Depression

Is depression a chemical problem or a psychological one? Conventional medicine tends to give the impression that the more severe depressions have a chemical cause. I think the issue is more complex, and that even in those there are deep-seated psycho-spiritual issues.

Depression is an extremely common problem and may present in many different ways.

It is often divided into endogenous and exogenous types. In endogenous type depression there is no known cause; in exogenous depression there is some easily identifiable cause. However it is probable that the endogenous type is just more deep-seated in a depressive type personality.

Of special interest is the question regarding the origins of depression. Is it a chemical problem or a psychological one? Many conventional doctors and psychiatrists tend to give the impression that the more severe endogenous type depressions have a chemical cause and are not due to emotional or psychological causes.

I think the issue is more complex.

Human beings are complex and it seems unreasonable to believe in single causes. Nevertheless I do believe that even in the severe endogenous types there are deep seated psycho-spiritual issues. The word psycho-spiritual may be disturbing to some people and needs clarification. I am not talking religion here, but only referring to the fact that conventional medical science has not yet discovered the full extent of what it means to be human. Our biochemists cannot measure emotions, unless you believe that the chemicals running around the body are molecules of emotions. This seems unlikely and we are anyway unable to diagnose patients’ emotions from blood samples.

Similarly with thought. Thought cannot be measured even though by using sophisticated equipment we may be able to see the movement of energy across the brain or concentrating in certain parts of it.

What we are measuring here are only the changes in the body as the result of emotions or thoughts.

When we think about movement, we see movement happen. Just as my hand going up is reflecting my thoughts, any biochemical changes or energy changes in the brain are reflecting thought and emotions.

This is our common experience.

If we become emotional then we are aware of sensations in the body. The movement of the body and physical sensations are secondary to the thoughts and emotions, just as the movement of my lips when talking is reflecting my thoughts.

What happens to our deep seated longings, sadness and unhappiness, past traumas, rejections, lack of loving, etc? These are like imprints buried in the subconscious part of our mind and, just like a virus in a computer, will interfere with our functioning, very often causing biochemical disturbances.

In some cases this is our endogenous type of depression, but it also could manifest as any other known disease, such as cancer for example.

I have used the word psycho-spiritual, however, rather than just psychological in order to bring up another aspect of the problem which most doctors don’t mention. I use the word spirit in its non religious context but it's okay to think about it in a religious way as well.

By spiritual I mean the non-material part of the human being, the thinking part,

our intentions and loyalty, our sense of a greater whole and our longing for union with something deep within. These, and the disturbances that arise because of our loneliness, fears and frustration around the above issues, cause the spiral of events which lead to depression both endogenous and exogenous.

Much can be said about the above issues, and I only wish to put them forward as it is time that the medical profession honours the fullness of who we are as humans rather than the more limited viewpoint of the conventional medical paradigm which prefers to view all diseases as biochemical.

Management

NATURAL NEUROTRANSMITTER PRECURSORS: Whatever the initiating cause of depression, it seems that the end point is the alteration in brain chemistry that produces depression. The primary chemical process involved appears to be a reduction in serotonin levels. Serotonin has widespread effects and appears to play a key role in regulating temperature, blood pressure, blood clotting, immunity, digestion, sleep, and daily rhythms. In the brain it inhibits the firing of brain cells, producing a relaxing effect on mood.

The pathway of the manufacture of serotonin passes from tryptophan to 5-hydroxytryptophan (5-HTP) to serotonin.

1. 5-HTP are precursor molecules and are used to increase the serotonin in the brain. Conventional medicine uses serotonin destruction inhibitors to increase the level of serotonin. The purpose of both approaches is to increase serotonin levels. A number of controlled trials using 5-HTP suggests that it may be as effective as standard antidepressants. It should be taken with a carbohydrate snack to facilitate absorption. The dose of 5-HTP is 100mg one to three times per day.

2. Phenylalanine and tyrosine: These two amino acids are precursors of the catecholamine pathway, giving rise to the neurotransmitters dopamine, norepinephrine and epinephrine (adrenalin). These have powerful antidepressant effects supporting arousal, alertness, optimism, zest for life and sex drive.

These amino acids are also found in chocolate which may explain chocolate’s mood enhancing properties.

3. S-adenosyl-methionine (SAM): SAM is essential to the metabolism of many neurotransmitters and appears to act faster than the standard antidepressants. In a number of trials it has been shown to be effective and well tolerated. It should not be used by persons with bipolar disorders.

Herbal supplements

1. Hypericum perforatum (St John’s Wort): This herb appears to work as well as classical antidepressants in mild to moderate depression. Side effects are far fewer than those of drugs. It does not appear to work for major depressions on its own, and other supplements may be necessary. Three million prescriptions for St John's Wort are filled in Germany every year, nearly twice the number of prescriptions written for other antidepressant medication. Like all herbal preparations St John's Wort is exceedingly complex and one should not try to understand its effects by simply looking at the chemical structure and comparing it to a drug with some similar molecular structures.

People taking other drugs should consult with their doctor before taking this herb.

2. Ginkgo Biloba: This may have significant antidepressant effects in older patients where the blood supply to the brain has diminished. It can be combined with St John's Wort and/or 5-HTP.

3.Kava Kava: This herb is particularly useful for depression with an anxiety component.

Other nutrients

Optimum nutrition is required for optimum health. Most people do not receive optimum nutrition in their diet. A high-potency multivitamin and mineral provides a good nutritional foundation upon which to build. A Vitamin B-compound containing folic acid, B12 and B6 is especially important. In some studies of depressed people folic acid deficiencies were present in 31 to 35% of them. In elderly persons this percentage may be even higher.

Lifestyle changes

Various studies have shown an improvement in depression when there are significant lifestyle changes including exercise, healthier diet and a change in scenery (painting the house or buying new carpets). A recent study has shown that exercise was at least as effective in preventing a recurrence as the anti-depressant drug Zoloft over 4 months and was more effective 6 months after the study had ended.

What else

A deficiency or imbalance of essential fatty acids may be a contributing factor and should be considered, especially in people not responding to other treatments.

The WHO recognizes acupuncture as a treatment for mild to moderate depression.

End notes

There is no single treatment for everyone with depression. Natural medicine when used in an integrated wholesome way is definitely successful in mild to moderate depression, and even in some severe cases.

The more severe the case the more professional help is required. Nevertheless many depressed patients continue to go the way of suicide, even while on heavy medication. Clearly medication does not work for everyone either.

A holistic integrative approach often requires a team working together for the benefit of the sick person. For some reason this seems very difficult to do and the patient therefore does not get optimum management.