression subtypes in men. Front Psychiatry. 2015 May 4;6:61. doi: 10.3389/fpsyt.2015.00061. eCollection 2015.

Xu Y, Sheng H, Tang Z, Lu J, Ni X. Inflammation and increased IDO in hippocampus contribute to depression-like behavior induced by estrogen deficiency. Behav Brain Res. 2015 Jul 15;288:71-8. doi: 10.1016/j.bbr.2015.04.017. Epub 2015 Apr 20.

Schüle C, Nothdurfter C, Rupprecht R. The role of allopregnanolone in depression and anxiety. Prog Neurobiol. 2014 Feb;113:79-87. doi: 10.1016/j.pneurobio.2013.09.003. Epub 2013 Nov 8.

Weber B, Lewicka S, Deuschle M, Colla M, Heuser I. Testosterone, androstenedione and dihydrotestosterone concentrations are elevated in female patients with major depression. Psychoneuroendocrinology. 2000 Nov;25(8):765-71.

Fakhoury M. New insights into the neurobiological mechanisms of major depressive disorders. Gen Hosp Psychiatry. 2015 Mar-Apr;37(2):172-7. doi: 10.1016/j.genhosppsych.2015.01.005. Epub 2015 Jan 16.

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