Depression

This factsheet is for people with depression and for friends and family of people with depression.
Everyone experiences some sort of unhappiness at some point in their lives and most people feel "down" from time to time. However, this unhappiness can develop into a depressive illness. This is a real illness that often goes unrecognised, yet about 1 in 5 women and 1 in 10 men get depression serious enough to need treating at some point in their lives.1,2 Children and teenagers can also be affected by depression.2

What is depression?

Someone is said to be suffering from depression when their feelings:

• don't go away quickly3
• are so bad that they interfere with everyday life3

There are different types of depression which are explained below.

Mild depression
People that get depressed due to stresses in life, such as the break-up of a relationship or a bereavement, may get mild depression.1 Mild depression does not usually stop a person leading their daily life but makes everything harder to do and seem less worthwhile.4

Major depression
If a person feels depressed or uninterested in doing anything nearly every day for at least two weeks, they may have major depression. There may be several other symptoms, including changes in sleep, appetite and concentration. Major depression is also called clinical depression or unipolar depression.1,2

Vitamin for Depression?
A Good Vitamin Supplement Could Be Just What the Doctor Ordered
Did you ever wish that you could take a vitamin for depression? Well, for some of you it may be just that simple. There are a variety of vitamin deficiencies that can lead to depression symptoms.

GETTING THE BODY TO MANUFACTURE NEUROTRANSMITTERS
"The composition of each meal could have a direct effect on the production of chemical signals in the brain." (The New York Times, January 9, 1979) Rather than give a synthetic drug to block or mimic the body's chemical nerve messengers (neurotransmitters), it is possible nutritionally to encourage the body to make its own natural ones.If we are what we eat, then our nerves also depend on what they are fed. Here is tremendous potential for the alleviation of depression, anxiety, neuroses, panic attacks and sleep disorders.

St. John's Wort Equivalent to World's Best-selling Antidepressant

St. John's wort (Hypericum perforatum L., Clusiaceae) is one of the world's best-researched phytomedicines. One criticism from the medical community, however, has been that most of the clinical research on St. John's wort (SJW) has matched it against the tricyclic antidepressants, rather than newer, more commonly used agents. It should be noted that during the time at which most SJW research was conducted, doctors favored the tricyclic antidepressants. Now, physicians claim that in order for research results to be truly meaningful, SJW must be compared with selective serotonin reuptake inhibitor (SSRI) antidepressants.

Three Concentrations of St. John's Wort Effective Against Depression

At least 25 double-blind clinical studies have established the efficacy of St. John's wort (Hypericum perforatum L., Clusiaceae) in treating mild-to-moderate depression. In a recent double-blind, multicenter study, Swiss researchers took off in a different direction. They attempted to determine the optimum dosage of hypericin, a constituent that is thought to play an important role in the plant's antidepressant activity (Lenoir et al., 1999).

Nutrition and Dietary Supplements
Certain nutrients and dietary supplements have been associated with depression, including:

Folate (Vitamin B9)

Studies suggest that folate may be associated with depression more than any other nutrient. Between 15% and 38% of people with depression have low folate levels in their bodies and those with very low levels tend to be the most depressed. Having low levels of folate may also affect treatment; some studies report that people with folate deficiencies tend to respond less effectively to the SSRI, fluoxetine, than those with normal amounts of folate. Therefore, folate supplementation (typically between 400 and 800 mg) may be useful in both treating depression and assuring the appropriate effects of some antidepressant medications.

Many healthcare providers start by recommending a multivitamin (MVI) that contains folate, and then monitoring the homocysteine levels in the blood to ensure the adequacy of therapy. Elevated homocysteine levels indicate a deficiency of folate even if the levels of folate in the blood are normal. If the MVI alone is not enough to lower homocysteine and improve folate function, the provider may suggest additional folate along with vitamins B6 and B12.

Omega-3 fatty acids
Essential fatty acids, such as omega-3 and omega-6 fatty acids play a crucial role in the function of brain chemicals, particularly serotonin and dopamine. Studies have shown that low levels of omega-3 fatty acids (found in cold-water fish such as tuna and salmon), or a high ratio of omega-6 fatty acids (found in certain vegetable oils, such as corn and soybean oils) to omega-3 fatty acids, may be associated with depression. A typical American diet is high in omega-6 compared to omega-3 fatty acids. Eating foods rich in omega-3 fatty acids on a regular basis helps maintain an appropriate balance of omega-6 to omega-3 fatty acids, and although unproven, restoring this balance may help with feelings and symptoms of depression.

S-Adenosinemethionine (SAMe)

Some studies suggest that the dietary supplement SAMe may be just as effective as tricyclic antidepressants for treating depression, but with fewer side effects. SAMe appears to boost serotonin levels in the brain, but further research investigating the mechanism of action (how it works), safety, and effectiveness of SAMe for depression is warranted. Until more is understood, it is best to avoid using SAMe in conjunction with other antidepressants. Discuss its use with your healthcare provider who can help tailor your treatment accordingly.

Tryptophan
Tryptophan is an amino acid involved in the production of serotonin. Studies suggest that tryptophan depletion can lead to diminished serotonin levels, and in some cases, may increase a person's susceptibility to depression. Some research indicates that tryptophan, together with tricyclic medications, may produce better results than the medication alone. Tryptophan supplementation alone may not be enough to reduce symptoms of depression. However, while research results are intriguing, tryptophan use has been associated with the development of serious conditions such as liver and brain toxicity, and with eosinophilic myalgia syndrome (EMS), a potentially fatal disorder that affects the skin, blood, muscles, and organs. (An outbreak of EMS caused by a contaminated batch of tryptophan led to the removal of this supplement from the United States market in 1989.) In addition, given the possibility of adverse interactions, tryptophan should not be used in conjunction with MAOIs or SSRIs.

5-Hydroxytryptophan (5-HTP)
Some studies suggest that a by-product of tryptophan known as 5-HTP may be as effective as SSRIs and tricyclic antidepressants in treating depression, but with fewer side effects. As with tryptophan, EMS has been reported in 10 people taking 5-HTP. Further research is necessary to determine whether supplementation with 5-HTP is safe and effective for the treatment of depression.

Selenium
Some reports indicate that the mineral selenium, found in wheat germ, brewer's yeast, liver, fish, shellfish, garlic, sunflower seeds, Brazil nuts, and grains, significantly affects mood. In one study of people with low levels of selenium, those who consumed a diet high in selenium reported decreased feelings of depression after 5 weeks.

Inositol
Inositol is a naturally occurring substance involved in the production of certain brain chemicals. In a few studies, levels of inositol were lower in the cerebrospinal fluid (fluid surrounding the brain and spinal column) of depressed people compared to healthy people. In addition, administration of inositol decreased signs of depression in two animal studies. Several small human studies suggest that inositol may be of value in the treatment of depression, particularly for those who do not respond to antidepressant medications. More clinical trials are necessary to draw definitive conclusions on this substance, however.

Tyrosine
A number of studies conducted in the 1970s showed encouraging results regarding the use of tyrosine to ease symptoms of depression. In one study from 1990, however, tyrosine failed to demonstrate any anti-depressant activity. More studies are needed in order to draw firm conclusions about the use of tyrosine to help treat mild to moderate depression.

Melatonin
In one study of only 10 people with seasonal affective disorder, those who received melatonin supplements had significant improvement in their symptoms compared to those who received placebo. Given the small size of this study, however, more research is needed before conclusions can be drawn regarding use of melatonin for either seasonal affective disorder or any other type of depression.

Vitamin C
Some healthcare professionals recommend vitamin C to reduce the symptom of dry mouth, a side effect experienced by many people taking antidepressant medications.