"I've been feeling down lately", reports patient X. "It's becoming harder to get out of bed, I'm irritated by everyone around me, and I can't get a grasp on these negative thoughts. I know it's all in my head, but...". More often than not, the way we feel easily becomes isolated to a psychological state. Depressed or anxious feelings = a mental condition, even though the symptoms can often be very physical. But what if I were to tell you that that's not the whole story and that evidence suggests otherwise?
We know that our hormones (and feelings, for that matter) are continuously creating a series of beautifully coordinated chemical reactions with the intent of communication within the body. And while these chemical reactions may produce very metaphysical feelings, I assure you, the process is very physical. Therefore, the way you feel isn't just all in your head, and believe it or not, there's a lot you can physically do to change it.
Mild to moderate Depression and Generalized Anxiety Disorder (GAD) are the two most common mental-emotional conditions affecting today's population, with no signs of slowing down. While depressed and anxious feelings are a normal part of life struggles and downswings, prolonged engulfing sadness and relentless states of panic are not. Standards of care suggest treatment of these conditions begins with conservative psychological interventions such as cognitive behavioural therapy, stress reduction therapy, etc, before the prescription of medication. However, it's not uncommon for medications (termed "antidepressants") to be introduced as primary treatment for anyone experiencing symptoms of moderate to severe depression or anxiety, with the most common type being selective serotonin reuptake inhibitors (SSRIs). They've even become the leading treatment for menopause these days. Generally speaking, these medications work by modifying the signal pathway I mentioned earlier, increasing circulating levels of our "happy hormones"; serotonin, norepinephrine, and dopamine. So before "happy pills" become the new recommended drug of choice for everyone (and we're not far off), let's look at the facts... Two meta-analyses published in 2008 & 2010 concluded that SSRIs have little to no benefit over placebo in cases of mild to moderate depression. They do, however, bring side effects of weight gain, decrease libido, and believe it or not, increased suicide risk in children and adolescents. The benefits were significant for those with severe depression and GAD, although only about half (50%) respond to treatment.
Is depression inflammatory?
This is a new and very promising area of research with respect to mood disorders. A study completed in our own backyard, the CAMH Research Institute in Toronto, links a direct relationship between depression and inflammation. PET scan results conclude people experiencing depression have up to a 30% increased level of inflammation in the brain, with inflammation levels being most severe in patients experiencing the most severe depression. While the research is preliminary, and we still haven't really figured out the roles of "the chicken or the egg", the implications of treating inflammation in depression are promising. What research does conclude is that inflammation certainly plays a role in both the risk of development and progression of depression.
BLOOD SUGAR Blood sugar spikes and drops affect insulin release, which affects cortisol, and ultimately our ability to cope with stress. It's very important to eat whole food meals and on a regular schedule. Refined sugar is a known pro-inflammatory substance, and is added to all processed foods on the shelves. SOLUTION: Fibrous foods and protein help to offset glucose levels, so make sure there's protein and leafy greens at every meal. OMEGA 3's Fish oil - specifically the EPA component - has been shown to be an effective way of managing mood and depression. Omega 3 fatty acids actually shunt the body away from producing inflammation, which is why they've been coined as anti-inflammatory. To receive mood benefits from fish oil, evidence suggests you need a fish oil with a minimum of 60% EPA content, as lower ratios are ineffective
SOLUTION: supplement capsulated fish oil daily with a 3:1 ratio of EPA: DHA, and a minimum of 1000 mg EPA per day VITAMIN D It's important to differentiate between depression and seasonal affective disorder (SAD). Decreased amounts of sunlight during winter months (and the natural tendency to hibernate from the cold - especially this year) lower our natural production of vitamin D, and have shown to have effects on our mood. During winter months, vitamin D supplementation can offset this drop. Vitamin D also supports our immune system, which is an added benefit.
SOLUTION: minimum 4000 IU of vitamin D during winter months, in a fat-soluble solution (liquid, NOT capsules) ADDRESS THE GUT While the science behind it is still not well understood, the state of our gut plays a critical role in how we feel. Not only does the gut have its own nervous system, but 75% of the body's happy hormone, serotonin, is produced there. Nearly 80% of those suffering from irritable bowel syndrome experience anxiety and/or depression. One study even showed a connection between probiotics and improved stress response.
SOLUTION: ensure healthy & regular bowel movements, ask your Naturopath if you need good probiotics, and reduce gut inflammation by avoiding dairy, gluten, and processed/refined foods.
References: 1. www.NICE.org.uk 2. Hammad TA (2004-08-116). "Review and evaluation of clinical data. Relationship between psychiatric drugs and pediatric suicidal behavior" (PDF). FDA. pp. 42; 115. 3. Kirsch I, Deacon BJ, Huedo-Medina TB, Scoboria A, Moore TJ, Johnson BT (February 2008). "Initial Severity and Antidepressant Benefits: A Meta-Analysis of Data Submitted to the Food and Drug Administration" 4. Fournier JC, DeRubeis RJ, Hollon SD, Dimidjian S, Amsterdam JD, Shelton RC, Fawcett J (January 2010). "Antidepressant Drug Effects and Depression Severity" 5. CAMH new release: New biological evidence reveals link between brain inflammation and major depression 6. Philip Rouchotas MSc, ND. What You Need to Know About Fats, The Good, the Bad, and the Ugly.