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Monday, 21 March 2011

Are you depressed?

Are you depressed?                from Food For The Brain
Depression is diagnosed on the basis of symptoms in a questionnaire, the most common being the Hamilton Rating Scale of Depression, or HRS for short. This contains questions about your mood, guilt feelings, suicidal thoughts, insomnia, agitation, anxiety, physical problems, sex drive, and so on. Depending on your total score on these questions, you will be diagnosed with either “mild,” “moderate,” or “severe” depression. Here’s a simplified questionnaire to check your mood.
How Depressed Are You?
Check yourself out on this simplified Mood Check.
  • Do you feel downhearted, blue and sad?
  • Do you feel worse in the morning?
  • Do you have crying spells, or feel like it?
  • Do you have trouble falling asleep, or sleeping through the night?
  • Is your appetite poor?
  • Are you losing weight without trying?
  • Do you feel unattractive and unlovable?
  • Do you prefer to be alone?
  • Do you feel fearful?
  • Are you often tired and irritable?
  • Is it an effort to do the things you used to do?
  • Are you restless and unable to keep still?
  • Do you feel hopeless about the future?
  • Do you find it difficult to make decisions?
  • Do you feel less enjoyment from activities that once gave you pleasure?
If you answered yes to:Less than 5: You are normal. You appear to be positive, optimistic and able to roll with the punches. The information below will give you clues on how to handle those occasions when things aren’t going so well for you.
5 to 10: You have a mild to moderate case of the blues. Read on to see how this can happen, and then, to the solutions. You might also consider seeking outside help.
More than 10: You are moderately to markedly depressed. Besides following the advice below, we recommend you seek professional help.
What causes depression?
Depression is usually linked to, or triggered by something stressful, such as a death, loss of a job, or break up of a relationship. If you don’t feel good about yourself and don’t have someone supportive to listen to that can be a major cause of depression however good your diet might be. For this reason we recommend counseling and psychotherapy as well as nutritional approaches. Exercise is also proven to make a big difference. There are a number of nutritional imbalances that can make you prone to depression. These are:

• Essential fats –do you need more Omega 3?
• Your homocysteine level – is it too high, corrected with B vitamins?
• Serotonin levels – do they need boosting with amino acids?
• Blood sugar balance – is yours within the healthy range?
• Chromium – are you getting enough?

DIET & NUTRITION – WHAT WORKS

INCREASE YOUR OMEGA 3 FATS
The richest dietary source is from fish, specifically carnivorous cold water fish, such as salmon, mackerel and herring. Surveys have shown that the more fish a country eats the lower is their incidence of depression. There’s a type of omega 3 fat called EPA which seems to be the most potent natural anti-depressant. Again, let’s examine the evidence.

There have been six double-blind placebo controlled trials to date, five of which show significant improvement. The first trial by Dr Andrew Stoll from Harvard Medical School, published in the Archives of General Psychiatry, gave 40 depressed patients either omega 3 supplements versus placebo and found a highly significant improvement. The next, published in the American Journal of Psychiatry, tested the effects of giving twenty people suffering from severe depression, who were already on anti-depressants but still depressed, a highly concentrated form of omega 3 fat, called ethyl-EPA versus a placebo. By the third week the depressed patients were showing major improvement in their mood, while those on placebo were not. The latest trial by Dr Sophia Frangou from the Institute of Psychiatry in London gave a concentrated form of EPA, versus placebo, to 26 depressed people with bipolar disorder (manic depression) and again found a significant improvement. Of those that measured the Hamilton Rating Scale, including one recent ‘open’ trial, not involving placebos, published last year the average improvement in depression was approximately double that shown by anti-depressant drugs, without the side-effects. This may be because omega 3s help to build your brain’s neuronal connections as well as the receptor sites for neurotransmitters; therefore, the more omega-3s in your blood, the more serotonin you are likely to make and the more responsive you become to its effects.
Side effects? 
In some earlier studies which gave 14 fish oil capsules a day mild gastrointestinal discomfort, mainly loose bowels. However, nowadays you can buy more concentrated EPA rich fish oils so the amount of actual fish oil required is less. Supplementing fish oils also reduces risk for heart disease, reduces arthritic pain and may improve memory and concentration.
INCREASE YOUR INTAKE OF B VITAMINS
People with either low blood levels of the B-vitamin folic acid, or high blood levels of the protein homocysteine, (a sign that you are not getting enough B6, B12 or folic acid) are both more likely to be depressed and less likely to get a positive result from anti-depressant drugs. In a study comparing the effects of giving an SSRI with either a placebo or with folic acid, 61% of patients improved on the placebo combination but 93% improved with the addition of folic acid. But how does folic acid itself, a cheap vitamin with no side-effects, compare to anti-depressants?
Three trials involving 247 people addressed this question. Two involving 151 people assessed the use of folic acid in addition to other treatment, and found that adding folic acid reduced HRS scores on average by a further 2.65 points. That’s not as good as the results with 5-HTP but as good, if not better than antidepressants. These studies also show that more patients treated with folate experienced a reduction in their Hamilton Rating score of greater than 50% after ten weeks compared to those on anti-depressants.
Having a high level of homocysteine, a toxic protein found in the blood, doubles the odds of a woman developing depression. The ideal level is below 6, and certainly below 9. The average level is 10-11. Depression risk doubles with levels above 15. The higher your level the more likely folic acid will work for you.
Folic acid is one of seven nutrients – the others being B2, B6, B12, zinc, magnesium and TMG – that help normalise homocysteine. Deficiency in vitamin B3, B6, folic acid, zinc and magnesium have all been linked to depression. Having a low intake of these nutrients means your brain is good at ‘methylating’ which is the process by which the brain keeps it’s chemistry in balance. So it makes sense to both eat wholefoods, fruits, vegetables, nuts and seeds, high in these nutrients and supplementing a multivitamin.
Side effects? 
There are none, except lower risk for heart disease, strokes, Alzheimer’s and improved energy and concentration. However, if you are vegan and B12 deficient, taking folic acid on its own can mask the symptoms, but the underlying nerve damage caused by B12 deficiency anaemia can persist. So, don’t take folic acid without also supplementing vitamin B12.
BOOST YOUR SEROTONIN WITH AMINO ACIDS
Serotonin is made in the body and brain from an amino acid 5-Hydroxy Tryptophan (5-HTP), which in turn in made from another amino acid called tryptophan. Both can be found in the diet; tryptophan in many protein rich foods such as meat, fish, beans and eggs, while the richest source of 5-HTP is the African Griffonia bean. Just not getting enough tryptophan is likely to make you depressed; people fed food deficient in tryptophan became rapidly depressed within hours.
Both have been shown to have an antidepressant effect in clinical trials, although 5HTP is more effective - 27 studies, involving 990 people to date, most of which proved effective. . So how do they compare with anti-depressants? In play-off studies between 5-HTP and SSRI antidepressants, 5-HTP generally comes out slightly better. One double-blind trial headed by Dr. Poldinger at the Basel University of Psychiatry gave 34 depressed volunteers either the SSRI fluvoxamine (Luvox) or 300 mg of 5-HTP. At the end of the six weeks, both groups of patients had had a significant improvement in their depression. However, those taking 5-HTP had a slightly greater improvement, compared to those on the SSRI, in each of the four criteria assessed—depression, anxiety, insomnia, and physical symptoms—as well as the their own self-assessment, although this improvement was not statistically significant.
Since anti-depressant drugs, in some sensitive people, can induce an overload of serotonin called ‘serotonin syndrome’ characterised by feeling hot, high blood pressure, twitching, cramping, dizziness and disorientation, some concern has been expressed about the possibility of increasing the odds of serotonin syndrome with the combination of 5-HTP and an SSRI drug. However a recent review on the safety of 5-HTP concludes that ‘serotonin syndrome has not been reported in humans in association with 5-HTP, either as monotherapy (on its own) or in combination with other medications.’
Exercise, sunlight and reducing your stress level also tend to promote serotonin.
Side-effects?
Some people experience mild gastrointestinal disturbance on 5-HTP, which usually stops within a few days. Since there are serotonin receptors in the gut, which don’t normally expect to get the real thing so easily, they can overreact if the amount is too high, resulting in transient nausea. If so, just lower the dose.
BALANCE YOUR BLOOD SUGAR
There is a direct link between mood and blood sugar balance. All carbohydrate foods are broken down into glucose and your brain runs on glucose. The more uneven your blood sugar supply the more uneven your mood.
Eating lots of sugar is going to give you sudden peaks and troughs in the amount of glucose in your blood; symptoms that this is going on include fatigue, irritability, dizziness, insomnia, excessive sweating (especially at night), poor concentration and forgetfulness, excessive thirst, depression and crying spells, digestive disturbances and blurred vision. Since the brain depends on an even supply of glucose it is no surprise to find that sugar has been implicated in aggressive behaviour, anxiety, and depression, and fatigue, .
Lots of refined sugar and refined carbohydrates (meaning white bread, pasta, rice and most processed foods,) is also linked with depression because these foods not only supply very little in the way of nutrients but they also use up the mood enhancing B vitamins; turning each teaspoon of sugar into energy needs B vitamins. Sugar also diverts the supply of another nutrient we haven’t mentioned yet but is also involved in mood – chromium. This mineral is vital for keeping your blood sugar level stable because insulin, which clears glucose from the blood, can’t work properly without it.
The best way to keep your blood sugar level even is to eat what is called a low Glycemic Load (GL) diet and avoid, as much as you can, refined sugar and refined foods, eating instead whole foods, fruits, vegetables, and regular meals. The book, the Holford Low GL Diet, explains exactly how to do this. Caffeine also has a direct effect on your blood sugar and your mood and is best kept to a minimum, as is alcohol.
Side effects? None.
UP YOUR INTAKE OF CHROMIUM
This mineral is vital for keeping your blood sugar level stable because insulin, which clears glucose from the blood, can't work properly without it. In fact it turns out that just supplying proper levels of chromium to certain depressed patients can make a big difference.
If you answer yes to a five or more of these questions and you might be suffering from what’s called “atypical” depression.
• Do you crave sweets or other carbohydrates?
• Do you tend to gain weight?
• Are you tired for no obvious reason?
• Do your arms or legs feel heavy?
• Do you tend to feel sleepy or groggy much of the time?
• Are your feelings easily hurt by the rejection of others?
• Did your depression begin before the age of 30?
It is called atypical because in ‘classic’ depression people lose their appetite, don’t eat enough, lose weight and can’t sleep but it affects anywhere from 25 to 42 percent of the depressed population, and an even higher percentage among depressed women so it’s extremely common rather than ‘atypical’. A chance discovery by Dr Malcolm McLeod, clinical professor of psychiatrist at the University of North Carolina, suggested that people who suffer with ‘atypical’ depression might benefit from chromium supplementation .
In a small double-blind study McLeod gave ten patients suffering from atypical depression chromium supplements of 600mcg a-day and five others a placebo for eight weeks. The results were dramatic. Seven out of ten taking the supplements showed a big improvement, versus none on the placebo. Their Hamilton Rating Score for depression dropped by an unheard of 83%; from 29 - major depression - to 5 – not depressed. A larger trial at Cornell University with 113 patients has confirmed the finding. After eight weeks 65% of those on chromium had had a major improvement, compared to 33% on placebos.
Side effects? None, except more energy and better weight control. Chromium, if taken in the evening, can increase energy and hence interfere with sleep. Chromium has no toxicity even at amounts 100 times this.

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W. Poldinger et al. A functional-dimensional approach to depression: serotonin deficiency and target syndrome in a comparison of 5-hydroxytryptophan and fluvoxamine,, Psychopathology vol 24(2), pp. 53-81 (1991)
Associate editor: K.A. Neve 'Serotonin a la carte: Supplementation with the serotonin precursor 5-hydroxytryptophan' ErickH. Turner a,c,d,*, Jennifer M. Loftis a,b,c, AaronD. Blackwell a,b,e Pharmacology&Therapeutics(2005) www.elsevier.com/locate/pharmthera
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Lifting Depression - The Chromium Connection by Dr Malcolm McLeod (Basic Health Publications):
J. R. Davidson et al, Effectiveness of chromium in atypical depression: a placebo-controlled trial, Biol Psychiatry, vol 53(3), pp. 261-4 (2003)
Docherty, J et al, 'A Double-Blind, Placebo-Controlled, Exploratory Trial of Chromium Picolinate in Atypical Depression' Journal of Psychiatric Practice. Vol 11(5), pp. 302-314, (2005)

We all know the hallmarks of depression – low mood, lack of motivation and feelings of hopelessness. Most people experience these as a fleeting reaction to life’s trials and tribulations. A survey, carried out by the Institute for Optimum Nutrition, involving 37,000 people in Britain found that as many as one in three people say they sometimes or frequently feel depressed and suffer from low moods . Perhaps you are one of them. A small percentage of these people are likely to go to their doctor to seek help and be diagnosed with ‘clinical’ depression – with more severe and disabling symptoms possibly including uncontrollable crying, suicidal thoughts and loss of appetite.
 
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