Understanding why you have depression
By Dr. Martin Gleixner, MSc, ND
Mood disorders were first introduced in a previous article entitled “Take a mind-body approach to treating depression, anxiety”.
Let’s broaden our understanding of depression as this medical condition is becoming more and more common. The month of February tends to be one of the worse times of the year.
The diagnosis criteria for depression disorders is beyond the scope of this article, but let’s review the most commonly experienced symptoms:
- Loss of interest or pleasure in usual activities
- Loss of energy (fatigue)
- Changes in appetite with either weight loss or weight gain
- Sleep problems (insomnia or excessive sleeping)
- Decrease in libido
- Physical hyperactivity or inactivity
- Feelings of worthlessness, self-reproach or helplessness
- Feelings of anger or irritability
- Diminished ability to think or concentrate
- Recurrent thoughts of death or suicide
The underlying causes for depression are often unique to each individual and as such, deserves specific attention. As a naturopathic doctor, being a detective is the most important aspect of my clinical practice. After all, discovering the reason(s) why someone develops the disease will be the basis for a sound and effective treatment plan.
Deficient or inappropriate secretions of neurotransmitters (e.g. serotonin) is only the tip of the iceberg (see diagram). Like the iceberg’s much larger block of ice hidden below the water surface, neurotransmitter imbalances are often the end-result of numerous causes such as hormonal imbalances, long-standing inflammation in the body, nutritional deficiencies, lack of exercise, emotional stress, only to name a few.
Many commonly used antidepressant drugs treat the end-result (neurotransmitter imbalances). Although, these drugs do provide relief for some people, for others they fall short of their goal because they don’t address the reasons behind such imbalances.
Furthermore, common side-effects while taking an antidepressant can include nausea, drowsiness, weight gain, and decreased sex drive. The off-label use of antipsychotic drugs (e.g. risperidone) to treat depression in adolescents for example, has recently received public attention due to severe side-effects. One case report described a 75lbs weight gain! There is no doubt that gaining weight and the subsequent decrease in self-esteem can dramatically decrease the long-term success of such an approach.
When antidepressant drugs are ineffective and if too many side-effects are experienced, alternative methods of treatment should be considered. Medical doctors (MDs) and naturopathic doctors (NDs) can work together so that the best treatment options are used for each individual.
Let’s review some of the long-standing imbalances in the body that can cause neurotransmitter imbalances and the resulting changes in mood:
Thyroid disease, fibromyalgia, drug side-effects, celiac disease and many serious chronic diseases (eg cancer) are common causes of depression and should always be ruled out first before any other treatments are used. Using an anti-depressant medication may mask a more serious underlying disease.
As an example, I have treated depression successfully for numerous patients simply by addressing their low thyroid function (a condition called hypothyroidism).
Hypothyroidism can be at the root of depressive symptoms. Our lab standards to officially diagnose someone with hypothyroidism are based on high TSH levels (TSH is released from pituitary gland to stimulate thyroid hormone production) and low T4 levels (thyroid hormone).
Thyroid function is said to be normal if TSH has a value between 0.4 to 5 mU/L (note: values may vary slightly between different laboratories). Many are recommending that these standards are too broad. The American Association of Clinical Endocrinologists (2003) stated that "TSH level between 3.0 and 5.0 mU/L... should be considered suspect." Optimal thyroid function is best represented by a TSH value between 1 to 2.5 mU/L rather than merely being under 5 mU/L.
In my practice, I commonly observe patients who experience symptoms of low thyroid function despite TSH levels that are below the normal cutoff of 5 mU/L (even when T4 levels are normal). Many patients are often told from their doctors “your labs are all OK”.
Whether it’s treating someone with hypothyroidism or helping patients achieve optimal levels of thyroid hormone production, depression can be cured by addressing the pathological cause of the disease.
Exposure to toxins that affect brain function
We are exposed to a great number of toxins during the course of our lifetime. Our lungs, kidneys, digestive tract, and liver can normally remove most toxins on a daily basis, but sometimes these detox mechanisms become inefficient or overwhelmed. The accumulation of neurotoxins such as heavy metals (especially mercury and lead), polychlorinated biphenyl (PCB), phthalate, etc… can be an important contributing factor to depression (and to other nervous system diseases).
As our waterways and oceans become more polluted, the overconsumption of fish and shellfish is becoming a very important contributor to the toxic burden in the body. Farmed fish and seafood caught in more polluted areas are particularly harmful.
Because of their inherently high saturated fat content and due to bioaccumulation, meats and dairy products are another important sources of numerous chemicals. For example, the main sources of exposure to PCBs for adults are non-organic butter (as well as Atlantic farmed fish).
Decrease your exposure to toxins by avoiding seafood that has higher toxic loads. Locally caught haddock, mackerel, shrimp, crab and scallops are good choices. Canned wild salmon and sardines from Raincoast Trading are also cleaner sources. Buying organic meats and dairy products is equally important.
Nutritional deficiencies can occur with dietary restrictions, insufficient whole foods, excess junk foods, and gastrointestinal disorders (eg celiac disease, Crohn’s disease or ulcerative colitis, etc…). Vitamin B12, folate, vitamin B6 (& other vitamin Bs), magnesium and iron are most important for supporting our mood. Addictions such as cigarette smoking, alcohol or other recreational drugs are common in mood disorders and can cause further depletion of many nutrients that are important for the nervous system.
Lack of sunshine and corresponding vitamin D3 deficiency is another important component of depression.
Vitamin deficiencies should be evaluated based on blood tests and the presence of symptoms observed via physical examination.
Lack of Exercise
Numerous research studies have shown that exercise benefits those with depression. Not only does it provide a jolt of endorphins that can be enjoyed short-term, it provides a substantial boost in confidence that is required for long-term lifestyle changes. Increased blood flow to the brain provides pulses of nutrients and oxygen to the brain that are required for healing. The increased circulation also allows improved venous return, that is, old blood that carries waste and toxins away from the brain so that the body can excrete it.
Lack of quality sleep
A full night of restful sleep heals the body by reducing inflammation and balancing the nervous and hormonal system. It also improves daytime energy levels, which goes a long way to improve mood.
Our thoughts and behaviours are also believed to affect neurotransmitter levels. Stress in any area of life (such as finances, work, or relationships) appears to decrease the availability of serotonin in the brain.
More recently, the increased use of mobile devices even after working hours (and during holidays) prevents people from being able to fully unwind. Technology is a wonderful tool, but limitations should be set to help people relax and recuperate.
Counselling and self-exploration can identify and improve our emotional and mental states. Whether you prefer a one-one approach through psychological counselling, the use of self-help books or practices such as meditation, the key is to start somewhere.
Adrenal and female hormone imbalances
Hormone imbalances are an important contributing factor to depression. Stress causes excess cortisol secretions (a hormone made by our adrenal glands) which can in turn affect our mood, increase sugar levels in the blood, decrease the amount of active thyroid hormones, and cause weight changes.
After periods of prolonged stress, cortisol levels can become suboptimal or imbalanced thereby contributing to increased fatigue and insomnia. In turn, depression often follows suit.
Mood changes in premenstrual syndrome (PMS) and during peri-menopause often occur due to progesterone deficiency (or estrogen dominance). Many women also experience depression after childbirth. An article published in the British Medical Journal (1994), found that among 120 women, those who scored highest on postpartum depression scores where those with the lowest progesterone levels.
Assessing hormone levels is best conducted through salivary testing, enabling your naturopathic doctor to recommend a personalized treatment protocol.
Naturopathic care includes a medical assessment and diagnosis evaluation including the interpretation of laboratory results. Treatment includes nutritional and exercise suggestions, the use of specific vitamins or minerals in medicinal doses as well individualized herbal or homeopathic combinations to address underlying functional or pathological imbalances.
As we can now appreciate, depression can be caused by one or a combination of difference causes. For a long-lasting cure of depression, naturopathic treatments can address the “whole” iceberg: provide relief by treating above the water surface (eg serotonin imbalances) and also below the water surface (all the other imbalances discussed herein).
Published by Dr. Gleixner on Friday, February 24th, 2012 in Times & Transcript.
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