DEPRESSION

ALMOST EVERYONE EXPERIENCES depression at some time in his or her life. Depression is that sad, hopeless, middle-of-the-winter, dark night of the soul place where one feels trapped in despair. But depression is more than just a feeling - it is a profound psychological and physical experience.

Depression is often defined as a condition in which a number of specific symptoms persist for at least one month. If you have four of the following symptoms, you are probably depressed; if you have five, you are definitely depressed.

• Feelings of worthlessness, self-reproach or inappropriate guilt
• Recurrent thoughts of death or suicide
• Poor appetite with weight loss, or increased appetite with weight gain
• Insomnia or hypersomnia (sleeping more than usual)
• Physical hyperactivity or inactivity
• Loss of interest or pleasure in usual activities, or decrease in sexual drive
• Loss of energy and feelings of fatigue
• Diminished ability to think and concentrate.

Along with these symptoms, many physical functions in the body can become unbalanced as well. Constipation and changes in the menstrual cycle are common. You may feel cold, weak and sluggish. Depression may occur as a brief, transient event or it may be a lifelong struggle. When depression results from a life event such as the death of a loved one, the end of a relationship, or the loss of a job, the feelings may be appropriate and normal. In fact, a period of grief and sadness is essential. Treatment is generally not needed unless the depression is unusually prolonged, is severe enough to make someone non-functional or is resulting in serious suicidal thoughts.

Some people experience lifelong or recurrent depressions not necessarily related to outside events. In these people, current scientific theory holds that there is an imbalance in neurotransmitters - compounds that transmit information to and from nerve cells. Among the neurotransmitters involved in depression are serotonin (a mood-controlling brain chemical), melatonin, dopamine, adrenaline and noradrenaline (norepinephrine). These compounds can be affected to some extent by most treatments that help ease depression, including drugs, herbs and nutrients.

Most people with depression should seek a thorough medical evaluation. Symptoms that look like depression might be caused instead by a specific medical condition, such as thyroid disease, hypoglycaemia or hormonal imbalances, or a drug side effect. These conditions need their own treatment. Also, whatever the cause of the depression, various types of therapy can be extremely helpful. Look for a therapist who has experience in working with depression. Support groups are also helpful.

WHEN DEPRESSION IS SERIOUS

Depression can be painful. If you are seriously considering suicide as a solution to your depression, please get help now. Call your doctor or a local crisis line such as the Samaritans; if you can't do either of these, go to the accident and emergency department of your local hospital.

DRUG TREATMENT

Selective Serotonin Re-Uptake Inhibitors (SSRIs)

Fluoxetine (Prozac), sertraline (Lustral), paroxetine (Seroxat), fluvoxamine (Faverin), others. Function: prevent the metabolism of the mood-controlling brain chemical serotonin, thus increasing the amount of this neurotransmitter available to the brain. Side effects: agitation, anxiety, insomnia, tremors, headaches, nausea, sexual dysfunction; less commonly, paradoxical sedation.

Tricyclic Antidepressants

Amitriptyline (Lentizol, Tryptizol), imipramine (Tofranil), doxepin (Sinequan), others. Function: adjust noradrenaline metabolism; some also affect serotonin, the mood-controlling brain chemical, and dopamine. Side effects: sedation, dry mouth, constipation, low blood pressure, nausea, blurred vision, sweating, rashes and other hypersensitivity reactions.

Monoamine Oxidase Inhibitors (MAOIs)

Phenelzine sulphate (Nardil), tranylcypromine sulphate (Parnate). Function: inhibit an enzyme that breaks down various neurotransmitters. Side effects: serious interactions with some drugs and some foods; headache, dry mouth, drowsiness, weight gain, constipation, oedema.

Sedatives

Trazadone (Molipaxin), nefazodone (Dutonin). Function: ease night­time insomnia due to depression. Side effects: sedation, dry mouth, constipation, low blood pressure.

Other Drugs

Venlafaxine (Efexor). Function: affects serotonin, noradrenaline and dopamine. Side effects: insomnia, anxiety, weight changes, increased blood pressure, nausea, constipation, sweating, vomiting, headache, dry mouth, dizziness.

WORK WITH YOUR DOCTOR

If you are already taking antidepressant drugs and wish to try herbs instead, it's absolutely essential to work with your doctor to develop a schedule for making this transition. Don't try it alone. Some herbs for depression can have harmful interactions with commonly prescribed antidepressants; others take time to show their full effects.

BITTERS MAKES IT BETTER

Here's an irony: something nasty tasting can help you recover your taste for life's sweethess. A preparation called bitters, often made from such herbs as gentian, wormwood and mugwort, can help ease depression's effects on the body because of the stimulating and enlivening effect of bitters on the digestive system. Remember that depression is not just a state of mind; it affects the entire body's physiology. Bitters improve hormone and digestive processes, lift energy and help to treat constipation, a common symptom in depression. Bitters are readily available in herb shops in a variety of liquid extract forms. Take the extract with meals, at a dose of 1 dropperful to 1/2 teaspoon in water three times per day; or follow the manufacturer's or practitioner's instructions.

THE ULTIMATE MOOD-LIFTER: MOVEMENT

There is no question that exercise can improve mood and lift depression. Exercise stimulates the body and may increase some of those important neurotransmitters. It is especially good to exercise outdoors at least some of the time; fresh air, sunshine and proximity to nature are all mood lifters. Although you might find it hard to initiate an exercise programme when you are already depressed, only the first steps are the hardest. So consider asking someone else to exercise with you; having company can encourage you to get going and reduce the isolation that is common in depression. You don't need to do anything elabourate, expensive or strenuous; just going for a walk will do the trick.

HERBAL REMEDIES

St John's Wort (Hypericum perforatum)

For mild-to-moderate depression, this herb lives up to its hype. More than 40 scientific studies have verified the traditional use of this herb for depression. Studies have compared St John's wort with placebos (fake pills) and with antidepressant drugs. The results of all the studies showed that this herb is effective in the treatment of mild-to-moderate depression, appearing to work in about 70 per cent of cases. It works as well as prescription drugs, and has significantly fewer side effects.

In all the studies, however, St John's wort took at least two weeks to have any effect. In some people it can take up to one month. Typical dosage: 900 milligrams of capsules standardised to 0.3 per cent hypericin per day in divided doses, with meals (including a dose at bedtime if you suffer from insomnia); or 1/4 to 1 teaspoon of tincture three times per day. (A tea made from the dried herb won't help depression; the herb loses its potency when it dries.) Caution: St John's wort may cause mild stomach upset, rashes, restlessness, insomnia or sensitivity to sun exposure. Do not use if you take prescription antidepressants or L-dopa.

Oats (Avena sativa)

This is the same plant that goes into your morning porridge. It is a wonderful tonic for the nervous system, having generalised nourishing and soothing qualities. The plant is traditionally used not only for depression but also for anxiety, stress, fatigue and debility. The seeds have the strongest medicinal qualities, especially when harvested at what is called the milk stage. If you squeeze the fresh green seeds, a little drop of milky fluid emerges. When buying dried oats for tea, look for pale green to yellow seeds, rather than something that looks like chopped straw. Typical dosage: 3 cups of tea per day (steep 1 tablespoon of dried seeds in 1/4 litre of hot water for 10 to 15 minutes); or 1/2 to 1 teaspoon of tincture three times per day.

Lavender (Lavandula angustifolia)

This beautiful, fragrant herb has a gentle, relaxing and nourishing effect on the nervous system, while lifting the spirits and easing depression. It promotes refreshing sleep as well. Just the smell of lavender has an antidepressant effect. Its essential oil can he applied to the body, inhaled, or added to bath water. Typical dosage: 1 cup of tea three times per day (steep 1 teaspoon of flowers in 1/4 litre of hot water for 5 minutes), or % to % teaspoon of tincture three times per day. Caution: do not take essential oil internally.

Vervain (Verbena officinalis)

This is another herb traditionally used in treatment of depression, though such use is not scientifically backed. Vervain has nourishing and balancing effects on the entire nervous system. It's also a gently relaxing remedy. Herbalists consider it especially helpful Ftvhen depression is related to long-term illness. As an added benefit, it can help to heal any damage that has occurred to the liver. Typical dosage: 1 cup of tea three times per day (steep 1 teaspoon of dried herb in 1/4 litre of hot water for 5 to 10 minutes); or 1/4 to 1 teaspoon of tincture three times per day.

Ginkgo (Ginkgo biloba)

This amazing herb is beneficial for treatment of diseases of the cardiovascular and nervous system. It increases blood supply to the brain and improves nerve cell function. It enhances memory and other intellectual functions. Ginkgo can be an excellent treatment for depression, especially in elderly people, where it may counteract age-related decreases in the receptors for serotonin. It can be exceptionally helpful in treating depression in two groups: older adults who have mild decreases in intellectual functioning, and those with histories of stroke or other diseases of the nervous system. In younger people, it might help if problems with memory or concentration are prominent. Typical dosage: 40 to 60 milligrams of standardised extract capsules three times per day; or % to % teaspoon of tincture three times per day.

Kava-Kava (Piper methysticum)

Especially appropriate for daytime use, this herb has been shown to alleviate the anxiety that can accompany depression without causing sedation or decrease in mental functioning. Scientific studies of kava actually show that it may improve memory and mental functioning. Typical dosage: up to six 400- to 500-milligram capsules per day; or 15 to 30 drops of tincture up to three times per day.

(For more herbal sedatives that work well in cases of insomnia or anxiety related to depression, see Anxiety)

 

THE MOOD-FOOD CONNECTION

Almost any nutritional deficiency can contribute to depression. So it is especially appropriate to correct possible deficiencies of vitamin C and the B vitamins (biotin, 612, folic acid, niacin, pantothenic acid, pyridoxine and thiamine). Other factors that can promote depression are food allergies, excess caffeine and sugar, and rich, heavy, nutrient-poor diets.