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beating the winter blues, part 1

Approximately 20 per cent of teenagers, 23 per cent of males and 18 per cent of females suffer from mental health problems. The highest incidence (27 per cent) occurs in the 18 -24 year age group. Episodes of depression vary significantly in severity and duration. Some bouts may last just a few hours. It ranges from mild to severe and may include single and recurrent episodes. As a disease, depression is characterised by a decrease in energy levels and activity, reduced concentration and interest in life and reduced capacity for enjoyment. Sleep may be disturbed and there may be weight loss or weight gain. It may also include feelings of worthlessness, self-reproach and inappropriate guilt, as well as recurrent thoughts of death or suicide.

How we treat depression is of great concern. The drugs we give to our kids don’t solve the problem, they manage the symptoms. As a result, the underlying problem remains until it is dealt with. In addition, these drugs can have many adverse side effects. Drugs can be effective when used with other treatments to identify the cause, and alongside treating the illness through modifications in diet, environment, attitude and lifestyle.

The main group of drugs used for to treat depression are the serotonin selective reuptake inhibitors (SSRI’s) the most infamous one being prozac. These are designed to keep more serotonin in the brain in circulation. Adrenalin reuptake inhibitors or noradrenaline reuptake inhibitors are designed to keep adrenalin in circulation, as do the monoamine oxidase inhibitors and the tricyclic antidepressants. How a child is classified determines the type of drug prescribed. Low mood is often a serotonin deficiency, while low motivation is an adrenalin/ noradrenaline deficiency. About 25 per cent of people who take these drugs experience negative side effects and a small number have severe reactions.

Attitude is a critical factor in depression. A large and growing body of research is highlighting the benefits of Cognitive Behavioural Therapies (CBT). It is now realised that the brain has its own internal pharmacy which can be activated by what we believe. With CBT techniques it’s possible to alter brain chemistry, altering mood and perception.

Some research in Australia is showing success in changing depression via the internet. This program is based on CBT and relies on people going through a number of modules. Early results suggest that it’s as beneficial as CBT and face to face contact with a therapist. You can log on to the website at moodgym.anu.edu.au. What’s there to lose? At the absolute least you can learn more about depression. Other cognitive techniques that have been shown to be useful include hypnosis, Emotional Freedom Techniques, goal setting and cognitive reframing.

Depression needs to be tackled with a range of tools, not just from a single perspective. CBT literally mean thinking and behaviour techniques so literally encompasses hundreds of different techniques. Use as many tools as possible. Some psychologists and psychiatrists may be skeptical of and criticise the role of other factors such as diet. Anyone who does hasn’t bothered to look into these issues at all. It’s interesting how much tunnel vision exists amongst some professionals, who seem unable to see beyond their own turf.

Apart from the normal dietary recommendations of more vegetables, beans, nuts, fish and fruit and less junk food, sugar laden starches and fatty foods, it’s important to reduce both nicotine and caffeine.

From a biochemical perspective, depression is an imbalance of brain chemicals, usually identified as a lack of serotonin. If you look at the biochemical pathway for the manufacture of serotonin, there are many reasons as to why it may be low. Sometimes this can be rectified simply through dietary modifications.

Serotonin is made in the hippocampus (a part of the brain) from the amino acid tryptophan. For this chemical to be converted to serotonin, it needs Vitamins B3, B6, Folic acid, C, and the minerals calcium, iron, magnesium, zinc and a particular essential amino acid called tryptophan. A deficiency in a couple of these nutrients can result in low levels of serotonin and depression.

In one experiment people who had a history of depression were given nutritionally balanced but tryptophan depleted foods. Within seven hours 10 of the 15 participants reported worsening moods and began to show signs of depression. When the tryptophan was replaced their more positive mood quickly returned.

Supplementing with tryptophan should be around one gram for low moods and up to three grams for depression. It’s best eaten on an empty stomach or in conjunction with carbohydrates. Because tryptophan is converted first to serotonin and then to melatonin, it is best taken at night before going to bed, as it will help you sleep.

Tryptophan rich foods include fish, turkey, chicken, cheese, beans, tofu, oats, eggs, nuts, seeds and milk. Ironically, following a protein rich meal, brain levels of tryptophan and serotonin levels decrease. This is because some of the other amino acids (the LNAA’s such as valine, leucine, tyrosine and phenylalanine) in the meal out compete tryptophan for carrier molecules into the neurons. In contrast, it’s a meal rich in carbohydrates and a small serve of protein which increases brain tryptophan and serotonin. Even though the food may lack tryptophan completely, it causes the release of insulin which stimulates the uptake of most of the amino acids (the LNAA’s) other than tryptophan. This phenomenon explains why some people suffering depression crave carbohydrate snacks.

The best way to get more tryptophan in your diet is to eat some of the foods rich in tryptophan with food high in carbohydrates food such as fruit (bananas) and vegetables, including potatoes and wholmeal bread. A little bit of protein should be consumed with every meal to ensure a constant supply of tryptophan for the brain. Not a huge piece of meat just a small serve of protein rich food.

During the day adrenalin levels are higher, keeping you stimulated. As adrenalin levels decline, serotonin levels rise. As the day progresses and it gets darker, melatonin levels rise and serotonin levels decline. Melatonin’s main role is to regulate the sleep-awake cycle. Without enough serotonin you can’t manufacture melatonin. This is probably why poor sleep patterns are often associated with depression.

A man’s average synthesis rate of serotonin is around 52 per cent higher than that of a woman and as a result women are more prone to low serotonin and depression.

SAMe (S-adenosyl methionine) is a naturally occurring chemical in the body that’s linked with reducing joint problems and cardiovascular disease. It’s also involved in the production of various other chemicals in the body. However, more than 100 double blind studies have shown that supplementing with SAMe is equal or superior to using antidepressants. SAMe doesn’t appear to have side effects and has many potential side benefits. SAMe has also been shown to increase the levels of serotonin and dopamine in depressed patients. Deficiencies in SAMe may be brought about by a diet low in the amino acid methionine or Vitamin B12. This can occur if you are following a stricitly vegetarian or fad diet ; in the case of stomach infections with helicobacter pylori; in situations which generate low stomach acid, or in the presence of excessive copper, lead or mercury.

The Omega 3 fats are linked with improved reception of serotonin. Studies using omega 3 fats alone and in conjunction with antidepressants have shown significant benefits. Again, no side effects and lots of side benefits. The EFAs are converted into the hormone-like prostaglandins, which stimulate the brain’s manufacture of serotonin and other neurotransmitters. Understanding this shows how very low fat diets and bad fat diets can lead to depression. Research has shown that countries, such as Japan, that have a high daily intake of fish have a much lower rate of depression than countries with a low intake of omega 3 fatty acids, such as Australia and the US.

Stress can have a depleting effect on the body and lead to particular deficiencies that may affect our mood. Stress has a negative effect on the production of DHEA, adrenalin and serotonin. This increases our need for the raw materials to build the mood enhancing neurotransmitters. Stress also increases our need for the B vitamins and tryptophan. Depression is an exhausting experience that depletes the body of mood enhancing chemicals.

Some additional triggers for depression include: Low oestrogen in women due to the fact that oestrogen blocks the breakdown of serotonin. This may partly explain for higher premenstrual and menopausal depression rates; Low testosterone for men; and, Spending too much time inside. By staying inside all the time we receive a mere fraction of the light (about 70 –200 times less) that we would get even on a dull, overcast day. Daylight increases serotonin production.

Supplements for depression include: SAMe (...), High potency vitamin B complex with 1000 milligrams folic acid and 1000 micrograms of Vitamin B12; and, St John Wort extract (0.3 per cent hypericin) (...). St John’s Wort has been shown to be effective in dozens of clinical trials. St John’s Wort does interact with some medications, so check with your doctor or pharmacist if you are uncertain.

By adopting the nutritional approach you not only work towards the solution to depression, you may also solve other problems such as joint pain and raised cholesterol levels. You may well avert possible future problems before they even arise. All this, without the adverse side effects.

Physical activity is the single best method of changing mood. Just five to 10 minutes of activity can have immediate and lasting mood enhancing effects. Exercise lowers tension, changes your body chemistry and increases your energy. These benefits can be increased by being active with other people.

Recent reviews have shown that aerobic exercise or strength training programs can reduce the symptoms of depression. A recent controlled trial found that exercise training was as effective as antidepressant medication, although the onset of benefit was slower. An increase in exercise has a direct correlation with a decrease in depression. The longer-term benefits of physical activity began to show up after one week for people who were moderately depressed. An important additional benefit in using physical activity as an antidepressant, as it’s more effective than drugs in keeping the depression away once it has lifted and been linked to reducing the susceptibility of relapsing back into depression. In a study on 156 participants who suffered from depression the only group that did not have a significant relapse back into depression 6 months later were the exercise group compared to the first group who used anti¬depressants.

The mechanisims by which physical activity can have such good effects includes biochemical and social reasons. Physical activity preferentially metabolises some of the other amino acids, leaving behind tryptophan which can then be converted into serotonin. It also alters the concentration of many active molecules, such as cortisol and cytokines, which affect mood. It is also very important effects on motivation, expectancy and human contact. Just getting out and being active with other people can have dramatic effects.

Relaxation and breathing techniques have been shown to have a positive effect on anxiety and depression. In a study of 18 patients who undertook a program of breathing every day for 30 minutes for 6 weeks, with 17 control subjects, the group taught breathing techniques had a greater decrease in anxiety and depression than the control group. Several studies have also demonstrated the positive changes in mood from meditation. Studies have shown that meditation increases alpha brain waves, which are the relaxed brain waves, which in turn can decrease anxiety and depression. Researchers from Harvard Medical School have found that meditation activates the autonomic nervous system. This controls the parasympathetic nervous system, which may be the reason for reduced anxiety, relaxation and calmness.

What role is played by the media in increasing depression levels? The antisocial activity of watching television and working on computers reduces the time we spend building social support networks. Much of the advertising is also based on the principle of showing you what you don’t have and how, if you have it, it will make you happier, more successful, more beautiful, sexy and so on. Then there are the false mentors – the media personalities we are encouraged to emulate.

Finally the content of the average program, including the news, depicts an exaggerated picture of violence and brutality. The average US teenager has seen more than 6000 murders and deaths by the time they finish high school. The number is likely to be much the same for Australian and New Zealand kids, who watch an average of three hours of television a day. My own experience has been that when the media ring up to ask if I have any news worthy stories they rarely, if ever, accept the positive ones.

I prefer to listen to the radio news rather than watch it on television, as it has more information in a shorter time, and none of the graphic scenes or replays of violence and destruction.

There are many forms of depression, as well as different degrees of severity and duration. One technique alone is unlikely to be an effective, long term solution. My philosophy is that every individual and each condition is different and so needs to be treated individually with a variety of appropriate techniques. Medication can be a part of this but only in conjuncition with other treatments that are much safer and common sense.

The politics of depression

In the United States up until 1990 tryptophan dietary supplements were being taken by approximately 15 million Americans. On March 22 1990, the Food and Drug Agency (FDA) banned the sale of L Tryptophan in response to several deaths the previous year from a deadly flu like condition called EMS (Wolfe Manders, 1995). This is despite it being used as supplement for decades prior to this, by a large number of people, without any adverse side effects. The problem was caused by a contaminated batch of tryptophan not the tryptophan itself.

One wonders why it was banned as most foods and supplements would be removed from the market place if this principle applied. Recent history with the Cox 2 inhibitors: non-steroidal anti inflammatory medications like celecoxib (brand name Celebrex) and rofecoxib (brand name Vioxx) has shown that it takes years to remove a pharmaceutical drug from the market place even though it may be linked with hundreds of thousands of deaths.

However, on March 26, only four days later, ’Prozac’ the great wonder drug in the treatment of depression was introduced in a fanfare by the media to the public after more than 10 years of development. What a coincidence. As mentioned earlier Prozac is a SSRI, whilst Tryptophan increases the serotonin levels in the body.

Other interesting facts about this controversy include: • L Tryptophan was banned as a dietary supplement in the United States and Australia until 2005. It could however, be imported from Japan and available as a prescription only drug. One hundred 500mg capsules cost approximately $75.00. This is about five times more expensive than previously as a dietary supplement. • L Tryptophan is still used in baby food produced and sold in the United States. Farmers are still allowed to use it in stock feed for animals. • Anti depressants are among the most heavily prescribed medications on the pharmacists’ shelves. From 1998 to 2002 in the United States, prescription among children under the age of 18 rose by 49%.

Associate Professor Peter Dingle
Murdoch University
www.drdingle.com