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  Depression  
 
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Signs, symptoms and indicators | Conditions that suggest it | Contributing risk factors | Other conditions that may be present | It can lead to... | Recommendations

 

Depression is a serious yet common psychological condition that changes how you think and feel and also affects your social behavior and sense of physical well-being. We have all felt sad at one time or another, but that is not depression. Sometimes we feel tired from working hard, or discouraged when faced with serious problems. This too, is not depression. These feelings usually pass within a few days or weeks, once we adjust to the stress. If these feelings linger, intensify and begin to interfere with work, school or family responsibilities, then it may be depression. Each year over 6% of American adults experience a period of clinical depression. Depression is 2-3 times more common in women than in men, in part because women's brains make less of the "happy" hormone, serotonin. Depression, which can affect anyone, is often not recognized because many of the symptoms such as sleep and appetite disturbances mimic physical illness. Once identified, most people diagnosed with depression can be successfully treated. Too often, untreated or inadequately treated depression results in suicide or the destruction of family life. The more serious the condition, the greater the importance of seeking medical and psychological help.

Major depression often begins between the ages of 15 and 30 and episodes typically recur. One diagnostic criteria for major depressive disorder is:

  • The patient has depressed mood (e.g., sad or empty feeling) or loss of interest or pleasure most of the time for 2 or more weeks plus 4 or more of the following symptoms (SIGECAPS):
    Sleep - Insomnia or hypersomnia nearly every day
    I nterest - Markedly diminshed interest or pleasure in nearly all activities most of the time
    Guilt - Excessive or inappropriate feelings of guilt or worthlessness most of the time
    Energy - Loss of energy or fatigue most of the time
    Concentration - Diminished ability to think or concentrate; indecisiveness most of the time
    Appetite - Increase or decrease in appetite
    Psychomotor - Observed psychomotor agitation/retardation
    Suicide - Recurrent thoughts of death/suicidal ideation
  • The symptoms do not meet crieteria for mixed episode (major depressive episode and manic episode)
  • The symptoms cause clinically significant distress or impairment in social, occupational, or other improtant areas of functioning
  • The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition
  • The symptoms are not better accounted for by bereavement

Some people have a chronic but less severe form of depression called dysthymia (or dysthymic disorder). It is defined as a state of depressed mood that persists for at least two years and is accompanied by at least two other symptoms of depression. These symptoms include poor appetite or overeating, insomnia or hypersomnia, low energy or fatigue, low self-esteem, poor concentration or difficulty making decisions and feelings of hopelessness.

Approximately 2% of American adults have dysthymia in a given year. Research has shown that stress in the form of loss, especially death of close family members or friends, may trigger major depression in vulnerable individuals. While unipolar major depression and dysthymia are the primary forms of depression, a variety of other subtypes exist.

As depression can have more than one cause, it is important to determine the primary or underlying cause whenever possible. Natural medicine can play an important role in preventing or resolving depression. Diet, supplementation, hormone replacement and balancing, allergy detection, herbs (such as the well documented use of St. Johns Wort) and other treatments have all been used successfully.
 

 
 

Signs, symptoms & indicators of Depression:
 
 
Symptoms - Aging  Loss of interest in activities

Counter-indicators:
  No loss of interest in activities

Symptoms - Food - General

  Weak appetite

Symptoms - General

  Constant fatigue

Symptoms - Mind - Emotional

  Attempting suicide or suicidal thoughts
 Using 10 years of data accumulated from 27 Texas counties, researchers found that the incidence of homicide, rape, burglary, and suicide, as well as other crimes and drug use, were significantly lower in counties whose drinking water supplies contained 70-170 micrograms of lithium per liter than those with little or no lithium in their water.

  (Deep/mild) depression
  Unexplained teariness/sadness

Counter-indicators:
  (No) history of depression
  Not suffering from depression

Symptoms - Mind - General

  Being unmotivated
  Trouble concentrating

Symptoms - Reproductive - Female Cycle

  Pre/menstrual depression
  Premenstrual/premenstrual bloating/ weight gain or premenstrual abdominal bloating

Symptoms - Sleep

  Unsound sleep
 
 

Conditions that suggest Depression:
 
 
Hormones  Low Sex Drive
 Mental states such as depression and strong emotions such as anger can effectively cool sexual desire.

Mental

  Low Self-Esteem

Metabolic

  Problem Caused By Being Underweight
 Being underweight and male is associated with a risk of depression.

  Hypersomnolence
 Depression and hypersomnolence are often seen together.

Symptoms - Mind - Emotional

Counter-indicators:
  Absence of depression
 
 

Risk factors for Depression:
 
 
Aging  Parkinson's Disease / Risk
 Depression is a common feature amongst Parkinson's disease victims. Depression may be difficult to diagnose in patients with Parkinson's because the signs of these two disorders overlap. In addition, patients with atypical Parkinson's more often have depression than patients with classical Parkinson's.

Allergy

  Allergic Tension Fatigue Syndrome
 Various degrees of depression may exist in cases of Allergic Tension Fatigue Syndrome.

Autoimmune

  Gluten Sensitivity / Celiac Disease

Circulation

  Anemia, Megaloblastic
 700 women over 65 (most in their mid-70s) in the Women's Health and Aging Study were interviewed and had blood samples taken for analysis. Overall, 14% were mildly depressed and 17% were severely depressed. Blood tests revealed that a deficiency in vitamin B12 was relatively common. Of the severely depressed women, 27% were deficient in the vitamin, compared with only 17% of the mildly depressed women and 15% of their happier counterparts. [American Journal of Psychiatry 2000;157: pp.715-72]

Digestion

  IBS (Irritable Bowel Syndrome)

Environment / Toxicity

  Gulf War Illness
  Copper Toxicity
  Heavy Metal Toxicity
  Morgellons Disease
  Mercury Toxicity / Amalgam Illness
  General Detoxification Requirement

Family History

  Depression in family members
 Research supports the existence of a genetic component toward developing depression.

Hormones

  Low Serotonin Level
 Serotonin levels can dictate if you feel depressed or not. Antidepressant medications like Paxil, Zoloft, St. John's Wort, and Prozac work by preventing serotonin destruction and loss. These antidepressants inhibit serotonin uptake ( or reuptake) by the neurons in the brains. Low serotonin levels cause depression.

  Histadelia (Histamine High)
 Histadelics are often chronically and suicidally depressed.

  Low Estrogen Levels
 Low estrogen levels trigger the brain to release MAO, an enzyme in the brain which breaks down and destroys the neurotransmitter, serotonin. Estrogen increases the destruction of this enzyme. The lower your MAO enzyme levels the better you probably feel, since MAO breakdowns serotonin. Low serotonin levels are associated with depression.

  Low DHEA Level
 The hormonal supplement DHEA could help relieve mild to moderate depression that starts in middle age.

Still, DHEA probably isn't the first option patients should consider, say the researchers. In their small study, treatment with DHEA resulted in a 50% reduction in depression symptoms in half the participants.

"With a 50% response rate, one would obviously select more reliable first-line treatments for this condition," write the researchers, who included Peter J. Schmidt, MD, of the National Institute of Mental Health (NIMH).

"However," the researchers write, "in the 50% of depressed outpatients who do not respond to first-line antidepressant treatments, or in those unwilling to take traditional antidepressants, DHEA may have a useful role in the treatment of mild to moderately severe midlife-onset major and minor depression." [ Archives of General Psychiatry, Feb. 2005]

  Low Testosterone Level
 Depression can be caused by low levels of certain hormones, including testosterone.

  Hypothyroidism
 Depression is a common symptom of hypothyroidism.

  Cushing's Syndrome / Hypercortisolism
  Low Pregnenolone Level
 A study found that depressed patients generally had low levels of pregnenolone. [Biological Psychiatry, 35(10): pp.775-80, 1994]

  Histapenia (Histamine Low)
  Hyperparathyroidism
  Low Melatonin Level
  Hypogonadism, Male

Immunity

  Chronic Fatigue / Fibromyalgia Syndrome
 70% to 100% (different studies show various numbers) of fibromyalgia patients are found to have depression, though many consider that this is more likely to be a result of the muscular pain rather than part of the cause.

A sample of 69 patients with FM underwent a standardized tender point examination and a semistructured psychological interview and completed a set of self-report inventories. Of the sample, 39 met criteria for depressive disorder and 30 did not. [Evaluation of the Relationship Between Depression and Fibromyalgia Syndrome: Why Aren’t All Patients Depressed? Akiko Okifuji, Dennis C. Turk, Jeffrey J. Sherman]

Infections

  Lyme Disease

Lab Values

  Elevated Homocysteine Levels
 Nutrients which lower elevated homocysteine levels, including the B-vitamins, are related to depression in several ways [Am J Psy 1997;154: pp.426-428]. The methyl group provided by normal homocysteine metabolism is necessary for the production of depression-relieving neurotransmitters such as serotonin and dopamine. The B-vitamins are also crucial in the direct synthesis of the brain neurotransmitters. [J Affect Disord. 1986;10: pp.9-13; Psychosomatics. 1980;21: pp.926-929]

Medications

  Birth Control Pill / Contraceptive Issues

Mental

  Obsessive-Compulsive Disorder (OCD)
 Depression is a common complication of OCD: "up to 80% of people diagnosed with obsessive compulsive disorder also suffer from depression" [Barlow, 1988]. This should not be surprising, given the distressing, time consuming, and interfering nature of obsessions and compulsions.

Metabolic

  Wernicke-Korsakoff syndrome
  Pyroluria
  Hypoglycemia
 Endogenous depression - depression originating from within as opposed to being due to external factors - is a known symptom.

  Anorexia / Starvation Tendency
  Acidosis
  Methylation, Insufficient
 More than 40% of all clinically depressed men are undermethylated and benefit from therapies which enhance methylation. Another 15% or so are overmethylated and need to head for the other goal line...... namely avoidance of methylating supplements and use of folate therapy. [Willam Walsh, Ph.D., past senior scientist, Pfeiffer Treatment Center www.hriptc.org]

  Methylation, Excess
 More than 40% of all clinically depressed men are undermethylated and benefit from therapies which enhance methylation. Another 15% or so are overmethylated and need to head for the other goal line...... namely avoidance of methylating supplements and use of folate therapy. [Willam Walsh, Ph.D., past senior scientist, Pfeiffer Treatment Center www.hriptc.org]

  Tinnitus
 Many tinnitus sufferers become depressed simply from having to deal with the constant noise. Treating the depression may make the tinnitus seem less severe. Certain anti-depressants may worsen tinnitus, while others may improve it. SRI anti-depressants may temporarily worsen tinnitus for the first few weeks.

Alprazolam (Xanax) in a double-blind study showed 76% of the subjects benefited with tinnitus reductions of at least 40%, whereas only 5% of the placebo subjects had an improvement. [Arch Otolaryngol Head Neck Surg. 1993:119: pp.842-845]

  Hemochromatosis (Iron overload)

Musculo-Skeletal

  Polymyalgia Rheumatica

Nutrients

  Folic Acid Requirement
 There is substantial scientific evidence linking folic acid deficiency to depression. Folate deficiency is common in depressed individuals. [Journal of Psychiatric Research 1982;20(2): pp.91-101, British Journal of Psychiatry 1991;159: pp.271-2, Nutrition Reviews 1997;55(5): pp.145-9]

Again, a lower dietary folic acid intake was associated with an increased risk of depressive symptoms in a study of over 2,000 middle aged men in Finland. There was no link detected between the intake of cobalamin (B12), pyridoxine (B6) or riboflavin (B2), and depression in this study. [J Nutr 2003;133(10): pp.3233-6]

  Vitamin B Complex Requirement
 If you have very low levels of any of the B-vitamins, one of the first symptoms is depression. Studies show that one out of four people hospitalized for depression is deficient in pyridoxine and cobalamin.

The B-vitamins are crucial in the direct synthesis of the brain neurotransmitters. [J Affect Disord. 1986;10: pp.9-13; Psychosomatics. 1980;21: pp.926-929] Low levels of thiamin (B1) [Psychopharmacology (Berlin) 1997;129: pp.66-71], riboflavin (B2) and pyridoxine (B6) are often found in clinically depressed individuals. [British Journal of Psychiatry 1982;141: pp.271-272]

  Manganese Requirement
 Low blood manganese levels may accentuate depression. A deficiency may contribute to depression stemming from low levels of the neurotransmitters serotonin and norepinephrine.

  Vitamin B6 Requirement
 B6 is a cofactor for the conversion of tryptophan to serotonin and for the synthesis of dopamine and norepinephrine. It has been found to be quite low in patients admitted to hospital for depression. [Lancet April 18,1970, pp.832-33] Some doctors claim that when women have depression and insomnia, B6 and tryptophan work consistently.

  Vitamin B1 Requirement
 See the link between Depression and B-complex Need.

  Vitamin B2 Requirement
 See the link between Depression and B-complex Need.

  Zinc Requirement
  EFA (Essential Fatty Acid) Type 3 Requirement
 Polyunsaturated omega-3 fatty acid deficiency may contribute to depressive symptoms in alcoholism, multiple sclerosis, postpartum depression and bipolar depression. An insufficiency of omega-3 oils in the diet, especially the metabolite DHA, has been linked to depression.

Ethyl-eicosapentaenoic acid reduced aggression and severity of depressive symptoms, compared to placebo, in a well designed study of 30 women diagnosed with borderline personality disorder. The dose used was 1gm per day for 2 months. [Am J Psychiatry 2003;160(1): pp.167-9]

[The Omega-3 Connection: The Groundbreaking Anti-depression Diet and Brain Program ] by Andrew L. Stoll MD is a must-read for anyone dealing with depression. Stoll, the director of the psychopharmacology research lab at Boston's McLean Hospital and assistant professor of psychiatry at Harvard Medical School, suggests that restoring our body's natural balance of omega-3s may help alleviate (and prevent) many types of depression ..."

Four studies have shown that those with depression do indeed have lower levels of omega-3 fatty acids in the blood. [ Depletion of omega-3 fatty acid levels in red blood cell membranes of depressive patients. Biol Psychiatry 1998; 43: pp. 315-19. Lowered n-3 polyunsaturated fatty acids in the serum phospholipids and cholesterol esters of depressed patients. Psychiatry Res 1999; 85: pp. 275-291. Plasma fatty acid composition and depression are associated in the elderly: the Rotterdam study. Am J Clin Nutr 2003;78:pp. 40-46.]

One of these studies showed that the lower the level of EPA, the more severe the clinical depression. [Arachidonic acid to eicosapentanoic acid ratio in blood correlates positively with clinical symptoms of depression. Lipids 1996; 31: pp. S157-S161.] In addition, a recent study showed that the patients with depression have 35% less DHA in fat storage cells versus healthy controls. [Depression and adipose essential polyunsaturated fatty acids. Prostaglandins Leukot Essent Fatty Acids 2002; 67: pp. 311-18]

Significant changes in the way food is produced and manufactured have not only reduced the amounts of essential fats, vitamins and minerals consumed, but have also disturbed the balance of nutrients in the foods eaten. The proliferation of industrialised farming has introduced pesticides and altered the body fat composition of animals due to the diets they are now fed. As a result, the population's intake of omega-3 fatty acids has decreased whilst the consumption of omega-6 fatty acids has increased. According to the research, this unequal intake combined with a lack of vitamins and minerals is associated with depression, concentration and memory problems. [Bipolar News Jan. 2006]

Supplements and Medications

  Antidepressant drug use
  Prednisone use
 A side-effect of treatment with prednisone can be depression.

Uro-Genital

  Andropause/Male Menopause
 
 

Depression suggests the following may be present:
 
 
Autoimmune  Microscopic Colitis (Collagenous Colitis / Lymphoc

Cell Salts

  Cell Salt, Kali Phos Need

Environment / Toxicity

  General Detoxification Requirement
  Gulf War Illness
  Morgellons Disease

Hormones

  Cushing's Syndrome / Hypercortisolism

Immunity

  Chronic Fatigue / Fibromyalgia Syndrome
 70% to 100% (different studies show various numbers) of fibromyalgia patients are found to have depression, though many consider that this is more likely to be a result of the muscular pain rather than part of the cause.

A sample of 69 patients with FM underwent a standardized tender point examination and a semistructured psychological interview and completed a set of self-report inventories. Of the sample, 39 met criteria for depressive disorder and 30 did not. [Evaluation of the Relationship Between Depression and Fibromyalgia Syndrome: Why Aren’t All Patients Depressed? Akiko Okifuji, Dennis C. Turk, Jeffrey J. Sherman]

Infections

  Lyme Disease

Mental

  Dreams-Need / Interpretation
  Obsessive-Compulsive Disorder (OCD)
 Depression is a common complication of OCD: "up to 80% of people diagnosed with obsessive compulsive disorder also suffer from depression" [Barlow, 1988]. This should not be surprising, given the distressing, time consuming, and interfering nature of obsessions and compulsions.

Metabolic

  Pyroluria
  Anorexia / Starvation Tendency
  Wernicke-Korsakoff syndrome
  Tinnitus
 Many tinnitus sufferers become depressed simply from having to deal with the constant noise. Treating the depression may make the tinnitus seem less severe. Certain anti-depressants may worsen tinnitus, while others may improve it. SRI anti-depressants may temporarily worsen tinnitus for the first few weeks.

Alprazolam (Xanax) in a double-blind study showed 76% of the subjects benefited with tinnitus reductions of at least 40%, whereas only 5% of the placebo subjects had an improvement. [Arch Otolaryngol Head Neck Surg. 1993:119: pp.842-845]

  Problem Caused By Being Underweight
 Being underweight and male is associated with a risk of depression.

Nutrients

  Manganese Requirement
 Low blood manganese levels may accentuate depression. A deficiency may contribute to depression stemming from low levels of the neurotransmitters serotonin and norepinephrine.
 
 

Depression can lead to:
 
 
Circulation  Atherosclerosis
 Depression is emerging as a risk factor for heart disease. A study of 688 women showed that depression and anger are associated with hardening of the arteries in women, in part through physical and behavioral risk factors such as bad cholesterol levels, obesity and smoking. [Psychosomatic Medicine, March/April 2001]

Diet

  Underconsumption

Metabolic

  Insomnia
 Sleep disturbances are an integral part of a depressive disorder. Insomnia is a frequent complaint, and it is reported by more than 90% of depressed patients.

Risks

  Increased Risk of Coronary Disease / Heart Attack
 While previous research has shown that depression in men and women is linked to heart disease, a recent study found that only men who are depressed face an increased risk of heart disease-related death. [Archives of Internal Medicine, May 8, 2000)]
 
 

Recommendations for Depression:
 
 
Amino Acid / Protein  Tyrosine
 Particular precursors such as tyrosine, which increases dopamine and noradrenaline, show beneficial results in the treatment of mild depression.

  Tryptophan / 5 HTP
 Tryptophan is a precursor to serotonin, a neurotransmitter that is frequently imbalanced in cases of depression. Conventional antidepressants work to increase neurotransmitter levels by blocking their breakdown. Depression associated with menstrual cycles and postpartum depression sometimes respond very well to tryptophan supplementation. Postpartum women usually have high estrogen levels and it has been found that high estrogen levels increase the conversion of tryptophan to niacin. Progesterone and hydrocortisone decrease its conversion. Women on birth control pills, when given vitamin B6 and tryptophan, generally tend to metabolize tryptophan more normally.

The therapeutic efficacy of tryptophan and tyrosine in the treatment of depression has been inconsistent. According to this review article, studies have shown that two subgroups of depressed patients can be delineated. The first subgroup (Group A) has low urinary levels of the norepinephrine metabolite MHPG (3-methoxy-4-hydroxyphenethylene glycol). This group fails to respond to amitriptyline, but shows a favorable response to desipramine or imipramine (which tend to raise norepinephrine levels rather than serotonin). They also exhibit mood elevation after receiving dextroamphetamine. The second group (Group B) has normal or high urinary MHPG levels, fails to respond to imipramine, but responds to amitriptyline (which tends to raise brain levels of serotonin, rather than dopamine or norepinephrine). These patients experience no mood elevation after dextroamphetamine. Group A would be expected to respond to L-tyrosine (a norepinephrine precursor) and group B should respond to L-tryptophan (a serotonin precursor). The biochemical separation of these subgroups may increase the therapeutic predictability of both L-tryptophan and L-tyrosine.

Comment: In my experience, L-tryptophan is effective against depression more often than is L-tyrosine. A careful history, however, may help to identify those cases in which L-tyrosine would be the appropriate amino acid to prescribe. I typically ask depressed patients what medications they have received and which ones have been helpful; I also ask whether they have taken amphetamines and how they have responded to them. It appears, as Buist has suggested, that the information obtained from those questions can help predict who will respond to which amino acid.

Buist RA. The therapeutic predictability of tryptophan and tyrosine in the treatment of depression. Int Clin Nutr Rev 1983;3(2):1-3.

  Phenylalanine
 Phenylalanine can affect depression via three separate pathways.
  1. D-phenylalanine (DPA) exerts antidepressant activity due to its metabolism to phenylethylamine (PEA).
  2. DPA inhibits the breakdown of the body's endogenous opiates thus producing a state of euphoria.
  3. Phenylalanine is an important precursor for the production of noradrenaline and adrenaline thus increasing the body's ability to cope with stress.
A number of double-blind clinical trials have demonstrated that dosages of DLPA, the form commonly found in supplements, at doses as low as 150mg per day is effective in the treatment of some forms of depression.

  Glutamine
 Glutamine supplementation has been proven to help decrease depression and reduce anxiety.

Animal-based

  Fish Oil / Krill

Botanical

  St John's Wort (Hypericum perforatum)
 St. John’s Wort has been shown to have a 60% to 70% response rate in adult patients with mild-to-moderate depression. A 2001 study found St. John's Wort (300mg extract per day) effective in children with mild to moderate depression also. Ratings of "good" or "excellent" were found by physicians to be 72% after 2 weeks, 97% after 4 weeks and 100% after 6 weeks. The ratings by parents were 65% after 2 weeks, 93% after 4 weeks and 98% at 6 weeks. The medication was tolerated well. [Phytother. Res 2001; 15: pp.367-70]

A large trial compared St. John's wort extract with sertraline (Zoloft) and placebo in adults with depression. The trial found that neither St. John's wort nor sertraline were more effective than placebo in treating major depression. Most successful trials with St. John's wort have focused on persons with milder forms of depression. St. John's wort should be used primarily in mild to moderate depression as well as dysthymia. [JAMA 2002;287: pp.1807-14]

Rarely, with high doses, there may be temporary withdrawal symptoms when St. John's Wort is stopped suddenly. [Ann Pharmacother 2003;37(1): p.151]

A combination product called Amoryn contains St. John's Wort, 5HTP, and small amounts of B6, B12 and folic acid.

  Green / Oolong / BlackTea (Camellia sinensis)
 Previous studies have reported that green tea exerts a variety of beneficial effects on stress and inflammation, Kaijun Niu, from the Tohoku University Graduate School of Biomedical Engineering (Japan), and colleagues investigated the relationship between green tea consumption and depressive symptoms. Studying a group of 1,058 community living elderly Japanese individuals, ages 70 and over, the researchers surveyed green tea consumption and evaluated depressive symptoms via the Geriatric Depression Scale. They found that those study subjects who drank four or more cups of green tea daily were 44% less likely to have symptoms of depression (as compared to subjects who drank one or less cups). The team speculates that the amino acid theanine, present in green tea, which has a calming effect on the brain, may contribute to the beneficial effect seen on depression in this study.

  Rhodiola rosea
  Noni

Not recommended:
  Marijuana
 Daily use of marijuana was associated with a 5-fold increased risk for later developing depression and anxiety among
adolescent females in a study of 1,601 Australian students aged 14-15 years at baseline who were followed for seven years. Weekly or more frequent marijuana use was associated with a 2-fold increased risk. Depression and anxiety in
teenagers was not predictive of later cannabis use. [BMJ 2002;325(7374): pp.1195-8]

Diet

  High Carbohydrate Diet
 A carbohydrate-rich diet helps the body produce serotonin - the "happy" hormone. Special serotonin foods include oats, whole wheat, bananas and other carbohydrate-rich foods.

  Therapeutic Fasting
  Specific Carbohydrate / GAPS Diet
  Artificial Sweetener Avoidance
  Pumpkin Seeds
 Due to the purported L-tryptophan content of pumpkin seeds, their use has been suggested to help treat depression. Further research is needed before pumpkin seeds should be considered for this purpose.

Drug

  Conventional Drugs / Information
 Dosage problems with antidepressants.

Doctors follow the guidelines in the drug company-written PDR. The PDR still advises 75 mg initially for Elavil® (amitriptyline), yet 10 mg or 25 mg is frequently enough for mild depressions or pain syndromes. Effexor® is recommended at 75 mg, but 37.5 mg or 50 mg often is enough initially. Zoloft® is recommended at 50 mg, but 25 mg works well for many mild depressions. Serzone is recommended at 100 mg twice-daily, but 50 mg once or twice daily is usually plenty initially.

Similar strategies apply to Paxil®, Wellbutrin®, Celexa®, Norpramin®, Pamelor®, imipramine, doxepin and just about every other antidepressant. "The sales representatives for most antidepressants are now giving out sample packs starting with half-strength doses," Dr. Anthony Weisenberger, a top psychopharmacologist, recently told me. "They lose so many sales because patients get side effects and quit treatment, the drug companies have finally caught on that the dose makes a big difference."

Why is this happening with drug after drug? One reason is that the standard doses of antidepressants are based on studies of major depression-a severe disorder that requires strong treatment. In contrast, the great majority of office patients with depression have mild disorders. Yet, no distinction is made about treating mild and severe disorders in the dosage guidelines of most antidepressants, so doctors prescribe the same doses to everyone.

Antidepressive drug use does seem to make a great difference in the lives of many who take them. To make an accurate diagnosis, for example to distinquish between depression and bipolar disorder, may require a doctor who specializes in this kind of work. Even with a skilled doctor, it may take a trial with several different medications before finding the one or combination of drugs that is right for you. However, the following article indicates that this may not be the case for everyone.

Antidepressants Proven to Work Only Slightly Better Than Placebo! (Excerpted from an article by Dr. Irving Kirsch, M.D.)

Although antidepressant medication is widely regarded as effective, a recent meta-analysis of published clinical trials indicates that 75% of the response to antidepressants is duplicated by placebo.

The authors analyzed the efficacy data submitted to the FDA for the six most widely prescribed antidepressants approved between 1987 and 1999: Prozac , Paxil, Zoloft , Effexor , Serzone, and Celexa. The FDA data constitutes the basis on which these medications were approved. Approval of these medications implies that the data is strong enough and reliable enough to warrant approval. To the extent that this data is flawed, the medications should not have been approved.

In order to generalize the findings of the clinical trial to a larger patient population, FDA reviewers sought a completion rate of 70% or better for these typically 6-week trials. Only 4 of 45 trials, however, reached this objective.

In clinical trials, the effect of the active drug is assumed to be the difference between the drug response and the placebo response. The data submitted to the FDA revealed a small but significant difference between antidepressant drug and inert placebo. This difference may be a true pharmacological effect, or it may be an artifact associated with the breaking of blind by clinical trial patients and the psychiatrists who were rating the severity of their conditions.

In any case, the difference was relatively small and its clinical significance was dubious. If there is a powerful antidepressant effect, then it is being masked by a nonadditive placebo effect. Conversely, if the drug effect is as small as it appears when drug/placebo differences are estimated, then there may be little justification for the clinical use of these medications.

The problem, then, would be to find an alternative, as the clinical response to both drug and placebo is substantial. Placebo treatment has the advantage of eliciting fewer side effects. However, the deception that is inherent in clinical administration of placebos inhibits their use. Thus, the development of nondeceptive methods of eliciting the placebo effect would be of great importance. [Prevention & Treatment Volume 5, Article 23, July 15, 2002]

March 22, 2004 — The U.S. Food and Drug Administration (FDA) has asked manufacturers of the several antidepressant drugs to include in their labeling a warning statement that recommends close observation of adult and pediatric patients treated with their agents for worsening depression or the emergence of suicidality

The antidepressant drugs are fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), fluvoxamine (Luvox), citalopram (Celexa), escitalopram (Lexapro), buproprion (Wellbutrin), venlafaxine (Effexor), nefazodone (Serzone), and mirtazapine (Remeron).

Several of these drugs are approved for the treatment of obsessive-compulsive disorder in pediatric patients (sertraline, fluoxetine, fluvoxamine). Only fluoxetine is approved for use in children with major depressive disorder. None of these drugs are approved as monotherapy in treating bipolar depression, either in adults or children, and fluvoxamine is not approved as an antidepressant in the U.S.

The FDA has been closely reviewing the results of antidepressant studies in children since June 2003, after an initial report appeared to suggest increased risk of suicidal thoughts and actions in the pediatric population, according to today's advisory.

Although it is unclear whether antidepressants contribute to the emergence of suicidal thinking and behavior, these interim actions are intended to draw more attention to the need for careful monitoring of patients being treated with these drugs, especially at the beginning of therapy and during dose changes.

Discontinuation of medication may be appropriate in patients whose depression is persistently worse or whose emergent suicidality is severe, abrupt in onset, or was not part of the patient's presenting symptoms. Therapy changes should be made under the guidance of a physician, as certain medications should be tapered rather than stopped abruptly.

Habits

  Aerobic Exercise
 Researchers found that walking for 30 minutes each day quickly improved depressive symptoms faster than antidepressant drugs typically do. Another study compared exercise with antidepressants among older adults and found that physical activity was the more effective depression-fighter. [British Journal of Sports Medicine April 2001;35: pp.114-117]

Previous studies have suggested that exercise is a potent mood-booster, and some research indicates that for some patients regular activity may be a better depression treatment than psychotherapy or medication. Exactly why is unclear, but exercise does influence certain mood-related hormones. And it is also believed to enhance people's sense of control over their lives.

The main conclusion to draw from studies conducted is that the practice of exercise shows a negative correlation with depression - in other words, the more you exercise, the less depressed you feel. Interestingly, any kind of exercise relieves the symptoms of depression.

Research has shown that listening to music while exercising not only improves mood, but may also boost cognitive levels. An example of this was seen in higher scores among cardiac rehabilitation patients on verbal fluency tests. The study looked at the effects of music combined with short-term exercise and found that people diagnosed with coronary artery disease had enhanced brainpower after listening to music while exercising. The study also had the participants fill out a 30-item checklist, which included adjectives to describe the patient’s current mood, before and after exercising as a way to assess their anxiety and depression levels. The study concluded that participants claimed they felt better both emotionally and mentally after exercising regardless if they listened to music or not. However, signs of improvement in the verbal fluency areas were more than doubled after listening to music compared to that of the non-music session. [EurekAlert! March 23, 2004]

More and more researchers and physicians are coming to the conclusion that exercise can be as effective as antidepressants in reducing the symptoms of major depression.

Research on the subject has demonstrated that:
*10 months of regular, moderate exercise outperformed a leading antidepressant (Zoloft) in easing symptoms in young adults
*30-minute aerobic workouts done three to five times a week cut depressive symptoms by 50% in young adults [Yahoo News November 6, 2005]

Hormone

  DHEA
 DHEA is a plentiful adrenal steroid hormone whose quantity decreases with age and may have significant psychiatric effects. In one study, six middle-aged and elderly patients with major depression and low plasma DHEA or DHEA-S levels were openly administered DHEA (30-90mg per day for 4 weeks) in doses sufficient to achieve circulating plasma levels observed in younger healthy individuals. Depression ratings as well as aspects of memory performance significantly improved.

One treatment-resistant patient received extended treatment with DHEA for 6 months: her depression ratings improved 48-72% and her semantic memory performance improved 63%. These measures returned to baseline after treatment ended. Improvements in depression ratings and memory performance were directly related to increases in plasma levels of DHEA and DHEA-S and to increases in their ratios with plasma cortisol levels. [Biol Psychiatry, 1997 Feb; 41:3, pp.311-8]

Another study evaluated the efficacy of very high doses of DHEA (450mg) in the treatment of midlife-onset dysthymia. In 15 patients who completed the study, a robust effect of DHEA on mood was observed compared with placebos. 60% of the patients responded to DHEA at the end of the 6-week treatment period compared with 20% on placebo. A significant response was seen after 3 weeks of treatment on 90mg per day. The symptoms that improved most significantly were anhedonia (failure to experience pleasure), loss of energy, lack of motivation, emotional "numbness", sadness, inability to cope, and worry. [Biol Psychiatry 1999 Jun 15; 45(12): pp.1533-41]

In a study conducted by S. S. C. Yen and associates at the University of California, San Diego, researchers found that 50mg a day of DHEA administered for 6-months restored levels of DHEA in both men and women. This DHEA replacement was associated with an increase in perceived physical and psychological well-being for both men (67%) and women (84%).

Another study at UCSD was conducted in which researchers considered the association between levels of DHEA and depression. Nine different hormones (including DHEA) were measured in 699 older women. Out of all of these hormones, only low levels of DHEA were linked with depression.

In studies conducted at Cambridge University in England, researchers discovered that children with major depression have abnormally low levels of DHEA accompanied by abnormally high levels of cortisol.

University of California San Francisco At the University of California, San Francisco, DHEA was given to people with depression to determine its antidepressant effects. After 6 weeks, psychological tests indicated that about half the participants responded to DHEA therapy, with an overall enhancement of mood scores by over 30%.

In another study conducted by the Department of Psychiatry at UCSF, DHEA was administered to six middle-aged and elderly patients with major depression. In patients who received extended treatment with DHEA for six months, depression ratings improved 48-72%.

In a study conducted by researchers at the National Institute of Mental Health, middle-aged people with dysthymia (a chronic, low-grade depression) were given 90 mg of DHEA a day for 3 weeks. This study concluded that this amount significantly alleviated the participants' depression.

DHEA is the only hormone besides cortisol and serotonin that has consistently been linked to depression. But unlike cortisol, where high levels increase depression – high levels of DHEA actually alleviate depression.

Researchers have different theories about how DHEA alleviates depression. DHEA and can cross the blood-brain barrier and interact with the brain directly. DHEA can affect serotonin, GABA receptors, and other brain factors. It might modulate the serotonin-signaling pathway. In addition, DHEA is the precursor for estrogen and testosterone, which also enhance mood.

DHEA also has antistress effects that may be part of its antidepressant action. Research shows that cortisol, the stress hormone, is elevated in major depression. DHEA counteracts cortisol. Calmness is also associated with higher levels of DHEA.


Not recommended:
  Melatonin
 On the basis of theoretical ideas about how melatonin works, some authorities specifically recommend against using it for depression, schizophrenia, autoimmune diseases and other serious illnesses, and in pregnant or nursing women.

Some studies showing melatonin to be an effective treatment for depression were flawed. Melatonin is unlikely to produce significant positive effects in the treatment of depression in most patients, especially if the patient is not already melatonin-deficient. Badly timed use of melatonin can worsen depression. However, some patients with SAD (seasonal affective disorder, a form of depression associated with the shortening of the days in autumn and winter) have been shown to have disrupted melatonin cycles, and have been treated effectively with light therapy.

Lab Tests/Rule-Outs

  Test Amino Acid Profile
 Amino acid profiles done on blood can reveal imbalances seen in a variety of disorders including depression. Low tyrosine or phenylalanine levels can result in abnormal levels of mood-regulating chemicals in the brain, such as dopamine and catecholamines. Low tyrosine levels can also create subnormal levels of thyroid hormone - a well-known cause of depression.

Methionine is the precursor of SAMe which is needed for proper functioning of catecholamines and may be low in patients with depression.

Tryptophan is the body's source material for producing the hormones serotonin and melatonin, which also influence sleep patterns and mood. Depletion of tryptophan can cause an increase in depressed mood states; lower tryptophan levels have been correlated with a higher depression score even in patients who were already under treatment with anti-depressant drugs. [Arch Gen Psychiatry 1990;47(5): pp.411-18]

  Test Essential Fatty Acid Profile

Mineral

  Magnesium
 Because of its nerve and muscle support, magnesium may also be helpful for depression.

  Chromium
 Dysthymic disorder is a relatively common illness that is often treated with antidepressants. Compared with the study of major depression, there has been little systematic study of potentiation strategies for antidepressant-refractory dysthymic disorder. METHOD: Following a patient's report of dramatic response to the addition of chromium supplementation to sertraline pharmacotherapy for dysthymic disorder (DSM-IV), the authors initiated a series of single-blind and open-label trials of chromium picolinate or chromium polynicotinate in the treatment of antidepressant-refractory dysthymic disorder. RESULTS: In a series of 5 patients, chromium supplementation led to remission of dysthymic symptoms. Single-blind substitution of other dietary supplements in each of the patients demonstrated specificity of response to chromium supplementation. CONCLUSION: Preliminary observations suggest that chromium may potentiate antidepressant pharmacotherapy for dysthymic disorder. Controlled studies are indicated to test the validity of these initial observations. [J Clin Psychiatry. 1999 Apr;60(4): pp.237-40]

In a separate study, fifteen patients (aged 18-65 years) with major depression, atypical subtype, who had been off of psychotropic medication for 7-30 days, were randomly assigned to receive, in double-blind fashion, in a 2:1 ratio, chromium picolinate (n = 10) or placebo (n = 5) for eight weeks. The dose was 400 mcg/day for the first two weeks, then 600 mcg/day, of elemental chromium (the dose was clarified in personal correspondence, Connor KM, 3/19/03). A response to treatment was defined as a decrease of at least 66% on a modified version of the Hamilton Depression Scale (HAM-D), along with a marked improvement in the Clinical Global Impressions of Improvement Scale (CGI-I; i.e., a score of 1).

Remission was defined as a final HAM-D score of less than 8. The response rates were 70% (7 of 10) in the chromium group and 0% (0 of 5) in the placebo group (p = 0.02). The remission rates were 60% in the chromium group and 0% (0 of 5) in the placebo group (p = 0.04). Compared with baseline, the mean HAM-D score decreased (improved) by 59% in the chromium group and by 36% in the placebo group (p = 0.11 for difference between groups).

Comment: Atypical depression constitutes more than 20% of all cases of depression in a typical clinic population. It is characterized by mood reactivity, increased appetite and weight gain, excessive sleepiness, leaden paralysis, and sensitivity to interpersonal rejection. Atypical depression is associated with greater chronicity and disability and more suicidal ideation than are other forms of depression. Conventional treatment consists primarily of monoamine oxidase inhibitors. Although it is a more serious condition than dysthymia (described above), atypical depression is similar to it in some ways, and might therefore conceivably be related to blood-glucose dysregulation. The beneficial effect of chromium picolinate in the treatment of atypical depression may be related to its ability to improve glucose metabolism. Another study has shown that chromium picolinate supplementation causes postsynaptic downregulation of 5HT2A (serotonergic) receptors, an effect which might also account for its antidepressant activity. [Davidson JRT, et al. Effectiveness of chromium in atypical depression: a placebo-controlled trial. Biol Psychiatry 2003;53:261-264.]

  Lithium (low dose)
 In some cases, lithium (as a drug) is even a successful treatment for those with unipolar depression, or those who have never had a manic episode. Individuals who respond to lithium for depression are often those who have not responded to tricyclic antidepressants after several weeks of treatment. When given lithium in addition to their antidepressants, some of these people have shown significant improvement.

A limited amount of testimonial evidence exists in support of the use of lithium orotate (150mg per day) in this condition. There is no study support that we are aware of regarding the use of this OTC product for depression.

Based on its general neuroprotective effect, researchers have suggested that "the use of lithium as a neurotrophic/neuroprotective agent should be considered in the long term treatment of mood disorders, irrespective of the 'primary' treatment modality being used for the condition." Translation: Lithium should be used along with any patent medicine being used for depression, anxiety, or any other "mood-altering" reason, since it will protect brain cells against their unwanted toxic effects. The researchers didn't say so, but I will: Any list of "mood altering substances" should include alcohol, tobacco, caffeine, "uppers," "downers," and-for those who do inhale-marijuana. Harmless as some of them might seem, these substances can cause brain damage with medium to long-term abuse. [taken from an article by Jonathan V. Wright, MD]

Miscellaneous

  Reading List
 Here is a website with lots of good information on the types and treatment of patients with depression.

Nutrient

  Inositol
  EPA (eicosapentanoic acid)
 There is an increasing body of evidence that indicates that fish oils, in particular those with high EPA to DHA ratios, have a major role to play in helping people maintain good mental health and to avoid mood swings and mild depression. Currently the only available source of EPA without equal amounts of DHA being present is "EPA rich" fish oil.

Ethyl-eicosapentaenoate (ethyl-EPA - 1gm per day), in addition to conventional antidepressant medication, improved measures of depression in a study of 70 patients with persistant depression despite ongoing treatment with conventional antidepressant drugs. Higher doses had no effect on measures of depression. [Arch Gen Psychiatry 2002;59(10): pp.913-9]

  DMAE
 DMAE reduces apathy and increases motivation in persons afflicted with depression.

  TMG (Tri-methyl-glycine) / SAMe
 The compound 5-adenosylmethionine (SAMe), potentially produced through the demethylation of TMG, has been shown to alleviate depression.

Six weeks of oral SAMe at 1600mg per day improved depression scores similarly to oral imipramine at 150mg per day in a comparison study of 281 patients with major depression. Fewer adverse effects were observed in the patients treated
with SAMe. [Am J Clin Nutr 2002;76(5): pp.1172S-6S]

  Meyer's

Oriental Medicine

  Emotional Freedom Technique (EFT)

Physical Medicine

  Calming / Stretching Exercises
 A few studies have looked at the effects of yoga breathing exercises, practiced daily for several weeks, on depression. One study showed that breathing exercises produced faster improvement than no treatment. Another study found that breathing exercises were as effective as an antidepressant drug for patients who were severely depressed, but less effective than electroconvulsive therapy (ECT).

Psychological

  Counseling
 Psychotherapy, as well as medication, can be effective in treating depression. Certain types of psychotherapy, namely cognitive-behavioral therapy (CBT) and interpersonal therapy (IPT), have been shown to be particularly useful.

Vitamins

  Vitamin B12 (Cobalamine)
 Research shows that those who suffer from depression respond better to their treatment if they have high levels of vitamin B12 in their blood. Over 100 outpatients experiencing depression were closely observed over a six-month period. The patients were grouped by how well they responded to the treatment of their depression. Researchers also measured the level of vitamin B12 in the patients’ blood. The measurements were recorded on the first day they came in, and again at their six-month checkup. This allowed the researchers to keep track of whether the level of the vitamin influenced each patient’s outcome.

The study found that the patients who responded fully to the treatment had higher concentrations of vitamin B12 in their blood at both the beginning and end of treatment. [BioMed Central Psychiatry December 1, 2003;3: p.17]
 
 


KEY
Weak or unproven link
Strong or generally accepted link
Proven definite or direct link
Strongly counter-indicative
Very strongly or absolutely counter-indicative
May do some good
Likely to help
Highly recommended
May have adverse consequences
Reasonably likely to cause problems







GLOSSARY

Allergy:  Hypersensitivity caused by exposure to a particular antigen (allergen), resulting in an increased reactivity to that antigen on subsequent exposure, sometimes with harmful immunologic consequences.

Arachidonic Acid:  A polyunsaturated 20-carbon essential fatty acid occurring in animal fats and also formed by biosynthesis from dietary linoleic acid (Omega 6). It is a precursor in the biosynthesis of leukotrienes, prostaglandins, and thromboxanes. Excess tends to produce inflammation.

Cholesterol:  A waxy, fat-like substance manufactured in the liver and found in all tissues, it facilitates the transport and absorption of fatty acids. In foods, only animal products contain cholesterol. An excess of cholesterol in the bloodstream can contribute to the development of atherosclerosis.

Chronic:  Usually Chronic illness: Illness extending over a long period of time.

Cobalamin:  Vitamin B-12. Essential for normal growth and functioning of all body cells, especially those of bone marrow (red blood cell formation), gastrointestinal tract and nervous system, it prevents pernicious anemia and plays a crucial part in the reproduction of every cell of the body i.e. synthesis of genetic material (DNA).

Cofactor:  A substance that acts with another substance to bring about certain effects, often a coenzyme.

DHA:  Docosahexanoic Acid. A metabolite of the omega-3 fatty acid alpha-linolenic acid.

DHEA:  Dehydroepiandrosterone (DHEA) is a steroid produced by the adrenal glands and is the most abundant one found in humans. DHEA may be transformed into testosterone, estrogen or other steroids. It is found in the body as DHEA or in the sulfated form known as DHEA-S. One form is converted into the other as needed.

Dopamine:  A neurohormone; precursor to norepinephrine which acts as a stimulant to the nervous system.

Dysthymia:  A milder but chronic form of depression.

Enzymes:  Specific protein catalysts produced by the cells that are crucial in chemical reactions and in building up or synthesizing most compounds in the body. Each enzyme performs a specific function without itself being consumed. For example, the digestive enzyme amylase acts on carbohydrates in foods to break them down.

EPA:  Environmental Protection Agency. Also: Eicosapentanoic Acid. A metabolite of the omega-3 fatty acid alpha-linolenic acid.

Estrogen:  One of the female sex hormones produced by the ovaries.

Fatty Acids:  Chemical chains of carbon, hydrogen, and oxygen atoms that are part of a fat (lipid) and are the major component of triglycerides. Depending on the number and arrangement of these atoms, fatty acids are classified as either saturated, polyunsaturated, or monounsaturated. They are nutritional substances found in nature which include cholesterol, prostaglandins, and stearic, palmitic, linoleic, linolenic, eicosapentanoic (EPA), and decohexanoic acids. Important nutritional lipids include lecithin, choline, gamma-linoleic acid, and inositol.

Fibromyalgia:  (FMS): Originally named fibrositis, it is a mysteriously debilitating syndrome that attacks women more often than men. It is not physically damaging to the body in any way, but is characterized by the constant presence of widespread pain that often moves about the body. Fibromyalgia can be so severe that it is often incapacitating.

Folic Acid:  A B-complex vitamin that functions along with vitamin B-12 and vitamin C in the utilization of proteins. It has an essential role in the formation of heme (the iron containing protein in hemoglobin necessary for the formation of red blood cells) and DNA. Folic acid is essential during pregnancy to prevent neural tubular defects in the developing fetus.

Gram:  (gm): A metric unit of weight, there being approximately 28 grams in one ounce.

Herbs:  Herbs may be used as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, teas should be made with one teaspoon herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots. Tinctures may be used singly or in combination as noted. The high doses of single herbs suggested may be best taken as dried extracts (in capsules), although tinctures (60 drops four times per day) and teas (4 to 6 cups per day) may also be used.

Hormones:  Chemical substances secreted by a variety of body organs that are carried by the bloodstream and usually influence cells some distance from the source of production. Hormones signal certain enzymes to perform their functions and, in this way, regulate such body functions as blood sugar levels, insulin levels, the menstrual cycle, and growth. These can be prescription, over-the-counter, synthetic or natural agents. Examples include adrenal hormones such as corticosteroids and aldosterone; glucagon, growth hormone, insulin, testosterone, estrogens, progestins, progesterone, DHEA, melatonin, and thyroid hormones such as thyroxine and calcitonin.

Hypothyroidism:  Diminished production of thyroid hormone, leading to low metabolic rate, tendency to gain weight, and sleepiness.

Lipid:  Fat-soluble substances derived from animal or vegetable cells by nonpolar solvents (e.g. ether); the term can include the following types of materials: fatty acids, glycerides, phospholipids, alcohols and waxes.

Manganese:  An essential mineral found in trace amounts in tissues of the body. Adults normally contain an average of 10 to 20mg of manganese in their bodies, most of which is contained in bone, the liver and the kidneys. Manganese is essential to several critical enzymes necessary for energy production, bone and blood formation, nerve function and protein metabolism. It is involved in the metabolism of fats and glucose, the production of cholesterol and it allows the body to use thiamine and Vitamin E. It is also involved in the building and degrading of proteins and nucleic acid, biogenic amine metabolism, which involves the transmitting of nerve impulses.

MAO:  Abbreviation for a breakdown enzyme monoamine oxidase. A MAO inhibitor blocks the action of monoamine oxidase, thus raising the levels of the monoamine neurotransmitters such as norepinephrine, epinephrine, dopamine, and serotonin - which have significant effects on mood and behavior. Epinephrine, norepinephrine and serotonin are normally deactivated by MAO-A while dopamine and phenylethylamine are normally metabolized by MAO-B.

Metabolism:  The chemical processes of living cells in which energy is produced in order to replace and repair tissues and maintain a healthy body. Responsible for the production of energy, biosynthesis of important substances, and degradation of various compounds.

Metabolite:  Any product (foodstuff, intermediate, waste product) of metabolism.

Microgram:  (mcg): 1/1,000 of a milligram in weight.

Mineral:  Plays a vital role in regulating many body functions. They act as catalysts in nerve response, muscle contraction and the metabolism of nutrients in foods. They regulate electrolyte balance and hormonal production, and they strengthen skeletal structures.

Multiple Sclerosis:  Demyelinating disorder of the central nervous system, causing patches of sclerosis (plaques) in the brain and spinal cord, manifested by loss of normal neurological functions, e.g., muscle weakness, loss of vision, and mood alterations.

Neurotransmitters:  Chemicals in the brain that aid in the transmission of nerve impulses. Various Neurotransmitters are responsible for different functions including controlling mood and muscle movement and inhibiting or causing the sensation of pain.

Noradrenaline:  (Norepinephrine): A catecholamine hormone secreted from the adrenal medulla and post-ganglionic adrenergic fibers in response to hypotension or emotional stress.

Obsessive-Compulsive:  People with Obsessive-Compulsive Disorder (OCD) have obsessions and/or compulsions. Obsessions refer to recurrent and persistent thoughts, impulses, or images that are intrusive and cause severe anxiety or distress. Compulsions refer to repetitive behaviors and rituals (such as hand washing, hoarding, ordering, checking) or mental acts (like counting, repeating words silently, avoiding). These obsessions and compulsions significantly interfere with normal routine, functioning, social activities and relationships.

Parkinson's Disease:  A chronic, slowly-progressing disease of the nervous system characterized clinically by the combination of tremor, rigidity, extreme slowness of movement, and stooped posture. It is characterized pathologically by loss of dopamine in the substantia nigra.

pH:  A measure of an environment's acidity or alkalinity. The more acidic the solution, the lower the pH. For example, a pH of 1 is very acidic; a pH of 7 is neutral; a pH of 14 is very alkaline.

Placebo:  A pharmacologically inactive substance. Often used to compare clinical responses against the effects of pharmacologically active substances in experiments.

Polyunsaturated:  Polyunsaturated fats or oils. Originate from vegetables and are liquid at room temperature. These oils are a good source of the unsaturated fatty acids. They include flaxseed with added vitamin B6 (pyridoxine), sunflower oil, safflower oil, and primrose oil.

Postpartum Depression:  The "baby blues" are a very frequent and completely normal consequence of childbirth, usually wearing off soon afterwards as hormonal and psychological systems get back to normal. Postpartum depression is a less common but severe depression that begins in the weeks following delivery. It impairs the ability of the mother to care for the child and fall in love with it. This makes her feel even more depressed and inadequate thinking that she can not be a good mother. At the extreme, postpartum depression may lead to dangerous delusions (for example, thinking the baby is in some way deformed or cursed) or hallucinations (that may command violent acts). This can occasionally result in a tragic episode of suicide and/or infanticide.

Prostaglandin:  Any of a class of physiologically active substances present in many tissues, with effects such as vasodilation, vasoconstriction, stimulation of the smooth muscles of the bronchus or intestine, uterine stimulation; also involved in pain, inflammation, fever, allergic diarrhea, and dysmenorrhea. A potent hormone -- similar in structure to an unsaturated fatty acid -- that acts in extremely low concentrations on local target organs; first isolated from the prostate.

Pyridoxine:  (Vitamin B-6): A B-complex vitamin that plays a role as a coenzyme in the breakdown and utilization of carbohydrates, fats and proteins. It facilitates the release of glycogen for energy from the liver and muscles. It also participates in the utilization of energy in the brain and nervous tissue and is essential for the regulation of the central nervous system.

Red Blood Cell:  Any of the hemoglobin-containing cells that carry oxygen to the tissues and are responsible for the red color of blood.

Riboflavin:  (Vitamin B-2): A B-complex vitamin that acts as a coenzyme that activates the breakdown and utilization of carbohydrates, fats and proteins. It is essential for cellular oxidation and necessary for healthy skin and eyes.

Serotonin:  A phenolic amine neurotransmitter (C10H12N2O) that is a powerful vasoconstrictor and is found especially in the brain, blood serum and gastric membranes of mammals. Considered essential for relaxation, sleep, and concentration.

Serum:  The cell-free fluid of the bloodstream. It appears in a test tube after the blood clots and is often used in expressions relating to the levels of certain compounds in the blood stream.

SRI:  Serotonin Reuptake Inhibitor. The result of this inhibition action is to maintain higher levels of serotonin.

Testosterone:  The principal male sex hormone that induces and maintains the changes that take place in males at puberty. In men, the testicles continue to produce testosterone throughout life, though there is some decline with age. A naturally occurring androgenic hormone.

Thiamine:  (Vitamin B-1): A B-complex vitamin that acts as a coenzyme necessary for the conversion of carbohydrates into glucose, which is burned in the body for energy. It is essential for the functioning of the nervous system.

Tinnitus:  A sensation of noise (ringing or roaring) that is caused by a bodily condition and can usually only be heard by the person affected.

Tryptophan:  Essential amino acid. Natural relaxant and sleep aid due to its precursor role in serotonin (a neurotransmitter) synthesis. Along with tyrosine, it is used in the treatment of addictions.

Vitamin B6:  Influences many body functions including regulating blood glucose levels, manufacturing hemoglobin and aiding the utilization of protein, carbohydrates and fats. It also aids in the function of the nervous system.