In two parts: by  Adam Stark (first appeared in 2002)

I: Lifestyle, diet, philosophy

As the joke goes, a man visits his doctor.  “Doc,” he says, “I’m feeling kind of blue.”

“Tell me more,” says the doctor.

“Well,” says the man, “just this week I got fired from my job, I found out my wife was cheating on me, my 15-year-old flunked out of school and started selling drugs, my daughter is pregnant, my dog died, my car got wrecked, I’m being sued, and my house burned down.”

“Hmmm...” says the doctor. “Sounds like a classic case of serotonin deficiency to me.  I prescribe Prozac.”

There is a running debate as to whether people are depressed due to what’s going on in their lives (“situational depression”), or whether it’s simply a matter of brain chemicals (“endogenous depression”).  Ultimately, it works both ways.  Our situations and how we perceive them create certain feelings and emotions, which in turn lead to an imbalance in brain chemicals.  And an imbalance in brain chemicals leads to feelings and emotions, which in turn effect the situations we put ourselves in.  You see the way they feed off each other.  You see how it can form a vicious cycle. So while the original trigger for depression may have been either situational or endogenous, depression often evolves into a complex combination of the two, where one feeds off the other and vice versa.

You can break the vicious cycle by changing your life, or you can break it by taking anti-depressants (pharmaceutical, herbal, or nutritional).  The problem with antidepressants, however, is that they can make you feel happy without your addressing the situational aspects of depression.  They can lull you into feeling that everything is fine when in fact it isn’t.  In a sense, they override what’s basically a normal, healthy reaction to your surroundings.

I’m not saying you always have to change your life – some depression really is just a chemical imbalance, plain and simple.  But if there are changes to be made and you start taking antidepressants, now is the time to make them!  Use whatever confidence and well-being the antidepressants give you to go out and do something: pick up the guitar, get in shape, deal with your arthritis, write a novel, go on a date, learn kung fu, let go of a belief, quit your job, get a dog, baby-sit, join a night volleyball league or the Peace Corps.  Succeed at something to remind yourself that you can succeed.  Find a way to be proud of yourself.  Spend time with people you really and truly like.  (Get away from people you don’t!)  Put long-range goals before immediate gratification.  Change the pattern which feeds the depression, so that one day, hopefully, you won’t have to depend on the drugs anymore. 

I know you know this, but I’m going to say it anyway: a balanced, whole foods diet is essential to maintaining good mental health.  The book, Natural Prozac, by Joel Robertson and Tom Monte, does a wonderful job explaining the role of food in controlling depression.  It describes two types of depression and the foods to emphasize for each.  There’s even a questionnaire to determine which type you are.  Focus on quality protein, beans, and unrefined grains.  A whey protein shake for breakfast is an excellent way (no pun intended) to start the day.  Frank, who we’ll meet later in this article, highly recommends Ultimate Nutrition’s Amino Gold capsules to bridge the gap between meals.

Perhaps the most important rule is to avoid sugar.  Sugar raises levels of serotonin (a “happy” brain chemical) temporarily... then lets those levels drop.  This rise and fall parallels the rise and fall of blood sugar that follows a sugary snack.  Sugar makes you feel good for a while, then afterwards leaves you feeling worse than you did to begin with... until you eat more sugar.  This is a classic setup for addiction.  Perhaps “addiction” is too strong a word (perhaps not) but you get the idea.

White sugar isn’t the only thing that spikes blood sugar levels.  All concentrated sweets, including honey, maple syrup, and juice act similarly.  (There are some advantages to the more natural sweeteners, however).  Even refined starches, like white pasta and breads, spike blood sugar the same way that sugar does.  My suggestion to anyone dealing with this issue (or low energy, or diabetes, or high cholesterol, or anything) is to spend 10-15 minutes reviewing the “glycemic index”, a listing of foods according to how strongly and quickly they spike blood sugar.  Don’t memorize the entire index, just get a general feel for how different types and combinations of foods stack up.  

And when it comes to sweeteners, beware Aspartame, a.k.a. ”Nutrasweet”: there is evidence it may have some drawbacks, especially for mood disorders

Sometimes when we’re looking for higher, therapeutic doses of nutrients, we need supplements because foods simply can’t supply high enough levels.  The B-vitamins are often called “the nerve and stress vitamins,” and for good reason.  A deficiency in any one of them can lead to depression.  While it is rare in this day and age to be outright deficient, you might still have less than an optimal amount.  And you’re more likely to be deficient if you are in fact depressed.  To be fair, I don’t think B-vites by themselves give people as much of a lift as other antidepressant supplements.  Still, I’d definitely take some, focusing on additional B-12 if you’re vegetarian.  Also, additional B-6 if you’re on birth control (which depletes it), have PMS (which benefits from it), or if you simply don’t remember your dreams.  Look for the active form of B-12, methylcobalamin; and the active form of B-6 called “P-5-P.”

Regular exercise, fresh air, and sunlight can work wonders.  You think this sounds new-agey?  Don’t knock it until you try it!  I have talked to so many people who say they feel so much better when they add these three simple bits of nature back into their lives. 

I recently had the opportunity to talk with one of our regular customers, who I will call Frank (not his real name).  Frank’s wife has suffered with severe depression for nearly thirty years.  Together, they’ve been through every treatment imaginable.  From this lifetime of experience, Frank offered a few pieces of advice, not only to those who are depressed, but to their friends and loved ones as well. 

“What depressed people need more than anything else,” says Frank, “is an advocate.  Somebody they trust who can negotiate for them with doctors, psychiatrists, the insurance companies, the whole medical system.”  Often, he says, when somebody is depressed, they have difficulty standing up for themselves in terms of saying things like “this medicine isn’t working,” or “I want a different doctor.” 

He also advises friends and loved ones not to feel rejected by the person who is depressed.  He gave me the following example: “Let’s say you have a friend, and every time you call him to get together, he says ‘I don’t feel up to it tonight.’  Now, he might be depressed.  He might feel like he just doesn’t have the get-up-and-go that evening.  But all you know is that every time you call him, he says no.  So you start to feel rejected.  After a while, you stop calling.  This way, depressed people manage to isolate themselves from the rest of the world, and it only makes them more depressed.”

Franks says you absolutely need to have psychotherapy, but he also says not to be intimidated by psychiatrists.  “Give them a chance, but in the end, trust your own judgment.  If they’re not working for you, or if they’re worse off than you are, fire them!”

And Frank says: “If the treatment you’re on isn’t working and it’s giving you side effects that make you gain weight and lose your sex drive, why are you still taking it?”

II: Amino Acids and Depression

Please bear with me... I’m going to use a fair amount of scientific terminology in this one!

No matter how depression originates, it always ends up effecting brain chemistry.  And while changing one’s lifestyle and outlook can be invaluable, there is no doubt that taking supplements and/or drugs to modulate brain chemistry can also have powerful results.

There seem to be two basic types of brain chemicals (or “neurotransmitters”) involved in depression, both of which play their own unique roles in maintaining good mood.  On one hand, there’s serotonin.  Serotonin-deficient depression is often characterized as an “agitated” depression, sometimes associated with anxiety, sleeplessness, compulsive actions including binge-eating, and aggression.  And there are the catecholamines (dopamine and norepinephrine).  Catecholamine-deficient depression is often characterized as a “flat, low-energy” depression and can be tied to loss of appetite, loss of sex drive, narcolepsy, low blood pressure.  Once again, I’ll refer you to Natural Prozac, by Joel Robertson and Tom Monte, for its wonderfully clear and informative descriptions of serotonin- and catecholamine-deficient depression.  There’s questionnaire to help determine which type you are.

As you read this, bear in mind a few things.  First of all, vitamin B-6 is necessary to make every single one of these neurotransmitters.  You can increase the efficiency of any neurotransmitter precursor by taking B-6 along with it.  Although these treatments may sometimes work literally overnight, they often take 1-2 weeks.  Finally, amino acids are components of protein.  Usually, when you take an individual amino acid, you want to take it away from protein foods so it doesn’t get “lost” in the wash of aminos released after a meal.  That being said, make sure to get enough protein in your diet!  A few eggs for breakfast, or a whey protein shake can sometimes be invaluable.

Serotonin Precursors: 5-HTP.  We make serotonin in our bodies from a compound called 5-HTP (5-hydroxytryptophan).  But before that can happen we must make 5-HTP from the essential amino acid tryptophan, present in our food.  It’s this first step of making 5-HTP from tryptophan which holds up the entire process, and it gets even slower if we are under stress, have type II diabetes, or are deficient in magnesium or vitamin B-6.  By taking 5-HTP as a supplement itself, we bypass this first step, making it a lot easier for our bodies to make more serotonin.

A recent article in Alternative Medicine Review states “Since the early 1970s, at least 15 studies have evaluated the clinical effects of 5-HTP on depression... taken together, these studies examined a total of 511 patients with different types of depression.  Of these 511 subjects, 285 (56%) showed a significant improvement while taking 5-HTP.”  In many of these studies, the 5-HTP was just as effective as the prescription drug that it was being compared to, with a quicker response time, and much fewer side effects.  While a 56% success rate is pretty good, I think that number should actually be higher.  To begin with, some of these studies included seriously depressed patients, people who usually don’t respond well to any one drug.  Some of them even included patients with bipolar disorder, for whom 5-HTP is not recommended.

5-HTP can is also useful at controlling food cravings, especially for carbohydrates.  It also can be used to help people get to sleep.  It also helps some people with migraines.

Unlike other amino acid supplements, 5-HTP can be taken with food.  I’ve seen dose recommendations range anywhere from 50 mg to well over 1000 mg a day.  Although 5-HTP is considered to be very safe, I’d be hesitant to use the much higher doses without a doctor’s supervision.  The Encyclopedia of Natural Medicine suggests 100-200 mg, three times a day.  On the rare instances when people do run into problems, they tend to be your basic run-of-the-mill digestive stuff like mild nausea, stomach upset, heartburn, etc., that go away when they stop taking it.    TO BE CONTINUED