OVERVIEW: Depression is one of the most
frequent complaints seen in any medical office with up to 25% of al
American adults exhibiting some symptoms.1 As with
insomnia, those with major depression suffer a four fold increase in
mortality in the next five years and major depression may account
for up to 60% of all suicides2.
Although depression and schizophrenia, for
example, may be seen in some families, the environmental factors
that include 1) sun light, 2) diet, 3) family stressors now appear
to be more important that genetic or family disposition.3
Therefore, if we are to focus on the limbic and
hypothalamic systems as they impact depression, we then chose to
evaluate the biologic amines involved in neurotransmission --
norepinephrine, serotonin and, to a lesser extent, dopamine,
acetylcholine and epinephrine. The role of
sleep
disturbances and
Vitamin D
(calciferol) is treated in a separate article.
Although there has been an evolution from the use
of mono-amine oxidase inhibitors (MAO), to tricylic antidepressants
like Elavil® -- both affecting
norepinephrine levels,
present day antidepressants are
predominantly selective serotonin reuptake inhibitors.
Serotonin deficiency is now considered an integral part of the
physiology of depression.4
Amino Acid
Supplements
Good nutrition is the basis of treatment for every disease. Specific
supplementation with these three amino acids may be somewhat
effective in treating some forms of depression. They are L-tyrosine,
D,L-phenylalanine and especially L-tryptophan and its derivative,
5-hdroxy-tryptophan (5-HTP).
L-Tyrosine: Precursor to the biogenic
amine norepinephrine and may be a natural substitue for those who
respond favorably to amphetamines. Dosage 50-100mg/kg before
breakfast or 2-3 times daily if better tolerated.
D,L-Phenylalanine: Precursor to
L-tyrosine. When the D,L form is used, some will convert to
phyenylethlamine (PEA) which has amphetamine like and mood elevating
like properties. Whether D,L-phenylalanine can be effective as an
anti-depressant is determined by trial-and-error with the patient.
Side effects are usually limited to those with severe blood pressure
problems.
5-HTP My choice of treatment for
depression, after treating for Vitamin D deficiency, is 5-HTP.
Not only will to assists in normalizing the sleep pattern, but it
will be useful during the day to treat both depression and
carbohydrate craving. 200mg at night; 100mg twice daily during the
day.
Vitamin and Mineral
Therapy
Vitamin B6, is necessary to convert L-tryptophan to serotonin
and L-tyrosine to norepinephrine. Vitamin B6 deficiency care noted
in with certain diets, the oral contraceptives, and selective
medication.
Folic acid deficiency has been identified
in patients with severe depression.. Psychiatric symptoms of folate
deficiency include depression, insomnia, anorexia, forgetfulness,
hyperirritability, apathy, fatigue and anxiety.13
Vitamin B12 deficiency can also manifest
as depression.15 In depressed patients with documented
vitamin B12 deficiency, parenteral (intravenous) administration of
the vitamin has resulted in dramatic improvement.16
Vitamin B12, 1 mg/day for two days (route of administration not
specified), also produced rapid resolution of postpartum psychosis
in eight women.17
Vitamin C, as the cofactor for
tryptophan-5-hydroxylase, catalyzes the hydroxylation of tryptophan
to serotonin.18 Vitamin C may therefore be valuable for
patients with depression associated with low levels of serotonin. In
one study, 40 chronic psychiatric inpatients received 1 g/day of
ascorbic acid or placebo for three weeks, in double-blind fashion.19
In the vitamin C group, significant improvements were seen in
depressive, manic and paranoid symptom complexes, as well as in
overall functioning.
Magnesium deficiency can cause numerous
psychological changes, including depression. The symptoms of
magnesium deficiency are nonspecific and include poor attention,
memory loss, fear, restlessness, insomnia, tics, cramps and
dizziness.20
Plasma magnesium levels have been found to be significantly lower in
depressed patients than in controls.21 These levels
increased significantly after recovery. In a study of more than 200
patients with depression and/or chronic pain, 75 percent had white
blood cell magnesium levels below normal.22 In many of
these patients, intravenous magnesium administration led to rapid
resolution of symptoms. Muscle pain responded most frequently, but
depression also improved. A nutritional supplement that contains
200400 mg/day of magnesium may therefore improve mood in some
patients with depression.
Phytomedicine
Considerations
St. John's wort: Having been unimpressed with the
anti-depressant effect of St. John's wort, it is listed here for
completeness.
Ginkgo (Ginkgo biloba) extract,
while clearly not a primary treatment of choice for most patients
with major depression, should be considered an alternative for
elderly patients with depression resistant to standard drug therapy.
This is because depression is often an early sign of cognitive
decline and cerebrovascular insufficiency in elderly patients.
Frequently described as resistant depression, this form of
depression is often unresponsive to standard antidepressant drugs or
phytomedicines like St. John's wort. One study showed a global
reduction in regional cerebral blood flow in depressed patients
older than 50 when compared with age-matched, healthy controls.31
In that study, 40 patients, ages 51 to 78, with a
diagnosis of resistant depression (insufficient response to
treatment with tricyclic antidepressants for at least three months),
were randomized to receive either Ginkgo biloba extract or
placebo for eight weeks.32 Patients in the ginkgo group
received 80 mg of the extract three times daily. During the study,
patients remained on their antidepressant drugs. In patients treated
with ginkgo, there was a decline in the median Hamilton Depression
Scale scores from 14 to 7 after four weeks. This score was further
reduced by 4.5 at eight weeks. There was a one-point reduction in
the placebo group after eight weeks. In addition to the significant
improvement in symptoms of depression for the ginkgo group, there
was also a noted improvement in overall cognitive function. No side
effects were reported.
Many nutrition-oriented practitioners have found
that the answer to depression is as simple as one's diet. A diet low
in sugar and refined carbohydrates (with small, frequent meals) can
produce symptomatic relief in some depressed patients. Individuals
most likely to respond to this dietary approach are those who
develop symptoms in the late morning or late afternoon or after
missing a meal. In these patients, ingestion of sugar provides
transient relief, followed by an exacerbation of symptoms several
hours later.
Primary Source of material:
Donald Brown, N.D., teaches herbal medicine and therapeutic
nutrition at Bastyr University, Bothell, Wash. Alan R. Gaby,
M.D., is past president of the American Holistic Medical
Association. Ronald Reichert, N.D., is an expert in European
phytotherapy and has an active medical practice in Vancouver, B.C.
Sidebars:
More
information on the pharmaceutical products
Excerpted with permission from
Depression (Natural Product
Research Consultants, 1997).
References:
From The
February 1999 Issue of Nutrition Science News
1. Risby ED, et
al. Mood disorders. In: Stoudemire A, editor. Clinical psychiatry
for medical students. 2nd ed. New York: J.B. Lippincott Co.;
1994. p 198.
2. El-Mallakh RS, et al. Clues to depression in primary practice.
Postgrad Med 1996;100:85.
3. Freeman PS, et al. Psychopathology. In: Sierles FS, editor.
Behavioral science for medical students. Baltimore: Williams and
Wilkins; 1993. p 253.
4. Rush AJ, et al. Neurobiological basis for psychiatric disorders.
In: Rosenberg RN, editor. Comprehensive neurology. New York:
Raven Press; 1991. p 563.
5. Goldberg IK. L-tyrosine in depression. Lancet 1980;2:364.
6. Gelenberg AJ, et al. Tyrosine treatment of depression. Am J
Psychiatry 1980;137:622-3.
7. Sabelli HC, et al. Clinical studies on the phenylethylamine
hypothesis of affective disorder: urine and blood phenylacetic acid
and phenylalanine dietary supplements. J Clin Psychiatry
1986;47:66-70.
8. Hawkins WW, Barsky J. An experiment on human vitamin B6
deprivation. Science 1948;108:284-6.
9. Azuma J, et al. Apparent deficiency of vitamin B6 in typical
individuals who commonly serve as normal controls. Res Commun
Chem Pathol Pharmacol 1976;14:343-8.
10. Stewart JW, et al. Low B6 levels in depressed outpatients.
Biol Psychiatry 1984;19:613-6.
11. Russ CS, et al. Vitamin B6 status of depressed and
obsessive-compulsive patients. Nutr Rep Int 1983;27:867-73.
12. Adams PW, et al. Effect of pyridoxine hydrochloride (vitamin B6)
upon depression associated with oral contraceptives. Lancet
1973;1:897-904.
13. Howard JS III. Folate deficiency in psychiatric practice.
Psychosomatics 1975;16:112-5.
14. Ghadirian AM, et al. Folic acid deficiency and depression.
Psychosomatics 1980;21:926-9.
15. Hector M, Burton JR. What are the psychiatric manifestations of
vitamin B12 deficiency? J Am Geriatr Soc 1988;36:1105-12.
16. Geagea K, Ananth J. Response of a psychiatric patient to vitamin
B12 therapy. Dis Nerv Syst 1975;35:343-4.
17. Daynes G. Cyanocobalamin in postpartum psychosis. S Afr Med J
1975;49:1373.
18. Cooper JR. The role of ascorbic acid in the oxidation of
tryptophan to 5-hydroxytryptophan. Ann NY Acad Sci
1961;92:208-11.
19. Milner G. Ascorbic acid in chronic psychiatric patients: a
controlled trial. Br J Psychiatry 1963;109:294-9.
20. Freyre AV, Flichman JC. Spasmophilia caused by magnesium
deficit. Psychosomatics 1970;11:500-2.
21. Frizel D, et al. Plasma magnesium and calcium in depression.
Br J Psychiatry 1969;115:1375-7.
22. Shealy CN, et al. Magnesium deficiency in depression and chronic
pain. Magnesium Trace Elem 1990;9:333.
23. Facchinetti F, et al. Oral magnesium successfully relieves
premenstrual mood changes. Obstet Gynecol 1991;78:177-81.
24. Morgan KJ, et al. Magnesium and calcium dietary intakes of the
U.S. population. J Am Coll Nutr 1985;4:195-206.
25. Singh A, et al. Magnesium, zinc, and copper status of US Navy
SEAL trainees. Am J Clin Nutr 1989;49:695-700.
26. Holzl J, et al. Investigations about antidepressive and mood
changing effects of Hypericum perforatum. Planta Med
1989;55:643.
27. Muller WE, Rossol R. Effects of Hypericum extract on the
expression of serotonin receptors. J Geriatr Psychiatry Neurol
1994;7(Suppl 1):S63-4.
28. Holzl J. Constituents and mechanism of action of St. John's wort.
Zeitschrift Phytother 1993;14:255-64.
29. Ernst E. St. John's wort, an antidepressant? A systemic,
criteria-based review. Phytomedicine 1995;2:67-71.
30. Monograph, Hyperici herba (St. John's wort),
Bundesanzeiger 1984 Dec 5.
31. Lesser IM, et al. Reduction in cerebral blood flow in older
depressed patients. Arch Gen Psychiatry 1994;51:677-86.
32. Schubert H, Halama P. Depressive episode primarily unresponsive
to therapy in elderly patients: efficacy of Ginkgo biloba extract (EGb
761) in combination with antidepressants. Geriatr Forsch
1993;3:45-53.
|
